Paediatric Nursing Teaching Session: Reflection and Analysis

Paediatric Nursing Teaching Session: Reflection and Analysis Critically analysing a teaching session which has been undertaken in practice for a child or young person. This reflective essay explores and analyses a teaching session carried out with a young person within a paediatric nursing setting, in order to evaluate positive aspects of the session, skills involved and skills developed on the part of the nurse during the session, the effectiveness of the session, and the ways in which this activity could have been improved to better meet the needs of the client. The client chosen is a 13 year old girl with Type 1 Diabetes, who, having made the decision to become independent in her glycaemic control and in managing her condition, was admitted to the children’s ward after a hypoglycaemic episode. The focus of the session was on re-educating the client in good practice in self-administration of insulin. Up until the period shortly before her admission, her mother had been administering BD insulin injections before school and in the evening. The client, who shall be called Sheila for the purposes of this essay (the name has been changed to protect confidentiality), had asserted her independence and demanded to be allowed to carry out our own injections, unsupervised, but after the hypoglycaemic episode, the question was raised whether or not she was able to draw up the correct dose. Therefore, the session was set up to allow Sheila to revisit the correct procedure for drawing up and delivering the correct dose of insulin in the correct manner. Confidentiality has been maintained throughout this essay by anonymising the personnel involved, and by ensuring no identifying details are used at any point. The importance of the teaching role within paediatric nursing will be discussed in the light of this activity and experience, and some recommendations for good practice will be drawn from this. The client chosen provides an interesting case because this is a young person who can be viewed as being in transition, between childhood and the onset of adolescence, asserting more maturity and independence in her management of her chronic condition, and so needing to be treated and interacted with in ways more similar to those usually used with adults. This presents a challenge for the paediatric nurse, because one key aspect of educating for health is to engage with the client on the appropriate level, and to avoid alienating the client (Agnew, 2005). This is a fundamental component of all nursing care, acting as both the human face of medicine and as a teacher or coach who acts to â€Å"take what is foreign and fearful to the patient and make it familiar and thus less frightening† (Benner, 1984 p 77). Approaching a young person such as Sheila requires skill in terms of using typical teaching approaches but adapting them to meet her individual needs as a person, according to her own perception of who she is and her levels of independence. Benner (1984) suggests that there is a need to use tone of voice, humour, and the nurse’s own attitudes in meeting these needs. Knowles et al (2006) state that â€Å"evidence-based, structured education is recommended for all people with diabetes; tailored to meet their personal needs and learning styles† (p 322). In this instance, planning the session required the nurse to draw upon knowledge of teaching processes and principles gleaned from her own study and research, clinical knowledge about the skill to be taught, and personal attributes which would (it was hoped), avoid patronising the client or alienating her(see Appendix for teaching plan). However, this author anticipated that there would always be some distance between nurse and client, because the nurse, no matter how skilled or capable in communication, might still represent an older authority figure to whom they might not necessarily Ã¢â‚¬Ë œrelate’ very well. Understanding this, the approach to the session was clearly and consistently hinged upon basic principles of learning, incorporating aspects of adult learning in order to attempt to be more appropriate for Sheila’s learning needs. There is some debate about the differences between learning in children and adult learning, or whether there are, indeed, any differences (Rogers, 1996). Because of the significant health impact of Type 1 Diabetes on individuals, and consequently, on society and the state’s healthcare systems and resources, it was thought important to include in this session some of the rationales for good glycaemic control and prevention of the longer term consequences of the disease. Type 1 Diabetes, is a disorder in which beta cells of the Islets of Langerhans located within the pancreas fail to produce insulin as required by the body to regulate blood glucose, resulting in high levels of circulating glucose(Watkins, 2003). The longer-term consequences of the disorder include atherosclerosis and cardiovascular disease (Luscher et al, 2003); diabetic retinopathy (Cohen Ayello, 2005; Guthrie and Guthrie, 2004); peripheral vascular disease, intermittent claudication and foot ulcers foot ulcers caused by impaired circulation and peripheral neuropathy(Bielby 2006; Edmonds and Foster, 2006; Lipsky et al, 2006; Guthrie and Guthrie, 2004; Bloomgard en, 2005; Soedmah-Muthu, 2006); renal disease and renal failure (Castner and Douglas, 