Patient Case Study

CASE STUDY 4

PART A: Client Case

Jack (pseudonym) is a fourteen-year-old Maori boy admitted to the hospital for Acute Rheumatic Fever with severe Mitral regurgitation and mild Aortic regurgitation. He's been in the admitted since the 22nd June 2006 and is expected to remain as an impatient for several weeks following his cardia surgery next week. Throughout his stay in the hospital, several medical and nursing interventions have been implemented and adapted in order to address each of the problem/ diagnosis and assist him in getting back to his former health. His parents, especially his mother, have been fully informed and involved on each step of the way, and have been supported by the health care team during this hard time.

Legal Knowledge

In any health care setting, it is a legal and ethical obligation of health care professionals to seek informed consent from a competent individual subjected for any treatment or investigation. Informed consent is defined as a process whereby an individual is accurately and adequately informed about a proposed procedure or treatment, and given the right to agree or refuse to have that procedure or treatment (Auckland District Health Board, 2003). It respects and protects the personal integrity of a patient by establishing the patient's right to determine what is done to him or her. Consent must be given voluntarily and may be given verbally or written (Ministry of Health, 1998).

Consent involving children or young adults take on additional complexity. According to Section 25(1) of Guardianship Act 1968, anyone who has reached the age of 16 years is regarded as an adult for the purposes of medical decision-making. Generally, this means that treatment or investigation involving children less than 16 years cannot take place without the informed consent of the child's parent or guardian, or someone acting on their behalf (Ministry of Health, 1998). Any health professional that wishes to undertake the care of Jack, by law must have the consent from Jack's parents. It is the parents' responsibility to make difficult decision whether to say yes or no to intervention with the support of the information given by the multidisciplinary team. The consent process also means that Jack's parents must be in close communication with the medical staff treating him, and are entitled to be informed immediately about any problems that are considered threat to his health. They must also be given full information about the problem, the course of treatment proposed, the benefit and risk of this treatment, and any alternative treatments (Australian Human Rights Commission, 1985).

Ethical issue

As mentioned before, informed consent involves patients right for accurate and adequate information relevant to exercising their decision-making rights. When dealing with children, the issue of informed consent is puzzled because the person giving the consent is not the person who will face the consequences of the treatment (Auckland District Health Board, 2003). The legal authority of parents or legal guardians to consent on behalf of their children is due to the belief that they are the ones assigned by the society with responsibility for the welfare and upbringing of children, and that they provide the best interests for their children with regards to health care (Forman & Ladd, 1991). Jack's parents have the right to consent or refuse medical treatment for him; however, if the physician feels that they are not showing competency in decision-making, he or she has the obligation to involve other health professionals for assistance in making treatment decisions. In these instances, nurses become accountable in ensuring that treatment decisions made by the health care team are guided by what is for the best interest of the child concerning his/ her welfare and health (Committee on Bioethics, 1995).

Even when a child is considered not competent to consent, he or she must still be provided with information at a level appropriate to his or her maturity and understanding. Jack is entitled to information about his condition, and explanation of the options available, including an assessment of expected risk, side effects, benefits, and costs of each option (Ministry of Health, 1998). Conflict can arise when the child has not been given full information because of the wishes of parents to limit the information provided to the child, or lie to the child about diagnosis or treatments. Some parents consider this as a way to provide protection and sense of security for the child. Often nurses are forced to choose between remaining silent in allegiance to the parents or providing truthful information to the client. Either action may have frustrating consequences (Timby, 2005).

Cultural Aspect

Cultural Safety is defined as "an effective nursing practice of a person or family from another culture, and is determined by that person or family" (Nursing Council of New Zealand, 2005, p.4). This requires nurses to have knowledge and skills to work in a behaviour that is culturally safe, appropriate, and acceptable defined by the patient receiving it (Nursing Council of New Zealand, 2005). In Maori beliefs, children (tamariki) are regarded as very special, gifts or treasure, and as belonging to the whanau in a broad sense of the word. They belong not only to their parents, but also to their grandparents and ancestors. The child also belongs to the whenau (land) and is part of the environment. Because of this, responsibility of making decisions about the health services and interventions Jack is receiving is shared with significant and available members of the whanau. Health practitioners and nurses have the responsibility of involving the whole family/ whanau in ensuring that our practices as health care providers are sensitive and respectful of their cultural beliefs and values. Nurses also need to have a clear understanding and awareness of their own values and beliefs, and how it affects their practice in interacting with families with different ethical and cultural background (Nursing Council of New Zealand, 2005).

PART B: ANALYSIS OF NURSING KNOWLEDGE

Impact of Nursing Knowledge (Advocacy, Accountability & Partnership)

Professionalism in nursing means that nurses are held responsible and accountable for providing safe, appropriate care to patient. Because nurses have specialized knowledge and skills,