Question

Case Study 4:

You are an RN and work in a community mental health clinic in Sydney. The clinic you work in primarily specialises in adolescent mental health and receives many referrals from the justice system of mentally ill, troubled or disordered minors who have gotten in trouble with the law. As part of their court orders they are usually required to undergo professional treatment and counselling. You are part of the multidisciplinary team which delivers this care.

As part of the multi-disciplinary team, you work along side a social worker, Justin. Justin’s primary role within the health clinic is to work with teenagers who do not have a diagnosed psychiatric disorder but who come from troubled backgrounds, usually involving trauma, family breakdown and abuse. Justin’s role is to develop strategies of re-integrating individual troubled youths back into their own social networks, schools and employment while establishing support networks, behaviour management strategies and education and career prospects. Justin is widely known for his skill in this field, has been the recipient of many awards and scholarships in his field, is highly regarded in the justice system and has demonstrated positive outcomes where other specialists have been unable to. He is often referred overly complex cases due to his skill in this area.

At many work social functions you have gotten to know Justin’s wife Sarah. Sarah is a linguist who teaches languages in private tuition, though mostly she is a stay at home mum. You have developed a nice friendship with Sarah though she always remains reserved. At the work Christmas party, you see that Sarah has arrived, so you start talking to her. Sarah confides in you that wants to separate from Justin but she is scared to as he is aggressive and violent, and she is afraid of the damage it will do to their two children – a six-year-old and a ten-year-old. Sarah tells you that Justin often hits the boys when he is angry, particularly the ten-year-old who Justin has recently punched in the face.

You mention to Sarah how concerned you are for her safety and suggest that she go to the police for support. Sarah tells you that she cannot go to the police, because if Justin’s abuse is reported he will no longer be able to work with children and young people, he will lose his credibility with the justice system and he will most likely lose his job. She is relying on Justin’s job to provide child support money so that she can afford to look after the children when she leaves him. If Justin loses his income, then Sarah won’t be able to afford to separate from him and she and her children will be required to stay with him. Sarah begs you not to tell anyone, and says that she has told you this in confidence. Sarah tells you she doesn’t want anyone else to find out, as she doesn’t want the information to get back to Justin and for him to find out that she is planning on leaving him until she knows she can leave safely without fear of being hit.

The next time you see Sarah is later that week at the supermarket. She has bruising to her throat and neck which she is trying to hide with a scarf, and their ten-year-old child has bruising to his nose and around his eye.

Q1: Which ethical principles are challenged in this case study and how?

Q2: Identify the legal issues raised.

Q3: Consider the application of mandatory reporting to this case study, and how it may or may not be relevant.

Q4: Considering at least 2 different ethical theories, outline some possible actions the nurse may take in responding to this situation.

Q5: What will you do?

Answer 1

Domestic Violence:

Violence committed in a domestic setting, such as marriage or cohabitation.

1. Ethical principles challenged in the case study :

Nurses has to work on the Ethical principles such as non maleficence, Veracity, justice, Autonomy, beneficience, integrity and fidelity.

Ethical principles are challanged in the case study are Nonmaleficence ( do no harm to others), Autonomy,Veracity and integrity. Nonmaleficence is challanged in a domestic violence atmosphere and if the nurse is not reporting to the police or her seniors, then it questions her Integrity to profession and duty. Same time the Nurse has to respect Sarah's decision on the basis of Principle Autonomy, recognizing Individual's right to decision making and has to be trustworthy ( Veracity) to her friend meantime to her profession.

2. legal issues raised in the case:

Legal issues raised in the case are;

* Domestic violence: Violence occur in domestic setting, such as marriage or cohabitation.This is considered as an offence by law and it attracts legal actions, if reported.

* Child abuse: Physical, sexual, emotional mistreatment of a child that causes Long term permanent damage.

3. Manadatory reporting: relevance

It is the ethical and legal responsibility of a nurse to report any observed signs of domestic violence and child abuse , while respecting the patient's privacy. It is mandatory to report the case as the case involve not only domestic violence to the spouse but also child abuse . If the RN is not reporting the person may continue his habit of abusing the children and wife. Abuse on children may cause Long term effects on their physical, emotional and mental health.

4. Two ethical theories

a) Code of ethics for the nurses describe about Nonmaleficence, which emphasise ' do no harm to others ' . Domestic violence is a harm to others. Nurse has to report and prevent the incident.

b) Feminist theory: According to feminist theory, domestic violence is the result of systematic opression of women globally rather than isolated case. Batterers often rationalize their behaviour by imposing blames on partners, as her disobidience caused such  incident.

Strict legal actions against domestic violence and socety reformation to favour women is recommended by the theory.

Nurse's actions

* Report to police and child help line

* Counselling for the victims

* Counselling of the batterer

* Assess the signs and symptoms of abuse and violence

* proper documentation of the incident.

5. ( I) will report the child help line and the authorities of the health care organizations, where he works. The incident is not as a result of sudden emotional outburst, but it was a long term problem.The person has to be punished.