Record Of The Formative Review Of Cross B

Record of the Formative Review of Cross B ranch Experiences

Adult Nursing Learning Outcomes: (see Chapter 5 & Chapter 9)

By the end of the Common Foundation Programme students will be able to:

1. Identify the health risks associated with smoking, and discuss strategies which may help patients stop smoking.

http://docs.google.com/Doc?docid=dd2c2mms_46fnk549&hl=en_GB

Strategies to stop smoking

Quitting Smoking

Emphasis on the health benefits may be helpful. The carcinogenic effects of tobacco were first discovered in 1948. These facts are widely known throughout society. However, smoking is still widespread, especially in the lower socio-economic groups.

Better Health After Quitting Time after last cigarette

Physical Response

20 minutes Blood pressure and pulse rates return to normal. 8 hours Levels of carbon monoxide and oxygen in the blood return to normal. 24 hours Chance of heart attack begins to decreases. 48 hours Nerve endings start to re-grow. Your ability to taste and smell increases. 72 hours Bronchial tubes relax and the lungs can fill with more air. 2 weeks to 3 months

Improved circulation; lung function increases up to 30%.

1 to 9 months

Decreased rates of coughing, sinus infection, fatigue, and shortness of breath; re-growth of cilia in the airways, increasing the ability to clear mucus and clean the lungs and reducing the chance of infection; overall energy level increases.

Long-Term Effects

After a year, risk of dying from heart attack and stroke is reduced by up to 50%.

2. Outline the advantages and disadvantages of day case investigative procedures for patients, and health care professionals.

Advantages Disadvantages

Patients · Investigation is over and done with all in one day.

· Less time off work thus less financially disadvantageous.

· Reduced time in hospital

· Reduced likelihood of developing a health care acquired infection.

. Less financial loss

·

· Shorter time in hospital can be linked with concerns that the individual is not being cared for with sufficient rigueur.

· There is less time to become fully acquainted with members of the care team thus perceived problems with the building of a therapeutic relationships

. Complications may not be directly observed by an HCP

. Patient may not know what is normal or abnormal.

Carers · Less time for client to be away from home.

· Client is not hospitalised for long periods which requires monies being spent on travelling and visiting.

· Carer may need a break from the client which they would have had if they had been hospitalised.

· Client may need follow-up care which may be delivered by carers. This may be complex thus it is essential that the carer is fully aware of what is required of them and aware of changes that my be problematic or indicative of problems.

Health Care Professionals

· Fewer patient bed days

· Reduced bed blocking

· More patients investigated.

· Reduced need for hospital resources being utilised.

· Due to the reduced time within the care setting means that there is less time for a therapeutic relationship so HCPs may not have as such in depth knowledge of the client

· More patients can mean that the job may become more monotonous and can lead to burn out.

3. Suggest 4 strategies which may reduce patient anxiety. · Increased information given at a level that is appropriate to the client, the quantity of which is at a level that is suitable for the individual. · The building and maintenance of an effective therapeutic working relationship between the worker and the client. · Showing active listening is being used by attending to what the client is saying, reflecting what is said back and th en any things that are promised are implemented. · Ensuring that any declarations of pain are responded to appropriately when they are reported.

. cognitive interventionsChanging the way people thing about something. Behavioural approachesBreathing technique, massage, listening to music. Give them a leafletAnxiety affects concentration. Things may not be remembered. Written instruction may be very helpful.

Get clarificationAsk them what they have just been told.

Talk to the person to find out what works for them.

4. Identify 6 key aspects of respiratory assessment

SoundsCoughWheezingStidaeCheyne stoking

ColourisingBlueness

Nail bedsNoseLips

PostureAccessory musculesDiaphragm

Using it to breathChest does not move so much

Can happen in head injuryPain

On inspirationPleurisy

Inflamed pleura grating

PatternRegular and steadyHyperventilation but still steady

In panicCO2 initiates breathing

So if you breathe too fastLevels of CO2 drop

Can get dizzySo re-breathing the CO2 (from a paper bag) can help

Chronic respiratory patientsUse an Oxygen level to breath

So they need low levels to encourage them to initiate breathing

SymmetricalSee mind map above

Flail segmentBroken rib in two places

A piece of rib “floats”It falls back on inspiration

Airway diversionPneumothorax

Collapsed lung caused by air going into plural cavityHaemopneumothorax

Collapsed lung caused by air and blond going into plural cavity

5. Discuss discharge planning following day case procedures. When an individual is first interviewed with regard to having a procedure, it is important that the subject of discharged planning is discussed. This may help to predict any potential problems that could be foreseen that may occur after the procedure that could delay or prevent discharge.

It is important to identify if the procedure will have any effects that will need special considerations that will need to be addressed once it has happened and that the individual has to take into account prior and after they have been discharged:-

· Are they any medications that are required? Is the client able to cope with dealing with these? If not, are they any systems that can help, i.e., Community Nursing input?

· Are they any exercise regimes that are required to be carried? If so, does the client understand them?

· Does the client require another competent adult to be with the client after discharge for a particular time period? E.g., after the client has had a general anaesthetic.

· Are they any adaptations that the client will have to make after the procedure that may impact on their lives, e.g. do they need to use a stick/wheelchair. If so, does the client know how to use them?

Do they have follow-up appointments?

Older people can take longer go recover so they should be treated earlier in the day.

6. Recognise the importance of Inter-professional communication, and suggest ways in which this could be enhanced. Inter-profession communication is a very important concept. It can facilitate individuals receiving the best care. It can also mean that all agencies are working in the same direction and not providing contradictory care. It can also ensure that actually receives care as sometimes care is not delivered by one agency because that agency assumes that another is providing a certain care aspect when they may not be.

How can it be improved:- Weekly team brief Training together Networking with each other Ward rounds together Shared documentation An effective cascade of information Case co-ordinator who liaises with all members of the MDT

7. Develop an understanding of the main issues related to being frail and elderly Over the period of the last three years, I have worked as a Healthcare Support Worker in both a Medical Admissions Unit as well as in an Emergency Department. In both areas, one of the highest client groups is the elderly. Prior I worked in a dedicated Eldercare Rehabilitation environment, where I gained a fairly in depth exposure to what it must be like to be frail and elderly.

Slower healing Weaker bones Fractured neck of femur Dental problems: loss of teeth Joint problems: reduced mobility, reduced speed Prostatic hyperplasia in men Reduced fluid intake

o Dehydration Urea and electrolytes become deranged

Causes toxic confessional stateso Medication blood levels raiseo Urea causes confusiono Electrolytes cause heart changes/muscle movement

problems

8. Outline the issues related to care management within a person's own home and within a nursing and/or residential home.

People own home

When nursing in an individual's home, it is important to remember that the nurse is a guest in their home. Whilst being accountable for the care of the client, they are right to autonomy must be respected. Individuals have differing levels and ideologies about personal hygiene and living conditions. These may differ from the visiting nurse. It is very important not to show disdain or made inappropriate comments when there is dissidence in this respect. Each individual has the right to live in the manner in which they see fit. One area where there may be significant conflict is with infection control. Some individuals may experience difficulty with wound healing due to their living environment impeaching on their ability to heal. As the rest of nurse is accountable for the care of the individual, it is very important that she/he mentions that a change in some aspects of lifestyle may persist with wound healing. Negotiation may be the key to assisting with compliance via concordance. When nursing in an individual's home, it is important to remember that the nurse is a guest in their home. Whilst being accountable for the care of the client, they have the right to autonomy must be respected.

Individuals have differing levels and ideologies about personal hygiene and living conditions. These may differ from the visiting nurse. It is very important not to show disdain or made inappropriate comments when there is dissidence in this respect. Each individual has the right to live in the manner in which they see fit. One area where there may be significant conflict is with infection control. Some individuals may experience difficulty with wound healing due to their living environment impeaching on their ability to heal. As the rest of nurse is accountable for the care of the individual, it is very important that she/he mentions that a change in some aspects of lifestyle may persist with wound healing. Negotiation may be the key to assisting with compliance via concordance

.

Nursing/Residential Home

Residential home

The role of a Registered Nurse in a Residential Home is very different to that in a Nursing Home. Registered Nurses tend to visit individual clients in residential homes when they have health issues such as leg ulcers, need injections, and other activities that are only within the realm of Registered Practitioners. There involvement with individuals tend to be reactive rather than proactive in that cases are referred to them rather than assessing all patients in the home. This has the indication that sometimes the health condition of individuals can alter without being assessed By a Registered Practitioner.

At the beginning of my career, I was an employment trainee care assistant in a residential home. One of the things that I noticed was that there was a fast difference in the self-care abilities of individuals. Some individuals needed a significant amount of help while others were practically self caring. I noticed that some of the latter individuals could sometimes deteriorate in their ability to self-care but this was not noticed as these individuals were self caring so assumed to be so. Sometimes, the only time when a review happened was when a crisis occurred.

This problem can be exacerbated by the fact that some individuals who are beginning to realise that their self-care abilities are not what they were can confabulate stories. This means that they can construct sometimes complex rationale for reasons why certain things have occurred.

Nursing homes.

The role of a registered nurse within a nursing home Setting is very different to of a said that within a residential home. Registered nurse cover needs to be in place 24 hours a day in nursing homes by law.

Having worked as an agency care assistant within nursing home settings I have observed that within some settings, all of the registered nurse tends to be drug Administration and clerical work rather than direct patient care. This tends to be carried out by care assistants. If there is not sufficient training of care assistants, then problems can sometimes go unnoticed. I have also worked in settings where registered nurses play an active role in all areas of care. This results in detection of problems earlier. Also, whilst working with care assistants, based at nurses have an opportunity to share their knowledge so that in future care assistants are more empowered.

Suggested activities:

5.1; Visit an outpatient clinic, or talk to a nurse working in the area. How does the nurse’s role differ from that of a ward-based nurse?

Outpatient Department Nurse Ward Nurse

Time spent with patient

Period of consultation

Patients are usually seen one by one so other patients are not competing directly all the attention of the nurse

Less time to gather information about each patient. Therapeutic relationship has to be built up very quickly and full knowledge each individual may be scanty.

