Introduction to Children and Young People’s Nursing – Lauren’s List

On Thursday I facilitated an online discussion for the student nurses in my module. The module is ‘Introduction to Children and Young People’s Nursing’ and the first half of the discussion was focused on how children are treated in hospital. We used Lauren’s List as the basis of the discussion. Lauren Sampson was 7 years old when she’d been in hospital more than 50 times. After becoming frustrated with the loss of control, Lauren taped a list to her door:

  • Please knock on my door
  • Please introduce yourself
  • Please explain why you are here
  • Please tell me if something might hurt

The discussion highlighted how sometimes nurses forget to knock on the door and after learning about Lauren, our students said they would be much more aware of how important this is. Knocking on the door before entering seems to be courteous and respectful, with one student suggesting that we wouldn’t just walk in to someone’s house so why would we walk in to someone’s hospital room without knocking? While the items on Lauren’s List may seem fairly simplistic, they are fundamental to an effective partnership in care.

The discussion also highlighted the need to introduce yourself and links were made to the Dr Granger #hellomynameis campaign. You can read more about this here. Our student nurses have also learned some British Sign Language this week. Some of them have even taught their children to sign “hello my name is…..”. Students reported the need to write down the name of the nurse caring for the patient so that the patient knows and can remember. This was something I did on every ward I worked on and I felt it was good for children and families. There are so many people involved in hospital care that it can be easy to forget names.

Explaining why you are here was discussed and reports of nurses doing procedures without really explaining why. We know nurses are busy but communication is key here. We talked about making every contact count and that every thing we do with our patients offers an opportunity to talk and communicate.

If something is likely to hurt, our students said they would be much more likely to discuss this in the future. Our students have a session on paediatric pain management later in the timetable and so it is really important to begin to think about children and their perceptions and understanding of pain.

The online discussion enabled each and every student to say something and so we had a different discussion to one we might have had in a physical classroom where not all students will offer their thoughts and opinions. We clearly have a great group of student CYP nurses who have been able to acknowledge areas for improvement and have identified actions for their next placement to make sure that they honour Lauren’s List.


Introduction to CYP Nursing : parenting styles

A few weeks ago I made the decision to blog about the module I lead. I’m the module leader for Yr 1 Semester 3 ‘Introduction to Children and Young People’s Nursing’. The module officially started yesterday and I was really pleased to meet March 14 student nurses all enthusiastic and ready to go. In preparation for the module, I’ve considered how social media may enhance learning and so we have a twitter hashtag #ICYPN which is also embedded on the virtual learning environment (Blackboard). I’ll also be posting items on our FaceBook page. Over the next five weeks of theory, I’ll be blogging twice a week (briefly) about the sessions delivered on this module.

After introduction to the module yesterday, sessions today included ‘communicating with children’, ‘parenting styles’ and ‘deaf awareness and sign language’. I personally delivered the parenting styles session. In this session we began to explore the work of Diana Baumrind (1966). Diana Baumrind identified styles of parenting and concluded that each style would have different outcomes for children. Today we looked at each of the Authoritarian, Authoritative and Permissive parenting styles. This was an introduction to parenting styles and other theories will be considered as we move through the module. Children’s nurses not only work with children, they work with the parents and the family unit and so it is important that we understand something about how parents parent. Additionally some of our students will go on to work as Health Visitors where of course working with families is key. An interesting element to emerge from today’s discussion was how we all make judgements on parenting ability, which is often based on minimal information and observation. The key message from the session is that we need to avoid judgement and instead work with families toward a positive outcome!

Why the VC Distinguished Teaching Award is important for our nurses

Wow what a day! Today I’ve attended the Vice Chancellor Awards at The University of Salford with my social media buddy, colleague and friend Moira McLoughlin. Our social media team (Me, Moira McLoughlin and Neil Withnell) were shortlisted for a Vice Chancellor Distinguished Teacher Award at The University of Salford. The award ceremony is to celebrate the good work done by university staff and to give awards to those who have been particularly outstanding. Today, we were lucky enough to be chosen for a coveted Vice Chancellors Distinguished Teacher Award for our work using social media in nurse education. In building our social media portfolio, we have developed a successful school twitter account which we run in partnership with students, a school wordpress account, and the recent addition of Facebook pages for each of the fields of practice. Each platform provides students with an opportunity to learn and develop from a huge online nurse community that also embraces other professions and service users and carers.

