Module 5 Discussion

Working in a pediatric emergency department means that I have faced and undergone plenty of ethical dilemmas in a shift and throughout my career. What makes the specialty of pediatrics so susceptible to ethical dilemmas is the fact that in pediatrics you are taking care of a vulnerable population, children. This means that you will encounter situations where there is something that needs to be done for the benefit of the patient but at the end of the day the patient isn’t consenting or agreeing, it’s the parent or the caregiver. Now, you run into a situation where even though you know the patient will benefit from a certain medical decision, the caregiver will be the deciding factor. What happens when the parent or caregiver decide that they will refuse certain care? You as a provider must determine if the benefits of keeping that caregivers wishes, outweighs the benefits of that child receiving care. This is the type of situation that I recently experienced at my job.

 I had a 2 week old female patient that came to the emergency department with her mother and father status post a closed head injury from a 2 feet fall from a bed. The patient was full term, had no complications at birth and did not receive the hepatitis B vaccine or vitamin K due to parent refusal. The parents stated she had no loss of consciousness or episodes of vomiting but they brought her to the emergency room because the child had a “bump” on the left side of her head that was soft and getting bigger after 3 hours of the injury occurring. The doctor explained to the parents that she wanted to collect blood work for coagulation studies and a type and screen as well as a CT scan to rule out any bleed or skull fracture. The doctor reiterated that it was of upmost importance because the child was at risk for internal bleeding due to her not getting her vitamin K at birth which helps with clotting. The parents refused to have any studies done being as they felt their daughter looked stable. The doctor and myself after attempting to reiterate the importance of the studies, had to collaborate with the social worker as well as the operation’s administrator of the hospital to determine if the doctor could override the parent’s refusal being as her physician judgment felt that the child was at high risk of an internal bleed or skull fracture. Fortunately, with communication and collaboration with the social worker, the parents finally consented to the pertinent studies. The child did in fact have a brain bleed and skull fracture and was admitted to the hospital.

Nurses need to recognize the potential ethical repercussions of their actions in order to effectively resolve problems and address patient needs (Milliken, 2018). Hamric (2014) states that compromise is the proper approach when it comes to ethical decision making. Compromise is appropriate to preserve the relationship between provider and caregiver and it allows each party to maintain their high moral position. In the case of this child, the providers were able to give effective care and the caregivers were thankful to have obliged to following the medical team’s suggestion for diagnostic testing.

References

Hamric, A. B., Hanson, C., Tracy, M., & O’Grady, E. (2014). Advanced nursing practice : an       integrative approach. Philadelphia: W.B. Saunders Co.

Milliken, A. (2018, January 31). Ethical Awareness: What It Is and Why It Matters. Retrieved     from             https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/O (Links to an external site.) JIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Awareness.html