PEDIATRIC VARIATIONS OF NURSING INTERVENTIONS

Question 1

Informed Consent

Answer 1

• Given by the child’s parent or guardian allowing an invasive procedure or participation in research
• *Obtained by the Physician

Question 2

Nurses Role in Informed Consent:

Answer 2

• Verifies that informed consent has been obtained prior to any procedure or research participation
• Alerts physician’s to the need for informed consent
• Serves as a witness
• Responds to questions asked by parents and children

Question 3

Implications for pediatric patient:

Answer 3

• Both children and parents must understand that they have the right to refuse treatment at any time
• *In an emergency to preserve life or limb (& eye) consent is not required
• *Proxy consent can be given in writing by the parent to an adult such as a caregiver, family member

Question 4

Consent: Joint Custody

Answer 4

In most cases either parent may give informed consent. If parents disagree the parent seeking treatment needs a court order.

Question 5

Consent: Sole Custody

Answer 5

The parent with sole legal custody is able to give informed consent

Question 6

Child’s Participation in Healthcare Decisions

Answer 6

Children under the age of 18 are considered minor children but can legally give consent when:
- They are minor parents of the child patient
- They are married or have been married
- They are emancipated minors as declared by the court
- They are older than 15 years old and self sufficient, not living at home
- They are members of the armed forces
- They are seeking birth control, prenatal care, STD Care, mental health counseling and substance abuse treatment

Question 7

circumstances in which the parent does not have absolute authority:

Answer 7

• When the child and parents do not agree on major treatment options- (pt must be deemed developmentally mature enough by the court)
• When the parents’ choice of treatment does not permit lifesaving treatment for the child
• When there is a potential conflict of interest between the child and parents such as child abuse or neglect- state makes decisions

Question 8

When child & parents disagree:

Answer 8

• First Step: Negotiation and compromise
• Medical Consultation to identify other treatment options
• The hospital Ethics Committee usually becomes involved
• The court can appoint a proxy decision maker for the child to determine if the child is capable of making major treatment decisions

Question 9

Stressors of Hospitalization:
On Parents

Answer 9

• Disrupts usual routines
• Changes in who is at home with siblings
• Changes in who is working
• May be anxious or fearful
• Severity of illness
• Watching child suffer pain

Question 10

Stressors of Hospitalization:
On Child

Answer 10

• Disrupts usual routine
• Disrupts development
• Causes fear and anxiety

Question 11

Purposes of Play:

Answer 11

• Facilitates normal development
  Helps child:
• Learn about health care
• Express anxieties
• Work through feelings
• Achieve control

Question 12

Parental Presence During Procedures:

Answer 12

• Most parents want to be present
• Determine extent to which parents want to be involved
• Maintain parent-child trust
• Respect their wishes