Optimization of Workload for Medical Staff - Essay Example

?Pediatric Case Study The rate at which children are attending emergency departments (ED) is increasing every year. It is expected that the advanced paediatric nurse practitioners will be in greater service in trying to help these children achieve that which they believe is the best for these children. The APNPs are expected to treat the children and then divert them to areas where they can receive the intended care with more appropriate services offered to their families as well (Barnes 2003:2). This will allow for the freeing of medical staff to deal with more serious patients while at the same time ensuring that the children regain their health within a short period. The APNPs are also expected to provide quality indicators that will assure the parents of the continued health of their children. They are however expected to act within a preset guideline that allows for structured assessment as required by the health regulators. It should also be noted that assessment is not a singular event that takes place when a child is brought in. instead, it is a continuous assessment process that dynamically changes in regard of the symptoms or results achieved with every assessment (American Academy of Paediatrics 2009:1233). It should be noted that an infant should be considered as sick unless it can be otherwise proven. This means that the APNP will have to get a good history of the illness and work on eliminating any possible illnesses until the most appropriate for the conditions observed after the assessments. As observed, child assessment is not a one-day affair. It is a continuous process that requires constant attention and keenness not to miss any cues or subtle signals that may pass unnoticed during initial testing (Barnes 2003:5). Thus, the report herein will look at the different attributes of the paediatric section and ways through which countries and researchers' advice on taking care of the children. To do this, the best method would be conducting an online search with the terms paediatric, emergency department, requirements and clinic being the key terms of reference. The search would be differentiated by how relevant the articles are on the topic of discussion. The results would then be used to provide an episodic care treatment for the sick Serena. Priorities At the moment, there are two important priorities that must take precedence in the case. First, a structured assessment is required. As noted above, the need for a continuous assessment is paramount with every step taken with deeper precaution. The dynamic nature of this assessment is also an integral part of the whole treatment regime (American Academy of Paediatrics 2009:1233). Given the fact that particular signs and symptoms may not be as readily expressed as those of an adult or as an adult would express them, repeated observations and assessments require proper attention and vigilance to avoid a relapse or worsening of the present conditions. The paediatrics are supposed to ensure that that they have put all measures that point towards quality improvement by providing an avenue through which indicators of good outcomes, proper data collection and synthesis and clearly defined outcomes that provide evaluative measures of success to ensure quality is maintained in the ED (Barnes 2003:8-9). This also implies that paediatrics have to be flexible enough in their response to the different signs and symptoms that the child portrays after a given interval. This flexibility is also meant as an avenue through which the doctors consult on certain issues that may have arisen from their assessment and also eliminate other possibilities. The second priority is to have her admitted. Safety is one of the most important considerations when a child is involved. The fact that any release could lead to more fatal effects or worsening of the conditions already stated should be a pointer enough that there need to be a greater caution when dealing with infants. Unless the APNP is assured of the infant’s safety, Serena should remain in their custody till they can be clear on what effects the release will have on her condition (Seow, Lin, Lin, et al. 2007:1004). This will also provide a chance to understand whether there are other underlying factors that need to be sorted out to ensure that they do not leave anything to chance. This may include having the parent near as a way of ensuring the child feels safe and can trust the nurse while the medical check up is taking place. Such interactions will assist in making it easier to avoid any worse conditions since the child will relax having someone they trust around them. Thus, the nurse must be well organized to help incorporate the caregiver and the patient in the same room without jeopardizing the safety of either. Furthermore, given the age, the flexibility with which the examinations will be done will detail the number of areas that the nurse can examine offering more detailed evaluations of the child and proper diagnosis at the end of it all (Barnes 2003:15). Meeting the Priorities Creating a developmental approach towards the physical examination of the infants is imperative at this juncture. Meeting the assessment requires understanding about the child and how the children at that age behave. At 20 months, children have a greater anxiety as a result of separation and stranger anxieties may impede proper examination. Children at this stage want to feel autonomous and will do all in their way to achieve it. Therefore, the child should be assessed with the parent around to provide that comfort that they find in a parent. The child is also having difficulties in breathing. This means that the child needs to be handled with greater care with the issue of lungs, the heart and the lungs being considered primarily before the child is placed on the examination table (Burt and Middleton 2007:683). The nurse must thus adjust their techniques based on the response cues that the child offers. This is important and contributes greatly to the realization of the goals of the assessment being carried. Further, bodily harm is something toddlers are wary of (American Academy of Paediatrics 2009:1235). Ensuring that the child receives great attention and distraction to prevent them from feeling pain or worsening the conditions already present is crucial. Serena is a child who has some difficulty in breathing. Approaching this with great caution will make sure that the child understands that the doctor is doing the treatment for her benefit. Further, it is important to understand that limited verbal communication skill may be quite distressing in this case. However, non-verbal communication cues also play a great role here and need to be incorporated (Barnes 2003:15). The parents also require assistance. Their perception of what development is will be a great assistance since they can give further details of what they have observed and that which might have escaped the nurse’s assessment. This will be helpful in providing special assessments of some of the most likely causes of the disease in question. The aftermath also prepares the parent for some responsibilities that require their attention. It will also provide an alternative care regime that will help the parent get closer to the child and learn how to respond to some of the symptoms from time to time (Guzzetta, Clark and Wright, 2006:17). As for the admission, let the age and the developmental level both of the