Period of shift

Greater knowledge of the individual patient may be gained over a longer period. A 24 hour picture may be elicited.

Other clients can complete for attentions of nurse. Other priorities, such as medication rounds, may get in the way of caring for patients.

Medication Administration

One off medications may be administered. There may be a specific clinic that requires a certain type of medication to be administered.

Long medication rounds which are subject to being interrupted.

Clinical skills Depending on the specific clinic, one clinical skill may be undertaken several times a day, such as specific wound dressings, giving opportunity to become expert in such fields. This may have a flipside of reduced opportunities for generality. It must be noted that some outpatient departments have a diversity of clinics occurring thus this is not the case.

Clinical skills tend to be more diverse but interspersed with other activities such as medication rounds, bedside care.

Shift patterns Usually week days and office hours 24 hour care

5.6; Have a careful look at some of the information leaflets available for patients in your practice area. Consider how effective they would be for a variety of patient groups; for example, a person with Learning disability, a person who has visual impairment, as well as people whose first language is not English.

5.7; This White Paper (Saving Lives: Our Healthier Nation, DoH, 1998) underpins the political development of the health service today. The executive summary provides an overview of the key points. The White Paper can be found on the Internet at http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4118614

Or visit your library for a copy.

Saving Lives: Our Healthier Nation (DoH, 1998) is a White Paper which sets out the Government's action plan for addressing poor health by improving the health of everyone, especially those from the lowest socio-economic groups. It sets out targets in five priority areas

Cancer Coronary heart disease and stroke Accidents Mental health

wider action.

The paper provides ten tips for better health Ten Tips for Better Health 1 Don't smoke. If you can, stop. If you can't, cut down. 2 Follow a balanced diet with plenty of fruit and vegetables. 3 Keep physically active.

Leaflet Individual with Learning Disabilities

Individual with Visual Impairment

Individual whose first language is not English

PALS Language used could be difficult to understand. Small text

Blue background with white writing may be difficult to read

No mention how to obtain other Languages.

Volunteering; who makes a difference?

Writing is small and language used may be confusing.

Small text. Confusing picture on the front

No consideration made.

health and safety

Designed especially for individuals with learning difficulties. Plenty of pictures. Some could have been confusing. Writing was clear and relatively easy to understand. Not good for individuals with limited literacy skills

Small text. Black text on white but quite small. Pictures may be helpful

Pictures may have been useful

Keep warm keep well

Is very user-friendly but text is of a different colour which may be helpful.

Text written and the pictures so may be difficult to read but text is of different sizes and colours which may be helpful

No consideration made for people who speak other languages

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4007059


4 Manage stress by, for example, talking things through and making time to relax. 5 If you drink alcohol, do so in moderation. 6 Cover up in the sun, and protect children from sunburn. 7 Practise safer sex. 8 Take up cancer screening opportunities. 9 Be safe on the roads: follow the Highway Code. 10 Learn the First Aid ABC - airways, breathing, circulation.

It is divided into three sections.

Our healthier nationsaving livesmaking it work

5.8; Consider for a few moments how effective you could be in supporting a patient, friend or relative who wanted to give up smoking.

I have never smoked. I hate what it does to individuals and the way that it seems to alter their point of view to justify their outlook. I also have asthma/bronchitis. This makes smoky environments very challenging to me.

As part of my adaptation process of becoming a Nurse, I have had to think of the bigger picture. Nicotine gives individual an instant relief. They enjoy consuming it. The fact that in the future they are many times more likely to experience more altered health as well as premature death may not be a strong enough argument to assist individuals to change their habits.

The psychology I have studied has been very interesting and has shown me some of the research and theories about operant conditioning, health behaviour as well as persuasion and other areas.

Having worked in healthcare for 16 years already has reiterated that non-judgemental approaches are the optimum. Everyone is an individual. Each has his own ideas and has her/his own beliefs and motivations to change their behaviour should they wish to.

As I have my own issues with smoking, I have, in the past, taken a moralising approach about individuals who smoke. All individuals may not want to stop smoking. They may know that facts and have them reinforced to such an extent that they become stressed and thus increase their smoking.

Recently, one of my friends told me she wanted to stop smoking. I was, of course, very pleased about this. However, these are my feelings, not the feelings of the person who wanted to change her behaviour. I did not preach but allowed her time to talk, focusing on her feelings and not my own. Some years ago, I undertook an RSA in Counselling in the Development of Learning. This has been very helpful.

Friends have approached me for support as I am someone who can listen to what they are saying and will try to be non-judgmental about what is discussed. When it comes to smoking I find non-judgmentalism very hard as I have said above. However, this concept can get in the way of trying to help someone. In my experience, individuals know that smoking is bad for them. I have not smoked and so I do not have full empathy with those that have. People have told me how nice it is. I cannot see past the fact that it makes me wheeze and kills those who do it and anyone is the vicinity. Smoking can sometimes be the sticking plaster which can be an indicator of something deeper going on. For example, individuals who are at various stages of depression can use tobacco to alleviate the symptoms. Despite all the health information about smoking, the depths of despair can drive people to do it. Sometimes helping people with their levels of stress and they cope in strategies with it can help to reduce smoking. Also, people who I have talked to about stopping smoking have needed to have wanted to have stopped smoking. If they don't want to do it, and are being forced to, then their chances of doing it reduced further. I have noticed that people can justify their actions and prove to themselves that they "have" to smoke.

During my career, I have assisted individuals in many settings, some of which have been acute. I've noticed that certain individuals, who are cutely unwell and had been admitted with such conditions as chest pain, would rather risk their lives and go outside and smoke and go without smoking and not increase risks to their health by going out and smoking. Being in hospital is a very stressful situation in some individuals. Smoking calms them nervous. Sometimes, despite their altered health status, going out and smoking can reduce and individuals anxiety state which, in itself, can alter health status and personally. At the end of the day, it is up to the individual whether or not the risk their life in such a way and at such a time. At the end of the day, moreover, it is up to the individual whether or not they smoke or not all whether they give for not.

As a qualified nurse of the future, I have a duty to inform individuals of the risks associated with their behaviour. However, this must be equated with the choice of that individual to carry out the activity. There is also a wider accountability for others in my care. It is important that others are protected from the smoke of smokers.

5.10; Find out which information systems are in place in your area of practice, and ensure you can use them effectively. Identify as many communication pathways as possible.

Hand-over

The ward where I am on placement is an elder care rehabilitation setting. One of the major information sharing opportunities is the "handover". This occurs approximately 1 to three hours into the shift. Shift patterns vary greatly in that there are four permutations of potential hours to work:-

07.45 to 16.15

07.45 to 13.15

12.00 to 20.30

15.00 to 20.30

On arrival, one Registered Nurse and one Healthcare Support Worker taken handover then, a full handover is given by that Registered Nurse to the remainder of the staff on duty.

This method ensures that there is always somebody available to the patients on the ward should they require assistance. However, there is a period when members of staff working on the floor, do not have full knowledge of what has been happening with the patients.

In the past, I have worked on wards where handover has been provided to each individual or group of individuals when they arrive on the ward. This has been time-consuming and, on occasions, it has been necessary for a member of staff to leave the handover to answer call bells thus missing some information. (I have known cases where information missed has not been recaptured and has had implications to clients in the past but I have not been aware of this on this placement).

I can see benefits of both methods of giving handover. However, my preference is for everybody having a handover as soon as they come on duty.

I have also worked on wards where a written handover has been given in conjunction with a verbal one. This can be very helpful in that it does not involve frenetic scribbling of what has happened that can result in information being missed. There are a couple of implications that are not so positive also that need to be remembered in this case. Pieces of paper with confidential information on them can be lost and found by individuals to whom the information on them is not permitted. Also, information on a written report I somebody may not be as comprehensive as is required and there may be cases where shorthand has been used which is not understandable that can then have the ramification of causing harm to a patient due to its misinterpretation.

The method of handover does not seem to be standardised in that each individual handing over does so in her/his own style. Although this allows for individuality, it can leave room for areas to be missed.

The morning report acts as a multidisciplinary team hand-over. Nursing, Occupational Therapy and Physiotherapy are all represented. This ensures that these disciplines share ideas and what has been occurring with individuals. However, other disciplines, such as medical staff are not involved.

Bed state board

A whiteboard is used to indicate which patients are occupying which beds on the ward. It is located next to the nurse’s station. It is very important that confidentiality is maintained at all times. It can be viewed by visitors and other clients as well. Its function is a quick reference so that any empty beds can be located at a glance as well as a reference point for planning. Individuals with diabetes mellitus and those with infections such those which are multi-resistant to antibiotics have a red spot by their name or a yellow square. There are two consequences of this. Confidentiality is maintained by no indication to clients what these marks mean. However, individuals can feel that there is something especially wrong with them and they could become upset by this.

5.14;

Review the control of respiration in a physiology text. Why might Mr Stevens be abnormal?

The body's autonomic nervous system controls breathing, as it does many other functions in the body. The respiratory centres that control the rate of breathing are in the brainstem or medulla. The nerve cells that live within these centres automatically send signals to the diaphragm and intercostal muscles to contract and relax at regular intervals. However, the activity of the respiratory centres can be influenced by these factors:

Oxygen: Specialized nerve cells within the aorta and carotid arteries called peripheral chemoreceptor’s monitor the oxygen concentration of the blood and feed back on the respiratory centres. If the oxygen concentration in the blood decreases, they tell the respiratory centres to increase the rate and depth of breathing.

Carbon dioxide: Peripheral chemoreceptors also monitor the carbon dioxide concentration in the blood. In addition, a central chemoreceptor in the medulla monitors the carbon dioxide concentration in the cerebrospinal fluid (CSF) that surrounds the brain and spinal cord; carbon dioxide diffuses easily into the CSF from the blood. If the carbon dioxide concentration gets too high, then both types of chemoreceptor signal the respiratory centres to increase the rate and depth of breathing. The increased rate of breathing returns the carbon dioxide concentration to normal and the breathing rate then slows down.

