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1799 results in Nursing

Page 57 of 90

  • Chapter 11 - Cardiovascular nursing skills

  • Elizabeth Forster, Griffith University, Queensland, Jennifer Fraser, University of Sydney
  • Book:
    Paediatric Nursing Skills for Australian Nurses
    Published online:
    06 August 2018
    Print publication:
    18 October 2017, pp 208-232

  • Summary

    Introduction

    The majority of paediatric patients do not have cardiac-related health problems, but some paediatric patients experience cardiac arrhythmias, have congenital heart disease or develop acquired heart disease. Therefore, as a beginning paediatric nurse, you will be required to manage these patients. This chapter will provide you with an understanding of the foundation skills, including performing an electrocardiograph (ECG), cardioversion and defibrillation, cardiac pacing, care of the post-operative paediatric cardiac surgery patient and the principles of care for infants and children with chronic heart failure.

    Background: Paediatric heart disease in Australia

    Congenital heart disease (CHD) affects between 0.4 and 1 per cent of all children, and is the most common cause of death from a structural abnormality in the world. There are over 2000 children born in Australia each year, or approximately six to eight per 1000 live births, with a congenital heart defect, and at least half of these children will require either a surgical or interventional procedure. CHD is the largest cause of death in children under the age of 1 year. Up to 20 per cent of congenital heart defects can be genetically linked. Acquired heart disease, including cardiomyopathy, Kawasaki disease and rheumatic heart disease, is also prevalent in young children. Australia and New Zealand have one of the highest incidences of rheumatic fever in the world, particularly among the Indigenous populations in both countries (Blue et al., 2012; HeartKids Australia, 2016).

    CHD is thought to be related to teratogens, the environment and genetics, as well as unknown causes. Contributing factors include maternal-related disorders such as phenylketonuria, diabetes, infection, obesity, systemic lupus erythematosus and epilepsy. Maternal drug exposure, including to non-therapeutic drugs, chemical exposure and genetics are also considered risk factors. The Human Genome Project, chromosomal analysis and advances in molecular biology have advanced our understanding of the causes of CHD (Blue et al., 2012; Hazinski, 2013). Chromosomal anomalies are present in 8–10 per cent of all congenital heart disease patients.

    The number of adolescents over 16 years of age with CHD outweighs the number of young children being born with CHD, which will require future planning and resource allocation as these children transition to adulthood. These young people have ongoing haemodynamic and electrophysiologic issues, including reduced exercise olerance, arrhythmias, heart failure and sudden death (Celermajer et al., 2016; Hazinski, 2013; HeartKids Australia, 2016; Khairy et al., 2010; van der Linde et al., 2011).

  • Chapter 12 - Supporting breastfeeding

  • Elizabeth Forster, Griffith University, Queensland, Jennifer Fraser, University of Sydney
  • Book:
    Paediatric Nursing Skills for Australian Nurses
    Published online:
    06 August 2018
    Print publication:
    18 October 2017, pp 233-252

  • Summary

    Introduction

    The focus of this chapter is the role of the nurse in supporting breastfeeding for newborns and infants, especially during periods of illness or hospitalisation. As a paediatric nurse, you need to develop an understanding of the anatomy and physiology of the breast and breastmilk production, as well as the development of oral structures, suckling and latch to the breast in order to support breastfeeding. You will also need to identify and develop skills to facilitate breastfeeding. It is important to understand the significance of global standards that support the initiation and maintenance of breastfeeding to ensure the highest possible health outcomes as outlined in Article 24 of the Convention on the Rights of the Child (UNICEF, 2009).

    Global perspectives on breastfeeding

    As background to developing breastfeeding skills, it is also important that you develop your understanding of the global and national recommendations and strategies supporting breastfeeding, and how these have been developed to inform and shape national and local policies and health professional practice. Globally, the World Health Organization (WHO) and United Nations International Children's Emergency Fund (UNICEF) recommend that breastfeeding should be initiated within the first hour of birth, that exclusive breastfeeding occur for up to the first 6 months of an infant's life and that breastfeeding continue to 2 years of age and beyond as the normative standard for infant feeding. Additionally, timely and appropriate introduction of family foods at about 6 months should be a key support to breastfeeding for optimal growth and development (UNICEF, 2015).

