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Portfolio of Exemplars Which Explores the Role of the Nurse as an Advocate with Adult Patients

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In the exemplary, the student nurse observed the mentor trying to negotiate with the patient to disclose her HIV status to her boyfriend. The mentor tried to convince the patient but was unable to obtain consent. It was observed that the mentor tried to initiate the dialogue with the patient, and listened to the patient’ s concerns as well. However, the patient’ s resistance to the nursing staff’ s suggestion of disclosing the information posed a conflict for them. In an effort to choose a course of action, based on ethics, the mentor gave time to the patient to explore her values and become ready to communicate (Daniels, 2004) but it did not help.

The situation poses professional, ethical and legal issues for the nursing staff. This is discussed below: 4.1 Professional IssuesThe professional issues facing the nursing staff are explored below. Principle of Autonomy and Fairness (Beauchamp & Childress, 2001)- The nursing staff had a duty to respect the patient’ s autonomy and her decision which could result in harm to another individual, while also upholding their duty to fairness and justice. In the above exemplary, duty to protect the patient’ s partner, conflicts with the principle of autonomy that the patient is entitled to. Principle of Loyalty (Beauchamp & Childress, 2001): They were torn between being loyal to the patient and owing a duty to society in controlling the spread of this infection, by putting another member of society at risk.

However, as the patient’ s advocate, the nurse has to consider the wishes of the patient (NMC, 2004). Yeoman (2007) suggests that “ the autonomy to make decisions remains with the patient. For patients who test positive for HIV, this is particularly important because disclosure could result in discrimination and social isolation” .

However since the patient’ s behavior could result in harm to another individual, is it ethical for the nursing staff to ignore the patient’ s autonomy? This is discussed later in the paper. Confidentiality: Confidentiality of patient records and patient’ s discussions is a professional requirement. However, if maintaining confidentiality results in harm to another member of society, the healthcare professional is faced with the challenge of the course of action. Literature suggests that patient confidentiality cannot be an absolute concept and it may even be acceptable to breach this sometimes in favor of a larger good (Wilks, 2004) and there can be “ exceptions to the rule” (NHS Code of Practice, 2003).

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