Hydrogen ion (pH): The peripheral and central chemoreceptors are also sensitive to the pH of the blood and CSF. If the hydrogen ion concentration increases (that is, if the fluid becomes more acidic), then the chemoreceptors tell the respiratory centres to speed up. Hydrogen ion concentration is heavily influenced by the carbon dioxide concentration and bicarbonate concentration in the blood and CSF.

Stretch: Stretch receptors in the lungs and chest wall monitor the amount of stretch in these organs. If the lungs become over-inflated (stretch too much), they signal the respiratory centres to exhale and inhibit inspiration. This mechanism prevents damage to the lungs that would be caused by over-inflation.

Signals from higher brain centres: Nerve cells in the hypothalamus and cortex also influence the activity of the respiratory centres. During pain or strong emotions, the hypothalamus will tell the respiratory centres to speed up. Nerve centres in the cortex can voluntarily tell the respiratory centre to speed up, slow down or even stop (holding your breath). Their influence, however, can be overridden by chemical factors (oxygen, carbon dioxide, and pH).

Chemical irritants: Nerve cells in the airways sense the presence of unwanted substances in the airways such as pollen, dust, noxious fumes, water, or cigarette smoke. These cells then signal the respiratory centres to contract the respiratory muscles, causing you to

sneeze or cough. Coughing and sneezing cause air to be rapidly and violently exhaled from the lungs and airways, removing the offending substance.

Why would Mr Stevens be different?

Mr Stevens had a productive cough and was expectorating green sputum although he had no haematemesis (coughing up blood from the lungs).

He was short of breath on exertion and his voice was hoarse and generally quiet

His x-rays showed a "left upper lobe mass, with consolidation and collapse

His pulmonary function tests were normal and indicated obstructive disease.

5.19; Consider the following:

1 Are you aware of the physiological markers of major haemorrhage?

pallor

tachypneoa

tachycardia

thready pulse

hypotension

individual feeling faint

2 Would you know the resuscitation procedure where you work?

On discovering an individual who has collapsed who is for active resuscitation

Sound emergency Alarm Ensure there is no danger around the site Ensure the client is flat (i.e., if the patient is bed ensure the head is of the bed is not

elevated. and remove bed ends) Screen off area from others as best as possible Check DR ABC procedure and ascertain if individual is not breathing/pulseless Attach to defibrillator and carry out defibrillation protocol as required

3 Do you know the location of the resuscitation equipment and whether it is checked and working?

The Resuscitation trolley including a defibrillator is situated in the treatment room of the ward where I am on placement. It is checked by a Registered Nurse on a weekly basis who signs to say that all equipment is in place and that the defibrillator is in working order. Part of this is to check to see if the all perishable good, such as drugs, are in date and that all equipment is working such as pen torch, defibrillator and stop watch.

It is your responsibility to ensure that you can answer, ‘Yes’!

5.20; Write a reflective account for inclusion in your personal profile, identifying how your learning in these key areas has developed.

Patient safety.As I have progressed in my career, I have become increasingly more aware of all patient safety. When I first started in this career, I was not always aware of situations where an individual was at risk. As a first level registered nurse in the future, I will be accountable for individuals safety needs. Sometimes, at my observational skills can let me down to some extent. I continued to me to hone my observational skills so that I reduce any risks of accidents happening.

Patient safety is not just a physical concept. Patients need to feel safe emotionally. It is important that patients trust their nets. This is where a therapeutic relationship is very important. It is very important that individuals feel that they can talk to the nurse looking after them and that's what they want to say is listened to and actioned upon. When I was a student in the 1990s, one of the issues was that firstly I was not aware of situations which put individuals at risk and secondly I could not have the trust of my patients. I was told that several patients had said to my mental at the time that they did not feel that I knew what I was doing. I have worked very hard to improve my confidence to a part where I feel that this use not such a case.

Reducing patient anxiety Reducing patient anxiety has numerous effects it can be very distressing to see an anxious patient. Sometimes, there anxiousness has a very simple cause. There can be a tendency for professionals to ignore the anxiousness all patients because it can be a time-consuming job as well as the nurse not knowing what they may uncover if a girl too deeply into the anxieties of a patient. However a calm patient is more able to communicate, feels less pain, and tends to be easier to deal with. Nurses have a duty of care to reduce the anxiety of their patients. It is important that nurses let their patients know that they are listening to their needs. This means showing that the nurses listening using active listening skills such as keeping our eye contact in a non-threatening way using their body language that implies that they are paying attention. Also, anything that is said, the

patient needs to know that it is being action.

Now I am a student nurse, I need to be more sensitive to the anxiety needs of individuals. If I can help to deal with a patient anxiety, then I must do that. If the cause of them anxiety is outside my sphere of influence, then I must seek the assistance of a registered nurse or other applicable practitioner to deal with the situation.

Effective inter-professional Communication

Healthcare is now a very diverse profession. Nursing, one of the pivotal professions in which nurses can be the only discipline who has a 24 hour a day picture of any individual, does not work in isolation. There are many roles which are fulfilled by other disciplines which lie outside of her sphere of influence of nurses. Example, when a nurse notices that an individual is in pain and that they are not prescribed anything for face, she/he must negotiate with a doctor to prescribe something for this. If an individual requires assistance with mobilisation, then a physiotherapist is the profession with whom he/he must communicate. Occupational therapy deal with adaptations which can be made so that an individual is self caring. They also assess the home environment of individuals, pre-empting any problems that could occur. Sometimes, the view of an outside professional can be very helpful because when individuals are being so closely monitored by their asses, objectivity within the situation can be very difficult to maintain.

As I am a student, I do not have the knowledge base and experience that a registered nurse has. I am still learning. I am still at the stage where I am finding out much about different disciplines such as occupational therapists and physiotherapists. I find it very interesting discovering what other disciplines do because in the future, you will need to access their skills when there are areas which I cannot deal with as a nurse.

Effective use of recourses

Having had the background of working as a healthcare assistant, I have not been bound by the nursing and midwifery Council's code of professional conduct in the same way as I will be one I qualify. You will be accountable for my actions and the use of resources within the environment where I work. In the past, I have not been mindful of my use of resources in the way that I now have to be. Since I started my training, I have been addressing this. I need to be moving towards developing a professional way of behaving. Wasting resources in a budgeted area with limited resources is not appropriate. With knowledge, I need to know which is not only the best treatment for a certain situation but the one which is most cost-effective that still be effective.

9.1; Construct your personal definition of the words elderly and frail. Are there any gender differences in your definitions? Determine if your ideas are supported by research.

Elderly

My definition of this word tends to include individuals over 70 years of age. This definition is not definitive as this may be influenced by the perceptions of the individuals concerned. Some individuals in 80s and 90s may have a very young outlook life whilst those in their 50s may be inappropriately aged in their thinking. I tend to consider physical abilities within my definition also. Demographically, men tend to die younger than men thus elderly people tend to be female.

Frail

Within the definition of this word, I tend to think of an individual who are both physically and mentally venerable. My definition also tends to include particularly compromised individuals and tends not to include those who are only slightly impaired. Despite tending to have different muscular structures to men, women tend to be stronger constitutionally than men.

9.5; Social service provision is vast and may vary from area to area. Collect examples of care packages from your own locality and consider the ways in which they are able to address individuals’ needs.

Washing and dressing

This can be helpful for those who need it. It can help individuals stay in their own homes but it can also have the effect that individuals do not proceed and can deteriorate. Having worked in the community as a care assistant, I have come across cases where I have been actively discouraged by relatives to involve clients in choices and doing such things as encouraging the client to wash his own face.

Night sitters.

These can help to keep individuals safe but it is quite an expensive use of recourses. One person being cared for one to one all night can prevent that person being able to look after several people at once. However, it does keep individuals in their own home for longer which, in the long term, can be a better and, in terms of finance, be less expensive.

Meal time visits.

So individuals can be supported with feeding and drinking, and for safe delivery of food, support with ensuring that meals are delivered can be put in place. There can be significant risk involved with cooking and preparing of food so this risk can be significantly reduce by offering help here. A monitoring role can be fulfilled by the care staff also.

Supervision of Medication.

As Social Services staff are not registered nurses, they can not administer medication. They can, however, support individuals give medication to their selves. This can mean that an individual can stay in their own home but can result in a lot of responsibility being placed on Non-registered staff. Also, significant harm can result if the individual take the wrong medication or omits a dose.

9.21; Read standards six international service framework for older people (D o H 2001 a) with regard to fall and all the people, and determine what actions can be taken to prevent falls occurring.


Guidance on services for falls and fracture prevention in older People. British Geriatric Society (BGS) Guidelines for the prevention of falls in older persons. 2001www.falls-and-bone-health.org.uk/pdf/Fallguide/pdf

1. Primary Care Assessment – routine enquiry about falls whenever older people have contact with the primary care team or social services (as part of single assessment process). Agree initial primary care assessment and local secondary care referral criteria.2. Referral pathway from the community for outpatient multidisciplinary assessment and treatment of community dwelling fallers, including strength and balance training by a physiotherapist. A home visit by an experienced occupational therapist to raise awareness of safety issues may be appropriate for selected patients.3. Referral pathway from A&E for the multidisciplinary assessment of older people presenting to A&E with a fall including access to specialist medical review and access to detailed cardiovascular investigation for patients with non-accidental falls. A home visit by an experienced occupational therapist to raise awareness of safety issues may be appropriate for selected patients.4. Referral pathway from community to physiotherapist-led (or nurse-led following training by a physiotherapist) home exercise programme for community dwelling, cognitively intact people aged 80 years or over. 5. Referral pathway from secondary care to a syncope/cardiovascular investigation/unexplained falls assessment service. 6. Use of calcium + vitamin D supplements in ambulatory female nursing/residential home population.7. Risk factors for falls and osteoporosis to be considered and addressed in a combined approach to prevention, particularly in those who have already sustained a low trauma fracture.8. Hip protectors are recommended for those at risk of hip fracture, particularly older people in care, although problems with compliance should be recognised.9. Appoint a falls coordinator (e.g. a clinical nurse specialist) who will have management responsibility (important that he/she is within the PCT hierarchy) to liaise with primary and secondary care, social services, housing, ambulance, voluntary sector etc. to develop a coordinated approach to falls services, health promotion and audit.

http://www.falls-and-bone-health.org.uk/pdf/Fallguide/pdf

9.22; Think of an example where you have observed the nurse acting as an advocate in order to ensure that a vulnerable person's interests are protected. Whilst working within an elder care rehabilitation setting, I observed registered nurse advocating for a gentleman who was unable to speak due to expressive dysphasia caused by a stroke. He was able to understand what was said to him, to some, as he was able to respond to close questions with appropriate nonce or shakes of the head. Sometimes, it was necessary to ask the same question again all ask it in a different manner to ensure that his responses were consistent.On the occasion in question, the gentleman pointed at the clock and looked very distressed. He put up for fingers and pointed to the clock again. Eventually, it was ascertained that he was concerned about his future but this took some doing and some lateral thinking on behalf of the nurse concerned. The approach to the patient was very calm and when he became particularly agitated that he could not get himself understood. The nurse said to him that she would come back again a bit later on and try again to find out what the problem was. The gentleman was concerned that his relatives, who were arriving at 4 p.m., would determine his future without him being involved. The qualified nurse in question was able to advocate for the patient but negotiations were put in place to determine his future.

