Health Assessment and Ethical Considerations

Scenario Selected: The parents of a 5-year-old boy have accompanied their son for his required physical examination before starting kindergarten. His parents are opposed to him receiving any vaccines
In the words of Riley, Locke, Skye and Arbor (2011), “the goals of the well-child examination in school-aged children (kindergarten through early adolescence) are promoting health, detecting disease, and counseling to prevent injury and future health problems” (683). Some of the evaluations that will be important for the five year old are his physical and developmental markers. Towards this end, the height and weight of the child will be checked and the BMI computed. The child’s vision and hearing will also be assessed and his blood pressure checked. The motor skills as well as language skills of the child could also be observed as part of the physical examination. Further, the child’s parents could be asked a few questions with an aim of evaluating the overall wellbeing of the child (Riley, Locke, Skye and Arbor, 2011). Questions to be asked on this front relate to the child’s sleeping, bathroom, as well as eating habits. It is also important to note that as per AAP recommendations, the child in this case ought to receive a minimum of three shots with regard to immunizations. These include MMR, DTaP, and IPV. Some of the other shots that could be administered include, but they are not limited to, a flu shot or a chicken pox vaccination.
The need to ensure that children receive the relevant vaccines at the opportune time cannot be overstated. This is more so the case considering that refusing children such vaccinations expose them to numerous vaccine-preventable illnesses that have the potential to cause serious complications and even death. Vaccine hesitance, however, as Opel, Feemster, Omer, Orenstein, Richter, and Lantos (2014) observe is one of the most frustrating scenarios health practitioners are likely to come across. Parents cite a myriad of reasons for refusing vaccine request for their children. These include, but they are not limited to, advice from various forums against vaccination, some celebrity campaigns citing vaccination side effects, etc. In this case, the parent’s refusal to accept vaccines and health practitioner’s insistence on the same could be informed by the same end result from an ethical and moral perspective, i.e. the need to maximize the child’s benefit, by minimizing any harm that could come their way. Parents fear that the vaccines could have serious side effects, while doctors fear that skipping the vaccine would expose the child to a myriad of vaccine-preventable diseases and illnesses. It is, however, important to note that decision making, from an ethical perspective, in this case is not dependent on the assessment and comparison of the harms and benefits of the said refusal, but on the autonomy principle. Barbacariu (2014) notes that under the principle of autonomy, parents have the right to refuse vaccination for their children, a decision which is best made after being properly informed by accredited sources” (89).
In the present case, I would be more inclined to embrace the autonomous assertions of the parents as they are presumed to be working in the best interests of the child. I would, however, attempt to engage the parents with an aim of convincing them to permit their son to receive the relevant vaccine. There are various approaches that a nurse like me could adopt in an attempt to have parents opposed to having their children vaccinated agree to the said requests. One of the more effective ones is explaining the need for vaccination and dispelling any misconceptions they could be having about vaccination. According to Krantz, Sachs and Nilstun (2011), “by listening carefully to their concerns, responding honestly, and providing clear information about the risks and benefits, NPs may be able to build trust and to convince once hesitant parents to have their children vaccinated.” Fernbach (2011) is in agreement. According to the author, building trust could come in handy in seeking to convince parents who appear hesitant to have their children vaccinated (Fernbach, 2011).













References
Barbacariu, C.L. (2014). Parents' Refusal to Vaccinate Their Children: An Increasing Social Phenomenon Which Threatens Public Health. Social and Behavioral Sciences, 149(8), 84-91.
Fernbach, A. (2011). Parental Rights and Decision Making Regarding Vaccinations: Ethical Dilemmas for the Primary Care Provider. Journal of the American Academy of Nurse Practitioners, 23(7), 336-45.
Opel, J., Feemster, K.A., Omer, S.B., Orenstein, W.A., Richter, M. & Lantos, J.D. (2014). A 6-Month-Old with Vaccine-Hesitant Parents. Pediatrics, 133(3), 71-78.
Riley, M., Locke, A.B., Skye, E. & Arbor, A. (2011). Health Maintenance in School-aged Children: Part I. History, Physical Examination, Screening, and Immunizations. Am Fam Physician, 83(6), 683-688.
Krantz, I., Sachs, L. & Nilstun, T. (2004). Ethics and vaccination, Scand J Public Health, 32(3), 172-8.