Applying your ethical training as a nurse is never more important than when you’re looking after children. It can be all the more challenging to stick to it because you’re likely to feel a stronger emotional involvement with them, but, as they are the more vulnerable, your patients will really depend on you to get it right. This article looks at some of the areas where ethical issues are more likely to arise and will help you think through what is required to ensure that they’re correctly handled.
Veracity
When you’re hardwired to protect children, it can be difficult to undertake actions that cause them distress. Although you should aim to minimize their concern, you can’t always avoid it entirely, such as when you need to give injections or persuade them to swallow pills. You will also need to be able to tell them the truth about their treatment and the reason they’re receiving it. Although you may need to simplify it, it’s important to be honest because the trust they have in you depends on your honesty. Answering questions need not mean going into depth, and you can choose how you phrase things to make them sound less scary, but it’s worth remembering that children tend to be most afraid of the unknown or of things happening to them that they didn’t expect. Just like adults, they can prepare themselves emotionally if given warning, and indeed they often surprise adults with their pragmatism.
Consent
State laws vary on when a child is old enough to consent to medical treatment, and there are differences depending on the type of treatment involved. In most cases, for anything more serious than routine testing, you will need the parent’s consent. This does not, however, reduce the obligation you have to the patient. While parental consent may cover you from a legal perspective, you should always seek the child’s consent to initiate the procedure. This helps children feel more secure and teaches them that their boundaries deserve respect, as well as helps them to respect the boundaries of others. Even very young children are capable of engaging in this process to a degree. While they lack the depth of understanding to give consent the way an adult could, they can, for instance, let you know when they’re feeling brave enough for a particular treatment to commence.
Competence and advocacy
Because children are limited in their understanding, they are not generally deemed competent to understand complex issues. There are exceptions in some contexts, such as when a child over 16 is emancipated or when an assessment determines that a particular child has unusual intelligence and maturity. In most cases, however, you will have to advocate on the child’s behalf. In this situation, it’s important to remember that your duty is directly to the child, not the parents or guardians, and that you are there to represent the child’s best interests. This applies even in situations where it goes against your own interests, for instance, by putting you at odds with your employer. It could also require you to speak in a court. If you feel intimidated by situations like this, it’s important to remember that other nurses will understand the situation you’re in and you can find support from the nursing community.
Tackling conflicts of interest
When there are conflicts of interest between what the child patients want, what their parents want, and what, in the opinion of medical professionals treating the child, is actually needed, nurses are often caught in the crossfire. They are also in a unique position to resolve such situations. Worried parents are often more willing to talk to nurses than to doctors because they recognize nurses as members of an inherently caring profession. You can act as a mediator. If parents object to a procedure for religious or cultural reasons, then, with their permission, it can sometimes be helpful to bring in an authoritative person from the relevant community who feels that there are appropriate ways for the procedure to go ahead. When you study nursing – Saint Joseph’s College of Maine offers an excellent 15 month BSN for non nurses with intensive support – you’ll learn communication skills that help in situations like this, as well as the ethical parameters within which you can engage in negotiations.
Parental concerns
Part of the reason why looking after a child is complicated is that parents may have very strong views they want you to abide by. Although it is the child who must come first every time, most nurses also feel a duty to help families cope with stressful situations related to treatment. You may feel that upsetting the parents could make the child’s life more difficult. In this case, you should begin by focusing on basic child safeguarding principles and explain them to the parents as required. You will need to be honest about what is practical (for instance, a hospital kitchen might be able to cater to allergies but lack the facilities to prepare food according to religious or cultural rules) and look for workarounds (e.g., in that case, you may be able to refrigerate and microwave food that the parents bring in). If you feel that what the parents want is harmful for the child, you will need to be firm in refusing to cooperate.
By consistently acting in an ethical manner, pediatric nurses provide role models for children and give them confidence that there are rules in place that will protect their interests. Whether they’re spending time in hospital or simply getting outpatient procedures done in a neighborhood clinic, it’s much easier for them to feel secure if they know that they can rely on the nurses taking care of them to do what’s right. Though sticking to the ethical code in nursing is often challenging, and never more so than when you’re working with a vulnerable patient group, in the end it makes everybody’s experience better and ensures the high quality of service you would want for a child of your own.
