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Unfolding Case Study 2:
Ethical Dilemmas in Advanced Nursing Practice
14 year old female
Background
Felicia Walker is a 14-year-old female who presents to your school-based teen clinic. She is complaining of daily stomachaches for the past several weeks. She states that she has been complaining about them but everyone tells her it’s just stress from moving and it will get better after she makes some friends. Felicia is new to your school this year and her record notes that she frequently misses her first class of the day. She lives with her aunt and uncle, who are her legal guardians. (Your clinic has private rooms that each person goes into; so there is no waiting room but they are assured privacy).
Decision Point One
What information do you need?
More information about her stomachaches, such as where they are, what makes it better or worse, and any other symptoms.
CORRECT
Although the other answers are getting at important information, this is your first time with Felicia, and starting off just addressing the problem is preferable. It is important to establish a rapport with her first. Additionally, she sees that you are listening to her.
Decision Point Two
Felicia states that if she eats something it is better, but if she gets hungry it’s worse. As you discuss her symptoms more, she relates that she is often late in the morning because she’s been so tired recently. She states she’s feeling better and doesn’t want to miss her next class.
Have her come back at another time.
CORRECT
You are letting her know that you are interested and listening. She appears to be starting to open up a little. Additionally, there are more assessments that need to be done.
Decision Point Three
Felicia comes back during her lunch break. You find out that she is also worried because she has not had her period since moving in with her aunt and uncle 3 months ago. She likes living with them but they are very religious and are at church three or four times a week.
As you talk with her more, you find she was removed from her mother’s care due to drug use, and her mother’s boyfriend was found to have drugs in the home. She says she’s glad to be away from him because he’s a “pig.”
Why do you call him a “pig”?
CORRECT
Although the other questions are good ones, Felicia may be giving you an opening to something she needs to tell someone.
Decision Point Four
She says he’s a pig because he smells like one. Upon further discussion, she tells you that he would come into her room at night and touch her. She is reluctant to go further with this conversation and starts crying.
Reflect on and clarify what she has told you, and ask if this is one reason she is concerned about stomachaches and missed periods.
COCORRECTAlthough the second two answers also are things you can do, you need to address what she has told you so far and clarify it.

Decision Point Five
Upon additional questioning, Felicia says she is concerned that’s why she hasn’t gotten her period and just thinking about it makes her nauseous. She says she can’t sleep at night because she thinks her aunt and uncle won’t want her if they know. You do a urine pregnancy test and the result comes back positive. She states she doesn’t want this baby in her. You find out that the mother’s boyfriend is 40 years old, and Felicia feels safer now that she’s in a different city than him.
You are aware of your particular state’s regulations and are aware that the age of consent is 12 unless there is coercion or if the other party is more than 5 years older. As in all states, you are a mandated reporter if abuse, rape, or coercion are involved. According to reproductive laws in your state, anyone 12 years of age or older can seek reproductive health care (i.e., contraception, screening, and treatment for STIs, and counseling) and psychiatric care without the consent of a parent or guardian. Teens younger than 18 years of age cannot sign for any other medical or surgical treatment for themselves however, they can sign for treatment of their child.
You are a mandated reporter and need to report the sexual assault. Additionally, you bring in the school counselor/social worker (with Felicia’s permission) to help her with the next steps as she chooses what she wants to do and how she wants to tell her aunt and uncle.
Felicia needs to be aware that you are a mandated reporter. Additionally, she needs unbiased assistance in helping her make her next choices.
JUST FOR THOUGHT
What do you think about being a mandated reporter and how the laws may allow a teen to make her own choices with regards to her reproductive health? What ethical dilemmas and/or other issues do you need to consider?
Ethical issues
Psychological issues
Physical issues
Financial issues
What is your differential diagnosis?
Why did you make this diagnosis decision?
What is your treatment plan?
What evidence-based research can you provide to support your decision (choice for differential diagnosis and plan/intervention)?
What resources did you use to meet your best practice guidelines?
Address the ethical dilemmas and/or other issues for your case study:
Ethical issues
Psychological issues
Physical issues
Financial issues

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