Record of the Formative Review of Cross Branch Experiences Child &

Family Health Learning Outcomes: (see Chapter 3)


1. Demonstrate knowledge of physiological measurements in children.

Centile charts

A child’s weight, height and head circumference are plotted On a graph called a centile chart. This centile charts work on averages so being on the "50th centile" for weight or height means a baby is precisely average for it’s age. Similarly, being on the "91st centile" for height indicates that your baby is tall for its age. This type of chart can provide new information as it can show whether a specific individual child is either thriving, is underweight or is overweight for its age

Head cirumfrance

Measured because

Too large

? Hydrocephaly

Too small

? Microcephaly

Height

May show if there are problems with development

Problems with bones

May show problems with hormones

Growth hormone

Weight

Dietary insufficiencies/excesses

May show metabolic disorders

Hyperthyroidism

Hearing

Speech

May show problems with learning

Vision

Social development

Gross and fine motor skills

To find out have they met “milestones” for certain ages to see if there are any problems.

2. Discuss the importance of nursing assessment. Nursing assessment is very important as it is quintessential to how the child is being cared for. As a registered Nurse, accountability is very important consideration with all actions that are undertaken or not undertaken. If the nurse has a thorough knowledge of the client, then being accountable for the individuals in ones care is facilitated. With thorough assessment, the other aspects of the nursing process are facilitated. It is the building block on which the other aspects oft he process are built upon.

o Information may be second hand (from a parent) but parent’s do know what is normal for the child. This is a part of the assessment

o Diagnosis may be difficult to obtain due to the fact that child may not be able to communicate verbally

o Observation of the behaviour may be very important.o The use of senses is VERY important.

It is at the crux of the nursing process:- assessment, planning, implementation, evaluation.

3. Discuss the effect of hospitalisation on children. IsolationChildren can feel very isolated when they are in hospital. In the past, it was common practice for children's parents to wave goodbye to their children when they were admitted to hospital and only see them again when they were discharged. This practice has changed via children's parents only being isolated from their children on the day of an operation (when it was believed that if a parent was there at the time of going to theatre that it would be too hard for the child to say goodbye to the parent) to a child being allowed to be supported throughout their stay in hospital. There is usually provision for a parent to sleep at the hospital.The fact that the parent of a child can stay can have a negative effect as well. The individual child may become over dependent on their parents which may have ramifications with the future with regard to independence development. Also, if a parent who is staying with the child becomes anxious, this can then be passed over to the Child who can learn to become anxious precariously.

Learning.Hospital can be a setting where individuals can experience a great amount of learning. It can be a positive area as individuals can learn to trust. Things may hurt at the time but the child may get better in the long run. The child does not get past the fact that it hurts, then they can learn not to trust.

Social learning is also very important. Individuals may watch others to see how to behave. For example, a child may see another have an injection and not take any notice and behave the same. If a child sees a child who is to have an injection become extremely anxious before he/she has the injection, they may behave in a similar way at the thought of having an injection.

The centre of attentionThe child can become the centre of attention and this can be very difficult as the child may actually enjoy the attention. When the attention moves from them, they may start to attract it in different ways. They may become naughty or they may even fabricate illnesses in extreme circumstances. The theory of operant condition is at work here.

4. Describe the importance of play. o It provides comforto May show that something is not quite right. Play may be subtly different in some

way. Knowing something is wrong, even if you don’t know what it is, may be very important.

o Distraction techniqueo Rehearsal of procedureso Learningo Discoveryo Interacting with otherso Sharingo Imaginationo Expression through play that would not be vocalised

5. Recognise the work of family in a child's life and well-being and propose strategies to work collaboratively with the child and family.

Family A stable influence in a different, sometimes scary environment They know the child and can be a source of information. They can interfere Family mood may leach to child Sure Start scheme can help with providing information and support to family

The activities below


3.12; Complete as much as you can on the assessment of Deepak and his family utilising

the information you have been given. From your assessment identified the nursing needs

of Deepak and his family.

Nursing assessment

1. Maintaining a safe environment

Normally:

Apart from those which are normal for his/her age and stage of development, does your child undertake any hazardous activities? Yes/no

If yes, please specify:

Does your child have any ongoing health problems? Yes/no

If yes, please specify:

Mild asthma controlled by Salbutamol inhaler

Is your child immunised and vaccinated? Yes/no please indicate:

[No information given in scenario ]

Diphtheria

Tetanus

Whooping cough

Polio

M. M.

H. I B.

BCG

Other

Is your child allergic to anything?


Drugs yes/no

Foods yes/no

other yes/no

Does your child anticipate danger? Yes/no

There is your child respond to commands Yes/no

Does your child respond to commands? Yes/no

Would you describe your child as hyperactive? yes/no


Does your child have any blackouts, convulsions, fixed, headaches? Yes/no


On admission

Parental medication discussed? Yes/no


Has your child any recent contact with infection? Yes/no


If yes please specify

Is isolation required? Yes/no

If yes please refer to trust policy

Does the child appear to be in pain? Yes/no

If yes, please indicate pain score

Identify pain tool used

Is the child possibly going for a general anaesthetic? Yes/no

If yes, does the parent wish to accompany them? Yes/no

Are there any family problems associated with general anaesthetics? Yes/no


Other problems

Child's problem/nursing need identified (actual or potential):

2. Communication/fears and worries

Normally

Does your child have full language? Yes/no

If no, please specify what ability:

Is your child able to express his/her feelings or fears? Yes/no

Does your child use a "comforter" of any sort? Yes/no

If yes, please specify


Does your child have any problems with?


Vision yes/no

Hearing yes/no

Behaviour yes/no

If yes, please specify (e.g. wears glasses, hearing aids, etc):


On admission:

Has the child ever been in hospital before? Yes/no

Indicate that parents understanding of the reason for admission

Increased Shortness of breath/unable to speak in sentences/unable to drink

Does the child appear to be worried? Yes/no

Please specified child's worries

Deepak has never been in hospital. He is worried about starting a new school

Other problems

Child’s problems/nursing need identified (actual or potential):

Deepak is anxious. This may exacerbate his condition.

Actual Need

To reduce Deepak’s anxiety

Potential need

To anticipate any areas which will cause distress and offer reassurance and explanation of all procedures

3. Breathing

Normally:

Has your child ever had a breathing problem of any sort? Yes/no


Mild asthma since the age of three

Does your child take regular medication for his breathing? Yes/no


Salbutamol Inhaler

Does anyone at home smoke? Yes/no


On admission

Are there signs of respiratory distress? Yes/no


Child unable to speak in full sentences. Significant wheeze present

If the child is coloured clinically normal? Yes/no

If no, please specify


Other problems

Child’s problems/nursing needs identified (actual or potential):

Deepak has problems maintaining his problem

Actual need

To maintain Deepak’s airway

Administer Salbutamol as prescribed

Potential need

To prevent further exacerbations

4. Eating and drinking

Normally

Do you restrict your child's diet in anyway? Yes/no



Does your child have a good appetite? Yes/no


Does your child have any special likes or dislikes? Yes/no



What does your child likes to drink?


Does he/she use a cup/feeder/bottle?

Does your child feed himself? Yes/no

If yes, does he/she use a knife/fork/spoon?

On admission

Is the child eating and drinking normally yes/no


Unable to drink properly

Is the child eating or drinking compromised in any way yes/no

Is yes, please specify

See above

Other problems

Child’s problems/nursing needs identified (actual or potential):

Potential Need

Deepak is at risk of dehydration

5. Elimination

Normally

Does your child wear nappies day or night? Yes/no


Is your child clean and dry by day and night? Yes/no

If no please specify

What word there is your child use for the toilet?

Does your child normally have urinary and bowel problems? Yes/no


Does your child ever take medication for bowel or urinary problems? Yes/no


On admission

Is the child's passing urine normally? Yes/no


Are there any problems associated with the urinary tract? Yes/no



Is the child having normal bowel actions? Yes/no



Other problems

Child's problems/nursing needs identified (actual or potential)

6. Personal cleaning and dressing

Normally

Is your child able to wash and dress independently? Yes/no


Does your child have any soap or lotion allergies? Yes/no



Does your child use special toiletries? Yes/no



How often and when does your child:


Bath/shower?

Wash their hands?

Clean their teeth?

On admission

Is there a risk of pressure sores? Yes/no

Condition of the skin

Condition of teeth (e.g. loose teeth? Braces? Etc)

Other problems

Child’s problems/nursing need identified (actual or potential):

7. Temperature control

Normally

Is your child prone to high temperatures? Yes/no


Has your child ever had a fit associated with high temperature? Yes/no

On admission

Is the child's temperature within normal range? Yes/no


If no, the specify

Has the child had a febrile convulsion prior to admission? Yes/no

Other problems (family history of hyperpyrexia)


8. Mobilisation/milestones

Normally

Is your child developing normally? Yes/no


If you know, please specify

Is your child fully mobile? Yes/no


On Admission

Is your child partially immobile for any reason? Yes/no if

Yes please specify

Present shortness of breath restricts mobility

Other problems


9. Activities

Normally

Which school does the child attends?