Competition was tough, with many academics and professional services staff there to celebrate their achievements. We sat with baited breath and were utterly shocked and surprised as our names were read out! There are many reasons why we were utterly shocked and surprised and why this award is so important to me but one reason is that earlier this week Teresa Chinn wrote a blog about her disappointment that the leader of The Royal College of Nursing, Peter Carter was not interested in using Twitter. So, to receive an award such as this from the Vice Chancellor of our University says to me that although some leaders haven’t yet seen the value of social media in nurse education, our academic leader certainly has. To have academic recognition for the work we’ve been doing to increase student nurse engagement with social media is indeed a huge accolade. It says that our work is valuable and worthwhile. It says that our work is important in the world of academia. It says that engaging student nurses and registered nurses on a local, regional, national and international scale to develop, learn and make connections is hugely important. It says that what we are doing matters.

I am proud to be part of our small but perfectly formed team and the work that we’ve done so far and I’m looking forward to our future developments. I’d like to thank everyone who has supported us including Teresa Chinn and WeNurses, our fabulous student nurses, our supportive colleagues and of course our Head of School Tony Warne for supporting and encouraging us to continually create and develop.

Our work using social media, means that in the future, our student nurses will become staff nurses who are ready for a professional nursing career in a digital landscape and that’s important – our Vice Chancellor certainly thinks so!

Onwards and upwards!


Response to NMC Draft Code

After chatting with @AgencyNurse earlier this week about the revised draft NMC Code which is now available for consultation, an ongoing twitter conversation has developed about point 114, relating to social media. Today @anniecoops has blogged sensibly about her response to the draft (you can read it here) and so I thought I would add my thoughts.

The draft NMC Code states ‘You must ensure that you use social networking sites and other forms of electronic communication responsibly and in line with our guidance, in particular by not referring to employers, colleagues or past or current people you have cared for

As a nurse, a nurse lecturer and a fitness for professional practice investigator and panel member at my place of work, I have seen a number of cases involving social media, and so like many others I welcome the inclusion of social media in the Code. Unfortunately, if this point remains as it currently stands, the progression and development of social media in nurse education and nursing will be terribly compromised. I am currently working hard with my colleagues to teach our student nurses how to remain professional online and utilise social media for their personal and professional development. We are doing this through partnership curation of a university twitter account, a university wordpress site and university Facebook pages. If the point remains that we cannot refer to employers and colleagues, I predict that our student nurses and registered nurses will become ever more wary of using social media, and indeed decide not to utilise it all. This would be a tragedy and a huge step backwards. So please NMC, consider this carefully because nurses are trusted with so many things, why not trust them with social media? If we are to develop professional networks and relationships using social media, how can we not refer to employers and colleagues? We need to be open, transparent and honest.

I suggest that the words are changed to ‘You must ensure that you use social networking sites and other forms of electronic communication responsibly and in line with our guidance. When using social networking sites registrants must only refer to their employers or colleagues to develop professional networks and create learning and development opportunities. Registrants should respect the confidentiality of people they have cared for previously and those they care for currently.’

All registrants need to respond to the consultation. Please take the time to do so.

My NHS Change Day Pledge: To Challenge Restrictive Hospital Visiting Hours…the story so far

Back in November I blogged about my experience of visiting my Father in hospital (you can read it here). After recently tweeting about my experience @KathEvans2 and @Thebestjoan encouraged me to make a pledge for NHS Change Day 2014. I was so astounded by the strict visiting regime enforced by nursing staff that I now intend to challenge restrictive visiting hours and encourage ward staff to review their visiting policies. After some heated debate on a Sunday morning (you can read the storify here) a few weeks ago, @WeNurses asked if I would like to guest host a #WeNurses chat. Of course I took the opportunity to learn more about why nurses enforce such strict visiting hours and to prompt discussion and debate. In preparation for the discussion I started with a very quick literature search and quickly found that research was limited. During the chat, there was much more heated debate, much based on experience from various perspectives and here are some of the highlights (you can read the full transcript here):

These reasons were cited during the chat as the case for restrictive visiting hours:

– It helps with infection control

– Open visiting exhausting for sick patients

– Patients said they were too tired for open visiting

– Causes patient’s stress

– Occasionally need to ‘make’ visitors go home and rest

– Nurses and patients need structure

– Visitors are too noisy

– Visitors are not carers and need rest

– Procedures need to be done without visitors present

– No consideration for patients from visitors

– Open visiting would diminish time that nurses spend with patients

– To allow washes and rest

– To enable cleaners to clean around bed spaces

– Protected rest period improves delirium rates

– Visitors change ward dynamics

– Relatives often anxious to leave

– Open visiting would be a logistical nightmare with cleaning, personal care and ward rounds

– Those with no visitors may struggle to interact with others

– Families wont get reassurance from staff in the morning – wards are too chaotic

