You are family nurse practitioner in busy emergency room. Mrs. Stewart brings her daughter, Paige, in to the ER around 6:30 pm, shortly after she has gotten off work for the day. Paige, who is 6 years old, has been experiencing cold symptoms for the past several days and Mrs. Stewart is concerned that the cough has gotten worse. She had called her pediatrician’s office that day and they stated that they did not have an open appointment for the next 3 days and that if she was concerned she could take Paige to the ER. Paige has is insured through the state Medicaid system and Mrs. Stewart has had difficulty finding providers that accept this insurance.
Paige is taken to the triage center to be screened and is categorized as non-urgent by the triage nurse. This particular ER does not have a separate unit or area for non-urgent or primary care patients.
Mrs. Stewart became upset when she was told that although she could continue to wait for Paige to be seen any urgent or emergent cases that came in would be seen first. She was encouraged to wait for an appointment with Paige’s pediatrician or take her to a community health clinic in the area. She was then provided a list of available clinics. The wait time was likely to be more than four hours and she had to work the next day, she wanted to be certain that Paige was able to go to school the next day.
The triage nurse comes to you to ask if you will take a moment to speak with Mrs. Stewart. She explains the situation and wants you to encourage Mrs. Stewart to take Paige home and wait for her to be seen in a clinic. You are aware of the EMTALA (Emergency Medical Treatment and Active Labor Act) rules and know that you must assess Paige if Mrs. Stewart chooses to wait. You are also aware of the difficulties a parent can face with taking time off work for several days with a sick child.
1. Review the case scenario
2. Describe the ethical problem
3. State what ethical principles are involved
4. Develop a stance and provide support for your decision
5. Discuss the possible consequences this may have on the situation
And we have the following after the scenario:
6)Should Mrs. Stewart utilize the emergency room for non-emergent situations?
7)What is the effect on health care resources?
8)What are the access to health care issues in this situation, and how could the nurse practitioner help this family?
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