Nursing Autonomy Case Study
Position
Jo was aware that Sandy is a transgender woman who did not want to disclose her gender identity publicly. She has violated Sandy’s autonomy, breached her confidentiality and failed to foresee the negative consequences her action could pose for Sandy. Although Jo did not act out of malice towards Sandy, I believe she has acted in an unprofessional manner. She has potentially put herself at risk of a legal liability and disciplinary action by Australian Health Practitioner Regulation Agency (APHRA).
Analysis of issues
Autonomy
Autonomy is a patient’s ability and right to make his or her own decisions that is in his or her best interest (Johnston, 2016). Respecting patient autonomy is also about gaining consent, maintaining patient confidentiality and respecting their decision about what information they disclosed and withheld (Johnston 2016; Hann, Ivester & Denton, 2017). Autonomy is one of the four key principles in nursing (Johnston, 2016) respecting, which should be a nurses’ priority (Nursing and Midwifery Board of Australia (NMBA), …show more content…
2008a, 2008b, 2016).
In the case presented, both Rose and Sandy’s autonomy is important and should be equally respected by Jo.
Disrespecting patient autonomy will in turn violate their dignity, which is their fundamental right (United Nations, 1948). Due to its interrelatedness, violation of her dignity could have negative consequences on her health and wellbeing (Johnstone, 2016). However, transgender individuals are a minority group (Leonard et al., 2012). Due to this, the impact of violation of autonomy and dignity could be severe for Sandy. Disclosure of gender identity and anxiety about potential consequences has been identified as one of the main barriers for transgender individuals to access proper health care (Roberts & Fantz, 2014). Implications of Jo’s action could result in something minor such as Sandy getting angry at Jo to something significant such as Sandy losing her trust in the hospital and staff and forgoing care
completely.
Non-maleficence and beneficence
Non-maleficence implies an obligation to refrain from taking any actions that will harm someone causing injuries that could have been avoided (Johnstone, 2016). In nursing, this harm could either be physical, psychological or related to access to services (Hann et al., 2017). This could be either by intent, ignorance or negligence.
By disclosing Sandy’s gender identity, Jo has potentially exposed her to risk of discrimination and stigma (Hann et al., 2017; Johnstone, 2016). If Sandy experiences these in the hospital, it could have detrimental effects on her health particularly mental health.
It is not apparent that Jo disclosed Sandy’s information with the intention of causing her harm. However, it appears not much thought was given to the consequences of her action. When Rose asked Jo about Sandy, she acknowledged that Jo might not be able to answer her question. Jo did not take this opportunity to stop and think before responding. A reason for this could also be that Jo is not fully aware of the issues and challenges faced by transgender individuals hence did not take it seriously.
On the other hand, one can argue that Jo was acting out of beneficence towards Rose who was there right beside her. Beneficence requires nurses to act with compassion and kindness for the benefit of their patient (Kinsinger, 2009; Johnstone, 2016; Munyaradzi, 2012). It stresses nurses should take action to maximise patient’s wellbeing and minimise harm (Kinsinger, 2009; Weaver, 2011). Spending a number of days in hospital can be mundane and lonely. Nurses spend majority of their time with patients and are in a better position to fulfill the communication needs to patients (Fleischer, Berg, Zimmermann, Wüste & Behrens, 2009). A number of studies have highlighted that nurse-patient interaction can have positive health outcomes for patients (Fleischer et al., 2009; O’Hagan et al., 2014). By engaging in conversation with Rose, Jo was contributing to Rose’s wellbeing and communication needs. Ignoring Rose could have upset her, which could then not only make her feel neglected but could also have negative effect on their nurse-patient relationship.
Jo was aware that Sandy is a transgender woman who did not want to disclose her gender identity publicly. She has violated Sandy’s autonomy, breached her confidentiality and failed to foresee the negative consequences her action could pose for Sandy. Although Jo did not act out of malice towards Sandy, I believe she has acted in an unprofessional manner. She has potentially put herself at risk of a legal liability and disciplinary action by Australian Health Practitioner Regulation Agency (APHRA).
Analysis of issues
Autonomy
Autonomy is a patient’s ability and right to make his or her own decisions that is in his or her best interest (Johnston, 2016). Respecting patient autonomy is also about gaining consent, maintaining patient confidentiality and respecting their decision about what information they disclosed and withheld (Johnston 2016; Hann, Ivester & Denton, 2017). Autonomy is one of the four key principles in nursing (Johnston, 2016) respecting, which should be a nurses’ priority (Nursing and Midwifery Board of Australia (NMBA), …show more content…
2008a, 2008b, 2016).
In the case presented, both Rose and Sandy’s autonomy is important and should be equally respected by Jo.
Disrespecting patient autonomy will in turn violate their dignity, which is their fundamental right (United Nations, 1948). Due to its interrelatedness, violation of her dignity could have negative consequences on her health and wellbeing (Johnstone, 2016). However, transgender individuals are a minority group (Leonard et al., 2012). Due to this, the impact of violation of autonomy and dignity could be severe for Sandy. Disclosure of gender identity and anxiety about potential consequences has been identified as one of the main barriers for transgender individuals to access proper health care (Roberts & Fantz, 2014). Implications of Jo’s action could result in something minor such as Sandy getting angry at Jo to something significant such as Sandy losing her trust in the hospital and staff and forgoing care
completely.
Non-maleficence and beneficence
Non-maleficence implies an obligation to refrain from taking any actions that will harm someone causing injuries that could have been avoided (Johnstone, 2016). In nursing, this harm could either be physical, psychological or related to access to services (Hann et al., 2017). This could be either by intent, ignorance or negligence.
By disclosing Sandy’s gender identity, Jo has potentially exposed her to risk of discrimination and stigma (Hann et al., 2017; Johnstone, 2016). If Sandy experiences these in the hospital, it could have detrimental effects on her health particularly mental health.
It is not apparent that Jo disclosed Sandy’s information with the intention of causing her harm. However, it appears not much thought was given to the consequences of her action. When Rose asked Jo about Sandy, she acknowledged that Jo might not be able to answer her question. Jo did not take this opportunity to stop and think before responding. A reason for this could also be that Jo is not fully aware of the issues and challenges faced by transgender individuals hence did not take it seriously.
On the other hand, one can argue that Jo was acting out of beneficence towards Rose who was there right beside her. Beneficence requires nurses to act with compassion and kindness for the benefit of their patient (Kinsinger, 2009; Johnstone, 2016; Munyaradzi, 2012). It stresses nurses should take action to maximise patient’s wellbeing and minimise harm (Kinsinger, 2009; Weaver, 2011). Spending a number of days in hospital can be mundane and lonely. Nurses spend majority of their time with patients and are in a better position to fulfill the communication needs to patients (Fleischer, Berg, Zimmermann, Wüste & Behrens, 2009). A number of studies have highlighted that nurse-patient interaction can have positive health outcomes for patients (Fleischer et al., 2009; O’Hagan et al., 2014). By engaging in conversation with Rose, Jo was contributing to Rose’s wellbeing and communication needs. Ignoring Rose could have upset her, which could then not only make her feel neglected but could also have negative effect on their nurse-patient relationship.