Mention is given to the fact the Deepak is about to attend a new school

Does the child have any schooling difficulties? Yes/no


Deepak is anxious about attending a new school

What activities does your child enjoy?


On admission

Is your child able to play normally? Yes/no


Deepak is short of breath and is unable to play

Is your child able to attend school? Yes/no/NA

Hospital School discussed with payments. Yes/no/NA

Other problems

Child's problem/nursing needs identified (actual or potential)

10. Self assessment

Normally

Is your child shy or easily embarrassed? Yes/no


(Girls) has your child started her periods? Yes/no/NA

If yes, when is her next period you?

Does your child have any self image problems? Yes/no



On Admission

Any problems

Child's problems/nursing needs identified (actual or potential

No problems apparent at this time in this area

What is your child's normal bedtime?


Does he/she nap during the day? Yes/no if yes, please specify


Does your child use a pillow? Yes/no


Do you want to use your child's own duvet/pillow? Yes/no


Is your child having a bedtime routine? Yes/no



Is your child afraid of the dark? Yes/no


Does your child have sleep disturbance/nightmare/sleepwalking/sleep with parents? Yes/no



On Admission

Is there any reason to suppose that your child may have a disturbed sleep pattern? Yes/no


Deepak had disturbed sleep at present as he is anxious about attending a new school

Child’s problem/nursing needs identified (actual or potential):

Actual need

To reduce Deepak’s anxiety so he is able to return to his normal sleep pattern

12. Social Issues

Normally

Is there a family history of long-term illness (e.g. epilepsy, eczema, asthma, diabetes)? Yes/no



Lives with:

Parents name are:


Stepparents names (if applicable)

Brothers and sisters (names and ages)

Sanjita (5 years), Rachid (3 months)

Name of other persons who regularly looks after your child


Do you have any social or financial problems which may make it difficult for you to stay with/visit your child? Yes/no



Are there any social issues/housing problems that we may be able to help you with? Yes/no



Do you have a social worker? Yes/no


If yes, please state the name

Would you like to see a social worker about any of the above? Yes/no


On admission

Can family/extended family visit easily yes/no?


Social worker required? Yes/no


Ward visiting disgust? Yes/no


If no, the specify

Family circumstances/visiting rights


Other problems

Child's problem/nursing needs identified (actual or potential):

13.Culture/is spiritual issues

We would like you to know that we respect your family's cultural/religious beliefs

Please identify your child's culture/culture and religion


Is your child baptised? Yes/no


In the case of an emergency, would you like us to call a minister/Elder? Yes/no if yes, please indicate person to be contacted (or hospital chaplain):


Are there any special religious/cultural observations you would like us to be aware of and respect?



On Admission

Other problems

Child’s problem/nursing needs identified (actual or potential)

No needs apparent

14. Care by parent

This ward operates a "shared care" system of nursing. We invite you to do as much, or as little, your child as you feel able.

Please indicate below, how much of your child's care you would like to be involved in but remember that carers need rest too, and we are willing to take over for you whenever you feel like a break

Will parent or carer and the resident? Yes/no


Basic care:

Comfort yes/no

Feeding yes/no

Hygiene yes/no

Recording temperatures yes/no

Charting temperatures yes/no

Charting intake and Albert yes/no

Medication

Other, please specify

On admission

Does the parent require education on any of the above? Yes/no



Other problems

Child's problem/nursing needs identified (actual or potential):

No problems apparent

15. Discharge

Do you foresee any problems with returning home? Yes/no


If yes please specify

On admission

Are there any reasons to prevent early discharge? Yes/no


Discharge plan discussed with parents/family? Yes/no

If not, why not?


Discharge plan commenced? Yes/no


Other problems

Child’s problem/nursing needs identified (actual or potential):

No problems apparent

3.13; make a list of the initial priority issues for this family.

Ensure that Deepak takes his medication regularly

Discuss with Deepak what his anxieties are

Discuss with Deepak School that he is anxious

3.15; Have you or a member of your family been in hospital as a patient? Think or ask if

any of the categories apply and how you felt whilst you were in hospital. Do you think they

are any differences between children and adults?

Safety

I always felt safe when I was in hospital however, it was in the days when parents had a

limited visiting rights. I was told I was lucky as when my father was young, children would

go into hospital and would not see their parents until they came back home. Some of the

nurses were nice but it was not like having ones parents around. The day of a prospective

operation is probably the most scary that an individual can experience. The unusual

setting, prospect of pain and generalised fear of the unknown concepts which are very

complicated for a young child to experience. There was a culture that you were not

allowed to be upset. This was probably due to the fear that it would cause others to

become upset. I remember it being absolutely terrifying going in for my tonsillectomy and

the drainage of a quinsy.

Nowadays, it is common practice for parents to be allowed to stay with children. This

helps them to feel safe. Parents are now allowed to accompany children to the operating

theatre until the point that they are asleep after the administration of anaesthetics. They

are also allowed to be around at the time of recovery. Having a figure that is familiar

around at times of stress and the unknown can alleviate stress significantly. It can also

help to reduce pain levels, decreased healing times and make individuals happier and

increased consent levels.

Information

I remember that information tended to be given to my parents rather than me. I feel that

this was done to protect me. If I didn't know what was going to happen then I couldn't get

upset about it. This is the point that has significant ethical issues. Nurses have a duty to

keep their clients informed however the consequences of their telling their clients what is

going to happen can cause significant amounts of stress.

Nowadays, children are far more involved in what is going to happen because this can

help with concordance with regimens rather than "you will do this because the doctor says

so!" I feel that it was very much a case of a hand to have intramuscular injections of

antibiotics because I had to rather than as a method of making it better. (This was long

before the days of topical anaesthetic cream).

Comfort

I remember being fairly comfortable when I went to hospital. I remember the nurses being

fairly nice but some were better than others. Having been on the other side of the blood

pressure cuff when doing a blood pressure on a child, I know how important it is to explain

the procedure and that it will be uncomfortable but if the child stay still it tends not to hurt

so much. Building up a relationship of trust is very important. I remember thinking that

"they are going to give me an injection! They say that they're not but that is what they do

is telling me". If a child asks me if they are going to have "Needles" I have always said

that I would not be giving them any Needles (at my level, I would not be in a position to

either cannulated, undertake phlebotomy all give a child an injection) but, I would say that

I would have to be honest and say that I didn't know if the doctors might have to give them

an injection. I feel being honest is important. It is like saying that a procedure is going to

hurt before it is undertaken. Blatantly lying to individuals saying that an injection will not

hurt I feel is unethical. I do not like the administration of injections/phlebotomy. This

makes me more aware of how my actions can be interpreted. It can be quite stressful to

have injections so I was remembering that. Remaining calm when faced with a stressed

child is something that I find very difficult but I have worked on very hard. Children still

have rights, even if they do not display Frazer competence (the ability to give informed

consent on their own if they are under the age of 16). Making a child feel comfortable,

especially in hospital situations, is very important. It must be remembered also that the

stress levels of parents can influence the stress levels in children. Was it working with

their child, I have glanced over at a parent to notice that they look more stressed than the

child does. I think it is very important to ask if the parent is okay also. At the role that I

was working at when I worked in accident and emergency (health care technician), I had a

limited role in giving information. As I become more experienced as a student of nursing

my role in giving information will increase. This I find it very frightening thought as

sometimes I will need to give information that the relative can take on board and

misinterpreted. As I become more experienced I will need to learn strategies to cope with

this.

The difference between children and adults

it is very interesting to compare the reactions of children and adults to being hospitalised.

Working in accident and emergency, I have noticed that there are some significant

similarities. Sometimes, adults can regress and start to act in a more immature manner.

Individuals have individual ways of coping with the hospitalisation experience. Some take

it in their stride; others almost break down, especially if they have a fear of hospitals.

Adapting the way of dealing with individuals is very important. Some people need the

minimal of intervention whereas others need a great deal of attention.

3.18; before reading on consider what particular functions play can have for a child in

hospital.

They can be used to divert children away from what is happening and can also help to

take her mind off their situation.

Play can be used to assist understanding with concepts that may be difficult to discuss at

an intellectual level with individuals. For example the use of a goal to demonstrate the

effects of an operation on a child may be helpful.

Play generally has a role of education which can be adapted to assist individual children to

learn about their individual conditions.

3.31; it is now generally accepted that a parent or another family member is resident in hospital with a sick

child and that they will assist in the care of the child. Discuss the possible advantages and disadvantages of

this with the following individuals:


1 Parents · They know the child and

can be comforted that they are

there for the child. It can be

very stressful when a child is in

hospital.

· Excess distress may be

experience as seeing the child within

a clinical environment with

surrounded by medical equipment

can be very distressing.

· Having a sick child can be

exhausting at the best of times. The

parent may feel obliged to stay when

they are physically and emotionally

tired when it may be better to be

rested and more ready to deal with

whatever occurs.

2 Child · The child has someone

they know when they are both ill

and in an unknown

environment. It can be very

stressful for a child within the

hospital environment so having

a parent there can help with

alleviating this.

· The child can become too

dependent on their parent being

there. Sometimes the presence of a

parent can be very facilitative. Over

dependence can result in the client

not developing.

3 Nurses · The parent can be a

valuable resource and fountain

of knowledge about the child.

· The presence of the

parent can be calming to the

child which can facilitate care

delivery and care understanding

to the child.

· Children who are not

Fraser competent require a

competent parent/guardian to be

present to give consent prior to

any procedure. For this reason,

it can be very useful and less

time consuming to have such a

person “on tap”.

· Parents can encouraged

children to undertake

uncomfortable/painful care

· As well as a calming effect on

the child, the presence of a parent

may have the converse effect. It can

be very stressful for a parent to have

their child hospitalised and in pain.

The resulting stress may leak from

the parent’s body language. From a

very young age, children can pick up

on these cues and anticipate when

uncomfortable/painful care is going to

be delivered.

· A child may be Fraser

competent and the presence of a

parent may cause difficulties.

4 Doctors · Parents tend to be the

people with the best knowledge

of their children. They can be

an excellent resource for

background information.

