NURBN1012 Professional Legal And Ethical Decision Making In Person Centered Care


This activity will allow you to demonstrate your ability to:

1. Demonstrate an understanding of the multifaceted role of registered nurses within the organisational structures and processes of health care;
2. Identify, analyse and evaluate the role, functions and skills in leading and managing teams across the spectrum of health care contexts;

Clinical Scenario: Jade’s Dilemma?

The lift doors open and Jade rushes into the lift. Jade is a newly graduated RN and she is running late for a shift at the start of her second week of her new graduate program. Inside the lift are two, night duty nurses on their way home after finishing their night shift. As they share the lift Jade over hears them discussing a patient.

“She should be made to take the drugs,” one of the night nurses said. “Yes,” agreed the second. “That mother is condemning Bethany to a death sentence.”  The lift doors open onto Jades floor, she quickly rushes to start her shift.

The shift coordinator reminds Jade about the importance of being on time to start her shift, but adds that she is lucky, as the night staff had left their handover information on a tape for her to listen to. Jade listened to the handover tape and discovered that she would be working with the shift coordinator as they are short staffed. She and the shift coordinator have six patients to care for in their patient load.

One of her patients is an 11-year-old girl, called Bethany and Jade wondered if this was the same child she had heard the two, night duty nurses discussing in the lift. The tape covered much of the essential care for all six patients, but additional information had been handed over verbally that Jade had missed. The coordinator (Lisa) failed to pass on the additional information. Primarily, it related to Bethany’s mother’s religious beliefs and a discrete move by the medical team to make Bethany a “ward of the state.”

Jade decided to check on the welfare of all six patients. Eventually, she met Bethany an 11 year old child, newly diagnosed with Acute Lymphocytic Leukaemia (ALL) and she had recently developed a serious chest infection. To Jade’s surprise Bethany was not receiving any medications and had no IV line. She also found Bethany in her mother’s arms as she sat in a chair at the bed side being gently rocked. Jade noticed that on Bethany’s medication chart she was written up for IV antibiotics.

“Has Bethany had these medications yet?” Jade asked Bethany’s mother.

“Oh no, our religious beliefs don’t agree with the administration of drugs of any kind and I have not allowed it,” Bethanie’s mother replied politely.

Jade thought Bethany looked flushed.

“Can I take her temperature?” Jade asked. It was 38.9 degrees.

“Can I give her some paracetamol for her high temperature?” Jade asked.

“No,” said Bethany’s mother, “as I explained, in our religion the use of medications of any kind is forbidden.”  Jade asked if Bethany’s mother would sponge Bethany with a cool sponge cloth. Her mother agreed and took the cloth.

Jade wasn’t sure what else to do about the pyrexia and spoke to the doctor at the nurses’ station about the situation. The doctor explained that they were quite concerned about Bethany, but that as a new registered nurse Jade would not understand their responsibilities as doctors and that the medical team were aware of the situation and had sought a court order to force the mother to release Bethany to the care of the hospital and ban the mother and close family from contact with Bethany while they aggressively treated the chest infection and underlying ALL. The doctor said, “we have tried to reason with the mother and now we have no choice but to secretly plan to treat the child without the mother’s consent.”

Shortly after, Lisa took Jade aside and suggested that when Bethany’s mother went to the toilet she should give Bethany some paracetamol for her high temperature. Jade refused. The doctor, who was nearby, suggested that Jade hide the paracetamol solution in some ice cream and give this to Bethany. Again, Jade refused. Bethany’s mother suspected the staff were planning to tamper with the ice cream and refused to allow Bethany to take it, even though it had not been tampered with.

Hoping to help reassure Bethany’s mother Jade spoke with her about the situation. During the conversation Jade disclosed the medical team’s plans to gain legal custody of Bethany. Shortly after the conversation Bethany and her mother left the hospital, suspending the medical treatment for either the chest infection or underlying ALL.

Lisa questioned Jade about her conversation with Bethany’s mother at the end of the shift. When Jade mentioned her conversation with Bethany’s mother Lisa became very angry with Jade and at one point said, “you have helped kill this child.” Jade left the shift at the start of her second week as an RN in tears.

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