A 19-year old female presents to your clinic with complaints of nausea and vomiting every morning for the past week. She admits she has been sexually active with 1 male partners in the past 3 months. She has never used any form of protection or contraceptive. She reports she took a home pregnancy test 1 week ago and that it was positive. She states her last menstrual period was almost 3months ago. She Lives with parents and one older female sibling in a single-dwelling home. She is a college student in local private Christian college. She describes herself as an “A-student” and involved in several extracurricular school activities or athletics. She reports experimenting with alcohol and cigarettes when she was in junior high school but that “both made her so sick” that she did not continue to use. Denies illicit drug use in the past or present. She reports feeling safe in her home. She’s had a 20-year old boyfriend for the past two months. She denies history of emotional, sexual, and physical abuse. She reports she feels safe in her home and when she is with her boyfriend. FICA assessment reveals that is of Christian faith and belief and that her faith is very important to her. She attends church on Sunday and is an active member of her college discipleship group. She holds her faith as essential to her life and desires faith integration into her health care.

The Nurse Practitioner informs the patient that her urine pregnancy test is positive. The patient upon hearing of her pregnancy began weeping. She told the NP that her parents and her boyfriend would be devastated that she had become pregnant out of wedlock and that she was terrified to share this information with them. The NP listened compassionately and asked the patient to consider sharing the information with a trusted Christian mentor. The patient said she knew just who she would seek guidance. The NP also referred the patient to gynecology for prenatal care.

The patient returned to the clinic two days later with her boyfriend to discuss pregnancy options. Her appt is scheduled with gynecology in 10 days. While her boyfriend is in the waiting room, the patient tells the NP that she has not discussed her pregnancy with her Christian mentor but did tell her boyfriend. Her boyfriend is not a Christian and he wants her to have an abortion. The patient is tearful, saying that she doesn’t know what to do. She requests that the NP help them understand their options and the boyfriend joins the meeting with the patient and the NP. The boyfriend states he is in his fourth year of premed, that his father and grandfather are physicians and his career trajectory cannot be compromised by a child. He wants the NP to counsel them regarding options for pregnancy termination. He states he’s heard she can just take a pill and that technically would not be abortion. The NP is also a Christian, facing a spiritual dilemma, as she believes that life begins at conception and that abortion is morally and ethically wrong.

QUESTION:

Identify and discuss a spiritual/moral/ethical dilemma that this patient is experiencing. Considering the NP Standards of Practice, the Nursing Code of Ethics and the six principles of spiritual interventions discussed in Shelly & Miller (2006) Chapter 14, discuss how the Christian NP should approach the care of this patient.