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HA3002: Ethical Issues in Health Assessment
Assessment Template
Instructions: For this Competency Assessment, you will respond to the following
prompts based on the case study that is related to a particular health issue: HIV partner
notification.
Scenario: You are a nurse in the surgical unit of a large metropolitan hospital. A young
woman has been admitted for an ovarian cyst removal later the same day. As you are
taking her health history, she reveals that she has recently been diagnosed as HIV
positive. In response to a query from you, she acknowledges that she has not yet seen
a healthcare provider regarding this diagnosis. She also quickly adds that she hasn’t
disclosed this condition to her new boyfriend, who is in the waiting room, or to any other
family members or friends.
Respond to the questions below from your perspective as the nurse providing care for
this patient. Support your thoughts and ideas with appropriate citation of scholarly
references.
With this patient’s right to privacy and confidentiality in mind, identify those whom you
need to inform about her HIV-positive status. Provide support from scholarly
references for your response. (1–2 paragraphs)
[Insert response here]
During the health assessment, your patient has revealed that her boyfriend does not
know about her HIV-positive status. Briefly explain how you might explore the
patient’s understanding of how her HIV positive status may impact her relationship
and the health of her partner. Explain why you would take this approach. Support your
approach with scholarly references. (1–2 paragraphs)
[Insert response here]
Identify two actions you would take—or ensure are taken—in this scenario to
preserve patient confidentiality. Support your response with reference to the ANA’s
position paper on privacy and confidentiality. (1–2 paragraphs)
[Insert response here]
The Code of Ethics for Nurses was developed to provide guidance for administering
quality and ethical care while upholding standards and obligations of the profession.
Select one of the provisions of the Code and explain how you might apply this
provision to guide your responses to the health assessment described in the scenario.
Support your response with appropriate citations from scholarly references. (2–3
paragraphs)
[Insert response here]
Once your patient has revealed her HIV-positive status to you, what else do you need
to think about and do in providing quality care? With a holistic approach to this
woman’s care in mind, describe one subsequent action you might take. Explain how
this action is in alignment with the Code of Ethics for Nurses. Support your response
with appropriate citations to scholarly references. (2–3 paragraphs)
[Insert response here]
Soon after revealing her HIV-positive status to you during the health history, the
patient appears to regret bringing it up. She is clearly worried and asks you if any of
this information will be sent to her home, which she shares with her parents, or to her
employer. Briefly explain how you would respond to her. Support your response with
scholarly references. (2–3 paragraphs)
[Insert response here]
HA3002: Ethical Issues in Health Assessment: Analyze ethical issues related to obtaining a health history and physical
exam.
Rubric Criteria
Module 1: Confidentiality
Apply confidentiality
guidelines to describe the
appropriate entities that
should be informed about a
patient’s HIV-positive
status.
Learning Objective 1.1: Apply
privacy and confidentiality
standards to a health
assessment.
Explain how you might
explore the patient’s
understanding of how her
HIV-positive status may
impact her relationship and
the health of her partner.
Learning Objective 1.2:
Apply privacy,
confidentiality, and
ethical guidelines to a
health assessment.
© 2020 Walden University
Assessment Rubric
Does Not Meet
Meets Expectations
Expectations
Exceeds Expectations
Response does not
adequately apply
confidentiality guidelines to
describe the appropriate
entities that should be
informed about a patient’s
HIV-positive status.
Response adequately
applies confidentiality
guidelines to describe the
appropriate entities that
should be informed about a
patient’s HIV-positive
status.
Response
comprehensively applies
confidentiality guidelines to
describe the appropriate
entities that should be
informed about a patient’s
HIV-positive status.
Response does not
adequately explain how
you might explore the
patient’s understanding of
how their HIV-positive
status may impact their
relationship and the health
of their partner.
Response adequately
explains how you might
explore the patient’s
understanding of how their
HIV-positive status may
impact their relationship
and the health of their
partner.
Response thoroughly
explains how you might
explore the patient’s
understanding of how their
HIV-positive status may
impact their relationship
and the health of their
partner.
1
Does Not Meet
Expectations
Explain why you would take Response does not
this approach.
adequately explain why the
selected approach was
Learning Objective 1.3:
chosen.
Evaluate rationale for a
selected approach to a
patient’s health issue.
Identify two actions you
Response does not
would take—or ensure are
adequately identify two
taken—in this scenario to
actions that could be taken
preserve patient
(or that you could ensure
confidentiality.
are taken) in the scenario
to preserve patient
Learning Objective 1.4: Apply confidentiality.
actions to preserve patient
confidentiality during a health
assessment.
