Professional Practice, Ethics, and Advocacy
Family-centered care is the frame
Care is planned around the family as the constant, with the child's developmental needs respected and the family's culture, language, and values incorporated. Atraumatic care, meaning minimize separation, minimize pain, and minimize disruption, guides every procedure. Use qualified interpreters, never siblings.
Consent, assent, and confidentiality
Consent generally comes from a parent or legal guardian; children about 7 and older should give assent and receive an explanation in their own terms. Know your state's rules for emancipated and mature minors and for sensitive services such as reproductive and mental health care. Confidentiality for adolescents has limits: danger to self or others and suspected abuse or neglect always override it.
Ethics and advocacy
Apply autonomy, beneficence, nonmaleficence, justice, veracity, and fidelity to concrete scenarios. Mandatory reporting of suspected child abuse or neglect is a legal duty; it requires reasonable suspicion, not proof, and does not require parental permission. Advocacy includes screening for food insecurity, housing instability, and transportation barriers and connecting families to resources.
Traps
Distractors suggest the nurse may obtain informed consent alone, may promise absolute confidentiality to a 15-year-old, or may delegate assessment and teaching to unlicensed assistive personnel, which is not permitted. Another trap: deciding to investigate suspected abuse personally before reporting.
Worked example
A 15-year-old asks that an STI testing visit not be shared with parents. Check state law and clinic policy; where minors may consent to STI care, provide confidential care, explain the limits of confidentiality before testing, and encourage but do not coerce parental involvement.
Rule of thumb
When ethics and law appear to conflict, follow the law, document objectively, and escalate through the chain of command.