Ethical Dilemmas in Pediatric Unit

Ethical Dilemmas in Pediatric Unit

Ethical dilemmas in pediatric unit arise following opinion conflicts between family members and healthcare providers on the most appropriate practice for the pediatric patient. Botkin’s (2016) explained that in modern healthcare, genetic testing is a practice used extensively in pediatric nursing. Genetic testing has revolutionized prediction of risk of disease among children through pre-symptomatic and susceptibility testing. According to Quaid (2016), the former involves highly sensitive and precise methodologies for the identification of genetic alterations because of their penetration capacity into the genetic make-up of the patient. The latter consists of the identification of the actual genetic mutations that constitute etiologies and risk factors for early onset or progression of a genetic disease.

Personal Experience in Clinical Attendance

Personal experience in clinical attendance has oriented me to several clinical dilemmas. I identified an instance of reluctance among family members to subject their child (pediatric patient X) to genetic testing to detect thalassemia because clinically, managing the genetic disease requires frequent blood transfusion. The parents of the child explained what prompted them to see the physician for genetic testing stating that their neighbors and friends commented that the child “did not look fine” because of his somewhat anemic manifestations and the comments were detrimental to them. The couple agreed that they needed to see a doctor and determine why the baby exhibited the signs of anemia owing to their educational background in health sciences, although they perceived that the condition could be restored to normal. Upon medical review, the physician recommended genetic screening for thalassemia. However, the parents to the child were reluctant of their child undergoing thalassemia genetic test due to the fear that the outcomes would be positive and their underlying knowledge that blood therapy would be involved. The parents knew that the disease is fatal and would result to death if not managed using regular blood transfusion. However, the parents and those who accompanied them were not ready to accept the adverse outcomes guided by negative cultural misconceptions that blood transfusion is a high-risk procedure associated with the transmission of other blood diseases. The physician recommended the test for early diagnosis and management of thalassemia because the early symptoms had begun manifesting on the child. Late diagnosis and delayed management would ultimately predispose the child to complications such as heart and liver diseases, osteoporosis, and infections that predispose an individual to a high risk of death. Therefore, genetic testing would help to inform on the necessity of early intervention through blood transfusion, but an ethical dilemma emerged.

Ethical Principles and Nursing Practice

Botkin (2016) explained that the role of a healthcare provider is to advocate for recommended priorities of care and should not incapacitate the patient’s or caregiver’s ability to make informed and independent decisions. Similarly, the role of the family in the case is to advocate for the holistic well-being of the child and the psychosocial wellness of its members. Therefore, the family disliked the opinion of genetic testing due to the associated cultural misconception, psychological and fiscal implications of positive outcomes of thalassemia. Hence, there was a need to establish interventions to aid the parents overcome the dilemma and prepare them to be strong to the anticipated outcomes.

Various Principles Related to the Ethical Dilemma

Various principles can be linked to the ethical dilemma explained above. According to the second provision of the American Nurses Association (ANA), a nurse should serve the interests of the patient, family and the community (2016). The prioritization of the patient’s interest should adopt an interactive and collaborative approach between the patient, family members, and the nurse. Additionally, ANA (2016) principles grant a nurse the authority, accountability, and responsibility, to ensure superlative decisions which support the optimal care of the patient are implemented. The principle notes that a nurse is responsible for the implementation of clinical decisions, judgments, and actions that prioritize the holistic wellbeing of the patient. Provision six further advocates that the nurse should undertake efforts to improve quality of care through research and scholarly inquiry (ANA, 2016). The nurse should advance care approach through the use of Evidence-Based Practice (EBP) in pediatric care.

Application of Ethical Principles in the Dilemma

ANA (2016) second provision relates to the ethical dilemma as it advocates for the prioritization of interests pertinent to the patient, which lies in understanding the underlying genetic alterations to determine current and anticipated health outcomes. However, in the situation, the family’s interest rests in refuting the recommended procedure because of fear of unintended consequences. Botkins (2016) states that it is imperative for healthcare providers to understand that predictive information from genetic tests may be burdensome for family members and the pediatric patient. Nevertheless, it is ethically justifiable for healthcare professionals to support genetic testing by using effective pre-testing approaches such as adequate counseling.

Nurse’s Responsibility and Authority

The fourth principle in the ethics code states that nurses have the responsibility and authority to make clinical decisions, judgment and actions which support optimal care (ANA, 2016). In the pediatric care setting, the nurse is responsible for the clinical choice and action for the pediatric patient to undergo genetic testing, but the family reluctance limits the implementation of this principle. However, Quaid (2016) argued that it is imperative for nurses to obtain informed consent from the parents or guardians of the before implementing the clinical decision.

Incorporating Research Findings in Patient Care

ANA (2016) provision six further suggests that nurses should incorporate research findings and scholarly inquiry in patient care. Within the pediatric setting, the nurse’s capacity to implement the superlative practice is affected by the family resistance. Contemporary EBP advocates for genetic screening for the identification of underlying inherited abnormalities which increase the risks of adult onset of genetic diseases (Botkins, 2016). Clayton et al., (2014) supported EBP stating that it is a central strategy in the identification of genetic anomalies that affect the population.

Resolution of the Ethical Dilemma

The outcomes of the ethical dilemma were affirmative. The family members understood the importance of genetic screening and provided informed consent for the genetic testing procedure on patient X and subsequently resolved the ethical dilemma. During the period of care, a time frame of two weeks was utilized for patient education and counseling to make the above resolution. Further, the nurses adhered to the code of ethics guiding nursing practice to resolve the dilemma.

Utilizing Healthcare Resources

The healthcare institution entails various resources that can deal with ethical dilemmas in the continuum of care. The nurse provided patient education to the family members regarding the importance of genetic screening. Botkin (2016) recommends that family members should be educated on the diverse options for genetic testing and the importance of the testing approaches. Nurses should utilize educational materials within the facility such as posters, pictures, and videos. Additionally, the family members were referred to the counseling department to acquire pre- and post-test counseling.

Conclusion

In conclusion, ethical dilemmas constitute significant setback towards effective provision of healthcare in the pediatric settings. Family members and nurses play an imperative role towards resolving ethical dilemma situations. Family members should be educated constantly on the superlative care approaches which meet the needs of the pediatric patient. Further, nurses should adequately understand the ethical principles which guide nursing practice in instances of ethical dilemma. In addition, more principles should also be developed to enhance the nurses’ ability to efficiently handle dilemmas arising in the course of care provision.

References

American Nurses Association, (2016). Code of ethics for nurses 2016, the 9 provisions. Accessed on 9/11/2018. Retrieved from https://anacalif.memberclicks.net/assets/Events/RNDay/2016%20code%20of%20ethics%20for%20nurses%20-%209%20provisions.pdf

Botkin, J. R. (2016). Ethical issues in pediatric genetic testing and screening for current opinion in pediatrics. Current opinion in pediatrics, 28(6), 700.

Clayton, E. W., McCullough, L. B., Biesecker, L. G., Joffe, S., Ross, L. F., &Wolf, S. M., (2014). Addressing the ethical challenges in genetic testing and sequencing of children. The American Journal of Bioethics, 14(3), 3-9.

Quiad, K., (2016). Ethical issue in genetic testing. Accessed on 11/9/2018. Retrieved from https://www.genome.gov/multimedia/slides/wgt/quaid.pdf