Through group decision by nonfamily members, an unbi-ased,
objective decision can be made.
REFERRAL TO SUPPORT GROUPSThere are also many community agencies
and groups to sup-port the family. Some of these agencies are
federally funded,while others are privately funded. The practical
or vocationalnurse should be aware of community support groups that
canhelp families cope with pediatric issues. For example,
localchurches or hospice may be the site of support groups for
par-ents of terminally ill children. Schools may offer
eveningseminars on health topics that affect school-age
children.
SUPPORT GROUPS FOR STAFFMany facilities have staff support
groups to assist nurses andother health care workers to adjust to
difficult situations inpediatric care. For example, when a
chronically ill child hasreceived care at the same hospital for
several years, the staffmay become attached to both client and
family. If the childdies, the staff may need time and a safe place
away from workto share their feelings of loss. They may also
experience feel-ings of failure because the child died despite
their care.
NURSING CARE
PRIORITIES IN NURSING CARE
When providing nursing care to a client who has legal orethical
issues, the priorities are therapeutic listening, criti-cal
thinking, and awareness of the law. Using skills such asreflecting,
open-ended questions, and silence, the nurse can
support the client and family to explore their reactions tothe
situation, whether it is a first pregnancy or the death ofa child.
The nurse can practice critical thinking by teachingthe family
about treatment options and by helping them toshape questions to
ask the care provider. In situations suchas suspected child abuse,
the nurse will also know that thelaw requires a report to social
services.
ASSESSING
The data the nurse gathers in legal and ethical situations
willlikely relate to psychosocial factors. Does the
2-year-oldflinch when the mother suddenly turns toward her? Does
thefamily argue in the visitors lounge about treatment decisionsfor
their boy with leukemia? Has the teenager been yelling atthe staff
since he heard the diagnosis of cancer? The nursewould document
these findings in objective, nonjudgmentalterms. In situations that
have legal or ethical difficulties, theLPN/LVN would collaborate
with other members of thehealth care team to see that client needs
were met.
DIAGNOSING, PLANNING,AND IMPLEMENTING
Some common nursing diagnoses in legal and ethical
clientsituations are:
Deficient Knowledge related to [details, such as begin-ning
pregnancy]
Altered Family Processes related to [details, such as learn-ing
a child was born with cerebral palsy]
Anticipatory Grieving related to [details of terminally
illchild]
Accurate DocumentationWhen documenting, remember the following
guidelines:
Make documentations correct and accurate.Show the timing and the
sequence of actions. Identify the dose, route, and time of
medications. Indicate equipment or materials used.Use accepted
terminology and abbreviations.Label late entries and continued
notes on charts.Provide facts, not opinions.Note the following two
examples. The underlined portions ofExample 2 make the second
documentation much more accurateand measurable than the first.
Example 1(date) On admission ulcerated area noted on lower,
inneraspect of right leg. No apparent dressing. Moderate
amount of drainage observed. Foul odor noted. Pedalpulses
present but weak, foot slightly cyanotic with edema.Wound edges
red, surrounding skin hot. Charge nurse noti-fied. Wound cleansed,
dressing applied. Acetaminophen500 mg given PO per physicians
order. Teaching done.M. Penn, LVN
Example 2(date) 0830 On admission ulcerated area noted on
lower,inner aspect of right leg. No apparent dressing.
Moderateamount of thick yellow-green drainage observed. Foul
odornoted. Area 15 cm long, 6 cm wide, 1.5 cm deep. Pedal
pulsespresent but weak, foot slightly cyanotic with +2 edema.Wound
edges red, surrounding skin hot. States wound hasstinging pain.
Charge nurse notified. Wound cleansedwith sterile normal saline,
wet-to-dry dressing applied. Footplaced in dependent position, with
blanket for warmth.Acetaminophen 500 mg given PO per physicians
order.Teaching about wound contamination done. M. Penn, LVN
NURSING CARE CHECKLIST
Chapter 2 Legal and Ethical Issues in MaternalChild Nursing
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