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NCS 3101 Child And Adolescent Health

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NCS 3101 Child And Adolescent Health

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Course Code: NCS3101
University: Edith Cowan University

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Country: Australia

Question: 

Sarah is a 12-year-old girl who has been transferred via Royal Flying Doctor Service [RFDS] to the hospital from a remote community, as a newly diagnosed type one diabetic [T1DM]. This follows a history of ill health, including abdominal pain, hyperglycaemia and a current presentation of mild ketoacidosis. Sarah and her mother have just arrived on the ward and the nursing team you are working with has been allocated Sarah to their patient load. You are responsible for completing admission details commencing initial nursing assessments when admitting Sarah to the ward. Sarah’s initial admission observations are T- 37.8 oC, HR – 104, RR – 30,  BP 90/55, weight 33.5 Kgs, height 135cms. Her current BSL = 16.1 mmols. Sarah has an intravenous cannula insitu with NaCl currently at maintenance rate, which is causing her distress. Sarah’s mother is understandably anxious and confides that Sarah is very scared of needles. Identify your initial nursing actions and considerations as Sarah arrives on the ward and for the next 24hrs. The medical team quickly stabilises Sarah’s blood glucose levels in response to a prescribed insulin regime, in the following days your nursing focus is to facilitate and educate Sarah and her mother on regular blood glucose testing, administering insulin, nutritional information and developing a C&FCC detailed and personalised maintenance plan for continued health in line with Sarah’s anticipated remote lifestyle following discharge.

Students are required to research and write a nursing case study essay with headings, directly relating to the above scenario parts A and B. Examine and discuss your initial relevant nursing assessments and management, subsequent health education planning and implementation, and, discuss all relevant general nursing care incorporating a C&FCC approach. Identify what nursing interventions you will consider and any referrals you will put into place during Sarah’s stay on the ward.
Discuss specialised members of the multidisciplinary team, and which particular members that would be involved in Sarah’s management of care, including what services that they will provide in the given scenario.
Referring to the C&FCC framework, develop a care plan incorporating a diabetes education plan for Sarah and her family that includes short and long term goals including discharge planning and followup services. Supportive rationale for your management is required. The care plan is not to be submitted but your planning, rationale for the plan and anticipated outcomes are to be discussed.

Answer: 

