1. Pediatrics Grand Rounds<br />NURS 421 – Clinical Management of Pediatrics<br />Purpose of Assignment<br />The purpose of this assignment is to provide the student an opportunity to integrate knowledge from the sciences, developmental theory and physical assessment data to the care of a pediatric client and family in the acute care setting. The student will utilize critical thinking and independent judgment in presenting a holistic plan of care in a formal oral presentation.<br />Student Approach to Assignment<br />After my experience in the Transitional Care Unit with this particular patient, I felt there was an incredible wealth of knowledge to be gained from this young girl. This was especially the case when I noticed I had never heard of her diagnosis. Dahlia was obviously handicapped both mentally and physically but it did not stop her from playing and interacting with her caregivers. Also, her family dynamics were very interesting to me as neither her twin brother nor her other siblings experience any major health problems and that her family speaks only Spanish. <br />Reason for Inclusion of this Assignment in the Portfolio<br />This was by far the most interesting patient I had during my pediatric rotation and the only one I had for two days in a row. I believe that this assignment allowed me to research her condition in more detail so that I could understand it enough to explain it during my presentation. I believe this gave me a new perspective on integration. The following program objectives are highlighted in this presentation:<br />Critical Thinking<br />Revises actions and goals based on evidence rather than conjecture<br />During my initial exposure to Dahlia I asked the nurses on the units about her and they told me some things about her development. I was told that she was unable to roll herself over to respond to her name being called. Because of these developmental delays I expected to spend much of my day interacting with her helping her to meet these goals. However, after spending time with her I discovered she was actually able to roll from her stomach to her back as well as lay on her side without support. I changed the direction of my actions with her and encouraged her to continue meeting the goals she has already met and encouraged other goals such as identifying herself in a mirror and playing appropriately with toys.<br />Nursing Practice<br />Demonstrates an awareness of complementary modalities and the effectiveness of care<br />While Dahlia was admitted to the unit based on her medical needs, her developmental needs must be attended to while under our care. Play is an intervention that is not nursing or medical in nature. By allowing Dahlia to play with her toys and with her caregivers, we are helping to further her mental development. Also, using toys and interaction can help distract her from her favorite pastime, which was pulling out her gastric tube. <br />Communication<br />Uses therapeutic communication within the nurse-patient relationship<br />I used therapeutic communication with this patient through some non-verbal methods since she was unable to speak. I ensured that her diaper was checked every couple of hours so that she would not spend a long time in a wet or dirty diaper. She also appeared to be excited when I came towards her bed which showed she enjoyed spending time with me.<br />Adapts communication methods to patients with special needs<br />This relationship was different from others that I have had in that this patient was unable to speak to relay concerns. I spoke in soft, cheerful tones, clapping, and other playful motions to encourage her actions and to play with her. <br />Research<br />Evaluates research that focuses on the efficacy and effectiveness of nursing interventions<br />I discussed a research article during this presentation about the effectiveness of using 100% oxygen before suctioning patients and whether it helps them maintain their oxygen saturation levels better. The study determined that while it did increase oxygenation levels, it was not truly necessary in the population studied in this article. <br />Professionalism<br />Differentiates between general, institutional, and specialty-specific standards of practice to guide nursing care<br />This children’s hospital has policies that are used throughout the building to guide nursing practice. I used the hospital’s enteral feeding policy in this presentation in relation to Dahlia’s gastric tube. This policy contains general information such as proper hand hygiene and cleaning tubing with alcohol, but also included more institutional-specific information. Those feedings with a 4-hour expiration include breast milk and syringe feedings sets and all formula sets for NICU or immunocompromised patients. All other feeding sets for other patient populations have a 24-hour expiration time. <br />Culture<br />Articulates an understanding of how human behavior is affected by culture, race, religion, gender, lifestyle, and age<br />This child is going to have some problems once she begins to mature to the level of speech. She is currently being raised in the American culture with English-speaking caregivers and the long-term plan for her was to be transferred to a long-term care unit until her family’s home is able to support the equipment she needs. American culture will continue to bring her up yet her entire family is of Spanish culture and speaks only Spanish. She will likely experience a crisis in knowing which culture she is truly a part of.<br />Integrates knowledge of cultural diversity in performing nursing interventions<br />In Dahlia’s family’s culture, caring for an ill member is a big deal and from the documentation in her chart and the nurses’ knowledge, when her family comes they do much of her care. The family needs to learn how to care for this girl if they are going to take her home one day. Each time they are expected to come, a translator is on the unit and is present for teaching between the nurses and the family about her care so that the family can be a part of it. <br />Maintains an awareness of global environmental factors that may influence the delivery of healthcare services<br />The family lives outside of Norfolk in a poor area of the Eastern Shore. They want their child at home, but unfortunately the location in which they live is not capable of supporting the equipment that she needs. Also, because of the location’s economics, there is not a facility close enough to allow her to be close to her family. <br />