Paediatric Nursing Teaching Session: Reflection and Analysis

Paediatric nurse article of belief Session Reflection and abstractCritically analysing a instruction school term which has been under chargen in practice for a child or new-fangled person.This reflective essay explores and analyses a doctrine academic term carried off with a young person within a pediatric nursing setting, in order to evaluate positive aspects of the session, skills come to and skills developed on the part of the soak up during the session, the in force(p)ness of the session, and the shipway in which this activity could have been improved to better meet the unavoidably of the invitee. The knob chosen is a 13 year old girl with suit 1 Diabetes, who, having make the decision to become independent in her glycaemic bidding and in managing her condition, was admitted to the childrens ward after a hypoglycaemic episode.The centre of the session was on re-educating the node in good practice in self-administration of insulin. Up until the period short ly before her admission, her mother had been administering BD insulin injections before naturalize and in the evening. The lymph gland, who shall be called Sheila for the purposes of this essay (the name has been changed to protect confidentiality), had asserted her independency and demanded to be allowed to carry out our own injections, unsupervised, moreover after the hypoglycaemic episode, the question was raised whether or non she was able to draw up the temper dose. Therefore, the session was set up to allow Sheila to revisit the sort procedure for draft up and delivering the correct dose of insulin in the correct manner. Confidentiality has been have goted throughout this essay by anonymising the personnel involved, and by ensuring no recogniseing details atomic number 18 used at any engineer. The importance of the program line role within paediatric nursing will be discussed in the luminance of this activity and experience, and some recommendations for good practi ce will be drawn from this.The client chosen provides an interesting case because this is a young person who set up be viewed as being in transition, surrounded by childhood and the onset of adolescence, asserting more maturity and independence in her manold agement of her inveterate condition, and so needing to be treated and interacted with in ways more similar to those usually used with adults. This presents a challenge for the paediatric nurse, because one key aspect of educating for wellness is to engage with the client on the appropriate level, and to avoid alienating the client (Agnew, 2005). This is a fundamental fragment of all nursing care, acting as both the human portray of medicine and as a teacher or coach who acts to take what is foreign and fearful to the patient and make it familiar and thus little frightening (Benner, 1984 p 77). Approaching a young person much(prenominal) as Sheila requires skill in terms of using typical teaching approaches that adapting t hem to meet her individual needs as a person, agree to her own perception of who she is and her levels of independence. Benner (1984) suggests that in that respect is a need to use banknote of voice, humour, and the nurses own situations in meeting these needs. Knowles et al (2006) soil that secern- found, structured education is recommended for all people with diabetes tailored to meet their in-person needs and culture styles (p 322). In this instance, planning the session required the nurse to draw upon association of teaching processes and principles gleaned from her own study and research, clinical acquaintance almost the skill to be taught, and personal attributes which would (it was hoped), avoid patronising the client or alienating her(see addendum for teaching plan). However, this author anticipated that there would always be some distance between nurse and client, because the nurse, no matter how skilled or capable in communication, world poweriness close up represent an older authority figure to whom they might not unavoidably relate very well. Understanding this, the approach to the session was clearly and consistently hinged upon basic principles of learning, incorporating aspects of adult learning in order to attempt to be more appropriate for Sheilas learning needs. There is some fence in about the differences between learning in children and adult learning, or whether there are, indeed, any differences (Rogers, 1996).Because of the significant wellness impact of Type 1 Diabetes on individuals, and consequently, on society and the states healthcare systems and resources, it was thought of the essence(predicate) to include in this session some of the precepts for good glycaemic reassure and cake of the longer term consequences of the disease. Type 1 Diabetes, is a disorder in which beta cells of the Islets of Langerhans located within the pancreas fail to produce insulin as required by the body to regulate blood glucose, r esulting in high levels of circulate glucose(Watkins, 2003). The longer-term consequences of the disorder include atherosclerosis and cardiovascular disease (Luscher et al, 2003) diabetic retinopathy (Cohen Ayello, 2005 Guthrie and Guthrie, 2004) skirting(prenominal) vascular disease, intermittent claudication and foot ulcers foot ulcers caused by impair circulation and peripheral neuropathy(Bielby 2006 Edmonds and Foster, 2006 Lipsky et al, 2006 Guthrie and Guthrie, 2004 Bloomgarden, 2005 Soedmah-Muthu, 2006) renal disease and renal failure (Castner and Douglas, 2005) and gastrointestinal complications (Guthrie and Guthrie, 2004).In preparation for the session, the nurse engaged in some background research, ensured that her acquaintance was up to date, and reviewed the key national policy document, the National Service manikin for Diabetes published by the Department of health which stresss the need for good, ongoing health forwarding and education for those with the condit ion (DH, 2002). Reading of