Review the clinical scenario presented and respond to questions.

Evaluate the following case study:

Keri, an active, bright, and attractive 13-year-old, 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 whether anyone has been hurting her, and after a long pause during which she starts to cry, Keri relates that her biologic 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 but that she had been living with her mother and her live-in boyfriend in a nearby town until just recently. However, her mother's boy friend 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 believes that it is much better to be with her biologic father even though he does have a bad temper, and she 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 deathly afraid. The nurse knows that the state law, as well as several federal statutes, require that suspected abuse be reported immediately.

1. What are the ethical principles involved in this situation?
2. How do you weigh the obligations? Does the obligation to confidentiality outweigh the obligation to report the abuse?
3. Are there any other options for the nurse other than to report or not report the abuse?
4. If you were the nurse, how would you handle this situation?