A Clinical Scenario: Terri’s Dilemma?
The lift doors opened and Terri gets out. Terri is a new graduate RN and she is running late for a shift at the start of her second week of her new graduate program. Leaving the lift are two night nurses on their way home from their shift. As they pass Terri, she over hears them discussing a patient.
“She should be made to take the drugs,” one of the night nurses said. “Yes,” agreed the second. “That mother is condemning Bethany to a death sentence.” The lift doors close behind Terri and she is soon on the ward.
The shift coordinator reminds Terri about the importance of being on time to start her shift, but adds that she is lucky, as the night staff had left their handover information on a tape for her to listen to. Terri listened to the handover tape and discovered that she would be working with the shift coordinator as they are short staffed. She and the shift coordinator have six patients to care for in their patient load.
One, an eleven year old, called Bethany and Terri wondered if this was the same child she had heard the two night nurses discussing in the lift. The tape covered much of the essential care for all six patients, but additional information had been handed over verbally that Terri had missed. The coordinator (Lisa) failed to pass on the additional information. Primarily, it related to Bethany’s mother’s religious beliefs and a discrete move by the medical team to make Bethany a “ward of the state.”
Terri decided to check on the welfare of all six patients. Eventually, she met Bethany an 11 year old child, newly diagnosed with Acute Lymphocytic Leukaemia (ALL) and she had recently developed a serious chest infection. To Terri’s surprise Bethany was not receiving any medications and had no IV line. She also found Bethany in her mother’s arms as she sat in a chair at the bed side being gently rocked. Terri noticed that on Bethany’s medication chart she was written up for IV antibiotics.
“Has Bethany had these medications yet?” Terri asked Bethany’s mother.
“Oh no, our religious beliefs don’t agree with the administration of drugs of any kind and I have not allowed it,” Bethanie’s mother replied politely.
Terri thought Bethany looked flushed.
“Can I take her temperature?” Terri asked. It was 38.9 degrees.
“Can I give her some paracetamol for her high temperature?” Terri asked.
“No,” said Bethany’s mother, “as I explained, in our religion the use of medications of any kind is forbidden.” Terri asked if Bethany’s mother would sponge Bethany with a cool sponge cloth. Her mother agreed and took the cloth.
Terri wasn’t sure what else to do about the pyrexia and spoke to the doctor at the nurses’ station about the situation. The doctor explained that they were quite concerned about Bethany, but that as a new registered nurse Terri would not understand their responsibilities as doctors and that the medical team were aware of the situation and had sought a court order to force the mother to release Bethany to the care of the hospital and ban the mother and close family from contact with Bethany while they aggressively treated the chest infection and underlying ALL. The doctor said, “we have tried to reason with the mother and now we have no choice but to secretly plan to treat the child without the mother’s consent.”
Shortly after, Lisa took Terri aside and suggested that when Bethany’s mother went to the toilet she should give Bethany some paracetamol for her high temperature. Terri refused. The doctor, who was nearby, suggested that Terri hide the paracetamol solution in some ice cream and give this to Bethany. Again, Terri refused. Bethany’s mother suspected the staff were planning to tamper with the ice cream and refused to allow Bethany to take it, even though it had not been tampered with.
Hoping to help reassure Bethany’s mother Terri spoke with her about the situation. During the conversation Terri disclosed the medical team’s plans to gain legal custody of Bethany. Shortly after the conversation Bethany and her mother left the hospital, suspending the medical treatment for either the chest infection or underlying ALL.
Lisa questioned Terri about her conversation with Bethany’s mother at the end of the shift. When Terri mentioned her conversation with Bethany’s mother Lisa became very angry with Terri and at one point said, “you have helped kill this child.” Terri left the shift at the start of her second week as an RN in tears.
Read the scenario a few times.
Reflect on what is happening in the scenario.
This assignment requires you to write a report about ethical and medico legal issues, clinical decision making, scope of practice and professional nursing standards, teamwork and interdisciplinary practice issues from the perspective of a newly graduated Registered Nurse and leadership roles.
You will need to follow the report writing guide offered.
The content of your report should contain information extracted from scholarly journals and books (i.e. do not rely on Moodle learning notes, newspaper articles, or your personal experience).
Please use appropriate in-text and end-text referencing from an appropriate scholarly source and APA version 6.
In your report make sure you address the following:
Your report should address the following specific issues:
1. Outline the specific events of this scenario in relation to the following topics from the perspective of a newly graduated Registered Nurse
ethical and medico legal issues,
clinical decision making,
scope of practice and professional nursing standards
teamwork and interdisciplinary practice issues
2. Use relevant national / policy documentation to support your decision.
3. Discuss the key roles and responsibilities of a newly graduated Registered Nurse in relation to this scenario, specifically consider
4. make recommendations for what should have occurred in this situation (e.g. did Terri act according to national standards for the Registered Nurse)