Clinical holding: ethical guidance for children's nurses working in the UK

This article explores ethical decision-making surrounding clinical holding of children and young people in healthcare environments with the aim of enhancing autonomy and engagement on their behalf. A considerable body of evidence, published over the last 20 years, suggests that this complex and challenging area of practice is not always well managed, with mixed messages about the nature of consent, choice and negotiated practice countered by best interests decisions taking precedence ahead of the child's wishes. An ethical framework is proposed comprising four levels of value-based interventions and how they may be applied in clinical practice, allowing for increased engagement, empowerment and support on behalf of children and young people in relation to clinical holding decisions.

Decision Making in Paediatric Care: an overview with reference to nursing care

The purpose of this overview of published articles on decision making in paediatric care was to identify important aspects of its possible use in clinical practice and to obtain a base for future research. A literature review was undertaken utilizing snowball sampling to identify articles because of the diversity present within the area of decision making in paediatric care. The databases PubMed and CINAHL were used. The search was limited to articles published in English during the period 1994-2004. The analysis entailed a series of comparisons across articles, focusing on major areas of enquiry and patterns of results. Various levels of decision making are described because these seem to form a basis for how decisions are made. Concepts found to be of importance for decision making are described under the following headings: competence, the child’s best interests, knowledge, values and attitudes, roles and partnership, power, and economy. Further research is suggested.

Care of the child with the desire to change gender--Part I

This article is the first in a three-part series describing the nursing and medical care of a child wishing to change genders. Part I will depict the psychological and hormonal treatment for children who express a desire to change genders. Part II will describe surgical treatments and nursing care for gender reassignment from female to male. Part III will present the surgical needs of transition from male to female.

Traditional, alternative and innovative approaches to health promotion for children and young people

This article considers the health promotion role of children's nurses and its relevance to children and young people. Definitions are presented and it is shown how traditional, alternative and innovative approaches may be applied in practice. Ethical issues are also explored. It is concluded that health promotion is an integral part of children's nursing and has the potential to enhance quality of life and longevity for children and young people.

Caring for dying children: assessing the needs of the pediatric palliative care nurse

Pediatric palliative nursing care, both stressful and rewarding, requires coping skills, confidence, and other attributes for successful patient care and nursing practice. Through a thorough literature review, clinical workshops, direct observations in pediatric palliative care settings, and personal nursing experience in the neonatal intensive care, pediatric intensive care, and oncology wards, this author confirmed the necessity for studies to clarify the needs of dying pediatric patients and their families, as well as the needs of nurses who provide their care. This article briefly reviews the history and current status of pediatric palliative care, describes the experiences of nurses caring for dying children, explores the impact of providing palliative care on the hospital staff, and seeks to discover possible interventions by the advanced practice nurse to influence more positive patient care and nursing staff job satisfaction and retention.

Medicine vs. prayer: the case of Kara Neumann

Religious beliefs and the use of complementary and alternative medicine can help or hinder health care and the well being of children, who are often unable to make informed decisions for themselves, but instead, depend on their parents or caregivers to make health care decisions for them. Tragically, this can sometimes result in prolonged suffering and death when parents or caregivers refuse treatment due to their own personal beliefs. This two-part article explores the case of Kara Neumann, an 11-year-old girl who died after her parents denied her medical care in lieu of prayer to cure her "spiritual attack," and the role pediatric nurses can play in educating patients and their families.

Issues related to children participating in clinical research

Research involving children is necessary to bridge the gap created by years of applying the findings of adult clinical trials to children. Given the mandate from the National Institutes of Health to include children in clinical trials, pediatric nurses will undoubtedly be asked to assist with pediatric research projects. Nurses working with children must consider the unique legal and ethical issues surrounding children as study participants. The purpose of this article is to examine issues related to children participating in clinical research. A review of pertinent literature is summarized, and practical approaches to the recommendations are discussed.

Politically-motivated torture and child survivors

It is critical that healthcare providers recognize behaviors common to children who have endured politically-motivated torture in order to create a safe and reliable treatment plan for such children and their families. Three vignettes taken from actual cases illustrate the way child survivors of torture are likely to present in educational, medical, or healthcare settings. Children or youth are resilient and can be helped to process their traumatic experiences and thrive emotionally and physically if providers are observant, competent and responsive. Federally funded resource centers exist to assist in caring for children who have survived torture.

Pediatric Nursing in the Context of the HIV/AIDS Epidemic in Resource-poor Settings—Balancing the “Art and the Science”

Pediatric wards in South Africa are largely occupied by children with AIDS-related illnesses. This study uses qualitative inquiry involving focus groups with nurses into the needs of children, caregivers, and healthcare providers. The findings indicate changes to the nature of nursing practice, knowledge of nursing, and ethics of nursing care.

Ethics in pediatric end-of-life care: a nursing perspective

Care of children at the end of life frequently involves ethical dilemmas and difficult decisions. These ethical dilemmas often complicate the already challenging circumstances surrounding the death of a child; therefore, the knowledge and application of ethical principles becomes an essential component of nursing practice. The purpose of this article is to describe bioethical principles and common ethical dilemmas faced by nurses in pediatric end-of-life care and suggest nursing interventions to promote a peaceful end-of-life experience for the child and family.

