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18 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Records keeping
"An integral part of nursing and midwifery practice. It is essential to the provision of safe and effective care." NMC, 2008 |
Nursing records can be used as legal documentation in a court of law (Dimond, 2008)
Record keeping is an essential part of nursing and is essential to the provision of safe and effective care. (NHS professionals, 2010) High quality information underpins the delivery of high-quality, evidence based healthcare. Information is most valuable when it is accurate, up to date and accessible (DOH, 2006) |
Healthcare staff need to know the symptoms, duration and Alex's usual behaviour. Vital obs plotted on a PEWS give an indication of improvement or deterioration. A fluid balance chart must be kept and a drug cardex clear and accurate. Clear records allow the MDT to follow the care plan. If it hasn't been documented it hasn't been done.
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Family centred care
"A way of caring for children and their families within health services which ensures that care is planned around the whole family, recognising that the whole family are care recipients. |
FCC understands that parents are a constant in children's lives,nurses are not (Jolley & Shields, 2009)
Judgmental attitudes of healthcare staff and hinder FCC (Shields, 2011) Families may feel guilty if they don't or can't provide care (Shields, 2010) FCC is limited by its lack of empirical evidence (Jolley and Shields, 2009) |
FCC in the case study involves Sophie and Dee caring for Alex. Sophie can consent to medical treatment for Alex and is supported by Dee. Nurses need to understand this dynamic without judgement.
Both Sophie and Dee need supported and involved with Alex's care. |
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Children's rights
"Based on what a child needs to survive, grow, participate and fulfill their potential. Rights apply equally to every child regardless of who they are or where they are from" |
Article 12 of UNCRC states children have a right to a say in decisions affecting them. (Unicef)
Children and their familioes should be encouraged to be active partners in decisions about their health and care and where possible, be able to exercise choice (NSF, DOH, 2008) In making any decisions in relation to the child, service providers should give due consideration to their wishes and feelings, having regard to the child's age and understanding (Children act, 1989) |
Healthcare decisions for Alex must be made by Sophie. Although Sophie is only 17 years old she can consent to treatment as her PND is not affecting her judgement. If Sophie refused consent to life saving treatment the hospital could apply to a court of law for consent. The principles of the child's best interests underpins all legal precedents (Dimond, 2008)
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Advocacy
"Having respect for the patients autonomy and supporting their decision, even if you disagree with it" |
Confusion often arises between acting as an advocate and acting in the best interest of the child (Charles-Edwards, 2013)
Advocacy viewed as central to the care of the child due to their perceived vulnerability and developing maturity (Hawlin, 2008) Advocacy requires a good nurse/patient partnership (Shields, 2011) |
Sophie will be making decisions for Alex and so is not advocating for her but is acting in her best interests. Nurses will need to listen to the wishes of Sophie and Dee as well as using their professional judgement to understand and respond to Alex's needs
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Collaboration
"Care and support built around the needs of the individual, their cares and family. It is vital that every single person is treated with compassion and respect" (National collaboration for integrated care & Support, 2013) |
To deliver person centred care, information about them needs shared with patients and care providers (NCICS, 2013)
Nurses need to recognise how much families want to be involved in care (RCN, 2013) Patient staff interaction model of care (2002) |
Dee is the driver of Alex's care as she detected her deterioration and worked with Sophie to get Alex assessed.
Once the diagnosis was made the assessment unit worked in collaboration with Dee, Sophie, Alex, the ward, healthcare staff to ensure urgent, high quality care was given. |
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Inter-professional working
" Such collaboration is facilitated in contexts where professionals, tasks and goals are clearly established and where feedback is the norm" |
Hospitals with high team work ratings experience higher patient satisfaction (Ezzione, 2012)
Each professional brings their own unique assessments (Jones, 2006) Decision making risks professionals conforming to the group and losing their professional voice (Ezzione, 2012) |
Information was passed from Dee and shared by the MDT. professionals need to work together to transfer Alex's care. SBAR could be utilised with staff asking Dee and Sophie for more information. Such collaboration allows for a care plan to be developed.
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Information sharing
"Person identifiable confidential information shared with that individual's express consent to allow agencies to work together to provide services to the individual. (inter-agency information sharing protocol review group, 2012) |
Means the patient and their family don't have to repeat the same information.