    The Baby-Friendly Hospital Initiative (BFHI) was launched by WHO and UNICEF in 1991 to implement practices that protect, promote and support breastfeeding (WHO & UNICEF, 2009). In 2006 in Australia, BFHI became the Baby Friendly Health Initiative to encompass the role of community health centres in supporting breastfeeding. Underpinning BFHI are the Ten Steps to Successful Breastfeeding, which outline what maternity facilities and other health agencies that provide care for mothers, newborns and infants can implement to promote breastfeeding.

  • Chapter 14 - Elimination

  • Elizabeth Forster, Griffith University, Queensland, Jennifer Fraser, University of Sydney
  • Book:
    Paediatric Nursing Skills for Australian Nurses
    Published online:
    06 August 2018
    Print publication:
    18 October 2017, pp 275-294

  • Summary

    Introduction

    The assessment and maintenance of healthy urinary and bowel elimination in infants, children and young people is crucial to maintenance of health. Infants and very young children are developmentally immature, and are therefore incontinent and dependent on an adult to maintain their hygiene and elimination needs. Sometimes, for developmental or physical reasons, children may be delayed in meeting toilet training milestones. There are specific issues related to urinary or bowel elimination, such as delayed toilet training, enuresis, constipation and encopresis, which can cause much distress to children and families. The interventions and skills required by paediatric nurses for managing these issues will be addressed in this chapter.

    Paediatric nurses are responsible for recording output of both urine and faeces, and this can be challenging in infants and young children who are not toilet trained or who are unwell and may be uncooperative. Approaches to obtaining specimens or measuring output in children who are too young or not yet toilet trained differ from those used for older children. It is essential when obtaining urine specimens that they are not contaminated if the specimen is being obtained for culture and laboratory confirmation of infection. Some children will require urinary catherisation. This may be an in–out catheter to obtain a specimen, intermittent catheters to aid urinary elimination or a longer term catheter to aid urinary drainage or provide accurate measurement of urinary output in the critically ill child. Children may also have permanent or temporary stomas, and nurses need to be well prepared to provide evidence-based care, and education and support, for the infant, child, young person and their family.

    Measurement of output in the paediatric Patient

    In any nursing context, it is important for the nurse to assess the fluid balance and hydration status of their patient to detect dehydration (Brown, 2017) or over-hydration; however, in paediatric nursing this takes on greater significance as infants and young children are reliant upon adults to meet their fluid and electrolyte needs, and are more vulnerable to imbalances. This means that paediatric nurses require astute assessment skills to identify physical signs that may indicate changes in homeostasis. One of the crucial tools a nurse will use is the fluid balance chart. The accuracy of this will depend on the accurate recording of input and output.

  • Chapter 4 - Mental health nursing skills

  • Elizabeth Forster, Griffith University, Queensland, Jennifer Fraser, University of Sydney
  • Book:
    Paediatric Nursing Skills for Australian Nurses
    Published online:
    06 August 2018
    Print publication:
    18 October 2017, pp 59-80

  • Summary

    Introduction

    This chapter will provide you with the fundamental skills for working with children, young people and their families to promote mental health. Adolescent mental health and wellbeing are covered in more detail elsewhere in this text, but it is important to acknowledge that good mental health is an important goal from birth (and even before birth), throughout childhood and into adolescence. Some adolescent mental health disorders are adolescent limited – that is, they begin and end in the period of adolescence – but mostly mental health and mental health disorders are experienced along a continuum. Indeed, as you will learn from this chapter, temporal assessment of children's behaviours is paramount in any assessment of mental health. As children mature, their behaviours change accordingly. Behaviours that can be expected among young children should disappear as they mature, such as the inability to regulate emotions, or to experience empathy for others. It is therefore imperative that mental health and behavioural assessments are not completed in one encounter. Paediatric mental health clinicians view the child or young person as a representative of a family system. This means that the family is necessarily incorporated into every facet of care, including assessment, planning, treatment and evaluation of care. Children and young people, their parents and guardians, families, school and broader communities are all considered in the planning for optimal mental healthcare service delivery.

    Children and young people are actually at high risk of mental health disorders, and in Australia 8.3 per cent of children and young people live with mild, moderate or severe mental disorders (Lawrence et al., 2016). Since the first Australian survey of children's mental health was reported in 2000, the prevalence of children's mental health disorders has been stable. The National Youth Mental Health Initiative launched by the Australian Government in 2005 (Headspace) has focused on increasing prevention and treatment services for children and young people. It seems that for children identified as having mental health disorders, the uptake of services is high. But there continues to be a need for improving the prevention and early intervention strategies and services, especially for those children and young people already experiencing mental health problems.

