Principles of Paediatric Nursing Practice | Case Study

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This essay will reflect on the principles of nursing practice in relation to my practice experience. A case study of a child and family I provided with care is presented in this essay and shall discuss how the care provided to the child and his family reflects the three principles of nursing applied during this episode of care. This shall demonstrate my knowledge of the principles of care based on evidence-based literature. In addition, the professional, legal and ethical frameworks that guide nursing will be explored. Furthermore, I will discuss the implications in relation to my future role as a child nurse highlighting my rationale behind the selected child and family. In this essay, I shall maintain confidentiality by using pseudonyms when referring to individuals and organisations involved in accordance with the Nursing and Midwifery code for professional practice (Nursing and Midwifery Council (NMC 2008). I will be using the name Andrew when referring to the patient.

Principles of nursing practice involve eight statements published by the Royal College of Nursing (RCN 2012). These principles apply to all nursing staff and tell what the public can expect from nursing practice, whether they are patients, families, friends or carers of patient (Watterson et al 2012). According to RCN (2012) the principles of nursing practice were developed by patients, nurses and others involved in healthcare to put in place values that can be supported by everyone. This was introduced by the RCN incorporation with the NMC, Patient and Service Organisation and the Department of Health (DOH). They were put in place to show service users and their families what they are to expect from nursing practice regardless of whether the provider is a registered nurse, practitioner, nursing student or health care assistant (RCN 2010). The principles of nursing practice consist of eight principles which provide a dominant framework for achieving good quality nursing care and excellent nursing’s involvement to improve healthcare outcomes and patient experiences (Manley et al 2011). These also explain how nurses must treat their patients with humanity and dignity, be responsible for care provided, manage risks, keep their knowledge and skills up to date, provide person centred care, communicate with their patients and work collaboratively with other health and social care professionals (Calkin 2010). The chief executive and general secretary of RCN highlighted how unique these principles are and how they bring the public together in one place and the expectations of nurses. He also pointed out how the principles have been designed to help patients, carers, nursing staff, organisations and decision-makers to know exactly what quality nursing care should look like (Carter 2010).

The NMC Code of Professional Conduct encourages health care professionals to provide high standard care and all care givers are expected to work within its framework and guidelines (Dolan and Bolt 2008). The code of is a set of rules that all nurses and midwives should follow in order to provide good practice and it also reminds them of their professional responsibilities. The code highlights the behaviour, ethics and performance expected from nurses and midwives in United Kingdom. The main purpose of the code is to safeguard the well-being and safety of the public. According to the NMC Code care givers must respect everyone and treat them with dignity. It also encourages nurses to take special care when vulnerable people are concerned (Herman Miller 2012). The code is also used as a tool to see if a nurse or midwife is fit to practise when their fitness to practise is questioned (Goldsmith 2011).The code is used as a guide for daily practice for nurses and midwives. The NMC also has other standard, guidance and advice alongside the code that are used to support professional development.

During my practice placement, I provided care to Andrew, a new born baby who was admitted to the ward I was placed. His mother took methadone while she was pregnant. Andrew was brought to the ward because he was presenting with some withdrawal symptoms such as diarrhoea and vomiting, fever, hyperactive reflexes, seizures and blotchy skin colouring. Doctors suspected neonatal abstinence syndrome (NAS) on Andrew. This occurs in newly born babies whose mothers abuse illegal or prescription drugs while pregnant. When the mother takes the drugs, the drugs will get passed through the placenta to the baby, this causes the unborn baby to be addicted to the drugs along with the mother. The baby will still be dependent on drugs whilst in the mother’s womb. After birth the baby will show some withdrawal symptoms because they will no longer be exposed to drugs (Vucinovic et al 2008). Andrew had severe symptoms which means he needed to be constantly monitored. Substance-using pregnant women represent a high-risk population; their substance-use has an impact on their own health and wellbeing as well as that of the developing foetus (Oikonen 2012). Babies born to a substance-using pregnant mother have high chances of developing withdrawal conditions in the immediate post-partum period; this is known as neonatal abstinence syndrome (NAS)

Part of my role as a nursing student in that unit was to observe the principles of nursing practice to ensure patients and their families are fully informed and provided with help that they needed to make decisions about their children’s care. Andrew’s mother was still using methadone and was known to be very reluctant and disengaged with healthcare resources and needed to be prompted about Andrew’s needs during her presents on the ward. Sometimes she would leave the baby unattended without informing the nursing staff of her whereabouts. There were also some situations whereby Andrew’s mother was kept away from Andrew especially when she is under the influence of drugs. It was our duty to ensure safety is maintained at all times.