research and professional writings also highlighted a wealth of teaching on the specifics of health promotion and education within diabetes, much of which is very applicable in this instance as it focuses on self-management of the condition (Cooper et al, 2003). While these support the transmission of info between health professional and client, so that the client becomes knowledgeable about their disorder and its management (Fox and Kilvert, 2003), there is also evidence which supports health education that actively incorporates and engages the client as a partner in the learning process as well as the control of their condition (Davis et al, 2000)Therefore, the session was planned to initially determine Sheilas level of knowledge and understanding, her stream competence in the skill, and her ability to describe the underlying principles of the procedure. As Rogers (2002) states, it is necessary to adapt our methods of teaching adults to the range of educational skills they possess. (p 76). Horner et al (2000) also underline the need to improve the readability of teaching materials, and some were identified during the crease of this session as being in need of improvement. Therefore, this element of the session also determined her level of understanding, reading ability and whether or not she had any difficulties much(prenominal) as dyslexia. It was discovered that Sheila had an above-average reading level, no picky educational needs and no specific requirements other than that she was spoken to as an adult, as she reiterated on a number of occasions that she was not a kid.The learning approach taken was what Hinchliff (2004) describes as a constructivist approach, which, based on cognitive and humanistic learning theories, places the most importance on self awareness, and the individuals understanding of the processes involved in his or her own learning (p 65). Hinchliff (2004) discusses Blooms (1972) learning domains, and this teaching session was designed to affect all three domains, cognitive, psychomotor, and affective. In relation to the cognitive domain, the aim was to reinforce and introduce knowledge. Psychomotor skills relate to the practical ability to administer insulin, and affective domain refers to the initiation of a process of attitude formation, wherein the nurse was hoping to help Sheila form a positive, proactive attitude to self-management of her condition. get ahead reading uncovered nurture on tailored educational curriculums for children with diabetes to elevate appropriate self-care and management of their condition, based on pre- hold uping adult courses which exist in the UK but are of limited value for children (Knowles et al, 2006). Knowles et al (2006) carried out a study to adapt the adult Dose Adjustment For popular Eating (DAFNE) course to design a skills training course, for children aged 1116 yr, focusing on self-management skills within an intensive insulin regim e. While this genial of approach would have been ideal for Sheila, a little research into facilities obtainable local to the client showed no provision of this kind, or similar, targeted at her age group, which this author believed was a failing of local provision. This is a key point in the lifespan of a young person with a chronic condition, and at the least such young people need age-appropriate health education activities (Knowles et al, 2006). However, this study has yet to be validated by a planned larger multicentre trial (Knowles et al, 2006).Viklund et al (2007) carried out a sixsome month randomised controlled trial of a patient education authorization programme, with teenagers with diabetes, but found after their trial that this empowerment programme made no difference on outcomes related to glycaemic control or empowerment. Their endpoint was that there should continue to be parental elaboration in educational programmes and in management of self-care and ongoing c ontrol in diabetes in teenagers (Viklund et al, 2007). This might suggest that this session should have included some parental involvement, or should have made reference to ongoing parental involvement, because it supports anecdotal evidence that the author has gleaned from practice, wherein nurses rarely trust teenagers to manage their diabetes appropriately themselves. Murphy et al (2007) describe a family-centred diabetes education programme which was successfully integrated into paediatric diabetes care in one location, with potential benefits on parental involvement and glycaemic control. In all three of these cited studies, multidisciplinary involvement was a feature of the programme (Knowles et al, 2006 Murphy et al, 2007 Viklund et al, 2007). This suggests that there should be programmes which provide ongoing, family-oriented support, but this author sleek over feels that the particular needs of teenagers may need something else, something indefinable as yet, but something which still supports their sense of self and emerging adult identity, fosters independence but also helps ensure proper management of the condition. This takes us to the issue of resources, and the leave out of them, but if there were more, good quality research in this area, it might provide the leverage for more resources to be mobilised to meet the needs of this client group.Sheila evaluated the session well, but the author was left with the feeling that there was no certainty that the client would take on this new learning and that her glycaemic control would improve. Having addressed issues from the point of view of diabetes, and of the needs of teenagers with this condition, the author can just conclude that the session was well designed and incorporated patient-centred, established educational techniques, but that these techniques are not necessarily the optimal way to drill and support teenagers with Type 1 Diabetes. The literature has shed a light on some potential app roaches to this, but the evidence is still low to fully change practice. However, Sheila was able to indicate correct technique, discuss the precept for the technique, and discuss with some confidence her management and control of her condition, and the ginmill of longer-term complications. A more multidisciplinary approach would perhaps be needed to address the delirious and psychological elements of her learning and development needs in the future.ReferencesAgnew, T (2005) lecture of wisdom. Nursing Standard 20(6),pp24-26Anderson, B. (2005) The art of empowerment stories and strategies for diabetes educators New York American Diabetes Association.Anthony, S., Odgers, T. Kelly, W. (2004) health promotion and health education about diabetes mellitus. Journal of the Royal ball club for the Promotion of wellness. 