Pediatric Nursing Grand Rounds

NURS 421: Clinical Management- Children of the Family

Purpose of Assignment
The purpose of this assignment is to provide the student an opportunity to integrate
knowledge from the sciences, developmental theory and physical assessment data to the care of a
pediatric patient and family in the acute care setting. The student will utilize critical thinking and
independent judgments in presenting a holistic plan of care in a formal oral presentation.

Student Approach to Assignment

The patient chosen for my pediatric nursing grand rounds is a 22-month old female with a
primary nursing diagnosis of acute lymphocytic leukemia (ALL). In this oral presentation I
discussed her history, assessments, developmental stages with theory, plan of care, different
teachings implemented, and research that is applicable to her case.

Reason for Inclusion of the Assignment in the Portfolio

This assignment is included in the portfolio because it highlights the care that I gave to a
complex patient and demonstrates integration of a wide variety of end of program behaviors.

Critical Thinking
Revises actions and goals based on evidence rather than conjecture.
Example: Throughout care for this patient, it required myself to revise actions and
goals whenever formulating a concept map with appropriate nursing diagnosis that
were relevant to her day by day. For example, my patient started vomiting due to the
chemotherapy she was receiving so risk for deficient fluid volume became a higher
priority over risk for bleeding since her CBC was within normal ranges.

Nursing Practice
Implements traditional nursing care practices as appropriate to provide holistic
health care to diverse populations across the lifespan.
Example: Some traditional nursing care interventions discussed in my oral
presentation that were used in the care for this patient was use of medication
administration for chemotherapy drugs, as well as pegfilgrastim used to
increase her WBC count. In addition, due to low WBC count this patient was
on neutropenic precautions, so the use of gown, gloves, and a mask was
necessary when providing care.
 Demonstrates awareness of complementary modalities and their usefulness in
promoting health.
Example: Along with the traditional nursing interventions, some
complementary modalities used in her care to promote health was the
utilization of Child Life program at CHKD. This program provides individual
session play room time to help reduce anxiety for children during their stay in
the hospital. I discussed how I spent 45 minutes in the play room with my
patient and played with her to help distract her from the procedures she
needed to have done.

Communication
Uses therapeutic communication within the nurse-patient relationship
Example: During my presentation, I discussed how it was absolutely necessary to
form a therapeutic relationship with my patient because at such a young age,
children are reluctant to trust just anybody. So it really was important to develop a
rapport with her so she could trust me to make different interventions easier to
perform on her. For example, she only allowed certain nurses to feed her
medications because she trusted them.

Adapts communication methods to patients with special needs.

Example: I discussed how it was necessary to use adaptive communication
methods with my patient considering she is a toddler and does not understand the
teachings. Most of these were aimed towards the parents to communicate
effectively with the child.

Teaching
Uses information technologies and other appropriate methods to communicate health
promotion, risk reduction, and disease prevention across the life span.
Example: The teaching I discussed specifically for this patient were those to the
parent of neutropenic precautions. It was stressed the importance of hand hygiene,
no fresh fruits or vegetables, all foods must be cooked, and meat is cooked until
well done. This teaching promoted health and reduced the risk of infection.

Research
Applies research-based knowledge from nursing as the basis for culturally sensitive
practice
Example: The research discussed in this presentation was an article from the
Journal of Pediatric Oncology Nursing that discussed coping with pediatric
cancer. The study aimed to explore common cancer-related stressors for children
and to examine child coping and parental assistance in coping with these stressors
 during treatment. Some coping strategies included distraction, cognitive
restructuring, relaxation, practical strategies, seeking social support, and
emotional expression. All of these strategies were discussed with the patients
family to help them cope with hospitalization. In these ways I applied research-
based knowledge as the basis for culturally sensitive practice in the pediatric
population.

Leadership
Assumes a leadership role within ones scope of practice as a designer, manager, and
coordinator of health care to meet the special needs of vulnerable populations in a
variety of practice settings.
Example: The pediatric population is a vulnerable population, the ways
that I assumed a leadership role within my scope of practice as a student
and coordinator of health was when I took charge of the Child Life
session. This complementary therapy is beneficial in reducing anxiety
while the stay in the hospital.

Professionalism
Demonstrates accountability for ones own professional practice.
Example: In my own professional practice, I demonstrated accountability
by adhering to the institutional protocols for neutropenia precautions and
following strict hand hygiene protocol. In addition, I knew as a student I
was not allowed to do IV push medications, so I just observed as my nurse
administered them to my patient.