N421 Pediatric Grand Rounds

Purpose of the Assignment

To provide the student an opportunity to integrate knowledge from the sciences, developmental
theory and physical assessment data to the care of a pediatric client 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 organization of this assignment began with spending a clinical day with the patient.
An assessment was performed which allowed for nursing diagnoses to be made and carried out.
The patient in the assignment was chosen based on their past and current medical and social
history. This assignment provided an opportunity to thoroughly evaluate the medical and social
aspects that affected the patients care.
Reason for Inclusion of the Assignment in the Portfolio

Critical Thinking
o Uses nursing and other appropriate theories and models to guide professional
practice
Ex. Erik Ericksons developmental theory showed that the patient was in
an Initiative vs. Guilt stage at 4 years old and is able to make simple
decisions on his own. By recognizing the patients developmental stage,
the care provided was able to be directly catered to his needs.
o Uses decision-making skills in making clinical or professional judgments
Ex. Giving the patient decisions allowed him to explore is developmental
stage. I was also able to assess the patient and make five nursing diagnoses
with interventions and then assess the effectiveness of the interventions
provided.
o Evaluates nursing care outcomes through the acquisition of data and the
questioning of inconsistencies
Ex. Data was assessed in order to apply nursing diagnoses. The patients
history and home life greatly affected his health and care at the current
admission. The outcomes were all either partially met or ongoing.
Explanations as to why the outcomes were rated as partially met or
ongoing are included in the presentation outline.
o Revises actions and goals based on evidence rather than conjecture
Ex. Goals were adjusted for the patient when he was not gaining weight
even though he was eating a majority of his meals and snacks. Suggestions
to promote a healthy weight gain include providing an Ensure drink for an
additional caloric intake.
o Engages in creative problem solving
Ex. In preparing for discharge, engaging the mother was imperative even
though she had voiced her disinterest. Teaching manual chest

physiotherapy to the mother was a step closer to getting a vibrating vest

prescribed. Actively engaging the mother to participate was a challenge
and took a lot of convincing throughout the day. The multidisciplinary
team used strategies such as: discussion, teaching hands on care, providing
educational handouts and arranging meetings with the social work team
and child protective services.
Nursing Practice
o Performs therapeutic interventions that incorporate principles of quality
management and proper safety techniques based upon assessment findings
Ex. Safety for the patient was promoted through assessment of the
patients needs and then implementing the precautions. The developmental
stage and history of the patient affected the patients overall state of safety.
Keeping the patients eyes free of discharge, reminders to wear the
nonskid socks and not to run were safety promotions implemented.
o Implements traditional nursing care practices as appropriate to provide holistic
health care to diverse populations across the lifespan
Ex. Traditional nursing care was provided to the four year old though the
administration of medication, ensuring adequate hydration and caloric
intake and the promotion of patient safety.
o Demonstrates an awareness of complementary modalities and their usefulness in
promoting health
Ex. Child Life specialists were utilized to provide distraction during the
administration of eye drops and while the mother was meeting with Social
Workers and Child Protective Services. Distraction was important for the
patient because it provided a reward system and a positive environment.
Teaching
o Provides relevant and sensitive health education information and counseling to
patients, and families, in a variety of situations and settings
Ex. Instructions and a demonstration of manual chest physiotherapy to
break up secretions within the lungs, was provided to the mother as the
patient was too young to learn them himself. The teaching occurred in the
evening in patients hospital room.
o Uses information technologies and other appropriate methods to communicate
health promotion, risk reduction, and disease prevention across the life span
Ex. Health promotion was communicated to the mother during the
teaching session. The importance of obtaining a high caloric intake in
order to gain weight and how the best way to do this at home. Handouts
from CHKDs Way to Grow were printed out and highlighted for her to
take home and utilize. By gaining weight the patient can avoid
hospitalizations and remain healthy.
o Evaluates the efficacy of health promotion and education modalities for use in a
variety of settings with diverse populations

Ex. Evaluation of the teaching was done through discussion with the
mother. She was able to identify how to promote a high caloric intake but
did not want to do a return demonstration of the manual chest
physiotherapy.

Research
o Differentiates between descriptive nursing literature and published reports of
nursing research
Ex. The nursing research utilized for the presentation reviewed the cause
of pediatric falls and suggested a new assessment tool for nurses. Intrinsic
and extrinsic factors were evaluated to determine what caused and
prevented falls. The article is nursing research because a nurse was an
author and current practice was evaluated with suggested adjustments.
o Evaluates research that focuses on the efficacy and effectiveness of nursing
interventions
Ex. The article used suggested what should be evaluated when considering
a pediatric patient a fall risk. The nurse must look at both the patients age
and condition as well as the safety of the hospital environment to prevent
pediatric falls.
Leadership
o 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
Ex. As a student, I performed assessments and implemented interventions
for the patient. I also provided distraction when the Child Life specialists
were unavailable. I attempted to instruct the mother on chest
physiotherapy, to break up respiratory secretions, while I performed the
action myself.
Professionalism
o Differentiates between general, institutional, and specialty-specific standards of
practice to guide nursing care
Ex. ANA Standards of Practice were followed to assess, diagnose, plan
interventions and evaluate outcomes. The institutional policy of the
Humpty Dumpty Fall Assessment was used in order to maintain patient
safety. The standards set guidelines in which nursing practice should
followed to provide safe care.
o Understands the effect of legal and regulatory processes on nursing practice and
health care delivery, as well as limits to ones own scope of practice
Ex. Understanding of scope of practice is demonstrated through diagnoses
with NANDA approved diagnoses. NANDA diagnoses are within the
nursing scope of practice which is guided by legal and regulatory process
to ensure that the care provided is by certified and trained individuals.
o Demonstrates accountability for ones own professional practice

Ex. By initiating a plan of action and evaluating the outcomes,

accountability was taken for my professional practice. The reevaluation
process identified my accountability for patient care because new needs
were identified.

Culture
o Considers the impact of research outcomes and, the effects of health and social
policies, on persons from diverse backgrounds
Ex. Research outcomes used in the presentation impact persons of all
levels of health and backgrounds because it identifies the causes of falls in
the hospital setting for patients with varying diagnoses. 12 previous
studies were analyzed which provided a large amount of participant
information to base conclusions on.