Introduction: 
In the opinion of Budden, Birks & Bagley (2017) it has been stated that victimization and provocation in nursing at the workplace is strictly prohibited. The public health issues can lead the nurses to experience grave physical and emotional injuries at their workplaces. These can be anxiety, fatigue, depression and burnout. In Australia, in particular, there have been reports of bullying and harassment of nurses quantifying to 6.8%.
In this context, employers have a lawful accountability of providing safe workplaces for their employees. Bullying and incivility at workplace can also be explained as physical, verbal, psychological and social abuse by the employer or other people at the workplace. It has been assessed that the Australian economy bears the costs of harassment between 6 and 36 billion dollars on yearly basis. The persons who bully and victimize the nurses at the workplace can be other health professionals, patients, their families and nurses (Nemeth et al., 2017).
The factors leading to stressful work environment for nurses can be decreased health funding, increased accountabilities and bed waiting timings of the beds in the hospitals. Nurses are susceptible to the impacts of changing health care practices at the workplace and augmented aggression by the patients and their colleagues. So, in this literature review, various views of different authors shall be compared, contrasted and evaluated in the light of specific settings in which they might occur and the factors involved in it.
Background 
In the opinion of Ferri et al. (2016) bullying and incivility in nursing is not a new occurrence and has been previously inserted. It is basically a profession controlled by females and it reveals a tradition  of bullying by same sex. This bullying behavior has been defined as ‘oppressed group’ behavior which is powered because of low self-esteem and loss of own individuality in the profession. Though there has been an introduction of changes in the field of nursing education ,scope of practice and  health care, the problem of bullying still continues in the profession.
The new graduates in the field are weak and are helpless to question their seniors about the concerned behavior. The violence, incivility and bullying is so much widespread in the industry that the staff is not concerned about the behavior of their colleagues towards the newly appointed nurses and they do not support them. Most of the negative behavior experienced at the workplace is of nonviolent nature. However, there are less incidences of physical and sexual violence experienced by those who are susceptible to its effects and not stood to defend themselves in an effective manner.
The negative behaviors have a component of personal elucidation such as being evaluated or judged in a negative manner. They are often denied of the learning opportunities .Many of the perpetrators include registered nurses who are at the positions of leaders. Their authority is reflected   in their behavior .It has been observed that the  junior or newly appointed nurses are being bullied by the  senior staff. Many of them do not have skills and experience to cope up with hardships.
This socio demographic profile makes the scholars more susceptible when they are challenged with behaviors which are intolerable. In this regard, it is expected by the clinical facilitators that they shall advocate, safeguard, mentor and become a role model of the amateur nurses . But on the contrary, they themselves are involved in bullying and harassing the nurses. It raises a serious question about the methods in which these organizers are selected, supervised, evaluated and prepared in the clinical workplaces.
Birks et al.,(2017) said that it is due to the reason of variations in health care and funding of education  and increased number of students have  led to the loosing of control over the off campus learning experiences  students . In some of the cases, it has been observed that universities pay for  providing health services to the nurses so that they can play the role of clinical facilitators  but they often lack commitment and loyalties and play dual roles.
The amateur nurses do not compliant against them as they are scared about the negative reactions of the staff. It has also been reported that some of them consider civility as a part of the job and contemplate such incidents to be too insignificant to be reported.  In this scenario there are many bystanders who are eager to know the consequences of whistle blowing on their colleagues in clinical setups which are risk averse and have proper procedures in place to deal with the same but often are unwilling to tackle such problems as and when they arise.
Allen, Holland & Reynolds (2015) contradicted the point by saying that the exposure to practices of bullying and harassment are considered to be a major cause of health problems for the sufferers. Apart from losses borne by the nurses, they have an adverse effect on the safety of the patients, quality of care and long term issues confronted by the profession as a whole. So, the economic impact of incivility and bullying on the workforce cannot be estimated. This reflects the complexity of the problem. It requires a multifaceted solution.
Literature search strategy
This search strategy of this literature review aims to find that incivility, violence and bullying at the workplace are some of the issues in nursing which can lead to serious consequences for all the stakeholders. Incivility is amongst the most rude, impolite and ill-mannered actions which may or may not have an undesirable intention behind them. Bullying is harmful, unwanted and repeated actions are intended to humiliate, cause distress and offend the receiver. Some of the activities of aggression are completely unacceptable and they comprise of verbal and physical abuse. They can be delivered by colleagues or patients of the nurses as well. These occurrences may have a serious impact not only on the wellbeing of the nurses but also on their capability to care for the patients (Rush  et al.,2014).
