nursing_grand_rounds-3.pdf
Pediatric Grand Rounds
NURS 421-Children of the Family
NURS 421-Children of the Family
- Purpose of the Assignment
- To provide the student an opportunity to integrate knowledge from the sciences, developmental theory and physical assessment data to the care of a pediatric patient and family in the acute care setting. The student will utilize critical thinking and independent judgments in presenting a holistic plan of care in a formal oral presentation
- Student Approach to Assignment
- During my pediatric rotation, I worked with a patient with sickle cell disease. I had never seen a patient who was admitted for this disease process, so I wanted to learn more about the disease and possible nursing implications surrounding it. The patient had also experienced some side effects of pain medication, and I wanted to be able to explain the effects to my peers.
- Reason for Inclusion of this Assignment in the Portfolio
- This grand rounds presentation allows me to examine the care provided to a patient. Due to the patient’s needs, I used critical thinking to create a plan of care. The plan included a few teaching elements, which I was able to perform and provide. It was also interesting to me to examine the unique health standards patients with a chronic condition hold compared to others.
- Critical Thinking
- Evaluates nursing care outcomes through the acquisition of data and the questioning of inconsistencies
- Example: In order to decrease her pain, the patient was given morphine, but the doctor had given her the choice to take a digestive prophylaxis or not. Days later, when I had the patient, she was constipated due to this and a lack of mobility. Although not making her walk around meant she did not need to put pressure on her legs, the lack of mobility led to longer pain and decreased intestinal movement. The choice the doctor gave the patient also was ineffective because pain medications can cause slower digestive motility. During our shift, we brought this to the attention of the physician, and had multiple laxatives added to her medications. We continued to evaluate, but no stool had been passed by the time I left the unit.
- Evaluates nursing care outcomes through the acquisition of data and the questioning of inconsistencies
- Nursing Practice
- Performs therapeutic interventions that incorporate principles of quality management and proper safety techniques
- Example: In order to maintain the patient’s safety, I walked with her to the bathroom and around the room. This meant she was ambulating while maintaining safe techniques. The use of compression stockings on the patient was to help improve blood flow. This is a small intervention, but it can help improve flow and is not intrusive to the patient.
- Performs therapeutic interventions that incorporate principles of quality management and proper safety techniques
- Teaching
- Provides teaching to patients and/or professionals about health care procedures and technologies in preparation for and following nursing or medical interventions
- Example: We instructed the patient to use an incentive spirometer, and I instructed on the frequency needed for the intervention. She had used the tool before, but I had her show me the technique she was using. When she was able to show her competency with it, I instructed her to do two rounds per commercial break of the show she was watching. This is a way ensure she is regularly doing the intervention. After giving this instruction, I observed her frequency from outside her room when she was not looking.
- Provides relevant and sensitive health education information and counseling to patients, and families, in a variety of situations and settings
- Example: We instructed her on the importance of mobility with sickle cell disease and the frequency and use of incentive spirometers. The education was to promote blood flow, and we acknowledged the pain associated with both interventions, but she understood it would prophylactically help with future pain.
- Provides teaching to patients and/or professionals about health care procedures and technologies in preparation for and following nursing or medical interventions
- Research
- Shares research findings with colleagues
- Example: This grand rounds presentation was shared with my fellow nursing students and our clinical instructor. During the presentation, I reviewed an article on the effectiveness of teaching deep breathing techniques that do not use tools such as the incentive spirometer. The article looked at the effectiveness of these techniques with patients with sickle cell disease. My peers seemed to be interested based on facial expression and the questions asked, and hopefully they could use this information in future hospital settings.
- Shares research findings with colleagues
- Culture
- Demonstrates sensitivity to personal and cultural definitions of health, and how these beliefs influence an individual’s reactions to the illness experience and end of life
- Example: The patient was in middle school, which is a time when people lean heavily on the views of their peers, so it was important to incorporate this into the care we were giving. As a child with a chronic disease, she also had a different understanding of her personal health. She typically lives with pain, so a pain level of zero would have been unrealistic, instead we tried to keep pain at below three. She is accustomed to pain, so even when she was having five out of ten pain around her ribs, she was watching a show and texting friends.
- Demonstrates sensitivity to personal and cultural definitions of health, and how these beliefs influence an individual’s reactions to the illness experience and end of life