Module 2: Code of Ethics
Apply one of the provisions Response does not
of the Code of Ethics for
adequately apply one of
Nurses to the health
the provisions of the Code
assessment described in
of Ethics for Nurses to the
the scenario.
health assessment
described in the scenario.
Learning Objective 2.1: Apply
a provision of the Code of
Ethics for Nurses to a health
assessment.
Describe one subsequent
Response does not
holistic approach you
adequately describe one
subsequent holistic
Rubric Criteria
© 2020 Walden University
Meets Expectations
Exceeds Expectations
Response adequately
explains why the selected
approach was chosen.
Response thoroughly
explains why the selected
approach was chosen.
Response adequately
identifies two actions that
could be taken (or that you
could ensure are taken) in
the scenario to preserve
patient confidentiality.
Response identifies two
thoughtful actions that
could be taken (or that you
could ensure are taken) in
the scenario to preserve
patient confidentiality.
Response adequately
applies one of the
provisions of the Code of
Ethics for Nurses to the
health assessment
described in the scenario.
Response thoughtfully
applies one of the
provisions of the Code of
Ethics for Nurses to the
health assessment
described in the scenario.
Response adequately
describes one subsequent
holistic approach that may
Response
comprehensively describes
one subsequent holistic
2
Rubric Criteria
might take to assure quality
care.
Learning Objective 2.2:
Analyze holistic approaches
to a health assessment for
quality care.
Explain how this action is
in alignment with the Code
of Ethics for Nurses.
Does Not Meet
Expectations
approach that may be
taken to assure quality
care.
Response does not
adequately explain how
this action aligns with the
Code of Ethics for Nurses.
Learning Objective 2.3: Apply
nursing practice to the Code
of Ethics for Nurses.
Module 3: Patient Rights and Responsibility
Explain how you would
Response does not
reassure patient privacy
adequately explain how
and confidentiality when
you would reassure patient
conducting a health
privacy and confidentiality
history.
when conducting a health
history.
Learning Objective 3.1:
Analyze a patient’s privacy
and confidentiality rights.
Meets Expectations
Exceeds Expectations
be taken to assure quality
care.
approach that may be
taken to assure quality
care.
Response adequately
explains how this action
aligns with the Code of
Ethics for Nurses.
Response thoroughly
explains how this action
aligns with the Code of
Ethics for Nurses.
Response adequately
explains how you would
reassure patient privacy
and confidentiality when
conducting a health history.
Response thoroughly
explains how you would
reassure patient privacy
and confidentiality when
conducting a health history.
Professional Skills Assessment
Professional Writing
Professional Writing:
Clarity, Flow, and
Organization
© 2020 Walden University
Content contains significant Content contains few
spelling, punctuation, and/or spelling, punctuation,
grammar/syntax errors.
and/or grammar/syntax
Content is free from
spelling, punctuation, and
grammar/syntax errors.
3
Writing does not
demonstrate adequate
sentence and paragraph
structure and requires
additional
editing/proofreading. Key
sections of presented
content lack clarity, logical
flow, and/or organization.
Professional Writing:
Context, Audience,
Purpose, and Tone
Professional Writing:
Originality, Source
Credibility, and Attribution
of Ideas
© 2020 Walden University
Content minimally or does
not demonstrate awareness
of context, audience, and/or
purpose. Writing is not
reflective of
professional/scholarly tone
and/or is not free of bias.
Style is inconsistent with the
professional
setting/workplace context
and reflects the need for
additional editing.
Content does not
adequately reflect original
writing and/or paraphrasing.
Writing demonstrates
inconsistent adherence to
reference requirements,
including the use of credible
evidence to support a claim,
with appropriate source
attribution (when applicable)
and reference. There are
errors. Writing
demonstrates adequate
sentence and paragraph
structure and may require
some editing. Content
presented is satisfactorily
clear, logical, and/or
organized, but could
benefit from additional
editing/revision.
Content demonstrates
satisfactory awareness of
context, audience, and
purpose. Tone is
adequately professional,
scholarly, and/or free from
bias, and style is mostly
consistent with the
professional
setting/workplace context.
Writing demonstrates
appropriate sentence and
paragraph structure.
Content presented is clear,
logical, and well-organized.
Content adequately reflects
original writing and
paraphrasing. Writing
demonstrates adequate
adherence to reference
requirements, including the
use of credible evidence to
support a claim, with
appropriate source
attribution (when
applicable) and references.
