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This paper presents a Portfolio of exemplars from nursing practice, which explores the professional role of the nurse as an advocate with adult patients, where ethical dilemmas are central.

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Portfolio <Student Name> <Institute Name> Date Contents 1. Introduction 3 2- Exemplar 1 -Advocacy 3 3. Exemplar 2 - Empowerment 3 4. Analysis 4 4.1 Professional Issues 4 4.2 Legal Issues 6 4.3 Ethical Dilemma and Decision Making 6 5 - Action Plan 9 References 11 1. Introduction This paper presents a 'Portfolio' of exemplars from nursing practice, which explores the professional role of the nurse as an advocate with adult patients, where ethical dilemmas are central. The paper begins with a brief description of the advocacy and empowerment exemplar, followed by a detailed analysis of the empowerment exemplar with regard to the professional role of the nurse, the legal and the ethical framework. It critically reflects on the issues that pose conflict and the role of the nursing staff who are faced with an ethical dilemma. The ethical decision making model is also applied to the exemplar presented, to gain a better insight into the possible course of action. The portfolio concludes with an action plan that can be implemented based on the reflective analysis. 2- Exemplar 1 -Advocacy Advocacy is defined as : "the process of befriending and where necessary, representing a patient, client, partner or prot�g�, in all matters where the nurse's help is needed in order to protect the rights or promote the interests of that person" (cited by Frizell, 2005) ...read more.


4.2 Legal Issues The "common law of confidentiality" is not codified in the Act of Parliament but is built on case law where practice has been established by individual judgments and law is not very clear on this issue (NHS Code of Practice, 2003; Hayter, 1997). Judgments establish that confidentiality can be breached 'in the public interest' however it is all dependant on a case-to-case basis. NHS Code of Practice (2003) states that according to the existing regulation, the one situation, in which confidentiality related to HIV positive status of a patient can be breached is for the purpose of treatment or prevention. In this particular exemplar, the reason why the nursing staff need to disclose the information to the boy friend is to ensure "prevention" and perhaps even "treatment" which is in line with the regulation. The UK courts have recognised that some breaches of confidentiality may be allowed if they are in the public interest (Yeoman, 2007). The other situation to consider is where healthcare professionals fail to disclose HIV positive status to boyfriend. In that situation liability could apply as the healthcare staff owe a duty to warn someone of potential risk (Yeoman, 2007) ad protect him from harm (Beauchamp & Childress, 2001). ...read more.


Only after every effort has been made to seek the consent of the patient should the HIV status be disclosed. In case the patient does not give consent despite every effort, the information should still be disclosed in the interest of larger societal good. Step 6 Evaluate Outcomes of Action The ethical dilemma will be resolved if patient's consent is obtained and then HIV status disclosed. If the disclosure occurs against the wishes of the patient it will still be acceptable since it is morally correct and for the larger good to control risk. Mc Manus (2006) suggests that it is acceptable to disclose when the patient poses harm to others. As part of negotiating, the patient could also be asked to seek legal advice. 5 - Action Plan Gathering data - Find out about support groups for such patients - Find out legal advise for such patients - Inform doctor and seek advise - Find out about more such cases and share with patient to open communication and build trust. Identify option - Focus on negotiating with the patient, sharing the implications of her wishes with her, understanding her situation and concerns and helping her to give consent for disclosure - Have her talk to communities of such patients, find community support and develop a relationship to get to know the patient better. ...read more.

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