Vogelpohl et al., (2013) contradicted the pint by saying that incivility and bullying includes violence namely patients with whom the nurses interact during their regular course of duties. It is one of the most common health care assaults which is based on the work place environment. Another is done with the intention of criminal intent in which the violence is carried out in association with crime. The third type of work related violence comprises of bullying in health care in which the culprit and victim work together . In this case, it is not necessary that both are in the same role or at similar levels. The last type of violence takes place when the victim is targeted due to the existing relationship with the wrongdoer along with the violence taking place at the work place.
On the contrary, Lachman (2014) suggests that it is a violation of the Code of Ethics .As per his opinion; disruptive behaviors can raise medical errors and contribute to the poor satisfaction of the patients. It instigates opposing consequences and intensifies the cost of care and encourages the qualified clinicians, managers and administrators to pursue new positions in more specialized surroundings. With the emergence of Medicare reimbursements for health care, the issues of cost , satisfaction of patients and their safety , they even become more important to address. Various health care systems still tolerate incivility, bullying and horizontal and lateral violence.
Hamblin et al., (2015) criticized by stating that majority of the nurses enter into their selected discipline with  the intention to care for the patients. Their expertise and idealism is weakened through the presence of the individuals who create a hostile and unhealthy work environment. Some of the examples of destructive behavior include banging down the receiver of the phone, throwing the objects, damaging the equipment intentionally and exposing the nurses or patients to contaminated fluid. Bullying is far beyond the aspect of incivility as it is an intense and intentional abuse targeted towards specific groups or individuals. It has been cleared here that incivility considers lack of admiration for others and it is psychological in nature. It is of lower intensity and inconsistent behavior. It is rude and its intent is unclear to harm others while bullying is repetitive in nature.
Work place violence can be explained as actions which are psychologically and physically damaging activities which nurses face at their workplaces. They can be physical assault with or without weapons, physical and verbal harassments and homicide. They involve expressed or implied challenge to the safety, wellbeing and health of nurses. In the recent era, the forgotten terms of bullying and incivility have become serious problems in various settings of work and amongst the staff in developed and developing countries.
It was also critiqued by Reknes et al., (2017) Workplace bullying and harassment is an occupational safety and health hazard and is subjected to provincial and territorial safety and health laws. It is the exercise of physical forces by perpetrators against the nursing staff at the workplace which can cause physical or psychological harm to them. In contrast, bullying can be a mental harassment and it is wider in scope. It is an intense impact as compared to harassment and is based on gender, race or ethnicity. It is one of the forms of intimidation and psychological aggression.
Literature review findings 
The findings of the literature review are that violence and bullying at the workplace in both verbal or physical can result in harm or personal injury. They can be overt or covert. Overt includes physical, financial, verbal or financial abuses and covert includes rudeness, humiliation, withholding information and neglecting the nursing staff. These can happen within or outside the organization.
The impact of violence at workplace can have a permanent effect on the mental health of the nurses. It can also compromise personal security and safety and can lead to absenteeism and reduced productivity .It can affect the entire stakeholder i.e. patients, their families, nursing staff, their colleagues and employer as well.
All the nurses have the right to work in a respectable way free from any violence and harassments. They have the right to work at a place where these behaviors are not tolerated as a part of their job. It should not be acceptable to work in, administer or regulate the workplaces in which there is an existence of violence and bullying. Every workplace should have the culture of the cultivation and promotion of respect for all the stakeholders. The promotion of violence and bullying free workplaces is a shared accountability amongst all the stakeholders such as nursing staff, employees, clients, employers, nurse educators, government agencies, researchers and nursing regulatory, professional and accreditation organizations   in a health care setting .Each of them have an significant role to play in promoting and accomplishing the objective of violence free workplaces (D’ambra & Andrews, 2014).
The activities of violence and bullying have been criticized by Spiri , Brantley & McGuire (2017).It is an international phenomenon. It has been researched that the nursing staff is prone to worst risk of the violence at the workplace amongst all the health care workers. It is hard to guess the true degree of violence at the workplace as the variations in the definitions of systems of data collection, workplace violence, under reporting of incidents by health care workers.