2005); and gastrointestinal complications (Guthrie and Guthrie, 2004). In preparation for the session, the nurse engaged in some background research, ensured that her knowledge was up to date, and reviewed the key national policy document, the National Service Framework for Diabetes published by the Department of health which underlines the need for good, ongoing health promotion and education for those with the condition (DH, 2002). Reading of research and professional literature also highlighted a wealth of information on the specifics of health promotion and education within diabetes, much of which is very applicable in this instance as it focuses on self-management of the condition (Cooper et al, 2003). While these support the transmission of information between health professional and client, so that the client becomes knowledgeable about their disorder and its management (Fox and Kilvert, 2003), there is also evidence which supports health education that actively incorporates and engages the client as a partner in the learning process as well as t he control of their condition (Davis et al, 2000) Therefore, the session was planned to initially determine Sheila’s level of knowledge and understanding, her current competence in the skill, and her ability to describe the underlying principles of the procedure. As Rogers (2002) states, â€Å"it is necessary to adapt our methods of teaching adults to the range of educational skills they possess.† (p 76). Horner et al (2000) also underline the need to improve the readability of teaching materials, and some were identified during the course of this session as being in need of improvement. Therefore, this element of the session also determined her level of understanding, reading ability and whether or not she had any difficulties such as dyslexia. It was discovered that Sheila had an above-average reading level, no special educational needs and no specific requirements other than that she was spoken to as an adult, as she reiterated on a number of occasions that she was not ‘a kid’. The learning approach taken was what Hinchliff (2004) describes as a constructivist approach, which, based on cognitive and humanistic learning theories, places the most importance on â€Å"self awareness, and the individual’s understanding of the processes involved in his or her own learning† (p 65). Hinchliff (2004) discusses Bloom’s (1972) learning domains, and this teaching session was designed to affect all three domains, cognitive, psychomotor, and affective. In relation to the cognitive domain, the aim was to reinforce and introduce knowledge. Psychomotor skills relate to the practical ability to administer insulin, and affective domain refers to the initiation of a process of attitude formation, wherein the nurse was hoping to help Sheila form a positive, proactive attitude to self-management of her condition. Further reading uncovered information on tailored educational programmes for children with diabetes to encourage appropriate self-care and management of their condition, based on pre-existing adult courses which exist in the UK but are of limited value for children (Knowles et al, 2006). Knowles et al (2006) carried out a study to adapt the adult Dose Adjustment For Normal Eating (DAFNE) course to design a skills training course, for children aged 11–16 yr, focusing on self-management skills within an intensive insulin regime. While this kind of approach would have been ideal for Sheila, a little research into facilities available local to the client showed no provision of this kind, or similar, targeted at her age group, which this author believed was a failing of local provision. This is a key point in the lifespan of a young person with a chronic condition, and at the least such young people need age-appropriate health education activities (Knowles et al, 2006). However, th is study has yet to be validated by a planned larger multicentre trial (Knowles et al, 2006). Viklund et al (2007) carried out a six month randomised controlled trial of a patient education empowerment programme, with teenagers with diabetes, but found after their trial that this empowerment programme made no difference on outcomes related to glycaemic control or empowerment. Their conclusion was that there should continue to be parental involvement in educational programmes and in management of self-care and ongoing control in diabetes in teenagers (Viklund et al, 2007). This might suggest that this session should have included some parental involvement, or should have made reference to ongoing parental involvement, because it supports anecdotal evidence that the author has gleaned from practice, wherein nurses rarely ‘trust’ teenagers to manage their diabetes appropriately themselves. Murphy et al (2007) describe a ‘family-centred’ diabetes education programme which was successfully integrated into paediatric diabetes care in one location, with pot ential benefits on parental involvement and glycaemic control. In all three of these cited studies, multidisciplinary involvement was a feature of the programme (Knowles et al, 2006; Murphy et al, 2007; Viklund et al, 2007). This suggests that there should be programmes which provide ongoing, family-oriented support, but this author still feels that the particular needs of teenagers may need something else, something indefinable as yet, but something which still supports their sense