Purpose of Assignment

 

The purpose of the assignment is to provide the student with an opportunity to analyze an ethical issue experienced during the student’s time in their Role Transition clinical practice. The ethical dilemma will be analyzed using several steps of the nursing process to make a decision and support the decision with ethical principles and provisions from the American Nurses Association (ANA) Code of Ethics for Nurses. When nurses are faced with having too few resources to support the needs of their patients in the emergency department, I argue that the military triage model needs to be used to determine the eligibility of each patient for access to these resources.

 

Student Approach to Assignment

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During my time in my senior year Role Transition, I saw the ethical dilemma of too few resources available to the mental health patients that entered the hospital seeking care. Decisions surrounding the allocation of resources pertains to all medical units and resources within a hospital, including in the Emergency Department (ED). Traditionally, patients are admitted based on a first come, first served basis; the issue with this criteria is that patients with minimal need for those resources will sometimes take a bed ahead of someone else whose need for the services rendered is greater.

 

Reason for Inclusion of this Assignment

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This assignment deserved to be included in my portfolio because it showcased my ability to research and develop solutions to ethical issues presented in our local community. Furthermore, there is vast need for greater access to treatment for mental health concerns for local pediatric patients. This essay and reflection encourages nurses and other medical health professionals to work together to creatively brainstorm solutions and to create partnerships that can serve the local community.

 

Teaching

• Uses information technologies and other appropriate methods to communicate health promotion, risk reduction, and disease prevention across the lifespan

  • In the Hampton Roads area, there are very few facilities that provide long term care for pediatric patients suffering from mental health issues. It has been communicated that the risk reduction for this population is a necessary step for disease prevention in our area because the state government has approved the construction of this facility. By recognizing the need for greater resources for these patients, we have the opportunity to creatively craft different and new interventions that could help these patients and their families as we wait for a new 48-bed facility to be built in 2022. While waiting for this new facility to be built, one option would be to reroute or transfer mental health patients to different hospitals. Since the children’s hospital is the only one in the local area, all pediatric patients are sent to this same facility. Additionally, local in-patient psychiatric centers focus on adult treatment and rarely admit pediatric patients younger than 17. An alternative would be for the hospital to refer these mental health patients to outside primary care physicians or child psychologists in the area. Another solution could be to have a separate waiting room area for mental health concerns. From that point, social workers, mental health professionals, and nurses would be able to pull a patient and her family individually to ask more detailed questions.

 

Professionalism

• Understands the effect of legal and regulatory processes on nursing practice and health care delivery, as well as limits to one’s own scope of practice

  • During one Role Transition shift, all the safed rooms were occupied by mental health (MH) patients, but there was still a mother and her adolescent child with SI in the waiting room; the wait for a safed room was over 6 hours. Mother and child were updated on the availability of the upcoming rooms, but at hour 3 of the wait time, mom asked if they should return tomorrow; they were told that it was mom’s decision whether or not to take her daughter home. The resources available in the ED were limited as the needs of many other MH patients were being addressed in those safed rooms. The nurses and charge nurse tried to get them brought back in order to receive treatment, but frustratingly, having the patient and her mother continue to wait was the only option.  It was difficult for me to recognize the extent of our scope of practice in this scenario. All of the nurses and other medical professionals desperately wanted to help this adolescent but we simply did not have enough resources to provide care at that time. For these reasons, it is both impressive and a relief that healthcare professionals in the area already advocated for a larger facility for pediatric mental health patients. However, we must continue to creatively brainstorm more ways to provide support for these patients.

• Applies an ethical decision-making framework and legal guidelines to clinical situations that incorporate moral concepts, professional ethics, and advocacy for patient well-being and preferences

  • Although we did advocate for the patient in this scenario by trying to move other patients around so that a room could be freed up for her, we were unable to provide the patient and the patient’s mother with resources that could aid the patient at that time. According to the American Nurses Association (ANA), nurses are to, “collaborate to address barriers to health... such as a lack of access [to resources] by engaging in open discussion, education, public debate and legislative action (2015, p.43). Having recognized this need for more pediatric MH beds, Virginia has granted the funds to build a 48-bed inpatient facility for mental health concerns to be completed by the year 2022. In order to provide help to this patient and her mother, we needed greater access to alternative resources for these patients. While waiting for the new facility to be built, healthcare providers at the local hospital should enlist the help of on-call child-life specialists, therapists, and psychiatrists to supplement the limited resources in the ED, especially overnight. Unfortunately, the mother and her adolescent child in this scenario had very limited options. Having arrived in the ED after 7:00pm, there were no offices or professionals who could have provided treatment for her daughter because all offices were closed.  Although it would take some careful planning, the implementation of another triage process for mental health patients within the ED is plausible. HIPAA protocols would obviously need to be observed, but not all patients who claim SI or HI require an intensive examination by a specialist in the ED. Instead, these patients who are not in immediate danger of harming themselves should be referred to an outside facility.

 

Culture

• Considers the impact of research outcomes and the effects of health and social policies on persons from diverse backgrounds

  • Because the community recognized the need for more resources dedicated to this issue, ground will soon be broken on the 48-bed facility to aid the  local population. It is important to also evaluate the role that social determinants of health play in this issue. If there is a social determinant of health that would bar the patient or the family from receiving treatment for the mental health concern, then the hospital should champion an effort to provide access to these resources through alternative channels other than the ED. Furthermore, there are many programs and students of mental health and social work in the area. If partnerships could be formed with local universities and some preliminary steps of crisis intervention could be facilitated by students as part of their clinical hours, then the cost of providing these interventions could be curtailed. Similar to how medical residents are employed by a teaching hospital and overseen by an attending doctor, the same structure could be implemented for psychology and social work students to increase access to mental health services within the ED, especially overnight. With this wide array of resources, I argue that our social policies can be adapted to service persons from diverse backgrounds.