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Diagnosis of Sickle Cell Disease (SCD)

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Part 1

It is traumatizing for any parent to realize that their child is diagnosed with a medical condition that will require life-long management or some input of sort. That is an example of the ethical dilemma that I once encountered while in my internship at one of the community hospitals in the city. Both Mr. and Mrs. Simpson (not real name) were in the pediatrics section of the hospital looking charmed and in high spirits. The bundle of joy in the name of baby Ryan (not real name) had just been welcomed into their world. The sad news was that Ryan had been diagnosed with sickle cell condition after the screening test revealed positive results. I became aware of the situation while doing my rounds under the supervision of one of the doctors in a shift. Those present or involved were the parents, one nurse helping the doctor, and the doctor himself. Both the doctor and the nurse were the ones involved with the Simpsons from the time of admission. In this country, it is mandatory for the newborn to undergo SCD screening. It was not easy to break the news to the Simpsons as their joy was short-lived by the unexpected turn of events.

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There are three ethical principles in the ANA Code of Ethics that are relevant or applicable to this case study involving baby Ryan and the Simpsons. The first ethical principle concerns with the nurse practicing with compassion and respect for the patient regardless of his or her status(ANA,2017).They are to keep in mind that every individual is unique and has an inherent dignity which should be respected regardless of the nature of their health problems. The second ethical principle that applies to the Simpsons states that the nurse has a primary commitment to the patient whether it is a family, community, group, or the individual (ANA,2017).The nurse has an obligation to perform her duties diligently to the satisfaction of the patients so that the patient outcomes are favorable. The last principle that applies to this ethical dilemma outlines that the nurse is the promoter, advocator, and protector of the health, rights, and the safety of the patients under their care. The patients’ health and wellbeing are under the care and protection of the nurse. These three are the most applicable to this particular case study.

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These three ANA Code of ethics principles relate to this ethical dilemma in many ways. The first principle obligates the nurse to act in all her professional relationships with compassion and respect to the patient. The nurse and the doctor, in this case, had to demonstrate their compassion for the Simpsons for having a child diagnosed with SCD. Compassion had to be shown during the entire time of disclosing the bad news to both the parents. It should be known that the disease is associated with a lot of psychological, financial, and emotional burden that can affect family life (Fadare, 2009). The other principle concerns the commitment of the nurse to the patient (ANA, 2017). This relates with the Simpsons for example when the mother was admitted for the child’s delivery a couple of days earlier, the nurse and the doctor walked the journey with them all through until the disclosure of the screening test. That demonstrated the nurse’s commitment to the Simpsons. Finally, the last ethical principle states the nurse’s role in advocating for the safety and rights of the patient. In this case, the nurse ensured that the child undergoes the SCD screening which is mandatory as it was meant to safeguard her child’s safety and well-being for the sake of starting treatment plans.

Part 2

The outcome of the dilemma was fruitful at the end of the entire session and from the onset of care for the Simpsons. It should be noted that the Simpsons did no expect to have an SCD child. The parents were not aware of their susceptibility or high chances of bearing a sickle cell child. Therefore, from the time of admission to the delivery of the baby, everything went on smoothly. However, after the mandatory screening for SCD on baby Ryan, the ethical dilemma of disclosure of the sad news cropped in. The case was unique since not so many white parents have the high risk of getting a sickle cell child. Nevertheless, it happened to them, and the process of disclosing the diagnostic results was accomplished with respect and compassion. They received the message positively after being taken through the acceptance journey.

When it comes to the resources availability and usage for this ethical dilemma, it is confidently reported that the community hospital was well equipped and vast with all the necessary avenues to assist patients like the Simpsons. First of all, the community hospital had the SCD screening services, an essential resource for diagnosis of the genetic disorder. It also had the human resource in the form of healthcare professionals with the expertise in taking care of such patients with SCD.The doctor who attended to the Simpsons was a hematologist and experienced general pediatrician. It also had follow-up management and treatment services for persons with SCD.However, in my opinion, the hospital lacked comprehensive prenatal diagnosis (PND) of SCD.It is proven that PND provides genetic counseling for the mother to reduce anxiety as well as the rate of newborns being born with SCD.If at all the community hospital had this service, maybe Ryan’s parents could have been diagnosed with the risk and advised accordingly. They could have been informed about the hemoglobin genotype of their unborn child and receive assistance. The ethical dilemma could have been avoided as such but all in all, they were counseled professionally and were ready to move to the next phase of management and treatment.

1. ANA. (2017). Short Definitions of Ethical Principles and Theories. Retrieved 4 October 2017, from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Resources/Ethics-Definitions.pdf

2. Fadare, J.O. (2009). Some ethical issues in the prenatal diagnosis of sickle cell anemia. Annals of Ibadan Postgraduate Medicine, 7(2), 26–28.

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