Casebaby Girl M. Is A 34-Week Gestation Infant Who Is Admitt

Casebaby Girl M. is A 34 Week Gestation Infant Who Is Admitted To Th

Case: Baby Girl M. is a 34-week gestation infant, who is admitted to the NICU for low blood sugar and difficulty breathing. Upon admission of the infant, the RN is informed that the mother refuses newborn screening. The mother is also refusing vitamin K and ophthalmologic prophylaxis. Questions: What is the nurse’s responsibility as this patient’s nurse as it pertains to the newborn screen? Under what circumstances is it appropriate for the mother to decline the newborn screen? How should the nurse communicate his or her nursing interventions to others when a patient’s mother declines the newborn screen? If the mother in this scenario changes her mind, when should the newborn screen be obtained and what is the method for obtaining the newborn screen? What are your feelings on this topic? Would it be difficult for you to respond to a parent who refuses the newborn screen? Why/why not?

Paper For Above instruction

Newborn screening is a critical public health initiative designed to identify infants at risk for certain genetic, metabolic, hormonal, and functional disorders that are not clinically apparent at birth but can lead to severe health problems if left untreated. As a nurse caring for a neonatal intensive care unit (NICU) patient, understanding the responsibilities related to newborn screening and the ethical considerations surrounding parental refusal is essential for providing comprehensive and ethically sound care.

The Nurse’s Responsibility Regarding the Newborn Screen

The primary responsibility of the nurse in the context of newborn screening is to ensure that parents are fully informed about the purpose, procedure, benefits, and potential consequences of the screening. The nurse must provide clear, unbiased information, respecting parental autonomy while emphasizing the importance of early detection of treatable conditions. In cases where parents decline screening, the nurse is ethically obligated to document the refusal accurately and to advocate for the infant’s health by informing the healthcare team of the parents' decision. The nurse's role also includes counseling and answering questions to help parents make informed decisions, ensuring they understand the potential risks of refusal and the impact on their child's health (Kenner & Lewis, 2013).

When Is It Appropriate for Parents to Decline the Newborn Screen?

While the default is to promote and facilitate newborn screening, there are limited circumstances under which parental refusal may be considered appropriate. These include cases where parents have deeply held religious or cultural beliefs that oppose certain medical procedures, and where alternative approaches are sought that align with their values. Additionally, if the infant's health status or specific circumstances make screening procedures unsafe or contraindicated, healthcare providers may reconsider or delay testing. However, in most jurisdictions, newborn screening is mandated by law, and refusal is typically considered a parental right unless it conflicts with public health policies or mandates for the child's safety. It’s vital that healthcare professionals respect parental autonomy while providing comprehensive education about the importance of screening (Kenner & Lewis, 2013).

Communicating Nursing Interventions to Others When Parental Declination Occurs

Effective communication within the healthcare team is essential when a parent declines newborn screening. The nurse must document the refusal in the infant’s medical records thoroughly, including details of the information provided to the parents and their stated reasons. This documentation ensures continuity of care, legal protection, and clear communication among team members. The nurse should also inform the primary care providers, neonatologists, and relevant staff to ensure everyone is aware of the parent's decision and the associated risks. When necessary, the nurse can also utilize interdisciplinary consultations, including social workers or ethics committees, to support families in understanding the implications and to ensure that care remains patient-centered.

If the Mother Changes Her Mind: Timing and Method of Screening

If the mother later decides to proceed with the newborn screening, the test should be performed as soon as possible, ideally within 24 to 48 hours after birth, to ensure early detection and treatment. The standard method involves obtaining a heel-prick blood sample using a lancet, then applying the blood onto a specialized filter paper card, which is sent to a laboratory for analysis. Repeat testing may be necessary if initial results are inconclusive or if the specimen quality is suboptimal. Timing is crucial because early identification of conditions like congenital hypothyroidism or phenylketonuria can prevent severe complications and improve long-term outcomes (Kenner & Lewis, 2013).

Personal Reflection on Parental Refusal

Refusing newborn screening presents significant ethical and professional challenges for healthcare providers. Personally, I believe that while respecting parental autonomy is fundamental, the health and future of the infant must also be prioritized. Communicating the benefits of screening empathetically and culturally sensitively is essential to fostering trust and understanding. It can be difficult to navigate these situations when parents decline potentially life-saving interventions, but maintaining a non-judgmental approach and providing thorough education is necessary. Such situations highlight the importance of advocacy, ethical decision-making, and balancing respect for family beliefs with the obligation to protect vulnerable infants (Oberklaid et al., 2010).

References

• Kenner, C., & Lewis, J. (2013). Genetics and Genomics for Nursing. Upper Saddle River, NJ: Pearson Education Inc.
• American Academy of Pediatrics. (2010). Policy Statement: Universal Newborn Screening. Pediatrics, 125(2), 393–396.
• National Newborn Screening and Genetics Resource Center. (2014). Ethical issues in newborn screening. [Online]. Available at: https://www.nnsrc.org
• Wilson, J.M.G., & Jungner, G. (1968). Principles and Practice of Screening for Disease. WHO.
• McCarthy, M. et al. (2018). Ethical considerations in newborn screening: Balancing public health and individual rights. Journal of Medical Ethics, 44(7), 470-474.
• Oberklaid, F., et al. (2010). Parental refusal of newborn screening: Ethical and practical issues. Journal of Pediatrics & Child Health, 46(11), 690–694.
• Green, N. S. (2017). Ethical and legal considerations in newborn screening. Current Opinion in Pediatrics, 29(2), 233-237.
• Orsini, J., & Rehm, J. (2019). Informed consent in neonatal screening programs. Journal of Law, Medicine & Ethics, 47(4), 565-576.
• Foster, S., et al. (2016). Challenges and opportunities in parental decision-making for newborn screening. Public Health Reports, 131(2), 226-234.
• Williams, C. L., et al. (2015). Improving communication strategies for informing parents about neonatal screening. Journal of Community & Applied Social Psychology, 25(3), 230-238.