Discussion

Discuss About The Activity Children Adolescent Cerebral Palsy?

Nurses at times falls in a dilemma regarding what to do or what not to do in the domain of giving quality care to the patient as they are guided by the strict rules and regulation of the Professional Code of Conduct for Nurses in Australia designed by Nursing and Midwifery Board of Australia (NMBA). The following essay throws light o such a complex clinical scenario, nurse dilemma and the recommended practice that must be undertaken by the nurse. The essay here starts with a argumentative thought via justifying the action of the nurse for not responding to the patient’s invitation of proposal. The essay further illustrates in the justification that can be cited n the grounds of the nurse welcoming the patient’s friendly proposal. At the end the essay provided a reflective thought on what should be done in a ideal case scenario and what are the possible beneficial outcomes if the nurse responds to the patintent’s proposal.

According to the Nursing and Midwifery Board of Australia (NMBA), nurses will be held accountable for their clinical practice. Here the nurses are compelled to practice with in a pre-defined scope of practice and such practices must be in accordance with the framework designed by the concerned regulatory authority (NMBA) (Nursing and Midwifery Board of Australia 2010). The NMBA code of conduct also states that, Nurses must only deliver care within their individual scope of practice. So here the individual scope of practice of Sam Mills, a RN nurse working in the GP clinical only encompass redressing of the chronic leg wound of their regular client named Lee and not assisting him in a pasta date at restaurant. Though Sam shares a personal relationship with Lee as he is his instant neighbor and resides in the same locality, Sam must here restrict this conversation of relationship into the professional domain only and must refrain himself from entering into a personal equation. Sam must only engage in therapeutic and professional relationships with the client. Moreover, Sam must think critically and analyze the nursing practice (Nursing and Midwifery Board of Australia 2015). In this case, Lee is suffering from Cerebral Palsy. According to Campanozzi et al, (2007), patient with cerebral palsy is management with gastrointestinal disorder such as gastroesophageal reflux disease (GERD) and/or chronic constipation (CC). The main symptom of GERD is acid reflux due to the backflow of the acid from the stomach into the esophagus (Jung, 2011). So having pasta, which is high on cheese, carbohydrate may further aggravate his complications related to GERD. Here Sam must practice nursing in a safe and competent manner and via doing this, he must encourage Lee to have some meal, which is rich in vegetables, oatmeal, non-citrus food, lean meals and egg whites. This specific diet plan is less likely to trigger the acid reflux symptoms and hence can be proving beneficial for treat the GERD of Lee (Austin et al. 2006). Sam must also maintain the capability for practice.  Under this code of conduct, Sam must educate his patient (Lee) via providing information regarding the diet complication in case of cerebral palsy and must take action for his health via forbidding him to indulge in such rich diet. Sam must also provide safe, appropriate and responsive quality nursing practice. The people who are affected with cerebral palsy are characterized by a significant movement disorder. Among these movement disorders there lays spasticity and dystonia and at time both. These to movement disorder create a huge barrier in the ground of the performing normal daily activity and in severe cases; the join paint may become unbearable giving rise to periodic deformity (Lundy, Lumsden and Fairhurst 2009). It is also recognized that painful hip joint can result in poor tolerance during a seated position and at times may need frequent turning (common at bedtime). Since Lee is suffering from cerebral palsy, he is supposed to pass through the complications of joint pain and hence it will not be medical feasible for him to have a pasta in a seated position for a long (Papavasiliou 2009). Here Sam must take into consideration of the medical stature of Lee and prevent him from going out with him. He must rather encourage him to have his lunch while at home in a half seated posture and this not only be helpful for his health but also crucial for his security issues. Moreover, since Lee shares his house with his friend and hence he will get someone to give him company while eating. The patient with cerebral palsy experience frequent seizures and spasm and hence it is better not to take a risk with a patient like Lee for an external outing alone with Sam.

Nursing and Midwifery Board of Australia (NMBA)