Content reflects original
thought and writing and
proper paraphrasing.
Writing demonstrates full
adherence to reference
requirements, including the
use of credible evidence to
support a claim, with
appropriate source
attribution (when applicable)
and references.
Content clearly
demonstrates awareness of
context, audience, and
purpose. Tone is highly
professional, scholarly, and
free from bias, and style is
appropriate for the
professional
setting/workplace context.
4
numerous and/or significant
errors.
© 2020 Walden University
There are one or two minor
errors.
5
1
Pre-Assessment
Giovanna Skylar
Walden University
HA3002
2
Pre-Assessment
Provision of the Code of Ethics for Nurses
Code of Ethics for Nurses provides an ethical framework to guide the decision-making in
ethical dilemmas. Besides, the code ensures nurses provide quality care through ethically guided
action that places the patient at the center of the care process. In this context, Provision 3 of the
code of ethics stipulates that nurse promotes, advocates for, and protects the patient’s rights and
safety (American Nurses Association, 2019). In this provision, nurses are ethically obligated to
protect patient’s privacy and confidentiality. In this regard, the nurse has the moral responsibility
to provide a safe and private environment to engage in conversation with the patient.
In the current case, the need-to-know basis would be appropriate to ensure quality care.
Studies by Stutterheim et al. (2014) revealed that explicit breaches of confidentiality and
carelessness were common violations of patient privacy and confidentiality for those diagnosed
with HIV. In part, eases of access to patient files, use of the nurse notes, and unnecessary referral
increased stigma and perception of poor quality. In this regard, the need to know will form the
basis of sharing the patient HIV status with other professionals. At the same time, documentation
and file storage will align with hospital standards of data protection and privacy policies.
Holistic Approach
Holistic approaches to the assessment of people with HIV should be longitudinal. In
particular, new complications and challenges tend to arise during the cause of the treatment. HIV
disclosure to the patient partner is vital in social support groups and has positive and negative
consequences. In part, disclosure can increase the risk of relationship dissolution, while on the
other hand, disclosure has the potential to increase social support and the subsequent adherence
to antiretroviral therapy (ART). Besides, the motivation to disclose among HIV patients is
3
related to various factors. Notably, when the patient considers the personal and interpersonal
gains for others, the likelihood of self-disclosure is high.
Thus, the narrative therapy approach offers a viable model for providing holistic care. In
particular, the narrative approach addresses the need to establish closeness, the fear of rejection,
and privacy concerns. In the narrative approach, the patient gains the ability to externalize the
problem rather than internalize the problems. In this case, the approach relies on the patient’s
skills and the sense of purpose as a resource during difficult times. The patients’ need is
addressed through the after-mentioned strategy, considering both the emotional aspects.
Alignment with the Code of Ethics
Research has consistently shown that the barrier to disclosing HIV is linked to the fear of
stigma. In essence, fear of discrimination, relationship dissolution, and intimate partner violence
are cited as the primary motive for withholding HIV serostatus (Xiao et al., 2015). Besides, the
legal mandate for self-disclosure further violates the patient’s rights to privacy and increases
emotional distress. On the other hand, the perception of control over privacy issues and the
perception of interpersonal and personal gain is associated with a higher willingness to disclose
HIV status to partners and friends.
In this regard, the narrative approach aligns with ANA provision 3. In this case, the nurse
focuses on protecting the patient’s right to privacy and confidentiality. In the narrative approach,
the patient needs and privacy concerns are fully addressed in that the potential of a breach of
confidentiality is limited (Obermeyer et al., 2011). Instead, patients leverage on own skills to
find the motivation to disclose while receiving emotional and social support from the health care
providers. Compared to mandatory reporting set by legal provisions, the narrative approach is
holistic. It addresses other underlying issues, such as adherence to ART and overcoming distress
4
due to violating individual privacy. Hence, rather than resorting to legal means, enabling the
patient to externalize the problem will increase the motivation to disclose the serostatus based on
the positive perception of support from the health care provider and total control over personal
privacy.
