Professional Caring and Ethical Practice
Professional Caring and Ethical Practice
These items test whether you can act as the child's advocate inside a family-centered system. Know the principles - autonomy, beneficence, nonmaleficence, justice, veracity, fidelity - and apply them through pediatric lenses: the parent or legal guardian gives informed permission, while the child gives developmentally appropriate assent. Emancipated and mature minors may consent under state law. The nurse does not obtain consent; the nurse verifies it is informed, witnesses, and clarifies. Confidentiality for adolescents is conditional - safety overrides secrecy.
Know your scope. Teaching, evaluation, and care of unstable patients cannot be delegated; routine tasks for stable patients can, with clear supervision. Know the chain of command and use it early rather than documenting a concern and waiting.
Traps: silently complying with a parental refusal that risks serious harm (the correct move is explore concerns, involve the ethics committee or chaplain, escalate, and follow law - not override or ignore); assuming a stepparent or grandparent may consent without legal authority; treating cultural difference as noncompliance; and confusing moral distress with incompetence.
Worked example. Parents refuse a transfusion for a symptomatic, severely anemic child on religious grounds. The nurse's role is to elicit their reasoning, ensure the refusal is informed and documented, mobilize ethics and the care team, and escalate through the chain of command if harm is imminent, while continuing supportive care. A court may authorize treatment; the bedside nurse does not decide unilaterally.
Rule of thumb: ask whose decision is this, is it informed, and is someone being harmed? Your tools are advocacy and escalation.