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Vulnerable adults and suspected abuse

Case study about confidentiality & ethical disclosure

Barb works in a private group home. Jamie, a competent 20 year-old resident with cerebral palsy, has been staying with his parents for the past week. When he returns in the evening with his mother, Barb notices that he seems nervous and quieter than usual. The support worker, while helping him get ready for bed, notices bruises on his arms and legs. His mother explains he fell at home. Concerned, the support worker alerts Barb. After assessing Jamie and talking with him privately, Barb believes he may have been physically abused. Barb knows she must make sure Jamie is safe and get him any needed medical assessment and treatment.

Since Jamie is a vulnerable adult, she believes he is at risk of harm. She wonders what her professional, legal and ethical responsibilities are.

Arrange medical assessment and treatment if needed.
Barb’s first priority is Jamie’s safety and well-being. She should take steps to ensure Jamie is safe and gets any needed treatment. Professional Standard 2.5
Determine if she has a legal duty to disclose this information

Barb is unsure of her responsibility and can’t find any policy. She shares the situation with her manager. (Professional Standard 3.1)

Barb learns that while there is no legal requirement to disclose, the Adult Guardianship Act, Part 3, allows her to disclose this without Jamie’s consent. Under the Act, anyone with information indicating an adult is abused and unable to get assistance may report this to a designated agency. (Privacy and Confidentiality principle 1)

Discuss their concerns with Jamie.
Barb and her manager share their observations and concerns with Jamie. He may agree to have them report the situation or want assistance to share the information himself. He may also refuse. If Jamie doesn’t consent, Barb and her manager must decide what to do next. (Legislation, Privacy and Confidentiality principle 6)
Decide whether they are ethically obligated to report the situation.
Barb and her manager must decide if Jamie is at risk of ongoing harm because of the abuse. They know they have an ethical obligation to disclose in situations that involve a substantial risk of significant harm to the health or safety of their client. They discuss the potential outcomes of acting and not acting and use a process of ethical decision making before they share their thoughts with Jamie. (Privacy and Confidentiality principle 7)
Identify where/to whom to report their concern.
If Barb and her manager decide to report their concerns, they need to identify the designated agency or individual they should report to. Barb could call the Community Care Licensing Office to ask for advice and direction.
Decide what to report.
Barb knows she must disclose the least amount of information to the fewest number of people as possible. She and her manager discuss what she will share and decide how to answer possible questions. (Privacy and Confidentiality principle 9)

Situations like this are complex. Nursing actions will depend on several factors including:

  • Is there a risk of harm?
  • Is the client capable of making decisions? 
  • Does the client have the information to make informed choices?
  • Has the client consented to disclosure?

Ethical decision-making requires accurate information, consultation, and judgment. The Privacy and Confidentiality Practice Standard provides direction for nurses when faced with complex situations. For further information or discussion, contact CRNBC Practice Support.


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