The ethical demands on a nurse practitioner do not always come to the fore when working individually with patients. Nurses often consider ethical regulations in the context of oversight from medical superiors rather than with respect to the knowledge of the patient. However, the question of what a patient knows or does not know does carry implications for how the nurse discloses or withholds information. What to say and how to say it is an ethical question, one that this case study analysis will briefly explore.

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Laws and Implications of Nondisclosure
The American Nurses Association claims that a nurse is required to share information with a patient that will improve the wellbeing of that patient (2001). The remainder of the guidelines share such a subjective stance, one guided by the goal of improved health but no more specific than doing what the nurse and patient deem best. This does not offer concrete guidance in the realm of the case study and disclosure, except that it validates both disclosure and non-disclosure based upon the situation. My state does not go beyond these rules but instead adheres to them as the standard set of ethical guidelines.

In the event that an error is made, disclosure levels depend upon the degree of error in the medication prescription. On the one hand, a minor fault may have occurred whereby the nurse gave the patient an inconsequential extra amount of medication. This, according to some, requires no disclosure unless something else happens or the patient asks. On the other hand, if a consequential error occurred that might alter the health of the patient, then disclosure is required. Notice that these ethical guidelines depend on the consequences that the error will engender. They do not rely upon the knowledge of the patient. But the case study focuses on just that knowledge: for the nurse does not think that the patient will know that he or she made the error. Both aspects, however, must be taken into account.

Implications for the Case Study
How, in view of these laws and implications of levels of disclosure, can a nurse practitioner positively move forward in practice? A helpful article by Anderson (2010) suggests three behaviors to reduce errors in the medication context: “Eliminate distractions while preparing and administering medications. Learn as much as you can about the medications you administer and ways to avoid mistakes. . . . Finally, be aware of the role fatigue can play in medication errors.” These all pertain not so much to ethical guidelines as to the disciplines of the nurse practitioner. Nevertheless they provide concrete methods for improving the dispensation of medicine and treatment of patients.

In the second place, I would, as a nurse, weigh the nature of the error and determine how great the degree of error was. I might also consult other nurses and experts in the medical field, those whom I trust and would keep our discussion confidential. If the error will lead to possible complications for the patient, then I would disclose the error to him or her. However, if the error does not appear to lead to any problems, and the patient does not ask about the medication levels, then I will proceed without disclosure and continue care. This decision finds justification in the ANA ethical guidelines as well as literature in the field of medical ethics. If a colleague sparked further deliberation or my own conscious did not sit well with the decision, then I would revise my behavior. For the ethical world of nursing offers no simple solutions. We must do our best to help the patients.