In the recent years, bullying has intensified at the workplaces. This type of violence in its lateral, horizontal or vertical forms has affected almost more than half of the nurses and nursing students. It has increased the feeling of anxiety, depression, low self-esteem and isolation amongst the victims. It has contributed to decrease in the job satisfaction levels and increased stress along with negatively disturbing the physical and mental  health of the nursing staff. It may also result in high absenteeism and low rates of retention and recruitment amongst the nurses. It has been reported that 40% of the workers experience bullying once in a week (Beckmann, Cannella   & Wantland, 2013).
Esfahani & Shahbazi (2014) criticized by saying that it is crucial to differentiate horizontal violence  by the coworkers from aggression by the clients. The former has been found to be more disturbing as compared to any kind of aggression. The aggression from the client is criticized by the coworkers while horizontal violence has been perceived as personal issue thus leaving the victim in isolation. The frequent occurrences of the incidences relating to workplace violence and bullying have been criticized and affect the clients, organizations and nurses.
With reference to clients, the workplace violence and bullying pose a danger to the distribution of efficient client care and they even compromise client safety may extend beyond the workplace. It has been criticized by Samnick (2016).According to her   , it has been found in a research that nearly 1,100 workers were injured in violence. 490 of them were injured by violence in 2013.
She has even bifurcated the types of bullying nurses into various categories. The journal says that there are super nurses who are more experienced, educated and specialized and convey a superior attitude. There is another type of nurse known as the resentful nurse who holds and develops grudges and the gossip and rumor nurses share negativity. There are backstabbing nurses who are multifaceted. They first cultivate friendship, and then betray their colleagues. The green with envy nurses spread envy and resentment and lastly the cliquish nurses show favoritism and are ignorant to others (Wilson, 2016).
Discussion
This literature review further discusses that violence and harassment at the work place have also being criticized in the context of five triggers which can make the nurses vulnerable to bullying. These are being a novice in the medical field. They also face difficulty in working with others and even receive promotion or honor which they do not deserve in the opinion of their colleagues. Some of them get special attention from their seniors and work under situations of understaffing (Gaffney et al., 2012).
Bennett & Sawatzky (2013) critiqued by saying that the mantra of ‘nurses eat their young ‘have been a consistent formula for the ions. This kind of bullying experienced by the newly appointed has not been a unique phenomenon to the health care field. In this context, the education system has been criticized for bullying culture in nursing profession. The nurses have been trained to be submissive rather than to be confident and independent. The training received by them is contradictory to that given to the doctors. The latter is taught to be confident and never break down even if they do not have any answers.
To eliminate this problem, certain recommendations can be given to improve the situation. The nursing profession is amongst one of the helping professions. So, its cultural framing should equally serve and empower the stakeholders i.e. patients, clients, communities etc. In this context, six core competencies are defined as safety, patient centered care, evidence based practice, improvement of quality, informatics and team work and collaboration (Blackstock et al., 2014).
These competencies define ethical and professional behavior for the nurses and advance the human rights and economic, environmental and social justice for the victims. They suggest the nursing community to respect and engage in diversity and differences in practice.  They should involve in implementation of policy and involve themselves in research informed practice and practice informed research.
They must also involve with various stakeholders and asses them regarding the use and practice of health care practice. This activity when translated to nursing students and stakeholders will enable them to connect the dots between theory and practice. Evaluating competencies and reflective practices shall provide a vehicle for young professionals to express the distinctive functions of practices for social work. The formulation of core competencies shall serve to boost the unique contributions of nursing in the community (Birks et al., 2014).
In this respect, the Nursing and Midwifery Board Australia (NMBA) has released a Code of Conduct for Nurses and Code of Conduct for Midwives. The codes instruct the nursing staff to never involve or ignore such behaviors. They should act to eliminate the practice of bullying and harassment in all its forms. They should also escalate their concerns if a suitable response does not occur (Cleary et al., 2014).
In this regard, Australian Health Practitioner Regulation Agency (AHPRA) should be consulted in case when the safety and health of patients is posed at a risk. The Australian Nursing and midwifery Federation helps in formulating a risk management approach to prevent workplace bullying   in consultation with the employees and Health and Safety Representatives which comprise of the evaluation of factors of risk by the employers such as culture of the company, negative leadership styles, unsuitable systems of work, characteristics of workforce and poor workplace relationships (Montes et al., 2013).
The employers should implement suitable risk controls to create an environment which discourages bullying and ensures better management practices, desiring safe systems of work, efficient communication, reviewing and monitoring of workloads and staffing and defining roles and responsibilities. They should help in promoting positive leadership styles, encouraging team work and cooperation and preventing negative behaviors (Lee et al., 2014).
