Comments regarding influences on behaviour

The RNs were asked to comment on other things which influence their behaviour such as other areas in which they had worked. They were also asked to write about influences which have a negative impact on their nursing practice such as workloads. Finally they were asked to

comment on anything else they felt was pertinent to their nursing practices. Six of the SPNs and 20 of the NSPNs made comments.

One RN felt the overseas specialist paediatric education:

―... developed in me a deeper sense of understanding of the issues that families face‖ There were several comments about positive influences on behaviour such as working in a tertiary centre and about colleagues having a positive effect on professional practice for example: ―work collegues [sic]‖and ―working as a team.”

“Being around other nurses and learning from them and seeing how they practice really is very influencial [sic].‖

One RN commented that ―information from education sessions may change my usual

practices.”

There were also several comments regarding colleagues having a negative effect on practice: “At times people disregard experience ...”

“Other staff members [sic] attitudes towards nursing ... interfere in your care” “lack of encouragement/appreciation”

―Years of experience - it seems the longer that a nurse has been working, the less time they

take to give personalised patient care.”

This last comment was made by an RN who had recently completed a12 month Graduate Nurse Program and seems to be contradictory to Coyne‘s (2007) report that more experienced/ senior nurses deliver family centred care more often. No explanation was given about the comment so the context is not clear, but it does not seem to imply the experienced nurses are more efficient. Glasper, Richardson and Whiting (2006) described how the perceived negative attitudes of some nurses may be detrimental to paediatric nursing. Glasper et al. (2006) was referring to the experiences of student nurses and how ―poor supervision‖ or a poor experience may have a

163 negative experience which ultimately impacts upon attrition rates. Although this small scale study focussed on paediatric student nurses‘ experiences, children‘s nurses do need ―... support from peers ...‖ (p. 25).

Negative peer attitudes are not the only factors which affect RNs‘ behaviour, environmental factors are prominent (Corlett & Twycross, 2006). Issues such as workload and policies may also be influential. Comments from the nurses regarding hospital policies include:

“... if the ward is busy there is not enough time to spend with parents” “ lack of support [from management]”

“ paperwork” “shift work- often tired as night duty has had a negative impact on my practice” “working in a busy ward with high dependency patients with a high staff ratio of junior staff”. “Poor leadership/managerial skills” “... change in managers can affect moral in general’ “lack of autonomy”

“lack proactive [sic] of health promotion within hospital”

“rushing so I don't do thinks [sic] as meticulously as I would if I had more time. Also if there is no clinical support or other people are too busy to help you and answer questions then that has a negative influence.”

“Ideally during the admission process & throughout the nursing care of the child my goal would be to gain the confidence of the child & parent/carer by relating at a level appropriate to each of them & delivering high standard of care, thus allaying any fears. This level of care is often difficult [to] deliver & frustrating due to time restraints & patients called for theatre prior to admission commenced/ theatre orders changed and increasingly high workloads. It is so important to have a positive impact on that first meeting during the admission this lays the path for their stay in hospital.”

“Staff numbers (particularly on Night Duty) are only considered on numbers of patients and not acuity, thus patient care/parent care may sometimes be compromised (in that I am unable to give time to address problems relating to either familial or psychological issues that should be addressed in order to provide holistic care).”

Workload seems to have a significant impact upon nursing practices but this is no different to many other areas both within and outside of the health industry. In addition, an RN made a comment regarding equipment failure within the hospital but again, this is probably no different to other areas of the workforce.

In the final comments section, which asked the RNs to make any other comment they felt was pertinent to their practice only four nurses responded. One was a SPN and the remaining three were NSPNs.

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“always having the threat of legal issues if you make a mistake.” “poor communication within the workplace.”

“Paediatric units within general hospitals need strong support from upper management who support family centred care and evidence based practice.”

The above comment may stem from a hospital policy observed by the researcher on several occasions during the data collection stage of the research. If the hospital was particularly busy then adults would be admitted to some of the side rooms in the paediatric ward. Co-locating children and adults on the same ward has been criticised by many organisations (RACP, AWCH, ACPCHN [now ACCYPN] & CHA, 2009). The standards of care for children/

adolescents clearly state that the practice of co-locating compromises care of both children and adults. The standards do include a contingency where there are ―unavoidable circumstances‖ to co-locating children and adults, such as outbreak of infections, but the standards stipulate that patient flow and bed occupancy be planned so that co-location does not happen as a result of this (RACP, AWCH, ACPCHN & CHA, 2009, Standard 2.2.5). However, the circumstances observed by the researcher were always about patient flow which resulted in adults occupying beds in paediatric areas.

The final comment below from an RN is definitive, effectively summarising many issues surrounding children being admitted to hospital (Glasper & Richardson, 2011; Hockenberry & Wilson, 2011; Kyle, 2008; London et al., 2007).

“I believe that it is essential to understand how an admission of a child not only impacts on the child and parent 'in that moment', but also how other issues for example, loss of parental role, altered body image, family dynamics (care of siblings and maintenance of family life for them), costs relating to admission - parking, food, loss of earnings, etc. can all become added burdens to the

child/family and, in providing holistic family-centred care, need to be explored and assisted with where possible.”

The main purpose of the survey was to ascertain if the RNs‘ perception was that their behaviour and practice were affected by the professional education they have received. The results of the survey demonstrate that education does affect behaviour and practices of RNs working in paediatrics. The comments of the RNs‘ reveal that their behaviour is also affected by other factors. These include the response of children and families at the admission, the observed practises of their colleagues, and hospital policies and systems.

165 The influence of parents and children‘s reactions could be reduced if RNs adhere to the QMs during the admission procedure. The nurses would have a greater understanding that every admission is unique and children and their families need help to guide them through the admission procedure. This is because when children and their parents are in unfamiliar

environments, such as a hospital ward, they are often scared (Coyne, et al., 2010; Feeg, 1989; Glasper & Richardson, 2011; Hockenberry & Wilson 2011; Shields, Pratt & Hunter, 2006). This understanding can best be gained through education.

Some of the RNs reported that hospital policies and procedures affect their behaviour during the admission procedure. These influences may be difficult for individual RNs to overcome.

However, if the philosophy of the hospital is to adhere to the QMs, the procedures which have a negative influence on the RN‘s behaviour, may be reduced and the admission becomes more focussed on the child and family, rather than the hospital processes.

There are many issues which affect behaviour and practices. As stated in the literature, best practice in paediatric nursing can be achieved through education. Clearly from the responses of the RNs to the survey, education does have a significant influence on nursing care within paediatrics, although this varies depending on the individual quality measure used.