Consider your current area of practice, what systems or frameworks govern the way that you work and why?

 Thinking about your current or most recent practice placement, what nursing model or underlying principles underpin how nursing care is delivered? If you could not identify one, why might this be important to your clients?

Your answer might include hospital or NHS trust guidance, local policy, documentation by the NMC or the way in which the service is organised. But underpinning many of these are key philosophies and frameworks for our professional practice which aim to guide us as professionals but also to support and protect our patients and clients. See latest NMC Guidance in The Code (2015).

A model or principle could have clear advantages to our clients particularly where we are trying to ensure the philosophy of care and setting supports child-centred care or the way in which care is delivered to support a particular speciality.

You are taking over care of a two-day-old baby named Jakob on a children’s ward. Jakob was admitted the previous day with respiratory distress. Following a clinical assessment and some oxygen therapy the child is now deemed ready for discharge; therefore all monitoring has ceased.

During your shift assessment you acknowledge that the infant now has a raised respiratory rate and subcostal recession.

• Why would this cause you concern?
• And what other assessments might you now consider?
• What would your next action be?

Answers: The clinical condition has now deteriorated from previously on the ward round when the decision to discharge home was made. The child now needs a full set of clinical observations, including saturation monitoring. The medical team need to be alerted to re-examine the child. It is likely that the discharge will be delayed; therefore full communication needs to take place with the shift co-ordinator in relation to bed management and the family as they are expecting to go home.

This would depend on a number of factors, the age of the child, the setting, how ill the child was and the engagement of parents/carers. However, there are many ways that children and families can contribute to the setting of goals either where they lead on this or where they could agree with suggested goals.

Sarah is 10 years old and has a diagnosis of cystic fibrosis. She was admitted to an acute paediatric ward. The hospital policy is that all medication must be administered by the nursing team. A delay in this administration caused the mother to verbalise her distress and frustration at not being given the authority to administer medication that she gives daily at home.

• How could this situation have been better managed?

Answer: Medication could be stored in locked bedside cabinets which would be more accessible. The trust could allow parents to give regular/usual medication. Nurses could have explained/communicated the delay and reason for this earlier.