disease and the child provide a guideline that will ensure the child meets the required standards for admission. Certain protocols have to be utilized in the case of Serena. Breathing could become fatal if not considerably attended to. The admission will be as a result of the assessment (Seow, Lin, Lin, et al. 2007:1004). The effort that the baby puts in breathing and the efficiency through which the baby breathes are the key determinants in the admission of this child. It is noted that breathing problem may result to hypoxia or hypercapnoea which may lead to a decreased level of consciousness as well as agitation (Guzzetta, Clark and Wright, 2006:17). This will allow the nurse to move from the more easily observed symptoms to the distressing ones without making the child feel insecure or in any way as part of a broken relationship with their caregiver. The admission will also act as a review of any symptoms or medications from earlier assessments and hence provide a complete review of what they believe is the problem (Seow, Lin, Lin, et al. 2007:1005). The family will be aware of any developments from a professional’s episodic nursing care of sick children and their families' point of view and understand what ought to be done in case the child gets worse. Nursing care should be appropriately directed towards the growth of the child as Serena undergoes her treatment, she expects to be well to avoid the agitation she is feeling. The nurses should work on making sure that the child feels better by incorporating all the quality improvement guidelines that ensure better health. There must be indicators that the health practitioners are working on periodic review of drugs and equipments as well as monitoring the changes in the child at regular intervals (Geelhoed and Geelhoed 2008:2). A well established criterion for meeting the patient requirement cannot be overlooked given the needed flexibility when it comes to breathing problems providing oxygen support to enhance breathing and lower breathing difficulties and unconsciousness means intensive overview of the conditions to ensure safety of the child. The parent may be given a chance to observe how some of the first aid precaution is done to enhance their tackling of such issues in case they occur when the child is at home or the doctor delay before attending to the child the main essence of this nurse development drill is to ensure that the child survives whether at the hands of the parent or the nurse (Moody-Williams, Krug, O’Connor et al. 2002:404). It is also expected to provide any results that have so far been observed from various treatment remedies, whether at home or at the hospital. Comparison The American guidelines have been specifically targeted at making sure the environment is safe for the child to be treated in. The Australia guidelines on the other hand venture into the core aspect of the illnesses and how the child needs to be attended to (NSW Health 2011:13-7). They all offer the child some significance by stipulating what ought to be done in an ED and what the APNPs need to do to make sure the children do not suffer more from the same illness again. The Americans are more concerned with the protocol while the Australians are considered about the ultimate care that the child is treated with (Moody-Williams, Krug, O’Connor et al. 2002:406). The APNPs need to know their profession and adhere to the protocols as stipulated in their code of conduct. The heads of these departments need to ensure that they staff the ED with qualified person rather than quacks. The Americans also rely on different institution to foresee the growth of the discipline while referring the case to different departments for solutions (Joint Commission 2008:51). The Australian guidelines offer a complete overview of what they ought to do in cases of emergencies or when they think they need further assistance from other quarters (NSW Health 2011:10). Communication It is proven that ineffective communication jeopardizes the quality of healthcare provided. This may lead to medical errors and patient harm which would be greatly harmful to the child. First and foremost, it is important that the nurses respect parent anxiety (Dingley, Daugherty, Derieg and Persing 2008:2). There is always an emotional bond that needs to be respected and this is what keeps the child and the mother in touch. Further, the bond must always be maintained to help gain the trust of both the parent and the child. Interpersonal kills that allow the nurse and the parent to work together on the same issue are also needed these kills will help clear the air about what the nurse needs from the parent and what information the nurse need to help in diagnosis and treating the baby the nurse must also have a way of assessing the communication need from what they have been trained (Nursingtimes.net 2007). This will help in diagnosing what the baby means during different stages of the treatment and how this may be tied to some of the responses the baby shows (NSW Health 2011:14). This will allow the nurse to coordinate the treatment session with great care and expertise. Conclusion From the above, it is important to understand that the needs of the child are at all times relevant when they are being treated. The caregiver and the nurse act as a medium towards what they believe is the best way forward for the child. There are different guidelines that may be applied but the most important re those that place the child’s interests at the forefront. Further, it is important to have good communication as a means of giving the best care for the child’s benefits. Nonverbal cues may be taken to mean differently by the child and that may worsen things of not taken care of in advance. Paediatric training needs to have all these concepts intertwined to help achieve the desired goal. References American Academy of Paediatrics (2009) Joint-policy statement-guidelines for care of children in the emergency department. Paediatrics, vol. 124, no. 4, pp. 1233-1243. Barnes, K. (2003) Paediatrics: a clinical guide for nurse practitioners. Butterworth Heinemann, London. Burt, C.W. & Middleton, K.R. (2007) Factors associated with ability to treat paediatric emergencies in US hospitals. Pediatr Emerg Care, vol. 23, pp. 681–9. Dingley, C., Daugherty, K., Derieg, M.K. & Persing, R. (2008) Improving patient safety through provider communication strategy enhancements. Agency for healthcare research quality, viewed 30 august 2012 . Geelhoed, G. & Geelhoed, E. (2008) Positive impact of increased number of emergency consultants. Arch Dis Child, vol. 9, pp. 2–4. Guzzetta, C.E., Clark, A.P. & Wright, J.L. (2006) Family presence in emergency medical services for children. Clin Pediatr Emerg Med, vol. 7, no. 1, pp. 15– 24. Joint Commission. (2008) National Patient Safety Goals: Hospital Program. Joint Commission, Oakbrook Terrace, IL. Moody-Williams J.D., Krug S., O’Connor R., et al. (2002) Practice guidelines and performance measures in emergency medical services for children. Ann Emerg Med, vol. 39, pp. 404–12. NSW Health (2011) Recognition of a sick baby or child in the emergency department. NSW Health, Sydney. Nursing times.net. (2007) Communication skills (essence of care benchmark). Nursingtimes.net. viewed 30 august 2012 . Seow V., Lin A., Lin I., et al. (2007) Comparing different patterns for managing febrile children in the ED between emergency and paediatric physicians: impact on patient outcome. Am J Emerg Med, vol. 25, pp. 1004–8. Read More