Consider the following case study. Be prepared to participate in a class or online discussion to be scheduled by your instructor.

Keri, an active, bright, and attractive 13-year-old girl, comes into the outpatient clinic for a sports physical before she can play on her school’s championship basketball team. While performing the initial assessment, the clinic RN finds indications of possible physical abuse, including bruises on Keri’s back and upper legs and a laceration in her earlobe, where an earring was ripped out. The nurse asks her if anyone is hurting her, and after a long pause during which she starts to cry, Keri relates that her biological father has a short temper, and when she came home from a party 2 hours late two nights before, he slapped her in the face, accidentally ripping out the earring, and spanked her with a leather strap. After some additional prompting by the nurse, Keri says that her parents were divorced 5 years ago and that she had been living with her mother and her mother’s live-in boyfriend in a nearby town until just recently. However, her mother’s boyfriend had been sexually abusing her while her mother was at work and told Keri not to tell anyone or he would kill her. Keri sincerely believes he is very capable of carrying out his threat.

Keri begs the nurse not to tell anyone. Keri feels that it is much better to be with her biological father, even though he does have a bad temper, and is afraid if the nurse reports her father, she will be forced to return to her mother and the sexually abusive boyfriend, of whom she is extremely afraid. The nurse knows that the state law, as well as several federal statutes, requires that suspected abuse be reported immediately.

Identify the ethical principles involved.

How do you weigh the obligations? Does the obligation to confidentiality outweigh the obligation to report the abuse?

Are there options for the nurse other than to report or not report the abuse?

If you were the nurse, how would you handle this situation?