A Nagging Uneasiness
You are a nurse on a pediatric unit. One of your patients is a 15-month-old girl with a diagnosis of failure to thrive. The mother says that the child is emotional, cries a lot, and does not like to be held. You have been taking care of the infant for 2 days since her admission, and she has smiled and laughed and held out her arms to everyone. She has eaten well. There is something about the child’s reaction to the mother’s boyfriend that bothers you. The child appears to draw away from him when he visits. The mother is very young and seems to be rather immature but appears to care for the child. This is the second hospital admission for this child. Although you were not on duty for the fi rst admission 6 weeks ago, you check the records and see that the child was admitted with the same diagnosis. While you are on duty today, the child’s father calls and inquires about her condition. He lives several hundred miles away and requests that the child be hospitalized until the weekend (it is Wednesday) so that he can “check things out.” He tells you that he believes the child is mistreated. He says he also is concerned about his ex-wife’s 4-year-old child from another marriage and is attempting to gain custody of that child in addition to his own child. From what little the father said, you are aware that the divorce was bitter and that the mother has full custody. You talk with the physician at length. He says that after the last hospitalization, he requested that the community health agency and Child Protective Services call on the family. Their subsequent report to him was that the 4-year-old child appeared happy and well and that the 15-month-old child appeared clean, although underweight. There was no evidence to suggest child abuse. However, the community health agency plans to continue following the children. He says that the mother has been good about keeping doctor appointments and has kept the children’s immunizations up to date. The pediatrician proceeds to write an order for discharge. He says that although he also feels somewhat uneasy, continued hospitalization is not justified, and the state medical aid will not pay for additional days. When the mother and her boyfriend come to take the baby home, the baby clings to you and refuses to go to the boyfriend. She also seems reluctant to go to the mother. All during the discharge, you are extremely uneasy. When you see the car drive away, you feel very sad. After returning to the unit, you talk with your supervisor, who listens carefully and questions you at length. Finally, she says, “It seems as if you have nothing concrete on which to act and are only experiencing feelings. I think you would be risking a lot of trouble for yourself and the hospital if you acted rashly at this time. Accusing people with no evidence and making them go through a traumatic experience is something I would hesitate to do.” You leave the supervisor’s offi ce still troubled. She did not tell you that you must do nothing, but you believe that she would disapprove of further action on your part. The doctor also felt strongly that there was no reason to do more than was already being done. The child will be followed by community health nurses. Perhaps the ex-husband was just trying to make trouble for his ex-wife and her new boyfriend. You would certainly not want anyone to have reported you or created problems regarding your own children. You remember how often your 5-year-old bruised himself when he was that age. He often looked like an abused child. You go about your duties and try to shake off your feeling. What should you do?
1. Solve the case in small groups by using the traditional problem-solving process. Identify the problem and several alternative solutions to solve this ethical dilemma. What should you do and why? What are the risks? How does your value system play a part in your decision? Justify your solution. After completing this assignment, solve Part 2.
2. Assume that this was a real case. Twenty-four hours after the child’s discharge, she is readmitted with critical head trauma. Police reports indicate that the child suffered multiple skull fractures after being thrown up against the wall by her mother’s boyfriend. The child is not expected to live. Does knowing the outcome change how you would have solved the case? Does the outcome infl uence how you feel about the quality of your group’s problem solving?