– A lack of space

– To ensure privacy and dignity

– Wards are too busy

– Ward rounds and physio make visiting unfeasible

– Patients feel rude asking visitors to leave

– Health and safety, children running around

These reasons were cited during the chat as the case against restrictive visiting hours:

– Enable partnership between family, friends and professionals

– Families can help with care

– To enable person centred care

– No right to stop patients seeing loved ones

– To encourage collaborative care

– Because restrictive visiting creates bottle necks

– Visiting hours are dictatorial, not conducive to caring

– Restrictive visiting is stressful for families

– Children’s nurses manage it successfully

– Improve patient expeience

– Some people cannot rest without their loved ones

– Empowering to involve family in care

– Encourage ‘normality’

– More relaxed, less pressure

– Component of healing process

– Reduces anxiety and social isolation

– Reduces the car park stampede

– Patients feel ‘lifted’ after seeing visitors

– Patients are capable of discussing timetables with their family

– To prevent boredom

– Useful when family is concerned about poor care

– Helps with work and family commitments

– Shared mealtimes are a social event

– Better co-operation

– Visitors will be spread out through the day

– It’s less disruptive

– Restrictive visiting hours are controlling and intimidating

– Its a hospital not a prison

During the discussion there were lots of calls for individualised visiting plans and nominated visitors. There were calls to remove restrictions and calls to keep them in place. There was participation from nurses in various fields of practice, patients, carers and nurses from beyond the UK but in the end there was no conclusion to this very heated debate.

Although consensus could not be reached, I am delighted that I have been able to work toward my pledge of challenging practice and encouraging a review of restrictive visiting hours. It is a subject close to my heart and I am now in the process of planning how to take this forward. There appears to be much paternalism and rituals in visiting hours practice and so it is clear that more research is needed to provide the evidence to support practice. I’m not asking for a blanket ban on visiting hours, I’m aware one size doesn’t fit all but I would like to see change based on evidence.

As the debate continues, I will continue to work toward meeting my pledge…will you join me?

To be continued….

A plea to nurses….please review your hospital visiting policy

The last two weeks has been rather difficult for me. I’ve been a regular hospital visitor for my Dad and consequently there’s been lots to do in addition to the usually busy daily routines. I work full time, I have a 9 year old daughter and my husband works night shifts. Last Monday, I went to the hospital at lunchtime to visit and also speak to staff, assuming that a ward round would have taken place, so presumably a good time to get an update. On arrival at the ward, the doors were locked so I rang the bell. I was stunned when I was met at the door and told that visiting wasn’t for another 30 minutes. I knew that I wouldn’t be able to come back, I had work to complete and l had to collect my daughter from school. I also knew that there would be no other visitors that day. Even after explaining all of this I still wasn’t allowed to visit until visiting time. I hadn’t even thought about visiting hours, no-one had spoken to me to explain anything. In fact it is incredibly difficult to get any information from anyone. Last weekend I couldn’t visit and so I rang the ward for information. I rang 8 times and each time, the nurse was either busy, with a patient, on her break, on the telephone, not on the ward etc. and each time I was promised a return call. Nothing. I then spent 2 hours telephoning the ward the following morning but nobody answered the telephone. This is incredibly frustrating and so a plea to all nurses…enable and value communication between patients, family and staff, it is crucial for all involved. Of course I understand that staff are busy but in addition to the practicalities, communication also reduces anxiety for both patient and family and builds trust. I am speaking from experience.

So this week I have found that visiting times are not always convenient for visitors…I work, I have family commitments, I live a long distance from the hospital, and the list goes on. I also wonder why on this particular ward, visitors are not welcome at mealtimes. Surely some patients would like visitors at mealtimes, so that they can enjoy the social element of eating a meal and maybe the visitors could/would like to help. So why do we even have visiting times…is it to give the patients some time alone? To limit noise? Because staff want to control routine? Do patients want visiting time or open visiting? Why don’t we ask? Why don’t we offer individualised care and enable the patient and family to negotiate visiting time? Visiting a relative in hospital is already problematic for many people, its a worrying time, its stressful, its expensive and its time consuming (it took me 45 minuted to find a parking space on one visit!), so another plea to all nurses…please review your visiting policies and consider what can be done to ensure that visiting is in the best interests of your patients and is convenient for relatives to visit. You may find it beneficial for your patients and families.

As a paediatric nurse, my experience has always been that open visiting is usually in operation, and one or both parents are able to stay with their children overnight. So I wonder why adults do not enjoy the same privileges? As a close relative of a patient in hospital, I have again experienced the frustrations shared by others every day. Please leave your comments, I’m really interested to hear your views on hospital visiting policies.