Role of the Registered Nurse in Pediatric Palliative Care Essay Example for Free

office of the Registered Nurse in paediatric Palliative Care EssayNursing is a thriller that requires cooperative relationships among professionals that assist batch ass to provide the best possible tuition for the client and family. These interprofessional relationships may involve a round-eyed range of wellness veneration professionals of multiple members that dissemble on collaboratively together to deliver spirit keeping. Nurses are undeniable to work with other professionals on a daily basis on the floor whether it is with a doctor, a lab tech, a respiratory therapist, physiotherapists or even a fellow nurse. Registered Practical Nurses (RPN) and Registered Nurses (RN) work together on a daily basis and work in partnership with one another to get out the level of care that is required in order for a patient to meet their outcomes. Pediatric alleviant care is a specialized setting that requires constant squadwork or addresss and majority of the centers so lo allow RNs to work on that floor, however some centers allow for RPNs to care for these sisterren. Crozier and autograph (2012) state that it has been estimated that 13.9% of all children are living with a chronic wellness condition and moderating care can be pass ond to these children as well (p.2). This paper will discusses the role of the RN in pediatric palliative care in relation to family body forth done the three occurrenceor frame work which involves the client, the nurse and the surround.The Three Factor FrameworkThe three factor frame work is used in many different settings to determine whether a RN or a RPN will be pity for a certain client. This fabric consists of the client, the nurse and the environment (College of Nurses of Ontario CNO, 2011). These three factors are implemented and piddle an have-to doe with on decision making related to care provider assignment for the RPN and RN. It takes into consideration the clients adopts, the quests for consu ltation as well as collaboration among care providers (CNO, 2011). The three factor material document is accessible to help nurses, employers and others make effective decisions about the utilization of individual nurses in the render of safe and ethical care (CNO, 2011, p.3). It also helps with outlining expectations for nurses that highlight similarities and differences of breast feeding knowledge and its impact on some(prenominal) personal and professional responsibility (CNO, 2011). This framework comes extremely all- Copernican(a) in specialized settings, such as the critical care unit, the emergency department, the operating room and especially pediatric care.The ClientThe client panorama of the framework focuses on the complexity of the client, the predictability and the happen for ban outcomes with the client (CNO, 2011). The client factors are combined to force a representation of a client that can be placed on a continuum that goes from less(prenominal) complex, to a greater extent(prenominal) predictable and low risk for minus outcomes, to highly complex, unpredictable and high risk for negative outcomes . the more complex the care requirements, the greater the need for consultation and/or the need for an RN to provide the full spectrum of care (CNO, 2011, pg. 2). In pediatric care on that point comes many different types of clients that a nurse may encounter and a number that is not touched upon too often is pediatric palliative care.This type of patient would be considered to be on the more complex side of the spectrum which would require a RN to care for this child. Ferrell, Malloy, Uman, Virani, and Wilson (2006) tell us that no one spends more time at the bedside observing, critically cerebration, consulting, and providing direct care then the pediatric nurse (p.1). This statement reinforces that a RN is more fitting for this task since the childs health condition is unstable and constantly fluctuating, their coping mechanisms an d supports are unknown, and the fact that they require frequent monitoring and reassessments (CNO, 2011). Pediatric care is a very complex world to work and requires a RN to care for these clients due to their needs not being well defined or established and their condition can change rapidly.Children can be unpredictable in their natural field and when it comes to their health they can be even more unpredictable. Crozier and Hancock (2012) tell us that it is important to acknowledge that death occurs in pediatrics (p.1) and those nurses caring for these children need to be aware that this could be the final outcome. The CNO (2011) document on the three factor frame work emphasizes the fact that a RN is ask when the client may have unpredictable outcomes as well as unpredictable changes in their health condition. With this being said this puts the risk for negative outcomes with this child at a high risk.Risk for negative outcomes comes with all types of nursing but it is a high er risk when talking about palliative care especially in children. Nurses are more likely to be aware of symptoms of a end immemorial client or an adult client rather than a child since this topic is not discussed that often. The CNO (2011) tells us that a RN is involved in care when the client is unpredictable, systemic or wide ranging responses, they have subtle signs and symptoms that are often difficult to detect and they are at a high risk for a negative outcome. Research studies have been done that create guidelines for nurses to follow in order to provide and meet the needs of the patient and their families when the child cannot benefit from intensive, brio extending support especially when the family is dealing with a dying child (Anita Rushton, 2002). In order for pediatric palliative care to be successful this framework is used in order to give the child the best care possible.The NurseWhen we discuss pediatric palliative care we are not fair(a) talking about the pat ient themselves, we are talking about the entire collaborative team including RPNs, RNs and most importantly the family of the patient. Not only do these nurses have the child to care for they also need to be there for the family and help them through their struggles they may be having. The nurse factors of the framework include leadership, decision-making, and critical thinking skills (CNO, 2011). Leadership is a quality that all nurses require in order to succeed in their career but being a pediatric nurse requires this skill on multiple levels. Anita and Rushton (2002) tell us that there is a need for increased leadership capacity in end of life care for children and their families. Nurses need to have the leadership skills to be an advocate for their client who may not be able to speak up for themselves depending on how ill they are.Ferrell, Malloy, Uman, Virani, and Wilson (2006) state that pediatric nurses have a distinctive role in advocating, promoting, and providing excell ent care to these children and their families (p.4), they also emphasize the fact that education is anchor to the skills and confidence they need to perform this task. RNs need to assume the role of a leader within the interprofessional team and