MMU Elective Placement 2019

GLOBAL PESPECTIVE OF NURSING – ELECTIVE PLACEMENT Margaret InyangAbout The Elective Placement Elective placement : • Children Ward • Patients age range : 0 – 17 Years • Care Delivery : Illness, injuries, parents education • Care Team : Paediatric consultants, junior doctors, nurses, healthcare assistanceAbout The Elective Placement Unit• Neonatal intensive care unit • Paediatric high dependency unit • Paediatric observation and assessment unit • Paediatric general medical/surgical ward. Operating Method• Handle referral from patient GP and from A&E including other Trust who might need their services due to lack of beds for the patient or qualified staff.About The Elective Placement Rational for choice• To learn what role nurses play in paediatric healthcare delivery. • To develop knowledge of the challenges faced by nurses in delivering care to children and managing parents/carers. • To witness how nurses conduct can impact care from babies that can’t express themselves to teens.About The Elective Placement Rational for choice• To see how nurses are uniquely positioned to support and work in partnership with the family for the child’s health and wellbeing. • To expand my clinical knowledge in addition to my other placement which has not involved working with children. • Being an observe only elective, it gives me an opportunity to improve my self – awareness in the context of a nurse and as a mother with young children.Case Study About the Patient• In accordance with the confidentiality within the code (NMC 2015) the Patient name has now been changed and hereby referred to as Joe • Joe, a 10 -months old baby was presented at a different A&E and reported to have had a fall. • Suspected of possible brain injury by A&E • Needed further assessment and monitoringCase Study Patient Journey• Joe and parents arrived the Children Paediatric Observation and Assessment Unit being referred from a different A&E • The Ward was busy and understaffed • No paediatric doctors, only junior doctors, nurses and healthcare assistance • Joe’s mother complained that despite the importance of quick assessment raised by A&E Joe has not been seen after 2 hours.Case Study Patient Journey• A doctor (not on duty at the ward) offered to see some patients but declined to see Joe because he overheard the parents complaining. • Parents decided to self -discharge Joe after waiting without any care. • After parents left with Joe, the nurse in charge called Social Service and reported the self -discharge.Care Evaluation & Learning Outcomes Care Delivery• This case study was selected to highlights a failing in the delivery of care as it reflects on the nursing role. • Holistic patient assessment and care was not achieved. • The nurse and the doctors failed in applying the value principle of holistic care in practice as regarding assimilation in how the nurse defined the parents’ attitude as a basis of making clinical decisions about health and treatment of the child. • Joe did not receive quality and patient -centred care.Care Evaluation & Learning Outcomes Collaboration & Communication• According to Morrison (2004), it is important that parents receive support during a child critical illness to assists parents with coping and managing their stress. They should be provided expert care with accurate and consistent information. • The parents in this case study did not receive the support needed in managing their stress. • The was a gap in the handover of that case as the unit failed to provide the patient with the right care but kept Joe in the waiting area for hours without being assessed.Care Evaluation & Learning Outcomes Collaboration & Communication• The doctor refused to see the patient because the mother was complaining and the nurse acceptance showed a failing of communicating the urgency and sensitivity of the case. • There was a breakdown in communication between the nurse and the doctor, resulting in the lack of collaboration and continuity of care between the referring A&E and the children unit.Care Evaluation & Learning Outcomes Self Awareness• Muscara et al (2015) studies found that a diagnosis of life -threatening childhood illness or injury can lead to significant distress reactions in parents. These findings were supported by Morrison (2004) who stated that “admission of a child to an intensive care unit, whether planned or unplanned, can be a daunting and distressing event for any parent”.Care Evaluation & Learning Outcomes Self Awareness• There was a lack of self awareness from the healthcare team and care was coloured with the prism of bias. • Self -awareness from the nurse on the parents’ experience should have highlighted that complain from the parents especially due to the delay in the assessment was a normal stress response to an abnormal situation.Key Learnings • In nursing practice, prioritisation of the patient need for care is an essential nursing skills which is an integral to our daily activities. • Lake and Duke (2009) highlighted that prioritisation is an intricate and complex clinical decision -making that requires nurses discretionary judgment with an ongoing assessment to determine the relative importance of the many aspects of individual patient situations as they unfold between the competing or even conflicting needs of the several individual patient presentations within the nurse’s caseload.Key Learnings • During the placement, I was able to witness and identify how self -awareness and communication issues are taken for granted by the nurses and how they can affect the prioritisation and delivery of holistic care to patients. • I learnt that while nurses interact with patients, patient families and visitors, medical staff (both consultants and other health professionals) , our role are interwoven with a myriad of other requirements from patients, ourselves and colleagues, hence we need to be aware of our biases and the need to separate it from influencing our clinical decision making process.Key Learnings • During the delivery of care, a nurse should not judge parents or carers based on their personal belief and disposition. Maxton (1997) research found that nurses sometimes place their our own values, beliefs and perceptions on the parents. • Because a nurse is familiar with the care process and also emotionally unconnected with the patient, we need to identify with the findings of Muscara et al (2015) which explained that for such parents to negotiate a path through complex diagnostic and treatment processes can overwhelm even to the most resilient parents.Conclusion • In concluding, I have highlighted some of the outcomes and learnings points during the elective placement. • The skills and learning are anchored on my personal and deep reflection as I observed the daily activity and nursing role with a view to gaining such insights. My experience aligns with Claxton (1997) which argued that reflection on activity leads to a recall of some detail in the gestation of subconscious understanding that can eventually result in a new insight.References • Claxton, G. (1997) ‘ Hare brain tortoise mind: how intelligence increases when you think less’ . Hopewell, NJ: Ecco Press. • Lake, S., Moss, C. and Duke, J. (2009) ‘Nursing prioritization of the patient need for care: A tacit knowledge embedded in the clinical decision -making literature’. International Journal of Nursing Practice , 15:5 pp 376 -388. • Maxton, F. (1997) ’Old habits die hard: changing paediatric nurses' perceptions of families in ICU’. Intensive and Critical Care Nursing , 13:3 pp 145 -150. • Morrison, A. (2004) ‘Stress in parents of children in the paediatric intensive care unit’. Paediatric Critical Care Medicine , 5:6 pp 585 -586. • Muscara , F., Burke, K., McCarthy, M., Anderson, V., Hearps , S., Hearps , S., Dimovski , A. and Nicholson, J. (2015) ‘Parent distress reactions following a serious illness or injury in their child: A protocol paper for the take a breath cohort study’. BMC Psychiatry , 15:1

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