I am going to be looking at how principles D, E and G were reflected on the care provided to Andrew and his family. Principle D states that nursing staff should provide and promote individualised care that enables patient centred approach. The patient centred approach is about looking at an individual’s personal preferences and concerns. This should include patients, families, service users and their carers and involve them in decisions and help them make informed choices about their treatment and care (National Institute for Health and Care Excellence (NICE 2012). In Andrew’s case family centred care was also provided. Family centred care aims to work with a child’s parents or guardians in order to effectively meet the child’s needs (Bowden el al 2011). According to HM Government (2004) on Every Child Matters, children will have the best outcomes through agencies working in partnership with families. The Children Act (2004) emphasises the need for all children’s services authorities in England to be aware of the importance of parents and other person’s, caring for children when trying to improve a child’s well-being. The benefit of partnership working needs to be communicated clearly to families and reinforced with positive practitioner’s attitudes, approaches and plans. Andrew’s mother was not always there for him, but the nursing staff made sure that she was regularly updated about Andrew’s condition and the treatment available for him. She was also reassured that there was a good family team which was ready to assist her whenever she needed help. Information concerning her own condition was also provided to her to enable her to get help and support that is tailored made for her. We were able to understand Andrew’s mother as an individual and show compassion and commitment in the provision of care as stated by the Chief Executive & General Secretary of the RCN (RCN 2012). A care plan which looked at Andrews care needs was produced by the nurses. This helped all the nurses who cared for Andrew see what his individual needs were. This care plan promoted person centred care because it just looked at Andrew’s condition and what his needs were. NHS Commissioning Board encouraged all staff, nurses and midwives to embrace the values of nursing care and comply with the 6Cs. The 6 Cs where brought about by a strategy called Compassion in Practice introduced by the NHS Commissioning Board and DOH. These include caring, compassion, commitment, courage, competence and communication (Ford 2012). According to Chief Nursing Officer for England, the values are there to make sure nursing staff provide their patients with the best care with compassion and clinical skill (Cummings 2012).

As a future child nurse, my first priority was Andrew. According to the safeguarding children, a person working in a sector where there is contact with children and/or their families has a duty to safeguard and promote the welfare of children. I and all the other nursing staff worked closely with each other and all multidisciplinary teams (MDT) involved in Andrew’s care to ensure care and treatment was delivered in high standards, communication was also maintained to allow continuous care across teams. This is stated in Principle G of the principles of nursing practice and in addition to this, the NMC (2008) expect nurses to refer patients to another practitioners when it is in the best interest of someone in their care. Andrew was referred to other professionals such as dietician to meet his nutritional needs, social worker to safeguard him and have access to other agencies that provide services to vulnerable children and physiotherapist. The physiotherapist was there because Andrew had Metatarsus Adductus which is a deformity of the feet. He was demonstrating and educating the mother about exercises she could give Andrew in order to help his feet. He also advised her to keep mobilising Andrew so that he can have the ability to move his limbs.

Principle E states that all nurses should be at the centre of all communication. They should assess documents and report on treatment and care. They should sensitively and confidentially handle information, be able to effectively deal with complaints and should always report situations they are concerned about (RCN 2008). Effective communication was very much maintained when Andrew’s care was concerned and throughout the MDT. Andrew’s mother would always be updated when there was any change in Andrew’s health or care. She was informed about Andrew’s treatment and all other information such as referrals to other professionals regarding Andrew’s condition. During these episodes, there were some people visiting and some calling the ward claiming to be Andrew’s close relatives, they also requested some information about Andrew’s condition, but we could not provide them with any medical information because all the nursing staff were aware of confidential issues. An element of education was also given to his mother because it seemed like she did not know a lot about Andrew’s condition. The nursing staff on the ward also maintained a record of Andrew’s mother’s movements and behaviour for Andrew’s safety.

During my stay in this placement area, I had the opportunity to witness a MDT meeting. They held a case conference regarding Andrew’s welfare. The meeting was held because Andrew’s mother wanted to be transferred to a hospital closer to Andrew’s father in order to get some support. This meeting involved other professionals and agencies such as nurses, social workers, doctors, police, health visitors and the safeguarding children’s team. The agenda of the meeting was to decide on whether to transfer Andrew and his mother to fulfil her wish and also to share information concerning safeguarding and protecting the welfare of Andrew. Every child matters (2009) expresses how effective information sharing by professionals is essential to protecting and promoting the welfare of children. In this meeting I observed all participants contributing information regarding Andrew’s care. According to the United Nations Children’s Fund (UNICEF 2013), every child in the UK has the right to be healthy. UNICEF works with families, communities and the government to protect the rights of children. It works with the government to ensure that laws and policies work in the best interest of children (UNICEF 2013). In this process Principle G was being applied, which states that all nurses and nursing staff should work collaboratively within their team and hand in hand with other professionals. They should make sure care and treatment provided for patients is co-ordinated and of high standard with the best possible outcome (RCN 2008). Principle G encourages collaborative practice, which is when different health care professionals work alongside each other in order to deliver the best quality of care. It lets health care professionals connect with other professionals who may have the skill achieve goals other professional cannot (World Health Organisation 2010).