  • 11 - Issues in abortion and euthanasia

  • Kim Atkins, University of Tasmania, Sheryl de Lacey, Flinders University of South Australia, Rebecca Ripperger, Bonnie Britton, University of Tasmania
  • Book:
    Ethics and Law for Australian Nurses
    Published online:
    21 June 2018
    Print publication:
    01 September 2017, pp 249-267

  • Summary

    LEARNING OBJECTIVES

    In this chapter, you will:

  • ➔ Learn about current legislation pertaining to abortion and euthanasia

  • ➔ Understand some of the arguments for and against abortion

  • ➔ Distinguish between different types of euthanasia

  • ➔ Learn about some of the arguments for and against euthanasia

    • In Western Australia in October 2012, 81-year-old Herbert Erickson pleaded guilty to murdering his partner in a mercy killing. His partner had suffered a stroke on top of a severe form of paralysis that confined her to a wheelchair. The court heard that the couple loved each other and had made a murder-suicide pact. Mr Erickson had unsuccessfully tried to electrocute himself immediately after killing his partner. He was granted bail on account of his age. One month later, he reported to police as usual, returned his library books, then drove to a nearby beach and killed himself (Spooner 2012).

    This book has considered ethics in the context of human vulnerability. We are vulnerable because we can be affected by things, and we can be affected by things because we are physical beings – part of the world around us and subject to the passage of time. Consequently, a life can come to an end at any time. For this reason, death is not only completely normal, but inevitable. Nevertheless, death is typically regarded as something regrettable. As philosopher Bernard Williams notes, our experience of being alive is essentially of having an openended and indeterminate future. From this perspective, death is ‘an abrupt cancellation of indefinitely extensive possible goods’ (Nagel 1979: 9–10).

    Perhaps because of our mortality, it matters to us – as individuals and as a society – how we die. It is not unusual, for example, to hear expressions such as ‘a terrible way to die’ (meaning that a person has died in a way that no one would want to) or ‘it's a blessing that he died’ (meaning that death brought a peaceful end to suffering) or ‘a good death’, which usually means that a person has died in a way that they would have wanted. These considerations give rise to some philosophical reflections: Is death always a harm? And if it is not always a harm, can death sometimes be a good thing? (Luper 2009).

  • 4 - The nurse–patient relationship and the regulation of nursing practice

  • Kim Atkins, University of Tasmania, Sheryl de Lacey, Flinders University of South Australia, Rebecca Ripperger, Bonnie Britton, University of Tasmania
  • Book:
    Ethics and Law for Australian Nurses
    Published online:
    21 June 2018
    Print publication:
    01 September 2017, pp 77-103

  • Summary

    LEARNING OBJECTIVES

    In this chapter, you will:

  • ➔ Gain an understanding of the nurse's power in the nurse–patient relationship

  • ➔ Learn about the fiduciary nature of the nurse–patient relationship

  • ➔ Gain an understanding of the legal and moral responsibilities of the nurse–patient relationship

  • ➔ Develop your understanding of how to foster a therapeutic relationship with your patients

  • ➔ Develop your ability to identify risks in the nurse–patient relationship

    • Christine is a patient in the medical ward where you are working. She is anxiously awaiting some test results. You notice that she asks your fellow nurse, Carole, to call the resident doctor for her because she wants to ask the doctor some questions about things that are bothering her. Carole agrees, but then goes to morning tea.

    When you ask Carole why she hasn't called the doctor, Carole replies, ‘I could call the doctor but I know that she won't come until her regular round at 11.30 a.m. Christine will just have to wait. If she asks me again, I'll just say that the doctor is busy but will be here at 11.30. She isn't going to complain. She knows how busy these doctors are.’

    The focus of this chapter is the moral aspects of the nurse–patient relationship. Some people might think Carole is treating Christine with disrespect by misleading and then avoiding her. Others might think Carole is just being realistic. After all, the doctor really is busy and will not be free until 11.30 a.m. In order to work out whether or not this is an appropriate way to treat a patient, the nurse will need to have a good understanding of their responsibilities to their patients and the moral basis of those responsibilities.

    In Chapter 2, we noted that rights and obligations are like two sides of the same coin. A legal right comes with a corresponding obligation, or duty. A right is a legal entitlement to do something, and an obligation is the constraint upon individuals’ behaviour that comes with that entitlement. However, the nurse– patient relationship involves more than legalities. As discussed in Chapter 1, interpersonal relationships involve moral values, such as respect, beneficence and compassion.

