One common dilemma faced by psychiatric nurse practitioners is determining who the “client” is. Given that children are typically brought for treatment by their parents, describe how the psychiatric nurse practitioner would respond to a child who discloses they are indulging in illicit behavior and asks you not to tell his or her parents.
Your initial post should be at least 500 words, formatted, and cited in current APA style with support from at least 2 academic sources.
Title: Confidentiality and Ethical Considerations in Treating Minors: A Psychiatric Nurse Practitioner’s Perspective
In psychiatric practice, one of the most significant ethical dilemmas faced by psychiatric-mental health nurse practitioners (PMHNPs) is determining who the primary client is when treating children and adolescents. While the minor is the direct recipient of care, parents or guardians often serve as the primary decision-makers. This situation creates complex ethical challenges, particularly when a minor discloses engaging in illicit behavior and requests confidentiality.
Confidentiality and Ethical Considerations
Confidentiality is a cornerstone of psychiatric care, fostering trust and open communication between patients and providers. The American Nurses Association (ANA) and the American Psychiatric Nurses Association (APNA) emphasize the importance of maintaining confidentiality to encourage honest disclosures from patients (ANA, 2015). However, the confidentiality rights of minors are not absolute and are subject to state laws and ethical obligations to protect the child’s welfare.
According to the Health Insurance Portability and Accountability Act (HIPAA) and various state laws, parents generally have the right to access their child’s medical records and treatment information. However, exceptions exist, particularly when disclosure may cause harm to the minor or when the minor has the legal right to confidentiality in specific treatment areas, such as substance use treatment or reproductive health (Substance Abuse and Mental Health Services Administration [SAMHSA], 2019). PMHNPs must be aware of the specific laws governing confidentiality in their state to navigate these situations appropriately.
Response to a Minor’s Disclosure of Illicit Behavior
If a child discloses engaging in illicit behavior and requests that this information remain confidential, the PMHNP must take several steps to address the situation ethically and legally:
- Clarify Confidentiality Limits Early
- At the start of treatment, it is crucial to discuss confidentiality limits with both the minor and their parents. The PMHNP should explain that while most discussions will remain confidential, exceptions exist when there is a risk of harm to the patient or others (AAP, 2016).
- Assess the Risk Level of the Behavior
- The PMHNP must assess whether the disclosed illicit behavior poses immediate harm to the minor or others. For example, casual experimentation with substances differs significantly from consistent substance use or engagement in criminal activities that pose serious risks.
- Encourage Open Communication with Parents
- If the behavior is concerning but not immediately life-threatening, the PMHNP can help the minor develop a plan for disclosing the information to their parents. This process empowers the child and fosters trust, rather than breaking confidentiality outright.
- Consult Ethical and Legal Guidelines
- If the behavior poses a significant risk, such as involvement in illegal activities that could lead to arrest or physical harm, the PMHNP must consult legal and ethical guidelines to determine whether disclosure is required. Many states mandate reporting serious illegal activity, especially if it involves harm to the minor.
- Engage in Harm Reduction Strategies
- Instead of immediate disclosure, the PMHNP might implement harm reduction strategies, such as education on the consequences of illicit behavior, providing alternative coping mechanisms, and offering resources for support.
Conclusion
Navigating confidentiality concerns with minors in psychiatric care requires a delicate balance of ethical, legal, and clinical considerations. PMHNPs must prioritize the best interests of the child while adhering to professional guidelines and state laws. By fostering trust, encouraging parental involvement when appropriate, and using harm-reduction strategies, PMHNPs can provide effective and ethical psychiatric care to minors.
References
- American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. American Nurses Publishing.
- American Academy of Pediatrics. (2016). Confidentiality in adolescent health care. Pediatrics, 138(1), e20162138.
- Substance Abuse and Mental Health Services Administration. (2019). Understanding child and adolescent confidentiality laws. U.S. Department of Health and Human Services.