NR 501 Week 2 Reflective Essay

Student Name

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 both a science and an art, particularly when addressing ethical dilemmas. One of the most challenging aspects of healthcare is making ethical decisions regarding truth-telling, especially when dealing with pediatric patients and their families. The complexity of this issue increases when a serious medical diagnosis is involved, as seen in the case of a 15-year-old girl diagnosed with a malignant brain tumor. This situation raises critical ethical questions about whether the patient or the parents have the right to know the full extent of the condition and how best to manage the psychological and emotional impact of disclosing such information.

The Challenge of Truth-Telling in Pediatric Care

In this case, the adolescent patient was admitted to the pediatric ward with complaints of severe headaches and menstrual irregularities. A subsequent brain CT scan confirmed the presence of a malignant brain tumor. The healthcare team, including neuro-oncology specialists, faced the ethical challenge of disclosing the diagnosis. However, the parents requested that their daughter not be informed of the severity of her condition. While the patient was aware of being unwell, she did not fully comprehend the gravity of her illness. This scenario presents a significant ethical dilemma: Should the patient be informed of her diagnosis, or should the parents’ wishes to withhold the truth be honored?

Parental Rights and Patient Autonomy

This ethical conflict highlights the tension between parental authority and the patient’s right to know about her condition. In pediatric healthcare, parents or legal guardians typically have the authority to make medical decisions on behalf of their minor children. This authority includes determining what medical information should be disclosed. The parents in this case believed that withholding the full truth would protect their daughter from emotional distress.

However, despite being a minor, the patient had a right to autonomy, particularly as she began experiencing worsening symptoms such as hair loss and fatigue. These changes led her to suspect that her condition was serious, creating confusion and emotional distress. As a nurse, I faced the moral challenge of respecting the parents’ wishes while also considering the ethical implications of withholding critical health information from the patient. Would disclosing the truth empower her to make informed decisions, or would it cause her undue emotional harm?

Ethical Decision-Making and Moral Distress

Deciding whether to disclose a severe diagnosis to a minor often causes moral and ethical distress for nurses. Nurses are responsible for advocating for their patients’ well-being while also respecting the family’s role in decision-making. In this case, the decision-making power rested primarily with the parents, who aimed to protect their daughter’s mental and emotional well-being.

Research suggests that withholding information may reduce immediate psychological distress but can lead to long-term issues, including a loss of trust in healthcare providers (Chaudhury et al., 2016). Non-disclosure may also prevent patients from fully participating in their treatment decisions. This ethical dilemma forced me to reflect on the reality that doing what is ethically “right” does not always align with what may be considered the best decision for the patient’s overall well-being.

The Role of Nurses in Ethical Decision-Making

Nurses play a crucial role in advocating for patient welfare but do not always have the final authority in ethical decisions related to truth-telling. In this case, the nurse’s primary role was to provide emotional support and facilitate communication among the patient, her family, and the healthcare team. Institutional policies and ethical guidelines often dictate the extent to which nurses can disclose sensitive medical information (Emo, Bankas, & Espedido, 2010).

In pediatric care, the family-centered care model emphasizes involving family members in decision-making. This approach ensures that the emotional and psychological needs of the child are met while addressing the parents’ concerns. Family involvement in truth-telling decisions can help alleviate the ethical distress experienced by healthcare professionals.

Balancing Truth-Telling with Emotional Well-Being

Truth-telling in pediatric care requires sensitivity, particularly in cases of severe or terminal illnesses. While honesty is essential, the manner and timing of disclosure significantly impact the patient’s emotional response. Research indicates that providing information in a supportive environment, with family presence, can help reduce the psychological burden on the patient (McElvaney, 2014). In this case, withholding full disclosure may have been the most compassionate approach, considering the patient’s age and medical condition.

To navigate such ethical dilemmas, nurses must balance honesty with the emotional well-being of the patient. Ethical principles, clinical judgment, and evidence-based practices should guide decision-making. The ultimate goal is to uphold the patient’s best interests while also considering the psychological impact on the family.

Conclusion

Truth-telling in pediatric nursing presents complex ethical challenges. The rights of the patient, the wishes of the family, and the potential psychological consequences of disclosure must all be carefully considered. Nurses must approach these dilemmas with compassion and professionalism, guided by ethical principles and empirical evidence. In this case, honoring the parents’ request to withhold the full truth may have been necessary to protect the patient’s emotional well-being, despite the ethical distress it caused. Ultimately, involving the family in decision-making ensures that the patient’s needs are met with empathy and understanding.

Table: Ethical Considerations in Truth-Telling and Decision-Making in Pediatric Nursing

Ethical Issue	Description	Implications for Nursing Practice
Truth-Telling in Pediatric Care	The ethical dilemma of whether to disclose a serious diagnosis to a minor patient.	Requires balancing honesty with the emotional well-being of the child.
Parental Rights vs. Patient Autonomy	Parents have legal authority over medical decisions, but minors also have a right to know about their health.	Nurses must navigate ethical conflicts between parental authority and patient rights.
Ethical Decision-Making and Distress	Nurses experience moral distress when truth-telling conflicts with family wishes.	Nurses should advocate for patient-centered care while respecting family-centered approaches.
Family-Centered Care	Involves parents in medical decisions to ensure emotional and psychological support for the child.	Encourages shared decision-making to reduce ethical tensions.
Long-Term Impact of Non-Disclosure	Withholding the truth may protect the child initially but can lead to distrust and lack of informed decision-making.	Nurses must consider both short-term and long-term effects of disclosure.

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. https://doi.org/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(3).