  • 8 - Patient information and confidentiality

  • Kim Atkins, University of Tasmania, Sheryl de Lacey, Flinders University of South Australia, Rebecca Ripperger, Bonnie Britton, University of Tasmania
  • Book:
    Ethics and Law for Australian Nurses
    Published online:
    21 June 2018
    Print publication:
    01 September 2017, pp 171-199

  • Summary

    LEARNING OBJECTIVES

    In this chapter, you will:

  • ➔ Gain an understanding of the concepts of privacy and confidentiality, and be able to differentiate them

  • ➔ Gain an understanding of the nurse's legal and moral responsibilities in relation to privacy and confidentiality

  • ➔ Gain an understanding of the safe use of digital and social media to maintain patient confidentiality

  • ➔ Learn about the legal requirements of mandatory reporting

    • Ross was admitted through emergency services with chest pain, and was found to have had a myocardial infarction. He was admitted to the cardiac unit and placed on bed rest with cardiac monitoring. On admission, Kate, his nurse, gathered information from him about his condition and lifestyle to help plan his recovery and rehabilitation. When collecting this information, Ross told her that he was married and had three teenage sons. He added that he also had a long-term and loving relationship with Gill, and together they had a daughter who was seven years old. His wife did not know about his relationship with Gill or about his daughter, and he asked Kate to promise that this would not be disclosed to her. He said, ‘I know I can trust you with this information.’ He was most concerned that Kate arrange for Gill and his daughter to visit as well as notify his wife what had happened to him. Kate briefly described this unusual family situation in his notes, and suggested that discreet management of visitors was required as part of his nursing care. The next day, as she entered the unit, she noticed several nurses – one of them from the neighbouring renal unit – huddled around Ross’ case notes. They were whispering and giggling, apparently about her notation regarding his family situation.

    This chapter introduces the concepts of privacy and confidentiality in relation to the management of patient information, and outlines legal requirements for reporting harmful conduct of health professionals and others.

    The above case demonstrates how easily private and sensitive information recorded about a patient can result in a breach of confidentiality and unprofessional conduct. Kate appropriately recorded very personal information Ross had disclosed to her because she judged that it was relevant to his care. Yet other nurses perceived this to be a source of curiosity and gossip, and in sharing this with a nurse not involved in his care, had breached Ross’ confidentiality.

  • 2 - Understanding legal rights and obligations

  • Kim Atkins, University of Tasmania, Sheryl de Lacey, Flinders University of South Australia, Rebecca Ripperger, Bonnie Britton, University of Tasmania
  • Book:
    Ethics and Law for Australian Nurses
    Published online:
    21 June 2018
    Print publication:
    01 September 2017, pp 32-55

  • Summary

    LEARNING OBJECTIVES

    In this chapter, you will:

  • ➔ Gain an understanding of the social basis of rights

  • ➔ Develop an understanding of why laws should be morally justified

  • ➔ Gain an understanding of social contract theory and its limitations

  • ➔ Be introduced to the ‘capabilities approach’ as a moral basis for legal rights

    • In 1997, Ms Lorraine Smith was interviewed for a position as a director of the Red Meat Producer Corporation. At the time of her interview, she was seven months pregnant. During the interview, she was asked whether she was married. When she replied that she was married, she was then asked why she had lied and left this information off her application. Ms Smith replied that her marital status was irrelevant. One of the interviewers then stated that he had a problem employing young people with children.

    After the interview, Ms Smith complained about the questions to a member of the panel who was representing the recruitment agency. The representative concurred and likened the situation to the Dark Ages.

    Ms Smith lodged a complaint with the Human Rights and Equal Opportunity Commission (HREOC), claiming she had been treated with discrimination on the basis of her marital status because the questions were in violation of the Sex Discrimination Act 1984. HREOC found in her favour and awarded damages (Smith v Commonwealth 2000).

    HREOC determined that Ms Smith's rights had been violated, and that the Red Meat Producer Corporation had failed to live up to its legal obligations. In handing down his determination, the commissioner took the view that the interview panel did not adequately understand the legal rights of the applicant nor, consequently, how to act in accordance with those rights.

    A right is a justified entitlement to something – for example, the right to vote in democratic elections. The entitlement to that right is justified by the value Australian society places on the idea of the moral equality of citizens and selfdetermination. Rights also entitle us to demand that other people act (or refrain from acting) in certain ways. For example, the right to vote in democratic elections obliges other people to refrain from interfering with a person's free choice of candidates.