5
References
American Nurses Association. (2019). American nurses association code of ethics for nurses.
https://nursing.rutgers.edu/wp-content/uploads/2019/06/ANA-Code-of-Ethics-forNurses.pdf
Obermeyer, C. M., Baijal, P., & Pegurri, E. (2011). Facilitating HIV disclosure across diverse
settings: A review. American Journal of Public Health, 101(6), 1011–1023.
https://doi.org/10.2105/ajph.2010.300102
Stutterheim, S. E., Sicking, L., Brands, R., Baas, I., Roberts, H., van Brakel, W. H., Lechner, L.,
Kok, G., & Bos, A. E. R. (2014). Patient and provider perspectives on HIV and hivrelated stigma in dutch health care settings. AIDS Patient Care and STDs, 28(12), 652–
665. https://doi.org/10.1089/apc.2014.0226
Xiao, Z., Li, X., Qiao, S., Zhou, Y., Shen, Z., & Tang, Z. (2015). Using communication privacy
management theory to examine HIV disclosure to sexual partners/spouses among PLHIV
in guangxi. AIDS Care, 27(sup1), 73–82.
https://doi.org/10.1080/09540121.2015.1055229
1
Ethical Issues in a Health Assessment
Giovanna Skylar
Institutional Affiliation
HHA3002
Dr. Tilman
July 26th, 2022
2
Ethical Issues in a Health Assessment
Question 1
The reporting of a client’s health status must abide by the disclosure policies and
procedures provided in the health and medical standards. After my client has tested positive, I
will report her health status to the state health departments. The information is supposed to help
public health officials monitor the state’s health status. It is fundamental to report this
information as the federal and state funding for HIV services is often targeted to regions under
severe attacks by the epidemic (HIV.gov, 2017). The second party that should be notified of the
status is the new boyfriend in the waiting room, who should be notified under the client’s
consent. The non-disclosure of this information will likely put the new boyfriend at risk of being
infected. As suggested by the HPCSA, for information to be disclosed, the potential for causing
harm to third parties must be high enough to surpass the patient’s right to privacy. The
information should, however, be disclosed through the counseling process to make them
understand the importance of extending care to the patients.
Question 2
Confidentiality of the client data is essential in communication between the health worker
and the client. Confidentiality is especially useful in the process of counseling and treatment
services. Although health workers’ professional ethics recommend adherence to patient
confidentiality, observing these guidelines strictly may risk the client’s significant other and the
public. Therefore, I will use the counseling approach to help the client realize the dangers that
might find her significant others. The lack of disclosure by the client is based on the assumption
the information could cause her separation from her new relationship. However, previous studies
suggest that couple counseling schemes have successfully reduced the number of marriage
3
separations after the HIV status diagnosis (Dessalegn et al., 2019). The impact the infection can
cause on a partner would be severe, and it is necessary to create awareness on this matter. I will
take this approach because counseling may enable my client to provide individual consent for the
disclosure, thus avoiding the breach of confidentiality.
Question 3
The first action that must be taken to protect the confidentiality of the patient’s
information is to prohibit sharing information without informed consent. Strict rules should be
implemented to help share information where there are exceptions (Liz Stokes, 2019). In this
case, exceptions should only be permitted when a person’s life is endangered, in case there is a
legal requirement, or where the non-disclosure threatens the public. This information should also
be limited to relevant entities, such as the public health department.
Some policies that must be implemented should include informing the patient through
writing regarding the information to be released, the party to release the information, and the
individuals who will receive the information (Liz Stokes, 2019). The second action that can help
to protect patient data confidentiality is offering education to staff concerning potential areas of
misuse of patient information. The health centers should implement policies regarding the
improper use of information (Araújo et al., 2020). For example, the policies should address areas
such as personal electronic data devices, emails, and electronic transmission of data.
4
References
Araújo, W. J. S., Bragagnollo, G. R., Nascimento, K. C. D., Camargo, R. A. A. D., Tavares, C.
M., & Monteiro, E. M. L. M. (2020). Educational intervention on HIV/AIDS with elderly
individuals: a quasi-experimental study. Texto & Contexto-Enfermagem, 29.
Dessalegn, N. G., Hailemichael, R. G., Shewa-Amare, A., Sawleshwarkar, S., Lodebo, B.,
Amberbir, A., & Hillman, R. J. (2019). HIV Disclosure: HIV-positive status disclosure to
sexual partners among individuals receiving HIV care in Addis Ababa, Ethiopia. PloS
one, 14(2), e0211967.
Liz Stokes, J. D. (2019). ANA position statement: Nursing advocacy for LGBTQ+
populations. Online Journal of Issues in Nursing, 24(1), 1-6.
HIV.gov. (2017, August 31). Limits on Confidentiality. HIV.gov. https://www.hiv.gov/hivbasics/living-well-with-hiv/your-legal-rights/limits-on-confidentiality

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