of self and emerging adult identity, fosters independence but also helps ensure proper management of the condition. This takes us to the issue of resources, and the lack of them, but if there were more, good quality research in this area, it might provide the leverage for more resources to be mobilised to meet the needs of this client group. Sheila evaluated the session well, but the author was left with the feeling that there was no certainty that the client would take on this new learning and that her glycaemic control would improve. Having addressed issues from the point of view of diabetes, and of the needs of teenagers with this condition, the author can only conclude that the session was well designed and incorporated patient-centred, established educational techniques, but that these techniques are not necessarily the optimal way to educate and support teenagers with Type 1 Diabetes. The literature has shed a light on some potential approaches to this, but the evidence is still insufficient to fully change practice. However, Sheila was able to demonstrate correct technique, discuss the rationale for the technique, and discuss with some confidence her management and control of her condition, and the prevention of longer-term complications. A more multidisciplinary approach would perhaps be needed to address the emo tional and psychological elements of her learning and development needs in the future. References Agnew, T (2005) Words of wisdom. Nursing Standard 20(6),pp24-26 Anderson, B. (2005) The art of empowerment : stories and strategies for diabetes educators New York: American Diabetes Association. Anthony, S., Odgers, T. Kelly, W. (2004) Health promotion and health education about diabetes mellitus. Journal of the Royal Society for the Promotion of Health. 124 (2) 70-3 Benner, P. (1984) From Novice to Expert: Excellence and Power in Clinical Nursing Practice London: Addison-Wesley Publishers. Bielby, A. (2006) Understanding foot ulceration in patients with diabetes. Nursing Standard. 20(32). pp. 57-67. Bloomgarden, Z.T. (2006) Cardiovascular Disease Diabetes Care 20 (5) 1160-1166. Castner, D. Douglas, C. (2006) Now onstage: chronic kidney disease. Nursing. 35(12). pp. 58-64. Cohen, A. Ayello, E. (2005) Diabetes has taken a toll on your patients vision: how can you help?. Nursing. 35(5). pp. 44-7. Cooper, H.C., Booth, K. and Gill, G. (2003) Patients’ perspectives on diabetes health care education. Health Education Research 18 (2) 191-206. Court, S. and Lamb, B. (1997) Childhood and Adolescent Diabetes London: John Wiley. DAFNE Study Group (2002) Training in flexible, intensive insulin management to enable dietary freedom in people with type 1 diabetes: dose adjustment for normal eating (DAFNE) randomised controlled trial. British Medical Journal 325:746–9 Davies, K. (2006) What is effective intervention? Using theories of health promotion. British Journal of Nursing15 (5) 252-256. Department of Health (2002) National Service Framework for Diabetes Available from www.doh.gov.uk Accessed 25-7-08. Edmonds, M. Foster, A. (2006) Diabetic foot ulcers. BMJ. 332(7538). pp. 407-10. Fox, C. and Kilvert, A. (2003) Intensive education for lifestyle change in diabetes. BMJ 327 1120-1121. Guthrie, R.A. Guthrie, D.W. (2004) Pathophysiology of Diabetes Mellitus. Critical Care Nursing Quarterly 27 (2) 113-125. Hinchliff, S. (Ed)(2004) The Practitioner as teacher 3rd Ed London: Balliere Tindall Knowles, J., Waller, H., Eiser, C. et al (2006) The development of an innovative education curriculum for 11–16 yr old children with type 1 diabetes mellitus (T1DM) Pediatric Diabetes 7 (6) 322-328. Luscher, T.F., Creager, M.A., Beckman, J.A. and Cosentino, F. 2003 Diabetes and vascular disease: pathophysiology, clinical consequences and medical therapy: part II. Circulation 108 1655-1661. Murphy, H.R., Wadham, C., Rayman, G. and Skinner, T.C. (2007) Approaches to integrating paediatric diabetes care and structured education: experiences from the Families, Adolescents, and Childrens Teamwork Study (FACTS) Diabetic Medicine 24 (1) 1261-1268. Northam, E. Todd, S. Cameron, F. (2006) Interventions to promote optimal health outcomes in children with Type 1 diabetes are they effective? Diabetic Medicine. 23(2). pp. 113-21 Reece, I. Walker S.(2003) Teaching, Training and Learning. Tyne Weir: Business Education Publishers Ltd. Rogers, A. (2002) Teaching Adults 3rd Ed Buckinghamshire: OU Press Soedmah-Muthu, S.S., Fuller, J.H., Mulner, H.E. et al (2006) High risk of cardiovascular disease in patients with type 1 Diabetes in the UK. Diabetes Care 20 (4) 798-804. Viklund, G., Ortqvist, E. and Wikblad, K. (2007) Assessment of an empowerment education programme. A randomized study in teenagers with diabetes Diabetic Medicine 24 (5) 550-556. Watkins, P.J. (2003) ABC of Diabetes (Fifth edition). London: BMJ Publishing Group. Appendix Patient Education Plan Self-administration of Insulin Lesson Aims: To support Sheila to develop the skills and knowledge to demonstrate competence in the independent self-administration of Insulin. To reinforce health promotion principles and information regarding long-term management and control of her Diabetes and the prevention of later-life health complications. Learning Outcomes – at the end of the session the client should: Be able to describe, discuss and demonstrate the principles of correct drawing up of accurate doses of