  • 7 - Culturally safe nursing practice

  • Kim Atkins, University of Tasmania, Sheryl de Lacey, Flinders University of South Australia, Rebecca Ripperger, Bonnie Britton, University of Tasmania
  • Book:
    Ethics and Law for Australian Nurses
    Published online:
    21 June 2018
    Print publication:
    01 September 2017, pp 154-170

  • Summary

    LEARNING OBJECTIVES

    In this chapter, you will

  • ➔ Consider the role of culture and diversity in nursing practice

  • ➔ Reflect on the vulnerability of Indigenous Australians and the need for attention to culture in the provision of their care

  • ➔ Gain an understanding of the concepts that underpin nursing practice that is culturally safe

  • ➔ Learn ways in which to provide culturally safe care

    • Li Wong, a 67-year-old woman of Chinese origin, presented with abdominal pain and nausea. She had a series of abdominal scans, which showed a growth in her liver; a biopsy confirmed that it was metastatic cancer. She was told that she had cancer and would need to have the growth removed and start chemotherapy. Mrs Wong was admitted to the surgical unit but on admission her family told the staff that complete truthfulness would severely overwhelm her, that their duty as a family was to protect her and that she would expect this. Following surgery, when it was known that the tumour was unable to be removed, Mrs Wong was told that her recovery would take a long time and would require many treatments.

    In this case, Li Wong's family requested that information about her illness and prognosis be withheld from her because she was vulnerable and would be severely affected by this information and the implications of it for her future well-being. To many nurses, the idea of concealing the truth from Li Wong would seem improper. Truthfulness underpins our practices of informed consent. In Australia, a patient is expected to give fully informed consent before treatment is provided, and should be provided with information about the risks and benefits of a procedure; otherwise, the nurse may be liable for assault (see Chapter 5). Truthfulness also forms the basis of clear communication and trust in the nurse–patient relationship. Concealing the true nature of Li Wong's illness may create a barrier to talking with her about advanced directives or about her feelings of grief, something Western nurses consider good practice. To many nurses, it would seem important that Li Wong have an opportunity to ‘put her affairs in order’, to address unfinished business and to prepare spiritually for death. However, in some cultures there is a common expectation that patients will not be told of certain diagnoses, and that the burden of knowledge and decision-making is delegated to family members.

  • 3 - Nursing and the legal system

  • Kim Atkins, University of Tasmania, Sheryl de Lacey, Flinders University of South Australia, Rebecca Ripperger, Bonnie Britton, University of Tasmania
  • Book:
    Ethics and Law for Australian Nurses
    Published online:
    21 June 2018
    Print publication:
    01 September 2017, pp 56-76

  • Summary

    LEARNING OBJECTIVES

    In this chapter, you will:

  • ➔ Distinguish between the two sources of law in Australia: statutory law and common law

  • ➔ Gain an understanding of the hierarchy of the courts in Australia's legal system

  • ➔ Gain an understanding of the difference between criminal and civil law and how each relates to nursing practice

  • ➔ Gain an understanding of the importance for nurses of gaining knowledge of the law and the legal system

    • The Australian legal system is complex. An illustration of its complexity can be seen in the protracted and controversial case of Dr Jayant Patel, a surgeon who had been working at the Bundaberg Base Hospital in Queensland. In 2010, following a commission of inquiry by the Queensland Government, and after being extradited from the United States, an action of criminal negligence was brought against Dr Patel under the Criminal Code 1899 (Qld). Although the legal action was initially successful, and Patel was found guilty on three counts of manslaughter and one count of grievous bodily harm, the case for the prosecution was not straightforward. Section 288 of the Criminal Code 1899 states that: ‘It is the duty of every person who … undertakes to administer surgical … treatment to any other person, or to do any other lawful act which is or may be dangerous to human life or health, to have reasonable skill and to use reasonable care in doing such act.’ Patel was found to have operated with appropriate skill and care. Jurors, therefore, were required to find that Patel's decision to operate showed ‘such a great falling short of the standard to have been expected of a surgeon, and showing such serious disregard for the patient's welfare … was so thoroughly reprehensible, involving such grave moral guilt, that it should be treated as a crime deserving of punishment’ (R v Patel [2010] QSC 233 [69]). Patel's convictions depended upon an interpretation of section 288 by Justice Byrne:

    Take a surgeon who performs a minor surgical procedure with consent. During the operation, in circumstances bespeaking criminal negligence, the surgeon lets the knife slip, wounding the patient. The surgeon will have breached the s 288 duty and be guilty of unlawful wounding.

Page 57 of 90