NR 501 Week 2 Reflective Essay

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Chamberlain University

NR-501: Theoretical Basis for Advanced Nursing Practice

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Date

Ethical Dilemmas in Truth-Telling and Decision Making in Pediatric Nursing

Nursing is not just a science, but also an art, especially when it comes to dealing with ethical dilemmas. One of the most challenging areas in healthcare is making ethical decisions regarding truth-telling, particularly when it involves minors and their families. The issue becomes even more complex when a serious medical diagnosis is involved, as was the case of a 15-year-old girl who was diagnosed with a malignant brain tumor. This scenario raises questions about who has the right to know the truth—the patient or the parents—and how best to navigate the psychological and emotional implications of disclosing such critical information.

The Challenge of Truth-Telling in Pediatric Care

In this particular case, the girl had been admitted to the pediatric ward with complaints of a severe headache and menstrual issues. After undergoing a brain CT scan, it was confirmed that she was suffering from a malignant brain tumor. The healthcare team, including the neuro-oncology specialists, was tasked with disclosing the diagnosis. However, the parents made a request that their daughter not be informed of the full severity of her condition. While the girl was aware that she was ill, she was unaware of the gravity of her condition. This raises the ethical dilemma: Should the truth be told to the minor patient, or is it appropriate for the parents to control the information?

Parental Rights and Patient Autonomy

At the heart of this dilemma is the tension between parental authority and the patient’s right to know about their condition. In pediatric care, the parents or guardians generally have the legal and moral right to make decisions on behalf of the child, especially when the child is under 18 years old. This becomes more complicated when the healthcare professional must balance respecting the parents’ wishes with the need to ensure the patient’s well-being. In this case, the parents requested that the information not be disclosed to their daughter, fearing that it would cause unnecessary emotional distress.

However, the patient, though a minor, is still an individual with her own rights. As she began to experience symptoms such as hair loss and exhaustion, she became increasingly aware of her deteriorating condition, which led to feelings of confusion and distress. As a nurse, I was torn between respecting the parents’ wishes and considering the ethical implications of withholding crucial information from the patient. Would telling her the truth empower her to make decisions about her care, or would it cause her emotional harm?

Ethical Decision-Making and Moral Distress

The question of whether to disclose a serious diagnosis to a minor is a common source of moral and ethical distress for nurses. Nurses are tasked with advocating for the best interests of their patients, which includes respecting both patient autonomy and the role of the family. However, in this case, the decision seemed to rest with the parents, who were understandably protective of their daughter’s mental and emotional well-being.

Empirical evidence suggests that, in some cases, withholding the truth may reduce immediate psychological harm, but it may also have long-term consequences on the patient’s trust in healthcare professionals. For example, research has shown that not disclosing a diagnosis can prevent the patient from properly preparing for treatments or making informed decisions about their healthcare (Chaudhury et al., 2016). In this scenario, I was confronted with the reality that sometimes, doing what is “right” in an ethical sense may not always align with what is “best” for the patient.

The Role of Nurses in Ethical Decision-Making

Nurses, while advocates for patient welfare, do not always have the final say in ethical decisions, especially when it comes to disclosing sensitive medical information. In this case, the nurse’s role was more about providing emotional support and facilitating communication between the parents, the patient, and the healthcare team. While nurse practitioners may have the authority to disclose diagnoses, nurses must adhere to institutional guidelines and respect the decisions made by the family (Emo, Bankas, & Espedido, 2010).

In pediatric care, it is especially important to consider the family-centered care model, which emphasizes the involvement of the family in decision-making processes. Family-centered care helps ensure that the child’s emotional and psychological needs are met while also acknowledging the challenges faced by the parents. The involvement of the family in decisions about truth-telling can help alleviate some of the moral and ethical distress experienced by healthcare professionals.

NR 501 Week 2 Reflective Essay

Balancing Truth-Telling with Emotional Well-being

Truth-telling in pediatric care must be approached with sensitivity, particularly when dealing with serious or terminal illnesses. While it is essential to be honest, it is equally important to consider the timing and manner in which the truth is revealed. Research suggests that disclosing information in a supportive environment, with the presence of the family, can help mitigate the emotional impact on the patient (McElvaney, 2014). In this case, the decision to withhold full disclosure may have been the most compassionate approach, given the patient’s age and the severity of her condition.

The key to navigating these ethical dilemmas lies in balancing honesty with the emotional well-being of the patient. Nurses must rely on their ethical principles, their knowledge of the patient’s needs, and evidence-based practices to guide their actions. Ultimately, the goal is to ensure that the patient’s best interests are upheld while also considering the emotional and psychological impact on the family.

Conclusion

In conclusion, truth-telling in pediatric care is a complex issue that requires careful ethical consideration. The rights of the patient, the wishes of the family, and the potential psychological consequences of disclosure all must be weighed. Nurses must navigate these difficult decisions with compassion and professionalism, guided by both empirical evidence and ethical principles. In this case, the decision to respect the parents’ wishes and withhold information from the patient may have been the best course of action to protect her emotional well-being, even though it left me with a sense of ethical distress. Ultimately, the family’s involvement in the decision-making process is crucial to ensuring that the patient’s needs are met with empathy and understanding.

References

Chaudhury, S., Kirk, C., Ingabire, C., Mukunzi, S., Nyirandagijimana, B., & Godfrey, K. et al. (2016). HIV Status Disclosure through Family-Based Intervention Supports Parenting and Child Mental Health in Rwanda. Frontiers In Public Health, 4. doi: 10.3389/fpubh.2016.00138

Emo, M., Bankas, D., & Espedido, B. (2010). Truth-telling and an adolescent diagnosed with a malignant brain tumor: who are we protecting? Canadian Journal Of Neuroscience Nursing, 32(03).

NR 501 Week 2 Reflective Essay

McElvaney, R. (2014). Disclosure of Child Sexual Abuse: Delays, Non-disclosure and Partial Disclosure. What the Research Tells Us and Implications for Practice. Child Abuse Review, 24(3), 159-169. doi: 10.1002/car.2280