Caring for a Child or Young Person with Severe Illness

Caring for a tiddler or Young Person with Severe IllnessIntroductionThis assignment allow smooth on and critically get hold of an accomp whatevering from a clinical setting whilst rebelment a model of reflection. This testament allow me to go and make sense of the incident and draw conclusions relating to personal learning out puzzles. The incident lead be described and analysed, followed by the move of reflection teaching Driscolls Reflective Model (2000) as it facilitates critical thinking and in-depth reflection which give help me to accumulate learning objectives for the future. To comply with the Nursing and Midwifery Council (NMC) (2015) ordinance of Conduct, confidentiality will be maintained therefore the individual will be tell apartn throughout as Ben.Reflection is defined as a process of explaining and expressing from our own experiences and helps to develop and purify our skills and friendship towards becoming pro practiti unrivaledrs (Jasper, 2003). I have chosen to use the Driscolls Reflective Model (2000) as a guidance as it is straightforward and encourages a clear description of the situation which will allow me to look at the experience and delineate how it made me feel, asking what was good and bad, and what I atomic number 50 learn (Sellman and Snelling 2010). Wolverson (2000) complicates this as an consequential process for all obliges assisting to improve their practice.What? Ben was born prematurely pursuit an emergency caes bean section, whereby he received prolonged resuscitation and suffered grim hypoxic-ischaemic encephalopathy (HIE). According to Boxwell (2010), sisters with severe encephalopathy have a 75% risk of dying with coma persisting, or progressing to brain death by 72 hours of invigoration. on that point was a realisation that continuing treatment may be causing Ben harm in that it was unlikely to recuperate his wellness or relieve suffering. Boxwell (2010) further states that survivors of HIE carry an al roughly authentic risk of poor neurological outcome. It is these magazines when consideration must be given to withholding and/or withdrawing treatment, subsequently re-orientating treatment to compassionate fright. I was informed by my teach that there would be a multi-disciplinary team up (MDT) opposition to discuss and justify the finding to withdraw treatment.I was invited into the MDT meeting by my mentor to some(prenominal) witness and actively participate in the discussion if I felt confident enough. The MDT consisted of two pediatricians, a paediatric registrar, the neonatal sister, and myself, a paediatric student nurse. The royal College of Paediatrics and youngster Health (RCPCH) (2004) suggest that all members of the health fear team gather up to feel part of the decision-making process in that their views should be listened to. At the time, I was hesitant to contri savee due to my knowledge, understanding and experience surrounding the clin ical and honour adequate to(p) matter. However, I was re certain that greater openness between disciplines will facilitate better understanding of individual roles and evoke the sense of duty (RCPCH, 2004).We considered what was legally permitted and required, but also at what was ethically appropriate. In considering tincture of life (QOL) determinations, it was important to refer back to the ethical foundation touch with surrogate decision making, which is the standard of best interest. Some professionals argued that Ben had no preliminary QOL on which to base a judgment. The barbarianren Act (1989) deliver the goodss an overall statutory mannikin for the grooming of fryrens welfare and services but makes no specific provision concerning withholding or withdrawing treatment (RCPCH, 2004). It does however state that the welfare of the child is paramount which is further supported by The United Nations Convention on the Rights of the nestling (1989). Article 3 under this legislation states that actions affecting children must have their best interests as a primary consideration (RCPCH, 2004).The NMC (2015) role model governs the maintenance of standards of practice and professional conduct in the interests of long-sufferings, acting as a guide to ethical practice within treat. The principle of non-maleficence is sensation of the hallmark principles of ethics in health care which prohibits healthcare professionals from doing any action that will result harm to the affected role. Also paramount, is the goal to restore health and relieve suffering, promoting good or beneficence. In the principle of beneficence, nurses are obliged to protect, prevent harm and maintain the best interest for patients (Beauchamp Childress, 2001). Those manifold needed to be condent in their ability to understand the ethical dilemmas they faced, and had to ensure they were aware of the underlying ethical principles to support their voice to the discussion.The decisio n to withdraw life sustaining treatment should be made with the parents on the basis of knowledge and trust, but ultimately, the clinical team carries the responsibility for decision