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Introduction
Numerous health disparities occur when communication barriers and failed collaboration
exist. The ethical dilemma addressed in this assignment reflects how various inequalities of a
Hispanic student with limited transportation, access to care, communication, and medical
coverage can negatively impact the outcome of a new seizure diagnosis. Research states
populations of indigent minorities with limited health insurance and low socioeconomic status
have an increased risk of health disparities and poor outcomes. (Nickitas, et al., 2020). This
reflection assignment will describe how the event led to positive changes and new policies for
the healthcare team.
Ethical Reflection
The ethical reflection addressed for this assignment stems from a situation as a school
nurse. The local school district required electronic and written medical forms to be completed at
the beginning of the school year with pertinent medical information about each student. This
reflection is about a young female Hispanic student with no known medical history other than
seasonal allergies. This student was on a field trip in a remote area with her teacher, a few
parents, and her first-grade classmates. While on this field trip, the student began having seizure-
like activity with an unknown cause. The teacher called this former school nurse and asked if the
patient had a known history of seizures, but it was not indicated on the student’s medical form.
This school nurse confirmed with the teacher that emergency services should be called, and the
teacher indicated another parent had already contacted them. The teacher stated she had
attempted to reach the student’s mother but was unsuccessful in her attempt. Due to the remote
location of the field trip, emergency personnel did not arrive for approximately 30 minutes from
the onset of the student’s seizure-like activity before transporting her to the hospital.
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Research indicates millions of people living in the United States do not speak, read, or
write the English language proficiently, but that every person is entitled to a medical interpreter
(Espinoza Suarez, et al., 2021). The mother of the student did not speak English and her phone
number was out of service. A resource officer and a bilingual Social Worker of the school district
went to the mother’s home to alert her of the situation. The mother had no transportation, so they
offered transportation to the hospital where the student was being transported.
After a medical evaluation, it was confirmed the student had a Grand Mal Seizure, likely
resulting from a high fever and infection. The student had pneumonia and had been sick the
weekend prior. The mother confirmed the student had been sick, but thought she just had a cold
and was well enough to attend the field trip. It was also suspected this was not the student’s first
seizure as the mother stated she had been having “tantrums or outbursts” a few days before this
event. The mom was unaware of seizure-like activity and did not seek medical attention for the
student prior because of limited access to care, no transportation, communication barriers, and no
knowledge of a seizure diagnosis. After several days in the pediatric ICU, the student was able to
be discharged home on seizure prevention medications and was given rectal Diastat to use as
needed at home or school.
Nurse Role Insight to Prevent Future Occurrences
The unfortunate events that occurred during the field trip made the school nurse realize
the need for additional training and education among school staff, teachers, parents, and students.
Emails, phone calls, and newsletters were sent home reminding parents of the importance of
keeping phone numbers, addresses, and medical information current. It was evident that all
stakeholders involved in this event needed education on the signs and symptoms of seizure
activity and the importance of reporting those symptoms to the school nurse. According to
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research, school nurses should provide a compassionate environment, trusting relationships,
health promotion, and education on chronic illnesses, even among healthy adolescents. (Hilli &
Pederson, 2021). The school nurse implemented an individualized health care plan for the
student and provided educational resources for the staff and family.
The school nurse met with the administration, teachers, guidance counselors, the social
worker, and the student’s parent to ensure a 504 accommodation plan was in place. A 504 plan
exists to protect students with chronic health conditions from discrimination regardless of their
diagnosis or educational abilities (McCabe, et al., 2021). This student’s 504 plan indicates the
student would have unlimited access to the school nurse’s office and the ability to participate in
field trips and off-campus activities if a nurse or parent of said student were present. The
prescription seizure medication, Diastat, would be readily available during school hours and on
field trips or off-campus activities. The social worker provided community resources such as
prescription drug plans to help cover the cost of the medication.
Implementing individualized healthcare plans and 504 plans proved to be beneficial for
this student, as she went on field trips in future years along with the school nurse. This process
has also been implemented for students with other chronic health conditions such as diabetes,
asthma, and those with severe life-threatening allergies.
Code of Ethics and Biblical Worldview
When the school nurse collaborates with school staff, social workers, and the family, it
helps reduce healthcare disparities as indicated by Provision 8 of the ANA nurse’s code of ethics.
The nurse recognizes that regardless of age, ethnicity, poverty, or social status, all individuals
should have protection of human rights and equal access to healthcare (ANA, 2015).
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When the nurse recognizes every human being is created in God’s image, it is obvious to
treat each other equally with respect and love. According to the Holy Bible, it states in Luke
10:27 the most important commandment is “love theALordAyour God with all your heart, all your
soul, all your strength, and all your mind…Love your neighbor as yourself” (New Living
Translation, 2015). Jesus made it evident to the scholar that to “love your neighbor as yourself”,
he should follow the teachings of the parable about the Good Samaritan helping the injured man
even though the man could offer nothing in return (New Living Translation, 2015).
Conclusion
It is refreshing that a parent and teacher without any medical knowledge helped this
student during her time of need until emergency personnel arrived. This nurse is a firm believer
that God places individuals in specific situations to help the sick and injured. The outcome of this
event could have been detrimental had the student continued to have seizure activity at home
without proper medical treatment. Even though the student faced many disparities, the
collaboration of all involved and God’s perfect timing provided her with equal access to care and
a community that rallied in her defense. God had a divine purpose for this student, and she is
now a thriving middle schooler involved in many school activities.
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References
American Nurses Association (2015). Code of ethics for nurses with interpretive statements.
Silver Spring, MD:Ahttps://www.nursingworld.org/practice-policy/nursing-excellence/
ethics/code-of-ethics-for-nurses/coe-view-only/
Espinoza Suarez, N. R., Urtecho, M., Nyquist, C. A., Jaramillo, C., Yeow, M.-E.,
Thorsteinsdottir, B., Wilson, M. E., & Barwise, A. K. (2021). Consequences of suboptimal
communication for patients with limited English proficiency in the Intensive Care Unit and
suggestions for a way forward: A qualitative study of healthcare team perceptions. Journal
of Critical Care, 61, 247–251. https://doi.org/10.1016/j.jcrc.2020.10.012
Hilli Y., Pedersen G. (2021). School nurses’ engagement and care ethics in promoting adolescent
health. Nursing Ethics. 28(6), 967-979. https://doi.org/10.1177/0969733020985145
McCabe, E. M., Kaskoun, J. R., & Strauss, S. M. (2021). School Nurses as Vital Members of
504 and Individualized Educational Program Teams: Do District-Level Policies Make a
Difference in School Nurses’ Involvement? Policy, Politics, and Nursing Practice., 22(3),
191–200. https://doi.org/10.1177/15271544211011959
Nickitas, D.M., Middaugh, D.J., & Feeg, V.D. (2020). Policy and politics for nurses and other
health professionals (3rdAed.). Jones & Bartless Learning, LLC.
The Holy Bible, New Living Translation. (2015).
BibleGateway.AAhttps://www.biblegateway.com/versions/New-Living-Translation-NLT-
Bible.A(Original work published 1996)
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