insulin as prescribed in her own regimen. Be able to competently self-administer insulin with correct technique, and describe the rationale for this technique Be able to discuss ongoing glycaemic control and prevention of later life complications of Diabets. Activity Method and Rationale Determine Sheila’s current level of knowledge. Determine Sheila’s reading level and identify any specific learning needs or difficulties (eg dyslexia) Discussion This allows for the identification of Sheila’s needs, and allows the nurse to set the tone and establish a relationship with Sheila. Provision can be made for specific needs such as augmented or specialist reading materials. Sheila to demonstrate drawing up technique Nurse to demonstrate drawing up technique Demonstration/discussion with supporting information/leaflets. Drawing comparisons between the two techniques should allow the client to identify whether her own practice matches that of the nurse/teacher. Discussion of this will draw out underlying knowledge and principles. Written information will reinforce learning. Review and demonstrate correct administration technique Discussion/Demonstration Discussion allows the nurse to identify gaps in knowledge and skill and address these in a responsive, flexible manner. Review knowledge of disease management and prevention of complications and identify further learning needs Discussion Provide a rationale and potential motivation to maintain good glycaemic control. Plan to meet further learning needs either immediately or in future sessions, perhaps involving the multi-disciplinary team. Gain client feedback To evaluate effectiveness of teaching session in client’s own words.

Catholic Response to Reformation

4. What were the responses of the Catholic authorities in the 16th century to the challenges posed by the Lutheran Reformation? The demand to reform the Roman Catholic Church stretched on for ages. Many people, such as Peter Waldo, John Wycliffe, and Jan Hus criticized the church for its worldliness and believed that one didn’t need direction from the Church, but just needed to read the Bible for guidance. It was from these men that Martin Luther came to the conclusion that faith alone would lead to salvation and you didn’t need to work for it.Martin Luther appealed to Pope Leo X to correct the abuses of the Church. When that didn’t work, he rallied the people to follow him. His beliefs spread through German states and most of Northern Europe. In response, the Catholic Church assembled the Council of Trent, which defined the Catholic religion and reformed the abuses of the Catholic Church. The Church also established the Jesuits, who spread the Catholic teachings during the Lutheran Reformation. Finally, the Church employed many policing tactics against the Lutheran Reformation.These responses kept Catholicism a major religion in Europe. Although the conciliar movement was ended by Pope Pius II around the 1450s, the people during the Lutheran Reformation were calling for a general council of the church. Charles the V, emperor of the Holy Roman Empire and King of Spain, tried to persuade the Pope to assemble a council because he hope that the church would fix some of the abuses, thus stop people from converting to Lutheranism. However, Francis I, King of France, actively promoted the Protestants in Germany, even though France is a Catholic country.He did this because Charles V’s land surrounded France. He wanted Germany to be in a state of argument so that it would be too weak to be a threat to France. While Francis II did this, he also used his influence in Rome to call off any assembly of a council because it would expose the flaws of the Roman Catholic Church. In time, the King of France lost and a council was called to reform the abuses of the Church and establish a statement of the Catholic religion. It began deliberations in 1545 in Trent, in the Alpine border between Germany and Italy.The Council of Trent reaffirmed many beliefs of the Catholic religion such as it justified that faith and works led to salvation, transubstantiation, purgatory, and the celibacy of the clergy. The council of Trent also declared reforms in monastic orders. It called to correct the abuses of indulgence while at the same time upholding the principle. It also called for bishops to take more responsibilities in their administrative control over their clergy and to make sure they were properly taking care of their own duties. The Council also wanted competent men running their churches, so they set up seminaries to educate the priests.The decrees of the Council of Trent would have been obsolete if it wasn’t from a new relig ious seriousness within the Catholic Church. There was much hatred toward the Roman clergy, as shown by the sack of Rome in 1527, where German and Spanish soldiers looted Rome, killed thousands, captured the Pope. Moralist began to speak and there words were heard. New popes, starting with Pope Paul III, regarded his office as a religious force to reform the church. New religious orders were founded on the basis of the new Catholic faith. The Jesuits, the most famous of these orders; it was founded by a Spaniard named St.Ignatius Loyola. He had a religious experience in 1521, when he was a child before hearing of Luther, and wanted to become a soldier of the church. On this experience, he founded the Society of Jesus (Jesuits). Authorized