making, as an expression of their moral and legal duties as health care professionals. It is not uncommon for parents to feel indecisiveness, shame or guilt or so the decision to palliate their neonate, particularly when the outcome of the neonates condition is uncertain (Reid et al, 2011). However, the final exam decision to withdraw intensive care was made with the consent from both parents, and this was clearly recorded in his clinical notes, together with a pen account of the process and factors leading to the decision.So What? Parents impending the loss of their infant experience a complex emotional reaction to their situation, typically one of anticipatory heartbreak, shock and confusion (Gardner and Dic attain, 2011). They may also experience feelings of ambiguous loss, related not only to the imminent loss of their child but also to a loss of their expectations, aspirations and role as parents (Gardner and Dickey, 2011). Parents are underlying in the decision-making processes around neonatal palliation and as it is they who will be the most significantly affected by these decisions (Branchett and Stretton, 2012), neonatal EOL care places a particular focus on feel for for parents. Developing a flexible, guileless and family-centred care plan is essential, and so that their preferences are met, parents should take a key role in this process (Williamson et al, 2008). Spence (2011) recommends that a holistic approach is interpreted to clarify the familys wishes, desires and needs in order to effectively advocate for infants.Whilst most parents wish to be involved in decisions and planning around EOL care for their baby, some may find this responsibility overwhelming (Williams et al, 2008). Despite this, we open(a) the parents to a range of options which they synthesise d in order to make the best decisions for their family. However, it was important for the neonatal nurse and I to realise that highly emotive situations can often cause significant deficits in parents ability to comprehend and process such information (Williams et al, 2008). As competent nurses, it is our responsibility to provide nurse care that advocates for our patients rights in life and death, showing respect and dignity towards them and the family. We advocated for Ben by protecting his rights, being attentive to his needs, ensuring comfort and protection, and by participating in the ethical discussion to ensure a collaborative perspective of ethical negotiation (Spence, 2011).The National Association of Neonatal Nurses (2015) suggests that mitigative care should include comfort measures, such as kangaroo care, an ongoing assessment of pain using an appropriate pain assessment tool and written care plans to get by discomfort, pain and other di emphasizeing symptoms such as seizures using the to the lowest degree invasive effective route of administration. As the parents wished to be present at time of death, the neonatal nurse prepared the family for what they would observe as critical treatment was dis go ond. This included informing them of gasping and other noises, colour changes, and stating that Ben may continue to breathe and have a heart rate for minutes or hours. This is an fundamental aspect of mitigatory care, and provides the family with the opportunity to ask questions. However, a study conducted by Ahern (2013) stated that nurses often express anxieties surrounding how to support agnatic grief and how to prepare them for the imminent death of their infant. Parental preferences were also assessed, including whom they wish present, whether they want to hold the infant, and whether they wished to participate in any rituals or memory-making activities.Although my mentor took the lead role in planning the infants EOL care, my contribution focused on memory-making activities. Although this is often nurse initiated, making memories is increasingly appreciate as an maintenance in parental coping and grieving (Schott, Henley and Kohner, 2007). However, McGuinness, Coughlan and Power (2014) reported that quite an than physical discoversakes, parents and families instead appreciated other actions and gestures that demonstrated respect for their needs, including having time alone with the infant and being encouraged and supported to provide care to their baby. I asked the parents if they would like photos to be taken, and although parents declined photography, I beared to take some to keep in the medical records in case they decided they would like them at a later date which they appreciated (Mancini et al, 2014). Despite this, the parents were acceptant of the offer to keep items that were related to Bens care, including his wristband, blankets and hat.Throughout planning Bens EOL care, the effectiveness of the therap eutic affinity in meeting the familys needs was achieved by showing empathy, and by doing so I obtained the individuals trust, and respect. Carl Rogers (1961) has influenced the shift from a task- to a person-centred and holistic view of breast feeding care, with the adoption of Rogers core conditions (Bach and Grant, 2005). Rogers identified unconditional positive