Being in third year nursing has been a whirlwind of a journey. At times nursing exudes a sense of excitement and amazement at how the pieces are beginning to fall in place, at other times it is quite unsettling how difficult it can feel at times. Experiencing my first few shifts in the paediatric unit has been a completely eye opening experience for me. On some level, it is amazing to reflect on my first few experiences on a medical floor in second year and how much my practice has changed over the last year and a bit, particularly in regards learning how to develop courage particularly when interacting with patient, their families, and other members of the healthcare team. While the concept of family centered care is not a new term to me, in practice it is very much a new aspect that I struggle to incorporate into my nursing practice at times, especially as a new nurse.
Unlike many other nursing students, I had little experience working with a paediatric population, on top of the small amount of clinical experience I have participated in while in nursing school. For me, the role of the nurse is constantly changing, especially as I develop new understanding of diagnostics, care plans, medication and IV administration, and aspects like discharge planning. As a result, at times I find it difficult to form relationships with some nurses due to feeling inadequate and incompetent compared to the level of care they can provide, even moreso with families often nearby and watching everything closely. Because of this I had felt my confidence slightly diminish when something unexpected would happen. Examples include when a baby is being fussy while counting respirations and heart rate or the young active toddler who can’t follow instructions during assessments. This would then make me feel unconfident in reporting my assessments to the family and nurse out of self-doubt because things had not gone according to my expectations. My feelings have been supported in the literature with Latham and Fahey (2006, p.47) stating that confidence can be influenced by several factors including achieving confidence in a skill or set of skills.
With this I found at times it was often difficult to talk to the families to ensure they felt included. My feelings of inadequacy in my ability to care for my patients have been further validated by other new nurses who have participated in a pediatric clinical rotation, where lack of confidence in our knowledge base and confidence in performing skills was a common theme (Bembridge, 2008, p 2). I believe one of the most difficult aspects in pediatrics is learning to balance the needs of the parents’ ability to independently care for their child and the role of the healthcare professional. For both of my infant patients, the mothers of the infant would largely take over most care in knowing their childs routine and feeding patterns. On some level, it made me feel less involved in caring for the child and unsure of what the next steps would be after I was done my assessments. This being in comparison to my experiences with an adult population where most of the care fell on to the nurse if the patient had no family and was not independent.
Being in a childrens unit is a lot different to being in an adult inpatient medical unit. With children, it means delivering care through a family centred lens, a concept that is still quite new to me. This past week I was responsible for caring for two infants who were both undergoing phototherapy to treat their hyperbilirubinemia. For one family, this was their first child and it was evident at times they were anxious to know every detail of what was going on with their child. These feelings have been illustrated in research, with illness in children often evoking strong emotions and expectations in parents who desire information on their child’s condition, particularly if this is their first experience with a child in hospital (Kelo, Martikainen, Eriksson, 2013, p.72). In comparison, the parents of the second infant had undergone a similar experience with the birth of their first child and were therefore much more relaxed and needed less reassuring as to the nurses coming into do assessments and tests. This was likely due to their positive experiences in having received the patient education provided to them on their previous visit to the hospital having been cared by knowledgeable nurses (Kelo, Martikainen, Eriksson, 2013, p.72).
As students within the nursing curriculum we are taught the importance of developing a trusting relationship with our patients. However, in a pediatric settling, nurses and other healthcare professionals have an additional responsibility to develop a relationship with the patients’ family. My initial few weeks in the pediatric unit have enabled me to realize that confidence plays a vital role in not only providing optimal patient and family centred care, but also in the development of my role as a student nurse. While I realize, my confidence has been on the lower end these past couple weeks, I realize that these feelings will subside as I continue to grow my knowledge and develop my own routines into how I develop a care plans that meets both the needs of my patient and their respective families.
Bembridge, E. (2008). Studentnurseconfidence- areflection. HNEHandoverforNursesandMidwives, 1(2), 1-3. Retrievedfromhttp://journals.sfu.ca/hneh/index.php/hneh/article/view/25.
Kelo, M., Martikainen, M., & Eriksson, E. (2013). Patient education of children and their families: nurses’ experiences. Pediatr Nurs, 39(2), 71-79. Retrieved from http://www.pediatricnursing.net/ce/2015/article39011010.pdf
Latham, C., & Fahey, L. (2006). Novice to expert advanced practice nurse role
transition: guided self-reflection. Journal of Nursing Education, 45(1), 46-48. Retrieved from http://libaccess.mcmaster.ca.libaccess.lib.mcmaster.ca/login?url=https://search-proquest-com.libaccess.lib.mcmaster.ca/docview/203963348?accountid=12347