discussion, an article from American Journal of Nursing

PLEASE RESPOND TO 2 DISCUSSIONS. ½ PAGE EACH.

1 For this discussion, an article from American Journal of Nursing, (2020), discuss how genomic sequencing may create ethical concerns in testing for preconditions with infants and children. In this article, a study on genomic sequencing on infants/children healthy and sick. The study would notify parents of any onset-illness of a child and provide standard of care. However, an infant detected in carrying gene BRCA2 mutation (normally detected in adults). The argument was to disclosure this information to parents or not? The pediatric ethics committee agreed not to notify parents of this adult-onset testing in which this should not have happened on infant/children (AJN, 2020, p.14). Evidence to support the pediatric ethics committee’s decision was testing was not relevant to the child/infant and second, allowing the infant to decide when of adult age.

If test are available during prenatal and newborn, why would the parents agree to a study in genomic sequencing in infants/chidlren? According to Williamson & Snyder (2115), prenatal testing is done while the fetus is developing in the mother’s womb and newborn screening which is a state program in early screening and interventions for possible genetic disease (p.475). From an ethical standpoint, this is extremely hard to ignore and not notify the family. Did the study conduct a thorough questionnaire of family history? The article did not mention a genetic counselor. Sometimes, it is hard to make tough decisions, but the best thing to do is have a genetic counselor educated parents of  test results and recommend options to take and make sure they understand and follow up with the family (Jones, 1996, p.27).

References

Jones, L.B. (1996). Jesus CEO: Using ancient wisdom for visionary leadership. Hyperion.

The fraught reality of genomic sequencing. (2020). AJN, American Journal of Nursing, 120(3), 14-14. https://doi.org/10.1097/01.naj.0000656268.80006.1b

Williamson, M.A., & Snyder, L.M. (2015). Wallach’s interpretation of diagnostic tests: Pathways to arriving at a clinical diagnosis (10^th ed.). Wolters Kluwer.

2 Ethics of Diagnostic Imaging 

COLLAPSE

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At one point in our healthcare careers we have received an order for a diagnostic imagining for a patient. It may just be another checkbox on our list of things to do, however sometimes that image may controversial, nevertheless, time-sensitive. Lozano (2007) found that, patients with compromised renal function are at high risk of nephrotoxicity from intravenous contrast. Nevertheless, CT angiography may be the most likely way to save the patient’s life in certain situations. This example is one where a person must be a patient advocate and bring up concerns to the referring physician to discuss if the risks outweigh the benefits of the diagnostic imaging. How will the patient benefit from having that imaging done sooner than later, or one type of image versus another (contrast versus no contrast).

As nurses, we are considered the patients advocate. Is the exposure of radiation warranted. Knowing more about the risks and benefits we must speak up for our patients, allowing them to choose what is in their best interest. Lozano (2007) reports that careful consideration of radiation exposure when ordering imaging studies, must be taken into account, by doing so the medical profession will be able to utilize remarkable diagnostic resources in a way that is safe, effective, and most beneficial for our patients. One of the takeaways from Jones (1995) was that Jesus processed three strengths essential to being a successful leader, self mastery, action and relationships. In looking at these strengths as they pertain to healthcare we can relay them to working in collaboration with others in the healthcare field and the patient/their families, self-mastery/ experience and knowledgebase of nurses, and taking action, being a patient advocate. As nurses whether we are in a leadership position or not we assist/collaborate with our patients to obtain the best care possible (evidence based practice), in the appropriate time frame ultimately taking action and nursing them back to health.

Jones, L. B. (1995). Jesus CEO. Hyperion.

Lozano, K. D., MD. (2007). Radiologists’ ethical and professional obligations. AMA Journal of Ethics, 9(11), 769–772. https://doi.org/10.1001/virtualmentor.2007.9.11.msoc1-0711