200 words1 reference within 5 years1. NoemiNurses and other health professionals have increasingly engaged in proxy reports to promote a high quality of life for children and infants whose age prevents them from reliably self-reporting. They must acknowledge that a patient’s incompetence does not influence their obligation to deliver treatment that reflects a patient’s best interests. The proxy subjective health status for children or those unable to self-report has underlying assumptions and potential ramifications.Caregivers have increasingly applied proxy evaluation techniques to understand the impact of disease and treatment on children unable to self-report. Proxy decisions have triggered concerns regarding the caregivers’ commitment to patient autonomy. Nurses have a challenging obligation to ensure the patient’s best interests align with the treatment decisions when those patients require a representative to speak for them (Germain et al., 2019). An underlying assumption proposes the moral appropriateness of substituted judgment for a proxy decision-maker. Clinicians must acknowledge that proxy decision-making could be ineffective if individual interests influence the proxies’ judgment. For instance, a parent may demand the treatment they want their child to have rather than the treatment the child could have wanted. They may justify the treatment using false information to convince a caregiver to prescribe inappropriate and potentially harmful medical care to the patient. Caregivers should decline proxy requests that fail to reflect patients’ wishes. Physicians must never allow proxy interests to override considerations of what is best for the patients (Dorscheidt & Doek, 2018). The concept of substituted judgment compels clinicians to consider the importance of proxy decisions over the medical interests of patients where those clinical decisions significantly influence the entire family. Unfortunately, in many cases, pediatric decision-making has overlooked the morally best treatment because of limited medical resources.Lastly, many concerns have arisen regarding the reliability of proxy reports. Various recent recommendations have argued that proxy reports are relevant for observable concepts rather than concepts of interpretation such as social functioning. Conducting extensive research on the validity and reliability of proxy reports to children at different developmental stages is paramount. The approach will support the evaluation and promote new and existing measures for effective pediatric decision-making.ReferencesDorscheidt, J., & Doek, J. E. (2018). Children’s rights in Health Care. Brill.Germain, N., Aballéa, S., & Toumi, M. (2019). Measuring health-related quality of life in young children: How far have we come? Journal of Market Access & Health Policy, 7(1), 1618661. https://doi.org/10.1080/20016689.2019.16186612. JorgeDifferent Middle range nursing theories suggest that there are some underlying assumptions of having a subjective health status of proxy. Chiefly, it is assumed that proxy subjective health status is temporal which means that the perception of patients can be altered by themselves, and they can understand what they believe to be a healthy or quality life. According to Eldredge, et al (2016), proxy subjective health status or evaluation measures are measures that the family members or the healthcare provider of the patient complete for their patients. Additionally, a quality- adjusted-life-year (QUALY) is another underlying proxy subjective health status assumption. The extent of health improvement of a patient can be measured through QUALY. Moreover, QUALY evaluates measures for both those who cannot speak for themselves and the children. Additionally, Health-Related Quality of life (HRQOL) instruments can ramify the proxy subjective measures, to define the health status and proxy subject of children and patients who cannot speak for themselves.For more deep assessments for children with communication disorders and problems, there are more different standardized tests that have been made available. When communication problems are considered possible because of factors such as clinical clues, concerns by professionals, and screening test results that turn positive, the standardized test is available for further children evaluation (Owens, 2009). There are some ways that children with communication disorders can be assessed using in-depth assessment. First, the in-depth assessment defines if the children’s problem to speak for themselves is a present disorder. A baseline for progress measurement is established and treatment outcomes are evaluated through an in-depth assessment. Additionally, a particular diagnosis is established which measures the intensity and particular characteristics of communication problems or disorders (Miller, & Wagstaff, 2011). Last but not least, an In-depth assessment defines if an intervention is designated and helps in intervention strategies planning and treatment target selection.Ramifications are the possible consequences of a decision or action. Therefore, like any other action, proxy assessment for children or patients who are not able to speak themselves has different ramifications. Proxy assessments help to provide clinical information about a patient or children who are not able to speak for themselves. However, during the assessment, the clinic professionals may fail to interpret or get enough information about the patient and as a result, the consequences of wrong medication can arise. Therefore, lack of complete information on the HRQL of the patient may lead to inadequate suffering relief and some clinical decision-making that is optimal (Pickard, & Knight, 2005). Moreover, wrong medication and prescriptions may be offered to the patient when there is incomplete patient information. Additionally wrong prescription with the wrong medication may lead to death or mortality consequences or more complications. When the disease is at advanced stages the patient’s HRQL self-assessment is limited and therefore unable to provide full information which leads to underestimation of the level of health status and wrong medication.ReferencesEldredge, L. K. B., Markham, C. M., Ruiter, R. A., Fernández, M. E., Kok, G., & Parcel, G. S. (2016). Planning health promotion programs: an intervention mapping approach. John Wiley & Sons.SMiller, C. A., & Wagstaff, D. A. (2011). Behavioral profiles associated with an auditory processing disorder and specific language impairment. Journal of communication disorders, 44(6), 745-763.Owens Jr, R. E. (2009). Language disorders. Pearson India.Pickard, A. S., & Knight, S. J. (2005). Proxy evaluation of the health-related quality of life: a conceptual framework for understanding multiple proxy perspectives. Medical care, 43(5), 493.