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Clinical holding: ethical guidance for children's nurses working in the UK
Andrea Page1, Bo Hejlskov Elvén2, Suzanne Seabra3
1Department of Mental Health and Learning Disabilities, Birmingham City University, Birmingham, England.
Insights
This study addresses ethical clinical holding decisions for children, aiming to improve their autonomy and engagement. A proposed ethical framework enhances decision-making, prioritizing children
Area of Science:
- Bioethics
- Pediatric Healthcare Ethics
- Clinical Decision-Making
Background:
- Ethical challenges persist in clinical holding for children and young people.
- Evidence over 20 years indicates suboptimal management of consent, choice, and negotiated practice.
- Best interests decisions often override the wishes of children.
Purpose of the Study:
- To explore ethical decision-making in pediatric clinical holding.
- To enhance the autonomy and engagement of children in healthcare decisions.
- To propose an ethical framework for improved clinical practice.
Main Methods:
- Literature review of evidence over the last 20 years.
- Analysis of ethical challenges in clinical holding.
- Development of a four-level value-based ethical framework.
Main Results:
- Current practices present mixed messages regarding consent and child's wishes.
- A proposed ethical framework offers a structured approach to clinical holding.
- The framework aims to increase engagement, empowerment, and support for children.
Conclusions:
- Improved ethical frameworks are needed for clinical holding decisions involving children.
- Prioritizing child autonomy and engagement is crucial in healthcare.
- The proposed framework provides practical interventions for healthcare professionals.
Abstract:
This article explores ethical decision-making surrounding clinical holding of children and young people in healthcare environments with the aim of enhancing autonomy and engagement on their behalf. A considerable body of evidence, published over the last 20 years, suggests that this complex and challenging area of practice is not always well managed, with mixed messages about the nature of consent, choice and negotiated practice countered by best interests decisions taking precedence ahead of the child's wishes. An ethical framework is proposed comprising four levels of value-based interventions and how they may be applied in clinical practice, allowing for increased engagement, empowerment and support on behalf of children and young people in relation to clinical holding decisions.