Introduction
Alcohol abuse is one of the leading causes of preventable deaths in people under 40 years of age in the United States, with the disease itself affecting around 17 million adults (Hasin et al., 2007). It is now estimated that 1 in 10 children live with a parent who has some form of substance abuse problem, suggesting that it is of increasing importance. In a recent observation while at clinicals, a woman who had an alcohol abuse problem became pregnant and decided to keep the child. Unfortunately, her alcohol addiction had started at age 14 and was an inherent part of her lifestyle, making it very difficult for her to stop. Despite significant counseling hours and interactions with doctors, she was unable to stop drinking during the time she was pregnant. Upon birth, her daughter was born extremely under weight but, fortunately, had no other obvious defects. Due to the mother’s alcohol abuse while pregnant, she was seen as an unfit mother and the child was placed in the care of the Department of Children Social Services.
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"Non-Punitive Alcohol and Drug Treatment for Pregnant and Breast-feeding Women".
Thesis
As alcohol abuse problems are common in the United States and impact both parents and their children, there should be rehabilitation programs which are easily accessible for women who are abusing alcohol or drugs rather than resorting to Social Services.
Beneficence
The patient has the right to expect beneficence. This moral and ethical principle is the expectation of the patient that the nurse will do good and prevent harm to the patient. (Westrick, 2014) Within this principle of beneficence the clinician has a duty to try and solve the problems of the individual, rather than taking the simplest route. In this case, it seems that removing the child from the home may be initially beneficial, but in the practice of beneficence, there is a duty to improve the health of both the mother and of the child, as well as giving the child a loving home environment (Shonkoff et al., 2012).
Research suggests that a child living with its biological parents has a much longer life expectancy. In addition they have reduced rates of depression when compared with those taken away by Social Services (Shonkoff et al., 2012) Based on this research, starting a rehabilitation program that helps mothers overcome drug and alcohol abuse problems could lead to children being able to live with their biological parents as long as the parents are abiding by the rules of the program(s).
Standards of Practice
One of the American Nurses Association standards of practice is communication (ANA, 2010). This standard is important because it guides how nurses should communicate with patients and their families, as well as other members of the clinical team (ANA, 2010). In this scenario, the nurse could use the communication standard to discuss possible options with the mother of the child and guide the mother into rehabilitation to protect herself (Arnold & Boggs, 2013). The standards of communication in nursing can vary considerably, with lower standards of communication being associated with lower nurse ratings, lower standards of care and reduced patient happiness (Burnard & Gill, 2014), which is why it is particularly important to understand this standard. Without communication, nurses are unable to learn and grow from their experiences, which also makes it an incredibly important part of practice (Vogelsmeier & Scott-Cawiezell, 2011).
Scope of Practice
The Arizona State Board of Nursing statutes and regulations govern nursing practice because they guide nurses on how best to apply their knowledge in the caring profession. They are there to guide nurses based on many years of practical nursing experience (ANA, 2010). They work to protect both the nurse and the patient, and aim to prevent any negative consequences (ANA, 2010). One of the problems with working outside of the scope of practice is that it can lead to negative health impacts of the patient and professional consequences for the nurse (ANA, 2010). In contrast, always working within the scope of practice may mean that the patient does not receive the standard of nursing care that is best for their situation. In this sense, removing a child from a drug- or alcohol-addicted mother is within the scope of practice but does not necessarily have the best consequences for mother and child (ANA, 2010).
Final Argument
It is wrong for a nurse to judge another human being based on their actions and addictions. The nurses’ role is to help others through the issues that they are dealing with rather than to assume things about their lives (Burnuard & Gill, 2014). In this case, a nurse may be likely to jump to conclusions that the child is better off without the mother, but this has been proven several times throughout this paper not to be the case. Rehabilitation offers both the mother and the child the best chance of survival and can really help them move forward into their new lives.
As with any argument, both sides of this have their own strengths and weaknesses. Non-punitive treatment for these women follows an ethical principle of freedom and allows the women to make their own judgments about their own bodies. It also follows the confidentiality and privacy agreements necessary for being a nurse. Despite this, it would be illegal for the mother to give a baby drugs in a bottle, and if they are present in her system this is essentially what she is doing during breastfeeding. Children born to mothers with drug and alcohol problems are also at a higher risk of low birth weight and sudden infant death syndrome.
Conclusions
Despite the evidence that mothers with drug and alcohol problems pose obvious problems for their unborn and breastfeeding children, there is evidence that taking them away for punitive treatment can do more harm than good. Infants are more successful when they have a biological parent around, and the process of childbirth can offer up a new perspective for the mother – it may help her to combat addiction. Although there are laws suggesting that the mother requires punitive treatment and should not be allowed around the child, it is unethical to take the child away from someone who would otherwise be a perfectly fit mother. There are complicating factors, but overall it seems as though this law would benefit from a reform.
- Arnold, E. C., & Boggs, K. U. (2013). Interpersonal relationships: Professional communication skills for nurses. Elsevier Health Sciences.
- Hasin, D. S., Stinson, F. S., Ogburn, E., & Grant, B. F. (2007). Prevalence, correlates, disability, and comorbidity of DSM-IV alcohol abuse and dependence in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Archives of General Psychiatry, 64(7), 830–842.
- Shonkoff, J. P., Garner, A. S., Siegel, B. S., Dobbins, M. I., Earls, M. F., McGuinn, L., … others. (2012). The lifelong effects of early childhood adversity and toxic stress. Pediatrics, 129(1), e232–e246.
- Vogelsmeier, A., & Scott-Cawiezell, J. (2011). Achieving quality improvement in the nursing home: Influence of nursing leadership on communication and teamwork. Journal of Nursing Care Quality, 26(3), 236–242.
- Westrick, S. (2014). Nursing Law and Ethics 297-298