Children's student nurses' knowledge of spirituality and its implications for educational practice

Children's nurse educators have to rely predominantly on adult-based literature to guide their educational practice concerning spirituality in the nursing curriculum. The aim of this study was to get a children's nursing perspective. A questionnaire was designed around the main themes emerging from the adult literature on spirituality. This was distributed to children's nurses on the undergraduate curriculum at a UK university. The results showed that some of the challenges of delivering spirituality are common to both adult and children's nursing. However, there were also significant differences revolving around the impact that children and families had in informing students' understanding of spirituality, and the problems of seeking a unified theory of spirituality in a children's nursing context. It concludes that children's nursing has important lessons to learn from the adult literature; however, it must strive to construct its own insights and use this understanding to inform educational approaches to the topic.

Interpreter services in pediatric nursing

A critical part of every encounter between a pediatric nurse and a patient is obtaining accurate patient information. Unique obstacles are encountered when patients and their families have little or no understanding of the English language. Federal and state laws require health care systems that receive governmental funds to provide full language access to services. Both legal and ethical issues can arise when caring for non-English-speaking patients. Often, obtaining accurate patient information and a fully informed consent cannot be done without the use of an interpreter. The interpreter informs the family of all the risks and benefits of a specific avenue of care. When inappropriate interpreter services are used, such as when children in the family or other family members act as interpreters, concerns about accuracy, confidentiality, cultural congruency, and other issues may arise. The purpose of this article is to: (a) explore principles related to the use of medical interpreters, (b) examine different models of interpreter services, and (c) identify available resources to assist providers in accessing interpreter services (e.g., books, online resources, articles, and videos). The case study format will be used to illustrate key points.

Privacy: what does it mean for children's nurses?

Children and young people have a right to privacy and respect. However, conflict can arise, particularly in relation to family life, which cannot be side-stepped by nurses. This article gives an overview of the legal and ethical rights of children and young people.

Parents' refusal of medical treatment for cultural or religious beliefs: an ethnographic study of health care professionals' experiences

Pediatric nurses working in acute care settings serving religious and culturally diverse families may encounter parents whose beliefs influence treatment decisions. Previous literature describes how these complex situations lead to emotional distress and strained relationships between health care provider and family members. An ethnographic study was conducted to investigate the impact of parental treatment refusal on the bedside interactions between pediatric nurses and parents. Twenty in-depth interviews with nurses were conducted, and extensive field notes were taken during data collection. Emotional feelings associated with possible loss of guardianship and subsequent mandated treatment, the impact of the situation on the nurses' health and stress levels, and functional status were all explored. Three themes were identified following interpretive narrative analysis of transcriptions and field notes: weathering the storm of moral conflict, closeness and involvement versus distance and retreat, and battles between the supportive and oppositional groups. The findings of the study lead to a deeper understanding of the complexities of the ethical dilemma surrounding treatment refusal in pediatrics.

The meaning of being in ethically difficult care situations in paediatric care as narrated by female Registered Nurses

Studies among physicians and nurses in paediatric care reveal experiences of loneliness and lack of open dialogue. The aim of this study was to illuminate the meaning of female Registered Nurses' lived experience of being in ethically difficult care situations in paediatric care. Twenty female Registered Nurses who had experienced being in ethically difficult care situations in paediatric care were interviewed as part of a comprehensive investigation into the narratives of male and female nurses and physicians about being in such situations. The transcribed interview texts were subjected to phenomenological-hermeneutic interpretation. The results showed that nurses appreciated social confirmation from their colleagues, patients and parents very much. This was a conditioned confirmation that was given when they performed the tasks expected from them. The nurses, however, felt that something was missing. They missed self-confirmation from their conscience. This gave them an identity problem. They were regarded as good care providers but at the same time, their conscience reminded them of not taking care of all the 'uninteresting' patients. This may be understood as ethics of memory where their conscience 'set them a test'. The emotional pain nurses felt was about remembering the children they overlooked, about bad conscience and lack of self-confirmation. Nurses felt lonely because of the lack of open dialogue about ethically difficulties, for example, between colleagues and about their feeling that the wrong things were prioritized in the clinics. In this study, problems arose when nurses complied with the unspoken rules and routines without discussing the ethical challenges in their caring culture. The rules and the routines of the caring culture represented structural barriers for creating open dialogue and an ethically justifiable practice, called inauthentic existence, blindness related to our own inauthentic understanding, which focuses on the routines, rules, theories and systems.

Ethics and children's rights: learning from past mistakes

The primary aim of this article is to examine, within the context of recent controversial child health practice and research, the underlying philosophy of the aspect of the Nursing and Midwifery Council's Code of Professional Conduct which states that: 'You are personally accountable for ensuring that you promote and protect the interests and dignity of patients and clients, irrespective of gender, age, race, ability, sexuality, economic status, lifestyle, culture and religious or political belief.' A description of the Nuremberg Code, the Helsinki Declaration, the United Nations Convention on the Rights of the Child, and the Human Rights Act 1998 will form the backdrop to this article and a range of contemporary examples will be used to illuminate the ethical dilemmas facing children's nurses in their day-to-day work. Within this context the four major principles that underpin healthcare this will be investigated and the legacy of historical unethical practice and research acknowledged. The vulnerability of children and their families to potential coercion, and the role of local research ethics committees, will be discussed.