by Pope Paul III in 1540, the Jesuits were an order less attached to the clergy and more actively involved in the affairs of the world. They believe the Roman Church was a divine institution, and all members had to take a pledge to obey the Pope. T he Jesuits were some of the most famous educators of the Catholic world, with around 500 schools in the upper and middle classes.They combined the faith and religious teachings of the Catholic Church with the etiquette teachings that a gentleman should have. The Jesuits also brought into their teachings the Renaissance humanism found in the Latin classics. The Jesuits were not only teachers of the Catholic religion, but they also acted as a missionary force. They recruited members from all over Europe, especially in areas that were still disputed over which religion to choose. After the initial burst of Protestantism faded, many people wanted to return to the Catholic religion, especially when the Council of Trent corrected the most obvious abuses of the Church.The Jesuits reconverted most of these people in the areas of Germany, Bohemia, Poland, and Hungary. They also recruited from countries that already turned Protestant, like England, where their goal was to stop Queen Elizabeth I because they believed that the universal church was more important than national independence in religion. The Catholic Church not only reformed and spread its teachings across Europe, but the Church set up laws and police to enforce the Catholic religion. Many books were censored by the Catholic Church. They were trying to suppress the knowledge of â€Å"heretics†, the Protestants, from the people.The Pope had a list published by the Pope called the Papal Index of Prohibited Books. Only individuals with special permission were able to study these books. There were many establishments that enforced the Church’s rules. None was more dreaded than the Spanish and Papal Inquisitions. Although the Spanish Inquisition was originally established to drive out the Jews and the Muslims, it was introduced to all the Spanish-ruled countries in Europe. It was employed against the Protestant movement in the Netherlands. The Papal Inquisition was established in 1514, under the Hol y Office, a permanent committee of cardinals.To Rome, it was a revival of a famous medieval tribunal for the detection and repression of heresy. Both of these Inquisitions employed torture for various tasks. Torture was used for heresy or employed on any person charged with a crime, whether it was in civil and ecclesiastical court. The Spanish Inquisition was harsher than the Papal Inquisition in terms of punishment, people were often burned alive and the Papal Inquisition was all about protecting the faith in all parts of the Catholic world. In 1560, the major powers in Europe were declared Catholic countries, like France, Spain, and Austria.All the countries that turned to Protestantism were very small countries like the German states and the Scandinavian kingdoms in the north. The biggest Protestant nation was England, but England was still small compared to France and Spain. The reason why Protestantism did not spread is because of the tactics the Catholic Church employed agains t the Lutheran Reformation. The Council of Trent, the Jesuits, and the police commissions like the Inquisition all helped halt the teachings of Martin Luther and convinced the people to believe in the newer and better Catholic Church.

The Mission of Stopping Creatures - 739 Words

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The road to mecca - 1530 Words

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Islam is aRead MoreThe Spread Of Christianity And Christianity873 Words   |  4 Pagesthis faith is the belief that Muhammad, a respected businessman in Mecca, received revelations from God that have been preserved in the Qur’an. The core of this Islamic life is said to be the five pillars of Islam: publicly bearing witness to the basic affirmation of faith; saying prescribed prayers five times a day; fasting during the month of Ramadan; giving a tithe or aims for support of the poor; and making a pilgrimage to Mecca at least once during the believer’s lifetime. In Muslim traditionRead MoreCC of Cultural and Intellectual Tradition of The M.E. (600-1450 CE)766 Words   |  4 Pages(alms-giving), Sawm (fasting), and Hajj (pi lgrimage to Mecca). Hajj was an essential aspect in the religion of Islam and as the years progressed the importance of this pillar became more eminent in Islamic society. Each Muslim was expected to take a pilgrimage to Mecca at least once in their lifetime and as the years progressed important Islamic figures began to promote this pillar even more by setting inns, mosques and Islamic institutes on the roads to Mecca. The teachings of the Qur’an, the holy book ofRead MoreIslam Is Construed As The Second Largest Religion After1077 Words   |  5 Pagesprovide the road that a Muslim should follow, and it forms the organic community that defines the relationship between politics, society, and religion. The Islam does emphasize on the practice in disregard to the belief. This means that they value the law over theology and it forms the most important part of the Muslims. The practice provides the sharia that Muslims do adhere to realize the will of God. At the heart of the Sharia, there are five pillars that are almsgiving, pilgrimage to Mecca, fasting