Consent and Mandatory Reporting for Medical Care of Children and Young Infants

Health of Infants, Children and Young People

Assessment 1

This essay will consider two important issues, consent and mandatory reporting, as they relate to the medical care of people in their early stages of life as an infants, young children and adolescents. The issues will be defined and analysed in detail in regards to legal and practical implications for the registered nurse (RN) in light of the current standard of practice (Nursing and Midwifery, 2016), in health care scenarios.  This framework will then be considered and elaborated in the context of a possible real health care scenario. The scenario is, a 10 year-old boy named Harry Tehrani who has broken his arm and has arrived at medical emergency accompanied by his grandfather.

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Consent is the expressed willingness by a parent or guardian (the consenter) to give permission for a child in their care to have treatment (GOSH NHS Foundation, 2014). In South Australia anyone who is under the age of 16 years old is considered a child and required medical treatment of that child must only proceed with granting of consent (GOSH NHS Foundation, 2014).  Similarly, the person granting consent must be the primary carer of the child and be older than 17 years of age.  (ref).  Often the RN will be assigned the task in light of their senior status as an informed and skilled healthcare professional.

The consent may be given either non-verbally, verbally or in written form.  In cases of limited communication non verbal consent may be given by the carer such as holding the arm out of a child indicating consent to take the child’s blood pressure.  For verbal consent, the permission must be marked in the child’s medical record.  In cases of complication or side-effect risk such as with the administering of medication, the consent must be in written form. 

The consent requires thorough explaining the by RN in a clear, comprehendible and understandable way enticing further discussion involving the carer and child. Details of treatment necessity, possible treatment alternatives, benefits and risks, need to be addressed. The consent must be purely voluntary requiring that they not be pressured into a decision.  The carer and child also need to be made aware of their rights and this in turn will help facilitate a non-pressured decision.  They have the right to refuse treatment or withdraw their consent at any time during the treatment process. In this way the RN uses standards 1, 2 & 5 since critical thinking and analysis help make a plan that is delivered in a therapeutic and empathetic manner where patient and carer are at ease in decision making.

In relation to the case study of Harry Tehrani consent will be required for his fracture reduction surgery and associated pain as he is under 17. The grandfather is of legal age naturally.  The nurse then presents the requirement for treatment and control of pain of stronger analgesics such as endone.  In the cases of emergency, treatment can be carried out without formal consent in the cases where either the patient’s life is threatened, there is a danger of serious irreversible damage to the patient’s health if treatment is not given or the patient is suffering due to pain and/or distress. In this scenario this might be caused by fracture complications.

In the case of refusal an appropriate form must be filled out but refusal is not final and can be negated at any later stage.  Medical staff are protected from consequences of refusal but they must comply with the refusal and not carry out treatment.  Harry’s grandfather might refuse consent or change his mind later requiring activation of legal process.

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Child abuse is the maltreatment of child or neglect by the parent or the caregiver that can potentially lead to short or long term injury physically and/or mentally or death. This can be of a physical, sexual or psychological nature. Legislation states that this is intolerable and the child has the right to be completely safe and so be removed from such occurrences.  Similarly, if a RN on the bases of evidence suspects a child is in such an occurrence, they have a legal obligation to report this to the relevant authority. They are protected form any form of prosecution for doing this as long as their report is honest and validated by available evidence, (Simpson & Kane 2014, p.33).  The nurse must use standards 2, 4 and 6 with respect to this issue as it is important they engage professionally  to confirm if there is evidence to justify reporting, they must look for physical or emotional indications by assessing the child and the carer that neglect or abuse is an issue  and they must provide  a safe and appropriate environment for medical care of the child. 

With respect to Harry of the case study it is possible that the broken leg was caused by abuse and the absence of primary carers may indicate negligence of some form.  Although injuries presented to the health environment should not be thought as likely abuse on impulse the RN should always be aware of the visible signs of potential mistreatment Harry, such as the occurrences of bruises, scratches on areas of body such as face and buttocks that could have been caused by blows of hands or other instruments  Harry could also show signs such as fear towards the grandfather or other staff from being touched or close in anyway, or in a withdrawn or depressed state.

Consent is the legal requirement to obtain permission to treat a child under 16 years of age by an adult carer.  Law requires this consent to be clearly explained, granted purely voluntarily and can be refused or revoked at any stage. In the case study Harry required consent for treatment of his fracture and associated pain.  Mandatory reporting requires by the RN to report where they suspect the child is being abused physically or emotionally. The nurse applies standards, evaluating and making assessments to decide if a report is justified.  In the case study the cause of his injury and other signs must be investigated.

References list (8)

• Tuohy P 1998, Consent in Child and Youth Health: Information for Practitioners,  <https://www.health.govt.nz/system/files/documents/publications/consent-in-child-and-youth-health.pdf>
• Great Ormond Street Hospital for Children NHS Foundation Trust: Information for Families 2014, Consent: giving permission  for your child to have treatment , <file:///C:/Users/denni/Downloads/Consent%20(1).pdf>
• Nursing and Midwifery Board of Australia 2016, Registered nurses standards for practice <file:///C:/Users/denni/Downloads/Nursing-and-Midwifery-Board—Standard—Registered-nurse-standards-for-practice—1-June-2016.PDF>
• Deverson, V 2016, ‘Child abuse and neglect: mandatory reporting and the legal profession’, UniSA Student Law Review, vol. 2, pp. 102–122.
• Simpson, J 2014, ‘Mandatory reporting of child abuse and neglect’, The Queensland Nurse, vol. 33, no. 2, pp. 32–3; quiz 34.
• Australian Health Ministers’ Advisory Council 2013, The National Framework for Universal Child and Family Health Services, The Department of Health, Australian Government, viewed 20 May 2019, <https://www.health.gov.au/internet/main/publishing.nsf/Content/nat-fram-ucfhs>
• Australian Human Rights Commission (AHRC) 2013, The Big Banter, Australian Human Rights Commission, Australian Human Rights Commission, viewed 22 May 2019, <https://www.humanrights.gov.au/our-work/big-banter-resources>.
• Bird, Sara 2011, ‘Child abuse: Mandatory reporting requirements’, Australian Family Physician, vol. 40, no. 11, pp. 921–926.

• Dahlbo, M, Jakobsson, L & Lundqvist, P 2017, ‘Keeping the child in focus while supporting the family: Swedish child healthcare nurses experiences of encountering families where child maltreatment is present or suspected’, Journal of Child Health Care, vol. 21, no. 1, pp. 103–111.
• Caneira & Myrick 2015, ‘Diagnosing Child Abuse: The Role of the Nurse Practitioner’, The Journal for Nurse Practitioners, vol. 11, no. 6, pp. 640–646.
• Child maltreatment http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-19-2014/No1-Jan-2014/Child-Maltreatment.html
• Child abuse – reporting procedures, https://www.betterhealth.vic.gov.au/health/healthyliving/child-abuse-reporting-procedures
• Women’s and Children’s Health Network 2017, Person- and Family-Centred Care Charter, Women’s and Children’s Health Network, SA Health, viewed 4 July 2019, <http://www.wch.sa.gov.au/support/consumer/pfcc_charter.html>.
• First International Conference on Health Promotion 1986, The Ottawa Charter for Health Promotion, World Health Organisation (WHO), WHO, viewed 22 May 2019, <https://www.who.int/healthpromotion/conferences/previous/ottawa/en/>.