Role of the Rn

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Role of the Registered Nurse in Pediatric Palliative Care
Stephanie Harley
Nipissing University

Nursing is a career that requires collaborative relationships among professionals that assist nurses to provide the best possible care for the client and family. These interprofessional relationships may involve a wide range of health care professionals of multiple members that work collaboratively together to deliver quality care. Nurses are required to work with other professionals on a daily basis on the floor whether it is with a doctor, a lab tech, a respiratory therapist, physiotherapists or even a fellow nurse. Registered Practical Nurses (RPN) and Registered Nurses (RN) work together on a daily basis and work in partnership with one another to provide the level of care that is required in order for a patient to meet their outcomes. Pediatric palliative care is a specialized setting that requires constant teamwork or consultations and majority of the centers only allow RN`s to work on that floor, however; some centers allow for RPN`s to care for these children. Crozier and Hancock (2012) state that “it has been estimated that 13.9% of all children are living with a chronic health condition … and palliative care can be provided to these children as well” (p.2). This paper will discusses the role of the RN in pediatric palliative care in relation to family support through the three factor frame work which involves the client, the nurse and the environment. The Three Factor Framework

The three factor frame work is used in many different settings to determine whether a RN or a RPN will be caring for a certain client. This framework consists of the client, the nurse and the environment (College of Nurses of Ontario [CNO], 2011). These three factors are implemented and have an impact on decision making related to care provider assignment for the RPN and RN. It takes into consideration the client’s needs, the needs for consultation as well as collaboration among care providers (CNO, 2011). The three factor framework document is available to “help nurses, employers and others make effective decisions about the utilization of individual nurses in the provision of safe and ethical care” (CNO, 2011, p.3). It also helps with outlining expectations for nurses that highlight similarities and differences of nursing knowledge and its impact on both personal and professional responsibility (CNO, 2011). This framework comes extremely important in specialized settings, such as the critical care unit, the emergency department, the operating room and especially pediatric care. The Client

The client aspect of the framework focuses on the complexity of the client, the predictability and the risk for negative outcomes with the client (CNO, 2011). The client factors are combined to create a representation of a client that can be placed on a continuum that: …goes from less complex, more predictable and low risk for negative outcomes, to highly complex, unpredictable and high risk for negative outcomes …. the more complex the care requirements, the greater the need for consultation and/or the need for an RN to provide the full spectrum of care (CNO, 2011, pg. 2). In pediatric care there comes many different types of clients that a nurse may encounter and a topic that is not touched upon too often is pediatric palliative care. This type of patient would be considered to be on the more complex side of the spectrum which would require a RN to care for this child. Ferrell, Malloy, Uman, Virani, and Wilson (2006) tell us that “no one spends more time at the bedside observing, critically thinking, consulting, and providing direct care then the pediatric nurse” (p.1). This statement reinforces that a RN is more suitable for this task since the child’s health condition is unstable and constantly fluctuating, their coping mechanisms and supports are unknown, and the fact that they require frequent monitoring and reassessments (CNO, 2011)....
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