In this discussion, I utilized the 7 steps of the Ethical Model for Ethical Decision Making as outlined in McGonigle and Mastrian (2015) to analyze the case study. Ethical Dilemma Examined with conflicting Values: The case manager was given a message by the physician which was to simply contact the family and have they come in for an evaluation. The case manager did much more by giving more information in the parent’s email that was not secured and went on to inquire about other treatment i. e. counseling that the parents were attending.
She further proceeded with attempting to suggest the cause of the of the glycemic control problem without even talking to the patient. The CM really over-stepped her boundaries because she made a suggestion as to what she believes is causing the blood sugar elevation. Another facet of this confidentiality breach may make the family loose trust in this individual and may be the team which may compel them to seek help somewhere else or it may affect their trust of the entire health care system.
Thoroughly comprehend the possible Alternatives Available 1. The CM follows instructions from the physician and completes the task as prescribed by the physician; to simply have made a home call or left a voicemail for the parents to call to set-up an evaluation. 2. The CM may send the e-mail telling them only to call to set up an appointment. 3. The CM calls the parents at work if they take phone calls there and leave a message for them to call the office on their voice mail. Hypothesize Ethical Arguments According to The International Council of Nurses (2006) code of ethics as cited in McGonigle and Mastrian (2015) (pp 83),”the urse holds in confidence personal information and uses judgement in sharing this information”.
The CM acted in a way that she portrayed herself as knowledgeable by coming up with cause for the poor glycemic control. She also wanted to give the impression that she knows the patient and family well and that she cares about them by asking about the counseling. There were consequences for her actions which resulted in Privacy and confidentiality violations. Although she may have had the right intentions but ethically, she failed by violating this patient’s privacy.
Investigate, Compare, and Evaluate the Arguments for Each Alternative 1. The CM follows instructions and completes the task as prescribed by the physician which would have entailed a simple phone call or left a voicemail to set-up an evaluation. Good Consequences: completed delegated job with no ethical violation. Bad Consequences: If unable to reach the parents, may delay care of patient with worsening sugar control. Do Any Rules Nullify: None Expected Outcome: The parents contacted and were able to schedule an appointment.
Potential Benefit exceeds Harm: 2. The CM sends the e-mail telling them only to set up appointment as leaves out the sensitive information. Good Consequences: The family will be informed of the need for an evaluation Bad Consequences: The parents may not check email every day or email may go to spam. There is no way to confirm receipt of the e-mail. Do Any Rules Nullify: Privacy and security violations if e-mail server is not restricted. Expected Outcome: The parents will receive the e-mail and contact the offi9ce for appointment.
Potential Benefit > Harm: The parents may get message immediately if they can access home email from work. 3. The CM calls the parents at work if they take phone calls there and leave a message for them to call the office. Good Consequences: The parents will receive the information in a timely manner. Bad Consequences: The parents may not receive the message because they do not take call at work. Any Rules Nullify: None Expected Outcome: The parents will receive the information and can confirm the appointment.
Potential Benefit > Harm: This option has the greatest likelihood of getting through to the family. Choose the Alternative Alternative 1 is my chosen alternative because the CM gets the job done right with no violation of privacy and no confidential information will be compromised. The consequence of not getting through to the family is a possibility but does not necessitate compromising personal information at the expense of getting through to the family which may still not be guaranteed. The CM made some assumptions about the parents’ schedule that may or may not have been factual.
Act on Chosen Alternative The CM in this case violated a trust but hopefully in the future, the CM Learned a vital lesson; Because trust have been violated, it requires that the CM owns up to her mistake and apologize to the family and give the family time to heal. It may be appropriate to reassign this patient but, whatever the family chooses to do to continue the care of their son will be supported. Trust may never be regained but this will hopefully be a learning experience for this CM with future patient encounters.
Examination of Outcome In examining the outcome of this ethical situation, the question arises as to if the patient, the family of the patient and their friends who received the email will ever trust the health care team again. This may adversely affect regular follow up visits and compliance with consequent decline in the patient’s condition . It may also affect the whole team who may lose the patient and family and may also affect the reputation of this particular clinic. Although the intention of this CM was good and was by no means malicious, however privacy and confidentially was severely affected by her actions.