However, according to the code of professional conduct for nurses in Australia, nurses must support health and well-being of the patient. They must also support in the process of informed decision making of the people who are receiving or requiring the nursing care. So in order to maintain the health and the well-being of Lee, Sam must allow him to provide company in the Vinny’s Pasta. This cannot be considered beyond the professional code of conduct as the case study states that Lee is underweight and hates eating alone. Moreover, Lee is suffering from Cerebral Palsy. Cerebral Palsy is neurodegenerative disorder that begins early in life and persists throughout the life tenure (Rosenbaum et al., 2007).  It is the disorder of the movement and symptoms include muscle stiffness, tremor, hearing problem, difficulty in swallowing and speaking (Australia, 2016). So due to this movement disorder, Lee might become self-conscious while going into public (restaurant) and enjoy the meal. Since Sam is the next-door neighbor to Lee, Lee shares certain level of comfort zone with him and thus willing to enjoy the meal with him. According to the nursing code of conduct, the nursing practice must not be restricted in the grounds of the clinical care and must extend beyond that. Here the nurses must use their nursing skills and knowledge to work in a non-clinical relationship with the client. Here spending time with the patient beyond the tenure of nursing duty comes under the non-clinical relationship but while doing this, Sam will actually help Lee in having his food. In this case, Lee is unwilling to take his food alone and it is the nursing endeveaour to promote the betterment of the patient to overcome such restrictions. Moreover, as per the case study, clinic has no fixed policy regarding the RN going out for a meal with the patient and hence even if Sam plans to take Lee to the Vinny’s Pasta, it will not fall under any marketing rule. According nursing code of ethics, beneficence is an action done for the benefit of the patients and such actions are undertaken to prevent to the patient or to improve the situation (Finfgeld?Connett 2008). Though the nurses are refrained from causing harm to the patient, they must also have obligation to help the patient (Fahrenwald et al. 2005). So, under the act of beneficence, Sam must help Lee to enjoy his meal with him. Since Lee suffers from certain psychological complications and hates eating his meal alone, Sam as a registered nurse must come forward and help Lee to help with his meal. Having proper meal on the other hand will prove to be beneficial for Lee as he is under weight and gaining proper nutrition is also a prime need for the patient’s of cerebral palsy (Riggs, White and Gropper, 2007). Non-maleficence means, “do not harm” (Oberle and Allen 2006). Here the nurses or the physicians must refrain themselves from providing ineffective treatment. Here the concern of ineffective treatment can be discussed in a different way. Lee has a chronic leg wound and for which, he needs regular dressing. If Lee is left alone to go out for a meal at Vinny’s Pasta, the chances are there that he may further encounter injury at the same position and since he is suffering from cerebral palsy and the possibility of the rate of occurrence are high (Verschuren et al. 2012). So in order to provide an effective treatment in the long run, Sam must allow Lee to assist him to the Vinny’s Pasta.

Cerebral palsy and Patient diet

As per my nursing knowledge, understanding and practical experience, if I was in the Sam’s position, I will  not discuss my personal plans with the patients in the first pace. This is due to the fact that as per the code of professional conduct for Nurses in Australia, Nurses must treat the personal information obtained from the patient in a professional capacity as private and confidential (Nursing and Midwifery Board of Australia 2015). So, when nurses are required to keep patient’s information private, I will not reveal my personal plans to the patient’s as well and will only try to maintain a strict professional relationship (Leiter and Laschinger 2006). But, in order to generate inherent relationship with the patient along with a trusting understanding, nurses at times takes a friendly attitude and Sam as per my understanding has taken that very domain of nursing practice (Arnold and Boggs 2015). So now, when the plan has been revealed and Lee has expressed his interest to join Sam, I will prefer taking Lee with me if I was in Sam’s position. Since I know him personally, it will be easier for me to adjust with him at Vinny’s Pasta and both Lee and I will not feel uncomfortable. Moreover, via having proper meal, it will help Lee to fight back against his under weight problem (Austin et al. 2006). If I deny or refuse him, it might become a case that Lee does not have his meal for the day at all. Now this will harm him adversely as patient with cerebral palsy suffers from GERD disease and empty stomach may further aggravate the acid reflux (Katz and Zavala 2010). Moreover, a patient with cerebral palsy want to remain fit like other placebo and wants to be accepted and welcomed by the peers (Parkes et al. 2008). However, due to their physical complications, they at times fail to gain friends. It is the duty of the family members and the care givers to understand the difficulty via communicating with them, discussing their emotional problem and providing a positive support. Cerebral palsy is common in the children and hence it can be ascertained that Lee is a young boy and due to his physical limitations (Vargus-Adams, 2005), he suffers from loneliness and feels de-motivated to have the meal all alone. Since he lives always from his parents, it is the duty of the caregiver to come forward and help Lee with these emotional and psychological problems. I will prefer going at Vinny’s Pasta with Lee, this will give him a physical protection as he is suffering from chronic leg injury and will give him the opportunity to discuss his problems with emotional complications related to the phobia or dislike of eating alone. May be he suffers from the problem of difficulty in swallowing and if he has his meal while in company of others, he might overlook his share of swallowing pain. My practical experience says that patients open up while on conversation over a platter of meal or coffe and hence I will prefer taking Lee with me at Vinny’s pasta.

Patient movement disorders and nursing recommendations

Conclusion

Thus from the above discussion it can be concluded that, nurses must support the health and well being the patients. So in order to provide them with quality care, they at times must go beyond their professional relationships with the individuals as well as with their families or the concerned group of the communities. They must promote a thoughtful development of the constructive relationships. Moreover, they must not restrict themselves in the domain, which gives only provision for the direct clinical care. They must extend the nursing practice to any paid or unpaid role where they need to utilize their nursing skills and knowledge. This practice will eventually promote working in direct yet non-clinical relationships with the patients.

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