· Sometimes their closeness to

the situation can be a disadvantage

int hat they are too close and cannot

see the picture as it rather than one

clouded by emotions.

sometimes

3.36 Having considered the theme is introduced in this chapter; can you suggest the

principles which should be observed to ensure that family-centred nursing care occurs

satisfactorily?

Showing respect to parents and children alike

give information to both children and parents

remain calm at all times and display a caring attitude.

Ensure that assessment is thorough so that all members of the care team can do the best

for the child.

Record of the Formative Review of Cross Branch Experiences

Learning Disability Learning Outcomes: (see Chapter 7)


1 Identify the key concepts in relation to nursing people with a learning disability. Individuals may have problems with comprehensive Individuals may have challenging behaviour which may require special understanding

and techniques for management. Individuals may require assistance with enablement and empowerment Individuals may require assistance with dealing with social skills Some individuals may have complex polypharmacy which requires both individualise

monitoring and management. One of the major concepts is that each individual, whoever they are, has value and

should be included. Concentrate for the strength Treating individuals equally Including individuals Involve individual as much as possible Specialist groups can be helpful too due to shared experience.

2. Recognise the importance of alliances between primary and secondary health care workers. Individuals with Learning Disabilities can present a challenge to any health care worker, be they primary or secondary in focus. The primary health care worker may have a thorough knowledge of the client and be aware of any idiosyncrasies and personality issues that may be important for the individual. However, they may not possess the specialist knowledge that a health care worker may possess in a secondary environment. There can be a source of conflict here as there are both areas of knowledge benefits and deficits in both areas. It is very important that there is co-operation between both areas of care. Having worked with individuals with Learning Difficulties as a supportive capacity and having cared for them in an acute setting, I have seen this in action. I have also seen when there has been excellent co-operation. There can be a fear of individuals with learning disabilities in that there may be an anticipated capriciousness in behaviour with a fear that individuals may not be able to understand what is said to them. Busy care environments can also have a part to play in causing stress.

Seamless care is very important between the two disciplines so that the individual get what they need.

Individuals need to understand to the procedure and the consequence of not having it. So, pitching the information at the correct level is VERY important. It is important that this level of pitching is correct as hitching it had to higher-level can cause embarrassment and a lack of understanding an individual. Pitching information act to basic level can be humiliating and belittling to the individual.

3. Identify alternative ways to communicate with people who have a learning disability or to augment spoken language.

Speech

Depending on the ability of an individual, the manner and speech used can facilitate communication. It is very important to gage the functional individual and tailoring communication thus. If speech is pitched at a level that is not compatible with the understanding of the individual in question, then the individual can feel either that they are being talked down to or conversely that they are not being included.

Touch

Therapeutic touch can be useful when individuals have visual impairment. Individuals who have added hearing impairment can also benefit from this especially.

Pictures

Pictorial communication can facilitate the communication process. Written communication may not be appropriate with some individuals so this may be a very useful method of communication. However, the issue of pitching information at the appropriate level is very important.

Makaton

This is a modified version of British and American Sign Language that is used with individuals with Learning Disabilities who have communication difficulties. It can be used with individuals with hearing impairments well as reinforcement for spoken communication. It may be used to assist with speech development, as signs can be used with speech to encourage individuals to use the sign then use the sign with speech then eventually use speech alone.

Individuals who are both hearing and visually impaired can be taught to communicate using sign language. Finger spelling whereby each letter of the alphabet is represented by a sign can be learned. These are adapted from the signs that are used with sighted individuals with hearing impairment.

4. Discuss the importance of access to generic and specialist health care for people with a learning disability.

GenericIndividuals with learning disabilities may not be able to express how they are feeling precisely in a way that workers in generic healthcare settings may not understand. It can be very challenging to ascertain what is wrong with an individual who has learning disabilities when they visit generic healthcare settings. It is very valuable to discuss any changes in conditions that have brought the individual into the care setting as these can

help to aid with diagnosis. Discussing with individuals families/carers can be vital to do this. Individual's body language may help to aid diagnosis however; a normal baseline of how the individual behaves is very useful as this can be a benchmark against how the individual is behaving at a time of presentation.One of the very important tenants of learning disability care is that all individuals should be included. Choice should be given as much as possible. If individuals are not able to communicate effectively, they may not be able to express that they need healthcare. Also, if there is a moderate amount of communication ability, health information must be given at a level at which the individual can understand it without it being at too low a level which could be conceived as patronising, or at too high a level beyond the range of understanding.

They may not understand the significance of some tests on offer such as cervical smear.

Some individuals may have physical health problems such as individuals with Downs Syndrome, cardiac insufficiencies and dementia. (chromosome 21, which is implicated in the development of Alzheimer’s dementia, is the chromosome which is duplicated. Is important that assessment for individuals in this situation is undertaken appropriately.

SpecialistSpecialist learning disability health settings need to cater for the specific needs of individuals with learning disabilities. Communication systems can be put in place that are specifically designed for this client group. This can facilitate the patient journey through this kind of setting. It must be remembered however that specific learning disability health settings, specifically designed for that purpose, may not be seen as "normal". This in itself may result in the individuals who use the service feeling that they are different. One of the main tenants of learning disability care is that, where possible, individuals should integrate as much as possible into society without being ghettoised. From a historical perspective, learning disability individuals were institutionalised in large hospitals. This had several effects. It removed individuals with learning disability from society as a whole. It made learning disability into an "illness". It protected individuals with learning disability from the stigma and prejudice of society as a whole by them not being to be integrated into society.

In the 1980s, these institutions were mostly shut down, resulting in individuals moving into the community at large. Having lived in Dawlish in Devon where such a closure of a learning disability hospital had occurred, I have observed that it is very important for there to be community backup for individuals when they are discharged into the community. It was noted that individuals were placed in bed and breakfast accommodation where although they received a commendation and the provision of a meal, they were removed from their residence after their breakfast and did not have anywhere else to go for the rest of the day until they could return home to sleep. This resulted in individuals standing in doorways, sitting on park benches and other activities without anything purposeful to do. Some individuals had challenging behaviour which members of society at large could find disturbing. Any prejudice in society could be made worse like this.


7.1; before reading further you may like to consider your understanding of the term

"learning disability". Who would you include it in your list?

Learning disability

This is a term which is used to refer to a range of neurological conditions that affect one or

more of the ways that a person acquires, stores, or uses information and may range from

being very slight to being relatively global. Intelligence quotient is used as a marker of

Learning Disability however this can be criticised as they are being culturally biased and

do not take into account intervals social capabilities or their ability to function.

Another paradigm is one where individuals are assessed as to what levels they are able to

self care.

For me, the term has a more global emphasis. It encompasses both self-care abilities as

well as cognitive functioning. I regard each individual as unique who can function at

her/his own specific level.

7.3; check out your present understanding of the causes of learning disability. Compare your list to a colleague or friend and you

may find that this leads to some discussion points.

7.4; Write down your definition for each of the terms "disability" and "illness" before

reading on.

Disability

An impairment which impede an individual. With the correct implementation, this can be

either significantly reduced if not eliminated.

Illness

Any factor that alters an individual health status. These factors are highly specific to each

individual.

7.6;

In your previous activity did issues in relation to communication come into your

discussion? Draw up a list of a variety of communication skills and strategies that health

professionals including nurses, needs to develop to communication skills and strategies

that health professionals, including nurses, have to develop to communicate effectively

with a range of individuals who have learning disability.

7.9 a in order to help you picture the scenario with Cathy at school, it may be helpful

to think about your own education experience. Where people were learning disabilities are

included in your school or college; and if they were how would they eat

I was born in 1970 and at that time, it was not common for individuals with learning disabilities to be integrated fully into "mainstream" schooling. In those days, the term mental handicap was the name used to describe individuals learn disabilities.I do remember that there was a boy in my class who had eczema, slight physical disabilities and was regarded as "slow". He was able to integrate fully with other members of the class and nobody regarded him as having learning disabilities. One of the teachers, used to pick on him. She had no time for anybody who was not "bright" and who would learn without her needing to put extra input in place. I was mildly dyslexic and at that time, this was not a recognized syndrome in the county where I lived. I too experienced her lack of concern and willingness to offer any extra help which has had many implications with regard to my levels of confidence. She believed that fostering a sense of competition would encourage individuals who were not as "bright as the rest of the class to work harder to catch up with them. This was the case with this boy also.The world is a very different place now. Pupils are now called students and are more empowered. They have rights. Teachers now must not discriminate against individuals in terms of their ability to learn.In the Cub pack I attended there was a boy who was obviously older than the rest of the clubs in the pack who had Down’s Syndrome. He was supported by his father and tended to be on the periphery of the things.In 1986, as I then wanted to be a teacher, I did some work experience in a primary school. A girl who had learning disabilities attended the school and was supported by an ancillary as well as an auxiliary worker. She worked in the same classroom as others of her age and was given her own work to undertake by the teacher.In 1988, I decided that I wanted to be, more specifically, a special needs teacher. To this end, I did some work experience in a special needs school. This I found very interesting. Students were placed in glasses according to age unless they had particularly complex needs when they were placed in a special needs class. Any class teacher had to be aware that within her/his group of children, there were very diverse needs and abilities. One particular skill that I noted that was demonstrated was that of having to adapt what was being taught so that all members could understand it. Although there was a great emphasis on academic work as individuals progressed up the school, there was also emphasis on social skills as well as practical skills that would help individuals to participate as fully as possible within society.Eating at schoolMy little experience of observing individuals who have special needs eating in schools has made me reflect that it is very important for individuals with learning disabilities to feel part of society. Children can be very cruel and can be quite nasty about other children who are “different". I feel is very important that there should be integration with heating for individuals with Learning Disabilities in most cases as the benefits of social role valorisations and learning that all individuals are different and should be accepted within society as a whole.

Supplementary discursive discussion with regards to Learn Disabilities

During my previous nurse training, I was placed within an autistic community. This I found

extremely interesting and alleviated a lot of the fears that I had about autistic individuals.

It was not something that I understood very much and found the diversity in behaviour

unquiet inning to start with but soon became accustomed to the fact that this is who the

people were and this is what made them unique.

