Reflection on Ethical Dilemma in Pediatric ICU Nursing Practice

This reflective essay, submitted by a nursing student, explores an ethical dilemma encountered in a pediatric ICU setting. The situation involves a 9-year-old heart transplant patient with a ventricular-assisted device (LVAD) who suffered multiple strokes, leading to difficult decisions regarding the continuation of care. The nurse reflects on the situation, identifying the nursing issue as the decision to continue or discontinue LVAD support. Using Carper's Patterns of Knowing, the essay delves into the esthetics, personal knowledge, ethics, and empirics of the situation, including relevant literature supporting the use of LVADs. The reflection highlights the emotional impact on the nurse, the importance of ethical considerations, and new insights gained from the experience, emphasizing the commonality of such dilemmas in the ICU and the development of coping mechanisms.

Running head: REFLECTION 1
Reflection
Name
Institutional Affiliation

REFLECTION 2
REFLECTION
Situation
As a Registered Nurse (RN) working within a pediatric ICU, I have faced some ethical
dilemmas that made me feel unprepared, underprepared and uncomfortable. The underlying
challenging situation involved a case of where we admitted a 9-year-old heart transplant patient.
The boy had been transferred to us from another hospital after being implanted with the
ventricular-assisted device and suffering multiple strokes. This situation warranted medical
providers of that hospital to remove this specific patient from their list of the patients to receive
heart transplantation. Accordingly, the family of the patient was consulting us for a view on how
to assist the suffering-patient.
Regrettably, the patient suffered a hemorrhagic stroke a few days following our
admission, causing substantial agony to the patient. It was a dilemmatic situation. We began
questioning ourselves as to whether to disconnect the boy from the LAVD, continue with
anticoagulant administration or our care termination to the kid. This triggered discomfort in me
bearing in mind that the life of the boy was at high risk. The patient would occasionally stay
actively while sometimes reliant on the ventilator to breath. I was uncomfortable keeping him
alive without conscious or unprompted locomotion. Nonetheless, I realized that such scenarios
are common in the ICUs. Unfortunately, such an incidence makes caregivers feel uncomfortable
and inadequate.
Nursing Issue
The nursing issue is how to make a decision during a dilemmatic situation concerning
either continuing using LVAD or removing it for the patient who is not a candidate for heart
transplant (Yuzefpolskaya et al., 2018).

REFLECTION 3
Esthetics
This refers to the underlying reason for the situation. The reason was that the patient
had been implanted with the ventricular-assisted device and suffering multiple strokes. This
made him be transferred to us.
Personal Knowledge
This deals with my thoughts and feeling in this situation. I thought of terminating my care
to the patient or continue administering the anticoagulant. Also, I thought of removing the
LVAD. I felt uncomfortable keeping the patient alive without consciousness or spontaneous
locomotion.
Ethics
This deals with my personal belief which impacted my actions. My own beliefs were that
this patient needed to be helped no matter what it takes. I believed that it was right and moral for
us to help the kid come out of the painful situation by maintaining professionalism and ethical
standards at all times.
Empirics
This deals with evidence in the literature on nursing supporting the nursing significance
of the issue identified. The importance of LVAD is that it is beneficial to patients who have
reached end phase heart failure (Rogers et al., 2017). This is important because it assists the
patient left ventricle to pump blood to the entire of the body (Schoenrath et al., 2018). This case
LVAD would help prolong and improve the life of the boy because he was not a candidate for a
heart transplant (Estep et al., 2015).
New Insights:

REFLECTION 4
I gained new insights through this reflective practice opportunity. I realized that it gave
me a chance to reflect when faced with a dilemmatic situation to find a way forward. I was able
to think fast and empathize with the boy. I got to understand that such a situation is common in
ICU and should not make me feel uncomfortable or unprepared. Thus, I got strengthened and
stopped feeling unprepared or uncomfortable.

REFLECTION 5
References
Estep, J. D., Starling, R. C., Horstmanshof, D. A., Milano, C. A., Selzman, C. H., Shah, K. B., ...
& Kasirajan, V. (2015). Risk assessment and comparative effectiveness of left ventricular
assist device and medical management in ambulatory heart failure patients: results from
the ROADMAP study. Journal of the American College of Cardiology, 66(16), 1747-
1761.
Rogers, J. G., Pagani, F. D., Tatooles, A. J., Bhat, G., Slaughter, M. S., Birks, E. J., ... &
Gregoric, I. D. (2017). Intrapericardial left ventricular assist device for advanced heart
failure. New England Journal of Medicine, 376(5), 451-460.
Schoenrath, F., Kikhney, J., Kursawe, L., Schoenrath, K., Hajduczenia, M. M., Schulze, J., ... &
Moter, A. (2018). Life on the driveline: Molecular detection and fluorescence in situ
hybridization-based visualization of microbial species in patients with left ventricular
assist devices. The Journal of Heart and Lung Transplantation, 37(1), 163-166.
Yuzefpolskaya, M., Nasiri, M., Onat, D., Royzman, E. A., Nwokocha, J., Pinsino, A., ... &
Topkara, V. K. (2018). Gut Microbiome-Generated Metabolite Trimethylamine-N-Oxide
is Reduced After Heart Transplantation and Continuous Flow Left Ventricular Assist
Device Therapy in Advanced Heart Failure Patients. The Journal of Heart and Lung
Transplantation, 37(4), S235.