narnar

Thanks to everyone for replying. This is very interesting and I'm learning a lot. Lots of good suggestions and points of view. What I'm learning is that the general consensus is to say something to the mom, but to use tact and respect. I liked the quote, "you can lead a horse to water, but you can't make it drink." I'm also seeing that this is a heated issue for some people. It is easy for people to feel attacked and defensive, which could likewise happen in this situation with the mother. I can also appreciate the point of view that this issue is like many others such as alcoholism, pregnant women smoking/drinking/drug-using, law, child protection, etc. These are complex issues, ethics issues to a T. It's all on a gray scale, there are no right and wrong answers. I would encourage people to not get personally offended or think that someone is attacking your parenting skills by responding to this question. This is a space to learn about others' thoughts and explore the complexity of this issue. Take it with a grain of salt. This is helping me understand patient advocacy and how to do it. I'm also learning about diversity. Thanks again.

I am a nursing student at the University of Nevada Reno. Recently in clinical I came across an ethical dilemma and am wondering what you would do in this situation. In a public health clinic, two kids under age 10 came in with their mother for physicals. As I took their vitals, heights, and weights, I couldn't help but notice that they wreaked of smoke. I assume that their mother smokes at home and in the car with the kids. I have done some research on the dangers of exposing children to second hand smoke as well as the problem of having a role model who smokes. The nurse practioner I was accompanying for the day completed the physicals with no mention of the smoke. My question is, aren't we in a position, as healthcare workers, to offer some sort of intervention on behalf of the kids? By this I mean educating the mother about what she is exposing her children to and encouraging her to either not expose the kids to the smoke and smoking or quit herself. If the subject was brought up, would she feel attacked and not come back to the clinic? Is that a risk that's worth taking in an attempt to make a positive difference? How can tact be employed? If you have been in a situation like this or not and have thoughts to share, please do. I wonder what others would do. Would you take the easy way out and not say anything ("that's none of my business") or be hopeful, take a risk, and try? How would you try? Would you go into detail, be brief, refer the parent to a smoking cessation help group, etc.? FYI, I am hoping to get some responses not only for my own benefit, but also to use in short paper. References: Brown, M. "The Effects of Environmental Tobacco Smoke on Children: Information and Implications for PNPs" from the Journal of Pediatric Healthcare, 2001. Horstman, K. and Van Rens-Leenaarts, E. "Beyond the boundary between science and values: re-evaluating the moral dimension of the nurse's role in cot death prevention" from Nursing Ethics, March 2002.

Greetings! I am a student nurse from the Orvis School of Nursing at the University of Nevada, Reno. I will be writing a summary paper of responses to this posting for my theory 2 class. It seems that med-surg is a great place to learn and solidify skills. I am attracted to it as a starting point for my nursing career. However, I wonder if med-surg nurses are able to be holistic in their approaches to patients. It seems that med-surg can be very busy with a high patient-nurse ratio. It seems that the nurses are so busy taking care of basic medical needs that there may not be time to look at the patient as a whole, to talk with him/her, listen, and provide other modalities of care that are not medical. I am a massage therapist changing careers. I believe in holistic healing, western medicine, and eastern medicine. Is there a way to encorporate it all? As med-surg nurses in the field, are you able to encorporate holism and how? I have researched the topic of holistic nursing a little and have found that it is popular in oncology nursing. Is that because oncology nurses have less patients per nurse? I have also found that some hospitals are creating departments of inpatient holistic services, but I haven't seen this in the places where I've done clinical. That seems to only exist in a few places. Is holistic nursing possible in main-stream, busy hospitals, particularly in med-surg? Please share your thoughts.... Thanks! References: Newshan, G. (2004). Development and evaluation of an inpatient holistic nursing care services department. Complimentary Therapies in Nursing and Midwifery. Vol 10, Issue 3. Smith, A. (2005). My Life as a Holistic Nurse. Journal of Holistic Nursing. Vol 23, No 4.