they need to lead the team in order to develop plans of care to achieve client and family goals when overall care requirements are more complex (CNO, 2011). With the role of leadership also comes decision making in collaboration with the family and other health care members. The preachings at the end of life are something that is not easy for anyone to make let wholly when it has to do with a child. Nurses have a key role in decision making when it comes to what treatment is provided, and they are there to guide the family in this process.Anita and Rushton (2002) tell us that the goal of palliative care is achievement of the best quality of life for patients and their family regardless of the outcome (p.2). In order for the nurse to make decisions that will benefit the client and the family nurses need to communicate therapeutically and make the focus on the client and their family (Palliative vexation and Symptom management, 2007). The RN then needs to take the information gathered from communicating with the family and make decisions actively as well as anticipating any possibilities and making proactive decisions (CNO, 2011). Communication is a key hammer when it comes to care between patients and family, different health care professionals and those that are caring for the child directly (Crozier Hancock, 2012). With intercourse and decision making comes critical thinking which is a crucial aspect when caring for a dying child.Not only does the nurse need to critically think about the childs health and final outcomes but they also need to think about how to help the family through this process. Everyone critically thinks on a daily basis especially in the health care profession, but RPNs and RNs operative with children need to think critically at all times. As a RN they are required to anticipate and recognize subtle changes in the childs health, assess further, post relevant factors, understand the significance and manage the situation and family members appropriately (CNO, 2011). As a RN working in pediatric palliative they need to be knowledgeable, be able to make decisions in consultation with the family and other health care professionals and most importantly be able to critically think speckle managing multiple nursing interventions in rapidly changing situations (CNO, 2011).The EnvironmentPediatric palliative care is an area of nursing that can occur in multiple settings including the home of the child, a hospital setting, hospice centers and even nursing homes. In Bartell and Kissanes article from (2005) they show that 72% of pediatrics die in the hospital (56% in patient and 16% as outpatients mostly in emergency rooms), 11% die at home, and just 0.4% in nursing homes (p.2 ). The environment factors of the three factor framework include place supports, consultation resources and the perceptual constancy and predictability of the environment. The need for RN staffing is required when these factors are less stable. Pediatric palliative care is an area that is considered to be less stable and the practice supports vary. A RN is required if there are unclear or unidentified procedures, policies, medical directives, protocols, plans of care, care pathways and assessment tools (CNO, 2011). The CNO also tells us that a RN is needed if there is a low proportion of nurses familiar with the environment and if there is a low proportion of effective nurses or a high number of novice nurses.In Coxs article in (2004) she talks about how the expert nurse may also support the developing nurse by sharing personal experiences and strategies. Having a RN work in pediatrics can allow the practice supports to become more of a stable environment by increasing the knowle dge of all nurses and family members from manpower on experience. Consultation or collaboration with health care professionals is a skill that is used every day but is very important when it comes to childrens health. Nurses need to be aware of the resources that are ready(prenominal) to them and use them to their advantage to help provide better care to the children and their families. Ahmann and Dokken (2006) tell us that nurses need to view parents as partners in care rather than a visitor. Not only is it important that nurses collaborate with health care professionals but they also need to be communicating and consulting with the family. Involving the family in the childs care makes them feel more a part of the care rather than a by stander (Boyle Roberts, 2005).According to the CNO (2011) document a RN is needed when there are little consultation resources available to manage outcomes. With consultation comes how predictable and how stable the environment is that the child i s being cared for. Death is a topic that many do not like to talk about but it is a reality of life that can cause for a high turnover rate in the health care system. Pediatric palliative care can have high turnover rates along with unpredictable events no matter how many assessments the RN performs (CNO, 2011). RNs need to be aware of the type of environment that they are working in order to provide the appropriate care to the child. Even if the environment is at a high turnover rate the nurse still needs to be able to bear their knowledge, critically think, make decisions and care for the patient and their family. The three factor framework set out by the CNO is important when it comes to determining the role of the RN in pediatric palliative care along with the support that is given to the family.Even though the three factor framework is needed when assigning patient assignments we need to keep in mind that with young children, a family centered model of care is a key concept (B artell Kissane, 2005). The more complex the client situation and the more dynamic the environment, the greater the need for the RN to provide the full range of care, continually assess changes, establish priorities and determine the need for additional resources or consults (CNO, 2011). By considering the client, the nurse and the environment factors, it can be determined whether a RPN or RN is more suited to care for a certain client. RNs require advanced critical thinking skills along with a large depth of knowledge in order to provide appropriate care to the children as well as their families. According to the three factor framework and research that has been done a RN is more suitable than a RPN to work in pediatric palliative care.ReferencesAhmann, E., Dokken, D. (2006). The many roles of family members in family-centered care part 1. Pediatric Nursing, 32(6), 562-565. Anita, C., Rushton, C. H. (2002). Pediatric palliative care The time is now. Pediatric Nursing, 28(1), 1-9 . Retrieved from http//moxy.eclibrary.ca/login?universal resource locator=http//search.proquest.com/docview/199391320?accountid=12792. Bartell, A. S., Kissane, D. W. (2005). Issues in pediatric palliative care Understanding families . Journal of Palliative Care, 21(3), 1-16. Retrieved from http//moxy.eclibrary.ca/login?url=http//search.proquest.com/docview/214198065?accountid=12792. Boyle, L. A., Roberts , K. E. (2005). End of life education in the pediatric intensive care unit .Critical care nurses , 25(1), 1-6. Retrieved from