124 (2) 70-3Benner, P. (1984) From Novice to Expert Excellence and Power in clinical Nursing Practice London Addison-Wesley Publishers.Bielby, A. (2006) Understandi ng foot ulceration in patients with diabetes. Nursing Standard. 20(32). pp. 57-67.Bloomgarden, Z.T. (2006) Cardiovascular Disease Diabetes Care 20 (5) 1160-1166.Castner, D. Douglas, C. (2006) Now onstage chronic kidney disease. Nursing. 35(12). pp. 58-64.Cohen, A. Ayello, E. (2005) Diabetes has taken a toll on your patients vision how can you help?. Nursing. 35(5). pp. 44-7.Cooper, H.C., Booth, K. and Gill, G. (2003) Patients perspectives on diabetes health care education. Health Education interrogation 18 (2) 191-206.Court, S. and Lamb, B. (1997) Childhood and Adolescent Diabetes London John Wiley.DAFNE Study conference (2002) Training in flexible, intensive insulin management to enable dietary independence in people with type 1 diabetes dose adjustment for common eating (DAFNE) randomised controlled trial. British Medical Journal 3257469Davies, K. (2006) What is effective intervention? Using theories of health promotion. British Journal of Nursing15 (5) 252-256.Department of Health (2002) National Service Framework for Diabetes Available from www.doh.gov.uk Accessed 25-7-08.Edmonds, M. Foster, A. (2006) Diabetic foot ulcers. BMJ. 332(7538). pp. 407-10.Fox, C. and Kilvert, A. (2003) intensive education for lifestyle change in diabetes. BMJ 327 1120-1121.Guthrie, R.A. Guthrie, D.W. (2004) Pathophysiology of Diabetes Mellitus. Critical Care Nursing Quarterly 27 (2) 113-125.Hinchliff, S. (Ed)(2004) The Practitioner as teacher 3rd Ed London Balliere TindallKnowles, J., Waller, H., Eiser, C. et al (2006) The development of an innovative education curriculum for 1116 yr old children with type 1 diabetes mellitus (T1DM) Pediatric Diabetes 7 (6) 322-328.Luscher, T.F., Creager, M.A., Beckman, J.A. and Cosentino, F. 2003 Diabetes and vascular disease pathophysiology, clinical consequences and medical therapy part II. Circulation 108 1655-1661.Murphy, H.R., Wadham, C., Rayman, G. and Skinner, T.C. (2007) Approaches to integrating paediatric diabetes care and struc tured education experiences from the Families, Adolescents, and Childrens Teamwork Study (FACTS) Diabetic Medicine 24 (1) 1261-1268.Northam, E. Todd, S. Cameron, F. (2006) Interventions to promote optimal health outcomes in children with Type 1 diabetes are they effective? Diabetic Medicine. 23(2). pp. 113-21Reece, I. Walker S.(2003) Teaching, Training and Learning. Tyne Weir Business Education Publishers Ltd.Rogers, A. (2002) Teaching Adults 3rd Ed Buckinghamshire OU PressSoedmah-Muthu, S.S., Fuller, J.H., Mulner, H.E. et al (2006) High risk of cardiovascular disease in patients with type 1 Diabetes in the UK. Diabetes Care 20 (4) 798-804.Viklund, G., Ortqvist, E. and Wikblad, K. (2007) Assessment of an empowerment education programme. A randomized study in teenagers with diabetes Diabetic Medicine 24 (5) 550-556.Watkins, P.J. (2003) ABC of Diabetes (Fifth edition). London BMJ Publishing Group.AppendixPatient Education PlanSelf-administration of InsulinLesson AimsTo support Shei la to develop the skills and knowledge to show up competence in the independent self-administration of Insulin.To reinforce health promotion principles and information regarding long-term management and control of her Diabetes and the prevention of later-life health complications.Learning Outcomes at the end of the session the client shouldBe able to describe, discuss and demonstrate the principles of correct drawing up of accurate doses of insulin as prescribed in her own regimen.Be able to competently self-administer insulin with correct technique, and describe the rationale for this techniqueBe able to discuss ongoing glycaemic control and prevention of later life complications of Diabets.ActivityMethod and RationaleDetermine Sheilas current level of knowledge.Determine Sheilas reading level and identify any specific learning needs or difficulties (eg dyslexia) discourseThis allows for the appointment of Sheilas needs, and allows the nurse to set the tone and establish a birt h with Sheila.Provision can be made for specific needs such as augmented or specialist reading materials.Sheila to demonstrate drawing up techniqueNurse to demonstrate drawing up techniqueDemonstration/discussion with supporting information/leaflets.Drawing comparisons between the cardinal techniques should allow the client to identify whether her own practice matches that of the nurse/teacher.Discussion of this will draw out underlying knowledge and principles.Written information will reinforce learning.Review and demonstrate correct administration techniqueDiscussion/DemonstrationDiscussion allows the nurse to identify gaps in knowledge and skill and address these in a responsive, flexible manner.Review knowledge of disease management and prevention of complications and identify further learning needsDiscussionProvide a rationale and potential motivation to maintain good glycaemic control.Plan to meet further learning needs any immediately or in future sessions, perhaps involvin g the multi-disciplinary team.Gain client feedbackTo evaluate effectiveness of teaching session in clients own words.