SBAR allows for concise and accurate informaton sharing (Wacogne & Diwalier, 2010) Child friendly information & education enables active participation & consultation with children and families.(RCN, 2003) 70% of preventable medical errors due to poor communication (Wagner, 2011) |
By sharing Alex's information, her care needs can be shared with the MDT. Dee and Sophie need to be fully included in this sharing although Sophie could withdraw consent for Dee's involvement. Information about Sophie's PND, although not relevant, could be useful in ensuring she is well supported.
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Negotiation
"Negotiation and influencing are important skills in public health as professionals lead without any real authority and as such are reliant on behaviour and skills when trying to influence others towards a particular goal (Health knowledge, 2013) |
The primary focus of the nurse is to assist the child in YP & their family to prevent or manage the physiological, physiocal, social, psychological and spiritual effects of a health problem/condition and it's treatment (RCN, 2003)
Nursesview themselves as hosts of care and families view them as guests. (Harrison, 2010) Mutual understanding and co-ordinated sharing of interests,aimed at common goals in the clients healthcare (Sousa et al,2013) |
Alex's care is a result of negotiation between Dee, Sophie, NHS direct and the MDT.
Nurses also need to negotiate with Sophie to aid her understanding that she is not a bad mother. Nurses need to negotiate between Dee and Sophie the care they will provide for Alex within the hospital and after discharge. |
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Role of the nurse
"The purpose of nursing is to promote health, healing, growth,and development and to prevent disease, illness, injury and disability. Nursing interventions are concerned with empowering people based on dignity, autonomy,holism, personal accountability & partnership (RCN, 2003) |
Facilitate reciprocal relationships with families (RCN, 2003)
Nurses act as gatekeepers setting limits on what tasks parents can and can't do (Priddis and Shields, 2011) Nurses transform the hospital into a warm, safe place (Sousa et al, 2013) Nurses role in shared care is based on criteria related to the characteristics of the parents and the reason for the hospital admission (Sousa et al, 2013) |
Alex should be given a named nurse upon her arrival to the ward. The nurse should assess Alex'ssafetyby assessing the ability of her carers and their needs,identifying a suitable bay or side room and building a therapeutic relationship with Sophie and Dee.
The nurse should use a model of care to ensure Alex's needs are met and include Dee and Sophie in all decisions related to Alex. The nurse will need to keep clear and accurate records and be able to understand observation readings. |
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Policy and protocol
"Protocol based care enables NHS staff to put evidence into practice by addressing the key questions of what should be done, when,where and by whom, at a local level. It provides a framework for MDT and standardises practice to improve quality of care (NHS institute for innovation and improvement, 2008) |
Development of multi agency child health services (RCN, 2003)
NSF children (DOH, 2008) Gillick competence (Dimond, 2008) Clinical governance focusing on children (DOH, 2003) |
Policy stating only consultants should treat children with meningococcal meningitis. protocol when referring care. Care pathway. Policy relating to meningitis admission, care and discharge
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Communication
"Communication is a major part of safe and effective team work ensuring tasks are successfully delivered (Leplat, 1991) |
e-communication leads to fragmented relationships among staff (Ezzione, 2012)
All information should be shared with parents (Shields, 2011) Sharing information with children and parents (DOH, 2003) You must keep collegues informed when sharing care (NMC, 2008) Poor communication is a risk factor for adverse healthcare events (NPSA,2008) |
Alex communicated her illness to Dee by changing her normal behaviour, Dee picked up on these cues.
