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Cases of conscience: casuistic analysis of ethical dilemmas in expanded role settings.

In the absence of a well articulated conceptual framework for nursing ethics, this article argues for a theory of applied ethics--casuistics--used within a clinical reasoning model, to analyse the complicated issues presented in three cases involving adolescents receiving treatment for abuse through a rural alternative learning centre. The clinical nurse specialist, as an independent practitioner within the community, is presented with many ethical challenges arising from cultural diversity. The inherent independent nature of such practice environments combined with the pluralism which exists in today's multicultural society demands that professional nurses working in these circumstances develop and utilize an ethical framework for the analysis of patient care in situations that involve moral conflict.

Adolescent

HIV education for gay, lesbian, and bisexual youth: personal risk, personal power, and the community of conscience.

Adolescent gay and bisexual males face a higher risk of infection with HIV than most other young people because of their behaviors and because HIV prevention programs have failed to address their unique concerns. Ironically, current efforts to heighten public awareness about the AIDS pandemic may be nullifying the potential for gay, lesbian, and bisexual young persons at high risk to form the support networks needed to modify their behavior. The personal and group empowerment of gay, lesbian, and bisexual young people is a necessary prerequisite to their ability to make healthy behavioral choices around HIV and other health issues. This paper proposes a comprehensive health education model for HIV prevention for gay, lesbian, and bisexual adolescents. Current health education efforts would be augmented by broader self and group empowerment training that would develop self-esteem, social skills, support networks, and access to risk reduction materials. An integrated system of care involving school-based programs, multi-service youth agencies, and self-help groups would be in a position to deliver appropriate educational, mental health, medical, and social support services. Such a system of care presents gay, lesbian, and bisexual youth with their best chance to reduce their risk of infection with HIV and develop into emotionally healthy individuals.

Adolescent