As adolescents mature and develop their independence, they will at times present on their own to seek health care services. Adolescents will also commonly present with their parents(s), requiring the nurse to practice family centred care.
When planning, delivering, and evaluating nursing care for adolescents who present without a parent in the emergency department setting, the nurse needs to build and sustain a therapeutic relationship with the adolescent, and advocate for their rights and needs.
In clinical scenarios where adolescents present on their own, and do not wish to include their family in their care, the nurse and medical team can be faced with moral and ethical dilemmas as to whether the family should be involved, despite the patient’s refusal. Adolescents should be viewed as individuals, and a determination should be made as to whether they are Gillick competent, whilst ensuring local legislation and policy is upheld. The determination as to whether an adolescent can be deemed Gillick competent, should also be made when an adolescent presents with parent(s) or a guardian, as it is essential to include the adolescent in decision making practices.
The case scenarios provided below, will test your knowledge of different pathologies and your understanding of the role of the Registered Nurse (RN) when caring for adolescents.
Task Instructions
To complete this assessment task, you must:
Visualise yourself in the role of the newly graduated Registered Nurse (RN), working in a busy metropolitan emergency department (ED). Your patient has been seen by a medical officer who has commenced assessment and they have handed the patient over to you for nursing care.
Choose one case study from the four presented.
Write a 1500-word (+/- 10%) essay using the suggested structure below.
Incorporate current evidence-based literature into the critical appraisal.
Respond to each of the points listed below pertaining to the selected case study:
Outline and describe the pathophysiology of the clinical diagnosis.
Identify and briefly describe the signs and symptoms of the clinical presentation and how they relate to and/or support the clinical diagnosis.
Consider the growth and development milestones for the age of the case study character and how this will influence nursing assessment and the planning of care.
Discuss whether the adolescent in the scenario can provide informed consent, and make independent medical decisions based on your knowledge of Gillick competence, considering the clinical diagnosis.
Identify the child protection responsibilities of the case study character whilst in the hospital setting and collaborative processes with a multidisciplinary team.
Outline any psychosocial and/or cultural needs which should be factored into nursing care and care planning.
Explain how the nurse can create and sustain a safe and emotionally supportive environment for the adolescent in the case study.
Outline and discuss the Registered Nurses role in the safe administration and management of medications for the adolescent.