regard, genuineness and empathy as necessary conditions for helping someone change effectively through a good therapeutic relationship. This was achieved through both proficient nursing knowledge and utilising interpersonal communication skills. According to Jones (2007), there is little research in nursing literature that discusses interpersonal skills, particularly in nursing education. There is also a critique that nursing education is often aloof from the realities that students experience during their clinical practice (Bach and Grant, 2005). I felt confident and assured that my interpersonal skills would bring pos itivity throughout a very surd time, helping them through the grieving process. I acknowledged that both parents appreciated my forward-thinking and empathy towards the current situation. Being empathetic during this situation required my ability to be understanding not only of the parents beliefs, values and ideas but also the moment that their situation had for them and their associated feelings (Greenberg, 2007).Egan (2010) identies certain non-verbal skills summarised in the acronym SOLER that can help the nurse to create the therapeutic space. I did this by sitting facing the family squarely, at a slight angle adopting an open posture leaning slightly forward maintaining good eye contact, without staring and presenting a relaxed open posture. To enhance the communication through these skills, I used active- sense of hearing skills to ensure a productive interaction through techniques that facilitated the discussion. I did this by using sounds of encouragement, demonstrating that I was listening and assimilating the information provided by the parents. This was also done by summarising, paraphrasing and reflecting on the feelings and statements. Effective use of reective skills can facilitate exploration, build trust, and spend acceptance and understanding to the individual (Balzer-Riley, 2004). Geldard and Geldard (2005) state that it is often the paralinguistic elements of speech sort of than what is actually said that betray true feelings and emotions.Now What?As EOL approached, Ben was extubated on the neonatal unit and transferred to the bereavement suite whereby my mentor continued to provide one-to-one care. I was not present throughout the final alleviator care phase as I wanted to respect the familys privacy. At this point, I held emotions of helplessness, sadness and anxiety, therefore I took some time to reflect on what had happened. It is important that nurses recognise and confront their own feelings toward death so that they can assist patients and families in EOL issues (Dickinson, 2007).Nurses often experience sadness and grief when dealing with the deaths of patients, and without any support, can suffer distress (Hanna and Romana, 2007). Debriefing is a beneficial intervention designed to help nurses to explore and process their experiences. Irving and presbyopic (2001) suggest that debriefing demonstrates a significant reduction in stress and greater use of coping strategies through discussion in a reminiscent fashion to let their feelings out. Through reflection, I have come to the realisation and understanding that patient death is an integral part of nursing practice in palliative care settings. I have recognised that support from all members of the MDT have positive implications for nursing students coping with stressors associated with patient death.Furthermore, the experience helped me learn the importance of both verbal and non-verbal communication. As an be later nurse, I have to continuously impro ve my communication skills because I shall be interacting with more varied patients in the future. I have also been able to utilise my knowledge of ethical principles in relation to withdrawing treatment, thereby integrate theory into practice.ConclusionTo conclude, the care that patients receive has the direct potential to improve through reflective practice. Becoming a reflective practitioner will help me to focus upon knowledge, skill and behaviours that I will need to develop for effective clinical practice. Reflection helps to make sense of complicated and unvoiced situations, a medium to learn from experiences and therefore improve performance and patient care.Reference ListAhern, K. (2013) What neonatal intensive care nurses need to know about neonatal palliative care. Advanced Journal of Neonatal share. 13(2), pp. 108-14Bach, S. and Grant, A. (2005) communicating and Interpersonal Skills for Nurses. Exeter Learning MattersBalzer-Riley, J. (2004) Communication in Nursing. Mosby, MO Mosby/Elsevier.Boxwell, G. (2010) Neonatal intense Care Nursing. 2nd Edition. New York RoutledgeBranchett, K. and Stretton, J. (2012), Neonatal palliative and end of life care What parents want from professionals, Journal of Neonatal Nursing. 18(2), pp. 40-44.Dickenson, G. E. (2007). End of life and palliative care issues in medical and nursing schools. Death Studies, 31, pp. 713-726.Driscoll, J. (2000) Practising Clinical Supervision. capital of the United Kingdom Balliere TindallEgan, G. 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