Spector, Zhou & Che (2014) advised that it is the accountability of employers to monitor and review the control measures consistently in consultation with various stakeholders and after the filling of a bullying compliant in particular so that it can be ensured that they are applied effectively for the management of the risks of bullying at workplace. The employers have been entrusted with the accountability to provide a safe atmosphere to the nursing staff. The organizations should have written policies and protocols evaluated in consultation with the staff and managers in respect to bullying and harassment at the workplace.
Conclusion: 
Hence to conclude, it can be said that bullying and harassment is a repetitive irrational behavior which is directed towards nurses. It generates a risk to the physical and psychological health and safety of the medical staff. It can be initiated by a single person or a group. This viewpoint has been supported by many authors in the study.
In this regard, they also suggest that the managerial actions should be taken in this regard. The performance goals should be set along with appropriate standards and guidelines.   They should also adopt a risk management approach to mitigate the risk.
References: 
Allen, B. C., Holland, P. & Reynolds, R. (2015). The effect of bullying on burnout in nurses: the moderating role of psychological detachment. Journal of Advanced Nursing, 71(2), 381-390.
Beckmann, C. A., Cannella, B. L.  & Wantland, D. (2013). Faculty perception of bullying in schools of nursing. Journal of Professional Nursing, 29(5), 287-294.
Bennett, K. & Sawatzky, J. A. V. (2013). Building emotional intelligence: a strategy for emerging nurse leaders to reduce workplace bullying. Nursing administration quarterly, 37(2), 144-151.
Birks, M., Budden, L. M., Stewart, L. & Chapman, Y. (2014). Turning the tables: The growth of upward bullying in nursing academia. Journal of advanced nursing, 70(8), 1685-1687.
Birks, M., Cant, R. P., Budden, L. M., Russell-Westhead, M., Özçetin, Y. S. Ü. & Tee, S. (2017). Uncovering degrees of workplace bullying: A comparison of baccalaureate nursing students’ experiences during clinical placement in Australia and the UK. Nurse education in practice, 25, 14-21.
Blackstock, S., Harlos, K., Macleod, M. L. & Hardy, C. L. (2015). The impact of organisational factors on horizontal bullying and turnover intentions in the nursing workplace. Journal of Nursing Management, 23(8), 1106-1114.
Budden , L.M. , Birks , M. & Bagley , T.(2017) Australian nursing students’ experience of bullying and/or harassment during clinical placement. Collegian,2017(24),125-133.
Cleary, M., Walter, G., Andrew, S. & Jackson, D. (2013). Commentary: Negative workplace behaviors at the University of Hard Knocks. Contemporary nurse, 44(2), 253-256.
D’ambra, A. M. & Andrews, D. R. (2014). Incivility, retention and new graduate nurses: an integrated review of the literature. Journal of Nursing Management, 22(6), 735-742.
Esfahani, A. N. & Shahbazi, G. (2014). Workplace bullying in nursing: The case of Azerbaijan province, Iran. Iranian journal of nursing and midwifery research, 19(4), 409.
Ferri , P. , Silvestri , M., Artoni , C. & Lorenzo , R.D.(2016) Workplace violence in different settings and among various health professionals in an Italian general hospital: a cross-sectional study. Psychology Research and Behavior Management, 2016(9 ),263-275.
Gaffney , D.A., DeMarco , R.F., Hofmeyer , A., Vessey , J.A. & Budin , W.C.(2012).Making Things Right: Nurses’ Experiences with Workplace Bullying—A Grounded Theory. Nursing Research and Practice.   Retrieved September 7th    , 2018 from   https://dx.doi.org/10.1155/2012/243210
Hamblin, L.E., Essenmacher , L., Upfal, M.J., Russell , J., Luborsky , M., Ager, J. & Arnetz, J.E.(2015). Catalysts of worker-to-worker violence and incivility in hospitals. Journal of Clinical Nursing, 24(17-18),2458–2467.
Lachman, V.D.(2014) Ethical Issues in the Disruptive Behaviors of Incivility, Bullying, and Horizontal/Lateral Violence. MEDSURG NURSING ,23(1),56-60.
Lee, Y. J., Bernstein, K., Lee, M. & Nokes, K. M. (2014). Bullying in the nursing workplace: Applying evidence using a conceptual framework. Nursing Economics, 32(5), 255.
Montes , A.M., Muniz , N.M., Simó , M.J.M. & Padilla , R.A.A.(2013) Workplace Bullying among Healthcare Workers. International Journal of Environmental Research and Public Health,2013(10), 3121-3139.
Nemeth , L.S., . Stanley , K.M., Martin , M.M., Mueller , M., Layne, D. & Wallston , K.A.(2017).Lateral Violence in Nursing Survey: Instrument Development and Validation. Healthcare ,5(33),1-12.
Reknes,I., Notelaers,G., Magerøy, N.,  Pallesen, S., Bjorvatn , B., Moen , B.E. & Einarsen , S.(2017). Aggression from Patients or Next of Kin and Exposure to Bullying Behaviors: A Conglomerate Experience? Nursing Research and Practice. Retrieved September 7th    , 2018 from     https://doi.org/10.1155/2017/1502854
Rush, K. L., Adamack, M., Gordon, J. & Janke, R. (2014). New graduate nurse transition programs: Relationships with bullying and access to support. Contemporary nurse, 48(2), 219-228.
Samnick , E.F.(2016) . The New Age of Bullying and Violence in Health Care: Part 2 Advancing Professional Education, Practice Culture, and Advocacy. Professional Case Management,21(3), 114 – 126.
Spector, P. E., Zhou, Z. E. & Che, X. X. (2014). Nurse exposure to physical and nonphysical violence, bullying, and sexual harassment: A quantitative review. International Journal of Nursing Studies, 51(1), 72-84.
Spiri , C., Brantley,M. & McGuire , J.(2017) .Incivility in the workplace: A study of nursing staff in the Military Health System. Journal of Nursing Education and Practice,7(3),40-46.
Vogelpohl, D. A., Rice, S. K., Edwards, M. E. & Bork, C. E. (2013). New graduate nurses’ perception of the workplace: have they experienced bullying?. Journal of Professional Nursing, 29(6), 414-422.
Wilson, J. L. (2016). An exploration of bullying behaviors in nursing: A review of the literature. British journal of nursing, 25(6), 303-306.

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