By Nadine Carter MBA,BSN,RN,CDMS,CCM
Turning 18 is one of those life transitions where a child thinks that they have instantaneously become an adult. Many celebrate this transition with a birthday celebration, graduation from high school and hopefully plans for a future: which may include going to the college of their choice or starting a career.
My granddaughter was ecstatic about turning 18, graduating from high school and moving into a dorm at college. She was on her own and no longer subject to her parents’ rules. All was going along fine until one day when she experienced severe abdominal pain. She called me to discuss her symptoms and being a nurse, I asked the prerequisite questions to assess if this was a true emergency: what she had eaten, had she moved her bowels, what was the exact location of the pain, what type of pain was it, etc. After a short discussion, I recommended that she go to an urgent care center to be examined. Being a struggling college student, she stated that she did not have money to go to an urgent care center. She was on her parents’ insurance policy but needed the $50 copay. I notified her father, my son, that she was going to an urgent care center and needed the copay which he promptly sent to her. Her roommate, a friend since the 6th grade, accompanied her to the urgent care center.
I later received a call from her friend stating that the nurses and doctors at the urgent care center told her she could have appendicitis and needed to go to the nearest emergency room immediately. They called an ambulance to transport her. I told her friend to let her know I would notify her parents as this situation had escalated into a medical emergency.
So, what happens when you are 18 years old, which is considered an adult in the state where you reside, and there is a pandemic in place? Total chaos…
Her parents met her at the emergency room but were not allowed into the hospital due to COVID restrictions. Even though she might be experiencing a medical emergency and was terrified, she had to do it alone. Her parents were told they would be notified if she needed surgery but until that time, they just had to wait outside until the hospital contacted them. They proceeded to run several tests, take bloodwork, and ask a zillion questions, most of which my granddaughter could not answer. It was a challenging situation for her, her parents, her friend, and me: who were patiently waiting at home for an update.
Thankfully, appendicitis was ruled out, but further testing continued until they could pinpoint the cause of her pain. She was kept in the emergency room overnight, and her father wound up spending the night in his car in the hospital parking lot. The following morning, they were waiting for the results of the testing and still did not have a definitive diagnosis. They stated that she would be admitted to the hospital until they could obtain a diagnosis as the pain had not subsided. Hospital staff told my son that they would allow him to visit her once she was transferred to a room. They further stipulated that one visitor would be allowed.
My daughter-in-law and I rode to the hospital the following morning in the hope of seeing her. When we arrived, we were told there was only one person allowed per day, not one at a time, and since her father was already there, we would not be allowed to visit. I tried to tell my son what questions to ask and see if the nurse would speak with me on the phone. He later called me to say that the nurse manager would speak with me. My son and the nurse manager met me at the elevator, and I tried to ask questions to determine the working diagnosis and how long my granddaughter would be kept in the hospital. The nurse manager took pride in telling me that as my granddaughter was 18 years old, she was considered an adult and could relay all the information to me herself. I explained that she turned 18 three months ago and was not an adult in the sense of knowing and understanding what was being done to her body and the implications of the same. The nurse manager was lacking sympathy and stated that she was an adult and I had to talk to her, meaning my granddaughter. I asked for the doctor’s name and phone number, which she would not provide but stated that she would give the doctor my name and number.
The doctor later called and was able to provide the needed medical Information to put my mind at rest. I spoke with him about my granddaughter being treated like an adult based solely on her age and not an assessment of her ability to understand. An emergency room and hospital admission can be a scary experience for a seasoned adult, never mind a teenager who just happens to be 18. She is not old enough to buy cigarettes or liquor, thankfully, but she can make medical decisions without any medical background whatsoever. She had IVs in both arms, a pulse ox monitor, and was receiving medications that she was not told the name of, so she could not repeat the information to me.
As a nurse, I was very disappointed by what I saw, lacking standard nursing processes and assessment. While I realized that there was a pandemic, which led to different rules being followed, we as nurses can never dispose of the basics which is assessing our patients completely and advocating for their needs. My granddaughter was terrified and needed someone with her to advocate for her and demand an explanation of her medical treatment so that she knew what was going on. Medical tests, medications and treatments needed to be explained at a level that she could understand and repeat. If she was really being treated as an adult, then she had the right to say that she needed the nurse or doctor to speak with her parents about her care. They spoke to her in medical terms, and she did not understand any of it.
ANA, the American Nurses Association, defines the nursing process as, “The common thread uniting different types of nurses who work in varied areas is the nursing process—the essential core of practice for the registered nurse to deliver holistic, patient-focused care.” They further define the nursing assessment, “An RN uses a systematic, dynamic way to collect and analyze data about a client, the first step in delivering nursing care. Assessment includes not only physiological data, but also psychological, sociocultural, spiritual, economic, and life-style factors as well.”
Unfortunately, the nursing process and assessment were not performed correctly, using the pandemic rules as an excuse. If they had a blind or deaf person, accommodation would need to be provided. A senior citizen who could not advocate for themselves would be allowed a companion to assist. The same consideration should have been given to an 18-year-old. If properly assessed, it would have been clear that she was struggling and wanted her parent(s) with her since proper explanations were not being provided.
My granddaughter was very happy about her transition to adulthood. However, she quickly realized that she was not a full-grown adult and still needs her parents at least in some situations, medical crises being one of them. Thankfully, a diagnosis was obtained, proper medication was given, and she was discharged back to her dorm without further complications.
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References: American Nurses Association. (n.d.) 5 Core Areas of the Nursing Process Explained. Website. Retrieved May 26, 2023, from https://www.nursingworld.org/practice-policy/workforce/what-is-nursing/the-nursing-process/
Bio: Nadine Carter is a goal and result driven Master graduate with 30+ years of varied experience in leadership and executive roles in various areas of the healthcare industry including case management, utilization management, managed care, transitional care, acute care, group health, and managed long-term care; 30+ years of experience in Case Management. Nadine possesses keen knowledge of case management, utilization management, transitional management, quality management, population management, risk management, improving of policies to improve efficiency and reduce costs, department organization, and personnel performances. She possesses exceptional analytical ability, particularly in developing and managing key performance indicators to ensure quality and financial success. She also understands and possesses ability to simultaneously manage prominent levels of compliance, client service and profitability. Nadine has been affiliated with CMSA since 1996, Past President of NJ Chapter 2003-2004, past Secretary of the Atlanta, GA chapter, current Atlanta, GA chapter President and Secretary of National, 2021-2023. Chair and/or member of multiple CMSA national committees. She is currently Chair of CMSA Membership Committee, 2022-2024, and a Member of the Editorial Review Board for the Professional Case Management Journal.