Communication on Alex given from Dee and Sophie to MDT. SBAR used as a framework to pass communication to MDT. Dee and Sophie need to be involved in communication about Alex to understand her needs. |
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Empowerment
"The process of enhancing the capacity of individuals or groups to make choices and to transform those choices into desired actions or outcomes |
Nurses must provide education to promote and enable active participation and consultation with children and families (RCN, 2003)
FCC considers families as full partners in the provision of children's healthcare (Harrison, 2010) Nurses must recognise family strengths and individuality and different coping methods (Shields, 2011) |
Sophie needs reassurance and information to empower her. Nurses and Dee can focus on the bond she has with Alex (Meins mind-mindedness)
Sophie will continue to rely on Dee as part of her developmental continuum where she is still developing her sense of parental independence (Neill, 2010) |
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Education
"The NHS is responsible for helping people to improve their health and well-being. The NHS' role in preventing poor health and promoting healthy living is essential to reduce health inequalities and sustain the NHS for future generations (NHS future forum,2013) |
Child friendly information and education to promote and enable active participation & consultation with children and families (RCN, 2013)
Health promotion 'make every contact count (RCN, 2013) Prevention & health promotion (DOH, 2003) |
the MDT need to work with Dee & Sophie to educate them on meningitis effects, treatment & mortality so they can feel reassured, involved and able to make informed decisions about Alex's care. Sophie has only been a parent for 10 months so it isn't surprising she didn't spot the signs of meningitis.She still needs education and support to empower her
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Parents as carers
"A carer is someone who is responsible for providing and arranging care for someone who can't care for themself. Being a carer includes anything from giving emotional support through to providing extensive practical support to enable their life from day to day (mind, 2013) |
Healthcare providers must recognise family as experts in the care of the child (Harrison, 2010)
If nurses understand the role of parental anxiety they may feel less threatened by parents (Priddis & Shields, 2001) |
Sophie is a single parent and, at 17 years of age she is still learning. Dee cares for Alex and was also Sophie's carer as Sophie recovered from PND. Dee has no parental rights for Alex although she has a strong bond with her. Understanding this relationship and Dee's importance to the family unit is part of FCC and will help the MDT to relate to the family.
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Safeguarding
"Any nurse who has direct or indirect contact with children must be able to identify when they are at risk of harm or abuse and act accordingly (RCN, 2003) |
Nurses have a role to safeguard (RCN, 2003)
Nurses feel duty and legally bound to assess parents competence before allowing them to undertake any procedures (Harrison, 2010) Maternal sensitivity (Degatardi & Sweller, 2011) Nurses role in shared care based on criteria related to the characteristics of the parents and the reason for the hospital admission (Sousa et al, 2013) |
Sophie was planning to leave Alex in the care of Dee while she went out but her night out was abandoned when Dee alerted Sophie to Alex's condition. Had this not been the case it could have been seen as neglect. Nurses & healthcare teams will be vigilant for any signs of abuse but the evidence so far does not suggest and abuse present.
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Decision making
"People need to be fully informed about the potential consequences of the choices open to them. Practitioners need to ensure that people have access to accurate and appropriate information to make their best decisions (DOH, 2007) |
Children have a right to self determination (Moore & Kirk, 2010)
Novice to expert (Banning, 2007) Information-procession model uses hypo-thetico deductive approach which assumes nurses ability to follow rational logic using experiences and current situation (Banning, 2007) The person obtaining consent must have sufficient knowledge to provide necessary information and have sufficient experience to make necessary assessment of the person providing consent (Wright, 2011) |
Dee made the decision to seek help for Alex, using her experience as a mother and grandmother and using her knowledge of Alex. Sophie did not have this knowledge. The diagnosis and treatment decision was based on a recognised care pathway (Nice, 2008)
FCC ensures decisions are made with the inclusion of Sophie and Dee. |
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Family dynamics
"Families are much more than groups of individuals. The family unit has it's own goals and aspirations. They are also places where every child should feel special, safe and able to aspire (healthy children, 2013) |
Baumrinds parenting styles-Authoritarian, Authorititive, Permissive and uninvolved (Moore& Kirk, 2010)
Maternal presence during medical tasks are related to greater adherence (Hafetz & miller, 2010) Children and YP nursing underpinned by beliefs based upon the patient, their stutus, rights withing the family and society (RCN, 2003) Family are a constant in children's lives, services are not (Shields, 2011) |
the MDT need to understand the family unit to understand how they function and support each member. Dee supports Sophie and her recovery from PND by caring for Alex. Alex will have a strong bond with both Sophie and Dee. In the hospital both DEE and Sophie's presence will help Alex to feel safe and secure. Care needs to be taken to ensure both Sophie and Dee are equal in Alex's care.
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Models of care
"Nursing models provide a knowledge base concerning the nature of people and their health-related needs which is central to good quality care. |
FCC by including families in care, higher quality care is provided (Harrison, 2010)
FCC does not have a lot of evidence to support it's application (Harrison, 2010) Activities of daily living not child oriented. Orem's model of self care unsuitable for very young babies. Casey's partnership in care (1998) forms the basis of FCC |
Alex is dependent on Sophie and Dee to meet all of her needs. The most likely model incorporated Mazlow's hierarchy of needs with who can provide for these needs. The FCC takes into consideration the care that Sophie and Dee provide for Alex and includes them in all aspects of Alex healthcare needs
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