In the year preceding the commencement of my nurse training this time, I worked in an

accident and emergency department as a healthcare technician. Within this role, I have

worked with individuals with learning disabilities who are acutely ill. This can be very

frightening to them. Not only are accident and emergency departments busy and noisy,

previous experience is of secondary health settings can induce extra stress in individuals

generally and especially those with learning disabilities. One of the most useful recent

medical advances is the production of anaesthetic cream which can be applied to topically

to provide localise numbing of prospective phebotomy/cannulation/injection sites. (This

can also be useful for individuals with needle phobia and children). This cream can be

very useful as it can help to alleviate some of the distress of individuals with a disability

within the Department.

Another very important aspect of dealing with individuals with learning disabilities within an

accident and emergency setting is that of communication. Many complex tests can be

required and these can sometimes involve pain or the need for individuals to sit very still,

It is very important for any healthcare professional to understand the functional level of

any individual with whom they are working. On the whole, individuals with learning

disability usually supported by a member of their family or a carer. This is very helpful as

this allows for discussion of the understanding of the individual so that any interaction can

be pitched at a level at which the individual would learn disabilities can understand. I have

found such support very helpful as it has helped me to explain such things as ECGs and

the concept of how much pain and individual is experiencing so that is understood.

Record of the Formative Review of Cross Branch Experiences Mental Health

Learning Outcomes: (see Chapter 6)


1. Discuss the concepts of mental health and mental illness.

Mentally health means.the successful performance of mental function, resulting in productive activities, fulfilling relationships with other people and the ability to adapt to change and cope with adversity; from early childhood until late life, mental health is the springboard of thinking and communications skills, learning, emotional growth, resilience and self-esteem.

mental illness means:-

A mental illness is a disorder of the brain that results in a disruption in a person's thinking, feeling, moods, and ability to relate to others. Mental illness is distinct from the legal concept of insanity.

Beware thyroidIf thyroxin is too high

Can appear manicBut eat a lot and loose weightExopthamus

If thyroxin is too lowCan appear depressed

With manic patientNo exopthamusNo raised thyroxin levelsPulse rate decreases on sleep

SchizophrenicLack of eye contactMay be looking away towards things that they are listening

See activities bellow

2. Discuss the development and aims of community care for people with mental health problems and relate these to local circumstances. See activities bellow

3. Identify some key legal aspects of mental health care.


6.1, With a friend or a partner in your learning group agree to spend at least half an hour together on this exercise. Talk about your experiences so far of mental health issues and identify personal experiences which may inform your understanding of the issues involved. Shared together as much as you feel able, but if there are any difficult issues or experiences which you decide not to share, notice your responses and reactions initially.

Identify any personal needs you may have in respect of mental health issues and the resources or support you may call on in working through this chapter.

Uncomfortable or personal issues may be raised for any of us in this area. If you feel that exploring this personally, all working with this client group may touch on personal areas for which you do not have sufficient support, make sure that you discuss it with your learning coordinator, a friend or will mental health professional.

I spoke with one of my colleagues who has been working in acute mental health settings for the past eight years. I have only had limited experience with individuals with mental health problems but these experiences have been more frequent due to my job within an accident and emergency department. A significant number of the attendees have mental health issues. These can be in the form of individuals who attend having an exacerbation of their mental health condition as well as people who have self harmed and overdosed.

One of the issues which we discussed was that of individuals who are experiencing hallucinations. I remember working on night duty in an acute mental health setting and talking to one of the mental health nurses who was working with me. What he said has stayed with me and has been extremely helpful. He said that it is a good practice to go with how the hallucination is making the person feel. The example if an individual is expressing that they are hearing voices, asking how the experience of this is making the individual feel that the very helpful. I have found this very helpful in my practice.

My colleague and I discussed this at some more depth and some of the pathways which can be offered to individuals when they express these fears.

My colleague had previously discussed with me how he had had experience at first hand with mental health problems. As I have not had mental health problems myself, I was interested to find out how he felt about the experience. He said that it has made him a better person and more appreciative of how he does his job. It has made him aware of how a professional's body language and actions can either calm all inflame individuals.

I discussed with him that one of my friends has just told me that he thinks he might have a bipolar disorder. I discussed that what I was doing was listening to my friend and was able to occasionally un-pick some of the things that he was saying.

6.2; Identify relevant factors in the area in which you live or work which may affect the mental health of the local population. Where there are specific problems, identify any services which may provide relevant help.

Factors affecting mental health

UnemploymentCornwall is a constantly changing economy. In the past, it has heavily relied on primary industry such as farming and mining. There has also been a significant china clay industry. Also, secondary industry has played an important part in the economy locally. Mining resources have been practically exhausted, farming is in crisis and the price of china clay in the worldwide market has fallen to the point where Cornish china clay is excessively more expensive to produce. This has an effect on the mental health of those who work in these industries. Stress and depression can be quite common.

Drug and alcohol abuseCornwall has a significant problem with substance misuse. The perception that the area has no deprivation can lure individuals to migrate to Cornwall where they perceive that their troubles will be over. When they get here they find that the economy is depressed and that the gold paved streets that they were expecting are not. Areas which have particular problems are the Newquay and Penzance environs. Mental health services tends to have much work to do in these areas.

The use of marijuana can cause paranoid psychotic episodes in some individuals which require hospitalisation due to their severity. It is said that the use of marijuana can either bring forth psychosis or, if it is dormant, bring it out into the open. Cornwall has a healthy surfing culture as well as an increasing student population. Now you're on the use is on the increase.

Tobacco

One drug seems to have a higher usage amongst individuals with mental health problems above all other. This is Tobacco. Users report that it can help them cope with life better and that it helps to make the day bearable. However, there are significant health risks associated with the use of tobacco such as cardiovascular problems, cancers as well as some discussion as to it being a depressant. It is very difficult to tell the effects of it as a depressant because if an individual is feeling very mildly depressed, they can either start all increased their smoking. Their condition may become worse at a point where the beginning to present to healthcare professionals. Despite all the health messages about smoking and tobacco use, if an individual is feeling so helpless, they may try anything to alleviate this feeling which can include smoking.

Isolationwith the perception that Cornwall is a rural idyll, individuals who migrate here can find that even in a supposedly close-knit village that there is no coherent community. This results in there being poor community support and/or network. The concept of social capital whereby individuals have a good support network which they can call upon at times of need can be lacking. Individuals who have high levels of social capital, experience less depression. It has been noted that the universe is true also.

6.4; A (for all students) Review your own reading so far about "schizophrenia". Identify the predominant ideas which emerge.

Schizophrenia is a psychiatric diagnosis that describes a mental illness characterized by impairments in the perception or expression of reality, most commonly manifesting as auditory hallucinations, paranoid or bizarre delusions or disorganized speech and thinking in the context of significant social or occupational dysfunction. No organic cause has been found about the condition although that neurobiology, early development and heredity have a part to play. Although it can manifest itself at any age, adolescence is the most common stage of its onset.

Increased dopaminergic activity in the mesolimbic pathway of the brain is a consistent finding. The mainstay of treatment is pharmacotherapy with antipsychotic medications; these primarily work by suppressing dopamine activity. Dosages of antipsychotics are

generally lower than in the early decades of their use. Psychotherapy, vocational and social rehabilitation are also important. In more serious cases—where there is risk to self and others—involuntary hospitalization may be necessary, though hospital stays are less frequent and for shorter periods than they were in previous years.

Predominant ideas

There is disorganisation of ideas

Different experiences of reality

Purposeless behaviour

B. (for mental health students) Arrange a discussion about "schizophrenia" with your peers and colleagues and note individual differences in beliefs and influences in the group.

6.6; A (for non-mental health students) identified the meaning of the terms "delusion" and "hallucination". Consider the judgement which is made in applying these terms to another's experiences.

Delusion

A delusion means holding an unshakeable belief that other people would regard as groundless. (http://www.mind.org.uk/Information/Booklets/Understanding/Understanding+Psychotic+Experiences.htm )

http://www.mind.org.uk/Information/Booklets/Understanding/Understanding+Psychotic+Experiences.htm

http://www.mind.org.uk/Information/Booklets/Understanding/Understanding+Psychotic+Experiences.htm

An individual who presents with delusions can have many negative judgements made about them. They may be seen as difficult or "mad" because any logical argument will not shake their beliefs.

Hallucination

This may include hearing things, such as voices, seeing something other people don't see.

(http://www.mind.org.uk/Information/Booklets/Making+sense/antip.htm)

Hallucinations can bring forth judgements by others which can be very harmful. Individuals who are suffering from hallucinations, whatever their cause, can be extremely frightened. If you are lying in bed and you are frightened of spiders, it must be terrifying if you see spiders crawling out of the bedclothes. Hallucinations can manifest themselves in many forms and can affect all senses. Individuals may even smell things that are not their. Individuals who have hallucinations can sometimes experienced these because they have been utilising recreational drugs. "Well, it's their own fault" can be the resulting judgement. As nurses, it is important that these judgements are not made because everybody has the right to be themselves. Judgements can get in the way of the nursing process.

B. Read the I CD-10 diagnostic criteria, or consult the equivalent section in the DSM-IV-TR, and ascertain the way in which the criteria which defined " schizophrenia" are organised. How might these criteria be applied to Martin's experiences?

http://64.233.183.104/search?q=cache:anBnm6q1uVUJ:www.who.int/classifications/icd/en/GRNBOOK.pdf+ICD-10+diagnostic+criteria&hl=en&ct=clnk&cd=1&gl=uk

6.8; what do you know of mental health inpatient units? Find out treatment and associated care are offered all available to people with severe mental health illness in your area.

Whilst working as a care assistant for a nursing agency and whilst working on a nurse bank for a Healthcare trust as a healthcare assistant, I worked some shifts in acute mental health settings. Patients were usually admitted when they became a danger to themselves or others. Having been used to working in general health settings, especially within hospital settings, I found it extremely difficult to adapt to the change of pace and the change in outlook. I wanted to be "doing something" all the time. I found that I had to step back and reassess how I behaved. I was usually called in to "special" individuals who required it either to protect them from themselves or to protect others from them. I found this very challenging and did not like it to start with because I was scared and I didn't know quite what was expected of me. However, in time, I learnt that it was very important to get to know the client and find out a bit about who they were. Several times, I found by the



end of the shift, that I was developing a degree of trust from the person whom I was supporting. There were others who for some other reason found my presence distressing and somebody else was found to support the individual. I used to get upset about that but now I realise that sometimes though one is universally acceptable to everybody.

