Ethical consideration in child and adolescent mental health nursing

Dear Editor, Child and adolescent psychiatry is a relatively new branch of psychiatry. Child psychiatric nursing evolved gradually as the therapeutic value of nurses' relationship with children began to be realized. In child psychiatric nursing, the nurse needs to get equipped with qualities of clinical experience in interacting with children and developing a therapeutic relationship.[1] Ethical issues arise seldom in the care of adults with a psychiatric disorder in comparison with the care of children with psychiatric disorders.[2] Nurses working at child and adolescent Psychiatry encounters various ethical issues. The most common ethical issues while implementing the ward routines includes 1. Consideration of children's preferences in food, clothing, Play allotment of room, 2. Complying the child to follow the ward routine which is entirely new to the child routine at home. 3. Setting too close or too harsh boundaries. 3. Not involving the child in the decision of admission and treatment plans. 4. Not providing adequate explanation about restraints, Prescription of medications, follow- ups including both in person and by teleconsultation. Apart from hospital stay the nurses face ethical issues at community set-up also whenever they are dealing with the children and adolescent with mental health problem. The common ethical issues at community includes 1. Identification of mental health problem in children. Proper history collection from various sources of information including parents, grand parents, other care givers, teachers, school attenders, drivers etc., 2. First consultation to the psychiatry it self is a challenging. The nurse cannot refer or arrange teleconsultations against parent's or child's wish. 3. Without proper evaluation child cannot be labelled with mental illness. 4. Disclosing the diagnosis to parents and explaining about importance of treatment. The nurse being a frontline health-care provider is essential to have sound knowledge of ethical issues in caring for a child and adolescent mental health needs. It helps in recognizing health-care dilemmas and making good judgments and decisions within the laws that govern them.[1] The duty of health-care providers is to do things that are beneficial or good. In pediatric care, this means the action of kindness that will benefit the child than harm him/her. The treatment decision will not be based on factors such as age, gender, religion, socioeconomic status, or ethnic group.[3] To Overcome these ethical issues both at hospital and community set up the nurses has to follow these; 1. The nurse has to empathize the parents' situation. 2. Provide adequate information. 3. Obtain assent and consent for admission, treatment and research activities. 4. Involve all the family members in participatory decision making. 5. Providing information about MDT (Multidisciplinary Team). 6. Psychoeducation on medications and its side effects. 7. Teleconsultations to reach the unreached with in the legal frame work. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.