An ethical quandary... no, a different one

[elizabells, BSN, RN]

So here's what happened to me today: I have a kid on head-cooling for HIE. Mom had a complete abruption at birth and is in the ICU at a different hospital. She's been unconscious for two days, dad's not in the picture, so mom's mom has been making the decisions. Fine, cool. But today gma tells me mom has regained consciousness, although she's still to weak to talk, and has a pericardial effusion that's going to be surgically taken care of in some way tomorrow. She says she hasn't told mom how sick the baby is, just that he was taken to a different hospital. She says she's going to call mom's room, have the nurse put me on speakerphone, and she wants me to tell the mom the baby is "fine". Now, the baby is so very, very not fine. Fine does not enter into it. I excused myself somewhat abruptly (which I feel bad about, but I totally panicked) and went and found my charge nurse, who tells me no, obviously I can't do that, which was my instinct. The attending says the same thing. By the time I got back to my kid gma was on her way out but said she'd come back, which thankfully didn't happen on my time. I wrote a lovely note about it, and passed it along to the next nurse, but for some reason I'm still kind of gobsmacked by the whole thing.

Now, obviously since my charge and attending agreed with me that telling mom the baby was fine was not only unethical but possibly illegal, I feel pretty secure in that. Frankly, I'm not even sure why I'm asking, but... I'm right, right? I totally can't tell the mom her baby is okay when he's absolutely not, right? Gma's feeling was that mom is so sick that she can't handle knowing how bad the baby is, which I get, but... right? That's not okay?

[UTVOL3]

No. You can't. You are right. I don't know what you could tell her, I mean of course if she is awake that is going to be the first and only thing she thinks about so somebody (not a nurse!) needs to talk to her, but what would they say?

I hate that about our jobs, ya know?

Geez I hope for a miracle for them both. For some reason that is just breaking my heart.

[NurseyBaby'05, BSN, RN]

No, it's not ethical to lie to your patient's parents. (Which is what Gma wants you to do.) I would speak in generalities.

"Baby's pretty sick right now. There wasn't enough oxygen to his brain for a time during delivery. We have a cooling cap on his head to minimize swelling and decrease his risk for any brain damage. It may also decrease the severity of any that might have occured. He seems to be tolerating it. Once we this settled we'll have more of a game plan for the rest of his treatment. I can have Dr. XYZ talk to you and your mom about more of the specifics of Baby's treatment plan."

I'm in Oncology and wind-up seeing a lot of the same. Mom is receiving Chemo while comatose bordering actively dying "Don't worry Mom. All you need is this treatment and next week you'll be out dancing." Uh . . . . . yeah, right! I can't tell you how many patients, family members, POAs all dance around the same elephant in the room.

[iyqyqr]

Eventually, we hope, this mom will be discharged and come to see her baby. It sounds like the baby is going to be with you for quite awhile. This mom needs to TRUST her baby's caregivers, so by telling her the truth ( good comments from another poster above) you will have a foundation of trust which is so important to all parents.

[NurseyBaby'05, BSN, RN]

iyqyqr hit the nail on the head. Mom has to trust you. Like my Onc pt's, your pt isn't just the baby. It's family too.

I would tell the Grandmother that it's important that her dd trust Baby's caregivers and that it won't happen if you were to flat out lie to her. I would tell her that you'll give dd basic, general information and a lot of reassurance. Also, if a loved one's condition is left to someone's imagination, what they imagine is often far worse than what is actually gong on.