I also did a significant amount of work in elder care mental health units. This I found really interesting. Not only was I having to get to know the client very quickly but I was developing skills with working with individuals with dementia. One of the settings where I worked quite intensively on the nurse bank was a place for individuals with challenging behaviour and dementia. These individuals could be quite violent at times which I found distressing to star with but began to be able to read their body language that as I got to know them. To reduce the stress in individuals, attempts were made to keep individuals in a routine so, even if this was in a very basic level, the individuals may be able to predict what was going to happen to them. Also, choice was given to them at a level that was appropriate to them as much as possible.

If you have the opportunity, talk to some of the service users about their experiences of the treatments they have received. Identify helpful and unhelpful aspects of the treatment and care as they have experienced it.

6.11; 1 ascertain what current provision is made in your locality for mental health, for people with mental health problems and by mental health services.

2 which aspects of the provision that lent care in the community, cared by the community or care of the community?

Type of provision

Of, by or in the community

Acute Mental Health Setting.In Cornwall, there are two main areas where mental health patients are catered for who require hospitalisation. These at Bodmin and Redruth. There are various types all acute settings such as secure forensic, acute admissions, ranging to rehabilitation settings and elder care settings. This is not particularly useful if family members are restricted in terms of travel. This provision has been radically reduced as a result of care in the community. At one time, there were over 1000 patients at a hospital in Bodmin, St Lawrence's with 88 ward managers. There are now approximately 3 wards in Bodmin at the hospital. This is an example of care of the community.

Community care for mental health patientsin the community, mental health provision is quite diverse. This can be provided by a community psychiatric nurse, social workers, community care assistants to name but a few. These, again care of the community and care in the community

Mind

This is an organisation who helped to support individuals with mental health problems providing defenders and other support networks. It is an example of care by the community.

Care given by family/friendsThis is where laypeople, such as friends and family, provided care for individuals with mental health problems. This is an example of care by the community.

3 how might these three different concepts conflict with one another? (Consider rights, risks and resources) .

There may be a conflict if professional bodies interact with lay bodies such as sometimes, an individual who is a member of the family is innovative, is "too close" to the situation to be objective. However, conversely, the reverse can be true in that members of an organisation, such as the NHS, can be too distant from the situation.

4. What sort of care might have been options for Martin in his locality?

Martin may find that as he likes talking to people one-to-1, that he may benefit from a befriend such as one provided by MIND. He sounds as if he is the type of person who prefers to "talk things through" rather than use medication all the time

5. Assess the National service framework and other key documents relevant to the implementation of mental health policy in your region. Identify the key elements of current policy which are influencing the services you are encountering.

This National Service Framework addresses the mental health needs of working age adults up to 65. It sets out national standards; national service models; local action and national underpinning programmes for implementation; and a series of national milestones to assure progress, with performance indicators to support effective performance management. An organisational framework for providing integrated services and for commissioning services across the spectrum is also included.

One issue that predominates is that of inclusion. This has been an area which has been increasingly developed in several different policy document including “Including People” and “Delivering Racial Equality”.

Record of the Formative Review of Cross Branch Experiences Mother and

Baby Learning Outcomes: (see Chapter 2)


1. Identify the social and health implications of pregnancy and child bearing.

Social implications.

Reduced ability to work including adaptions needing to be made due to pregnant state

reduced ability to earn money

social life may be altered due to restrictions on alcohol and tobacco

there may be a case of social stigma being present if the individual is not married in certain cultures

Health indications

increased fluid volume and wait put stress on the heart.

Increased fluid volume can result in raised blood pressure

pre-eclampsia may present itself by raised blood pressure and protein in the urine as well as urate in the blood being raised.

The pancreas may not be able to cope with the excessive demand of the foetus as well as the demand of the mother so insufficient insulin may be produced to cope with this demand

Morning sickness could cause issues to social situation

Heart burn do to muscle relaxation

Piles

Pain

Joint problems

Bladder weakness

Psychological changes – preparing to be a mother

Stretch mark

Depression, worries, concern

2. Recognise common factors which adversely affect the physical, mental and social well —being of patients and clients.

Birth defectsMultiple birthsChild birth painHousingTransportIsolationDepression of not having a jobFear of the unknownLeaving children in child care.Changes in body image

3. Identify physical, social and spiritual needs of the patient or client and be aware of the values and concepts of individual care.

Physical needs

a need for adequate and appropriate nutrition throughout the pregnancy as well as pre-and post-pregnancy

a need to know how to adapt to the change in body shape such as learning techniques to reduce pain.

A need to learn breathing exercises to ensure good oxygenation due to restrictions on the lung caused by the foetus in the uterus

an adaption in clothing worn to facilitate dressing as pregnancy can make this more complex. Exercise is to maintain blathered tone prior to during and after pregnancy to facilitate good blathered tone and reduced risk of complications such as incontinence

the eating of a balanced diet to promote normal stalls rather than becoming constipated or having loose stools

optimum amounts of exercise which helped to maintain fitness that do not cause over fatigue.

Social needs

the choice of birth partner for example of friend, a parent, a partner

a need to feel supported throughout the complex changes back pregnancy and birth can bring

support with the changes that motherhood can bring after the birth of the baby

a need to equate them and shall security with ensuring the health of the baby (ie, is it more important for a mother to work at the detriment of the baby in size her or is it more important that she leaves her job that is harmful and concentrates on staying well)

a need to be accepted as a pregnant woman as well as a mother after pregnancy has finished

a need to be supported through the changes in body and body image which can result from this

spiritual needs

and need to be an individual rather than "a pregnant mother"

and need to express oneself as an individual

and need to express and practice religious beliefs

a need to mourn if the trials is lost prior to


2.1. There may be other concepts which you have already decided that you would like to

explore. As you work through the list yet more may arise.

As you work through the chapter refer to a dictionary to check your understanding of

technical words and phrases.

Pre-eclampsia

Pre-eclampsia is typified by a lady presenting with raised blood pressure and protein in

her urine. The tests can show high levels of urate in the blood. Its primary cause is not

entirely know but there is some believe that the centre dysfunction has something to do

with it. A further side-effect is swollen limbs. If the condition is not dealt with, eclampsia,

which means fitting can ensue you.

2.2. What may make Jackie come to the conclusion that she may be pregnant?

Human Chorionic Gonadotrophin in the Urine (however, this may be confusing as the

embryo produces this but may not be implanted.

Absence of menstruation

Tender breast

Morning sickness

Funny taste in the mouth (metallic taste)

May go off tea and coffee

Heightened senses

Excessive fatigue

2.6. A. Look at Jackie’s antenatal sheet (table) to see how may different people gave care

to Jackie at this time.

B. Can you find out the situation in your local area perhaps by talking to friends or

colleagues who have recently had a baby?

To be discussed orally

2.7. Consider what aspects you would want to find out more about to be able to support

Jackie confidently during her pregnancy

2.8. Before reading on, list fac kitty kitty shooting like shooting fish in tors about Jackie’s

history which may interfere with her experiencing a fulfilling and safe pregnancy.

2.17. List the advantages and disadvantages of breast- and bottle-feeding.


Breast feeding It is naturals.

Baby inherits

antibodies from

mother.

Breast milk can be

expressed and

stored for 3

months. It can be

thawed and kept

for 48hrs.

It is cheap

Less obesity

Less diabetes

Less cardiac

disease in later

lived

Quite difficult

Governed by milk

supply

May be

uncomfortable

May be considered

“dirty” in some

cultures.

Better mental

development

Better mouth

formation and

slighter teeth

Protection against

ear infections

Protection against

chest infection and

whe3ezing

Lower risk of

diabetes mellitus

Less eczema

Protection against

diarrhoea, gastro

enteritis

And tummy upsets

Less smelly nappies

For mother

Reduced

Osteoporosis in

later life

Lower risk of

ovarian cancer

Lover risk of pre-

menopausal breast

cancer

Stronger bones in

later life

Faster return to

pre-pregnancy

figure

Bootle feeding May be easier to

set up as a regime.

Babies put on

weight quicker

Babies are more

easily satisfied

No colostrums

Not recommended

by UNISEF

Cannot be made up

and kept chilled for

long periods

Complicated to

make up from dried

formula

2.18 Find out what groups are available in your area and what is their role.

Breast feeding drop in clinicTo encourage and support mothers with the breast feeding process. Midwife run

Parent craft run 2 x 2 hour sessions provided by community midwives to introduce and support

mothers/fathers with the expectant birth and what will happen after.

Aqua natal servicesTo help mothers to exercise in water which can be very relaxing.

Yoga exercise craftExercises to assist with comfort in pregnancy as well as exercise to facilitate the

birthing process.

Natural child birth trust private parenting classesPrivate classes run by the National Child Birth trust. Groups as smaller and can be

more tailored for individual mothers.

BAPS (Breastfeeding Advice and Peer SupportBAPS mums are trained to meet other breastfeeding mums to give advice and

support on breastfeeding.

National Childbirth Trust Courses run on an informal and friendly basis with plenty of time for asking questionsThey cover aspects of pregnancy birth and life with a new baby and are geared for parents of birth supporter to attend, as well as just the mother to be.Information on relaxation, breathing, massage and different positions in labour can help whilst still considering other option for pain relief and giving birth.Practicalities of caring for new babies and how this might affect coping and changes in lifestyle are covered.Support with breast feeding.

Incredible yearsSupporting parents to cope with all aspect of behaviour ages 5-10

DippersTeach your baby to love water

Cornwall women’s refuge trust

Munch wellHealthy eating scheme

Chatterbox Parent and toddlers morning

Cornish real nappy projectwww.crnp.org.uk

http://www.crnp.org.uk/

Record Of The Formative Review Of Cross B

Health & Medicine

thereduced time

doneshorter time

health care professionals

better health

health benefits

health risks

care team

care setting