My rationale for choosing Andrew and his family as the subject of this essay was for me to reflect on his case. It was a very interesting experience which gave me an opportunity to carry out a research on matters of safeguarding children. I have acquired some knowledge and understanding about NAS and the issues around the care of children and the application of the principles of nursing practice. In this episode of care, I have learnt a lesson in situations that staff nurses need to be aware of when planning to deliver and develop patient care. I have also learnt that patient centred care is essential when carrying out my duties in my future role as a child nurse (Dougherty and Lister 2011). As a student nurse I am now aware of the importance of applying principles of nursing practice that help guide nursing staff to deliver good care. I also learnt to be understanding and non judgemental when it comes to patients and their families. Spouse et al (2008) highlighted the requirement of commitment to be an effective tool for nurses, in order to develop effective relationships with patients and their families and also being concerned about their well-being and best interests. She also expressed the importance of nurses’ availability and open to patients and avoiding distancing themselves from patients.

This essay has explored three principles of nursing practice in relation to my practice placement experience. A case study of a patient and family provided with care has been discussed and professional, legal and ethical frameworks that underpin nursing practice have been provided. However, nurses should ensure that the principles of nursing practice are always observed in order to allow the delivery quality care.

References

Bowden V and Greenberg C (2011) Paediatric Nursing Procedures: Principles of Family-centred care

Every Child Matters (2009) Change for children available at https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/257876/change-for-children.pdf (accessed on 26 March 2014)

Ford S (2012) All NHS staff told to embrace nursing 6Cs (online) at http://www.nursingtimes.net/nursing-practice/clinical-zones/management/all-nhs-staff-told-to-embrace-nursings-6cs (accessed on 20 March 2014)

HM Government (2004) Every Child Matters: Change for Children available at http://m.nottinghamcity.gov.uk/CHttpHandler.ashx?id=13383&p=0 (accessed on 26 March 2014)

Dougherty L and Lister S (2011) The Royal Marsden Hospital Manual of Clinical nursing Procedures 8th edition Wiley-Blackwell

Manley K, Watts C, Cunningham G and Davies J (2011) Principles of Nursing Practice: development and implementation Nursing Standard 25 (27): 35-37

Nursing and Midwifery Council (2008) Code of Conduct of Professional Conduct: standards for conduct, performance and ethics NMC

Oikonen JM, Montelpare WJ, Bertoldo L, Southon S and Persichino N (2012) The impact of clinical practice guideline on infants with neonatal abstinence syndrome British Journal of Midwifery 20 (7): 493-501

Royal College of Nursing (2012) The Principles Of Nursing Practice (online) at http://www.rcn.org.uk/development/practice/principles (accessed on 20 March 2014)

Spouse J Cook M and Cox C (2008) Common Foundation Studies in Nursing 4thedition Churchill Livingstone

Vucinovic M, Roje D and Vucinovic Z (2008) Maternal and neonatal effects of substance abuse during pregnancy: our ten year experience. Yonsei Medical Journal 49(5): 705-713.

http://www.nice.org.uk/newsroom/pressreleases/PatientExperienceQSAndGuidance.jsp

UNICEF (2013) Working for Children worldwide (online) at http://www.unicef.org.uk/ (accessed on 26 March 2014

Nursing Commissioning Board (2012) Compassion in Practice Nursing, Midwifery and Care Staff Our Vision and Strategy, Available at http://www.england.nhs.uk/wp-content/uploads/2012/12/compassion-in-practice.pdf (Accessed 13 March 2014)

http://www.ncbi.nlm.nih.gov/pubmed/24435188

http://www.nlm.nih.gov/medlineplus/ency/articlej/007313.htm

http://www.ncbi.nlm.nih.gov/pubmed/24435188

http://www.nmc-uk.org/Documents/Guidance/NMC-Guidance-on-professional-conduct-for-nursing-and-midwifery-students.PDF

http://www.nursingtimes.net/nursing-practice/clinical-zones/management/new-set-of-principles-for-nursing-care-launched/5022099.article

http://www.rcn.org.uk/__data/assets/pdf_file/0007/349549/003875.pdf

http://www.rcn.org.uk/development/practice/principles#content

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HMGovernment(2004)Every Child Matters: Change for children.London: Department for Education and Skills, Available at http://www.infed.org/archives/gov_uk/every_child_matters.htm

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