Question

An infant is admitted with a volvulus and scheduled for surgery. The parents are Jehowah's Witnesses and refuse to sign the permit. Which action by the nurse is most appropriate? A. Obtain a court order. B. Call the doctor. C. Tell them that the surgery is optional. D. Monitor the situation.

Short answer

Answer: The most appropriate action for the nurse is to call the doctor (option B). This option ensures the infant's best interest while keeping the doctor informed and allowing them to guide further actions in resolving the situation.

Step-by-step solution

Understand each option

To choose the most appropriate action for the nurse, let's first understand each of the given options: A. Obtain a court order: This would involve legal intervention to override the parents' refusal and allow the surgery. B. Call the doctor: This would involve informing the doctor about the parents' refusal to sign the permit and seek their guidance. C. Tell them that the surgery is optional: This would involve trying to convince the parents by suggesting that the surgery isn't necessary. D. Monitor the situation: This would involve observing the infant's condition without taking any immediate action.

Analyze the situation

As the infant has a volvulus, which means a twisted intestine, it is a serious medical condition that requires urgent surgical intervention. Delaying the surgery could lead to life-threatening complications for the infant. Therefore, it is essential for the nurse to act in the best interest of the infant's health and safety.

Evaluate the options

A. Obtain a court order: While this option might lead to the surgery, it could take considerable time, and the infant's condition might worsen in the meantime. B. Call the doctor: This option enables the nurse to report the situation to the healthcare professional responsible for the infant's care. The doctor would be able to guide the nurse on the appropriate next steps, which might include discussing the issue further with the parents or contacting a hospital authority that could help with the situation. C. Tell them that the surgery is optional: This option is not accurate, as the surgery is, in fact, necessary for the infant's well-being. Providing false information to the parents is unethical and could have serious consequences. D. Monitor the situation: This option is passive and would not help in resolving the situation. The infant's condition might worsen while waiting, and it is not in his best interest.

Choose the most appropriate action

Based on the evaluation of the given options, the most appropriate action for the nurse is to #call the doctor (option B)#. This option ensures the infant's best interest while keeping the doctor informed and allowing them to guide further actions in resolving the situation.

Key concepts

Jehovah's Witnesses and medical decisions

When it comes to medical decisions, particularly involving life-saving treatments or surgeries, Jehovah's Witnesses may face significant ethical dilemmas due to their religious beliefs. Jehovah's Witnesses generally refuse blood transfusions because they interpret certain biblical passages as prohibiting the ingestion of blood. This belief can present challenges in healthcare situations that require blood transfusions, such as in cases of surgery or severe anemia.

Medical professionals must respect the religious convictions of Jehovah's Witnesses while also considering their ethical duty to save lives. In some cases, this means exploring alternative medical treatments that align with the patient's beliefs or seeking legal intervention if life-saving measures are refused. Understanding these dynamics is crucial for healthcare providers to navigate such ethically complex situations effectively.

• Respect patient autonomy while ensuring they understand the implications of medical decisions.
• Explore bloodless medicine options or use cell salvage techniques.
• In emergencies, life-saving actions may require ethical and legal considerations.

Informed consent in pediatrics

Informed consent is a foundational principle in healthcare which demands that patients or their guardians comprehend and agree to the proposed medical treatment. In pediatrics, this responsibility falls to the parents or legal guardians, as children cannot legally make their own medical decisions. However, the complexity intensifies when parents' decisions conflict with medical advice, especially if refusing treatment that a healthcare provider considers necessary for the child's welfare.

The nurse's role is to ensure that parents are fully informed about the infant's condition and the consequences of not proceeding with the necessary medical intervention. This includes ensuring that parents understand the seriousness of the medical issue and the benefits and risks of the suggested procedure or surgery. Effective communication and empathy can foster a trusting relationship, enabling the healthcare team to discuss alternative treatments that might be acceptable to the parents.

• Ensure all information is provided in a clear, understandable manner.
• Support parents in understanding the urgency of specific medical interventions.
• Engage the healthcare team in discussions to explore acceptable alternatives.

Emergency surgical interventions

Emergency surgical interventions are critical procedures performed to address life-threatening medical conditions that require immediate attention. In the case of volvulus, which involves a twisted intestine, delaying surgery can result in severe complications, such as bowel necrosis or sepsis, necessitating urgent medical action to save the infant's life.

In emergency situations, the standard protocols for informed consent might be bypassed if the delay could jeopardize the patient's health. In such circumstances, healthcare professionals have a moral and ethical obligation to act swiftly to preserve life. However, respecting the parents' rights and seeking their permission, unless absolutely impossible, remains a priority. Nurses play a vital role in coordinating these efforts by maintaining communication between the medical team and the family.

• Recognize signs that necessitate immediate surgical action.
• Facilitate swift decision-making processes in crisis situations.
• Understand legal and ethical frameworks guiding emergency care.