Journal of Clinical Nursing 1994; 3: 1-2

i-/ClltOri3.1 'f' ^''' Identifying quality components in clinical nursing practice—ansioiq is.f! ?:-. example from personal experience

•iUi1?.r: .rj(ir /.'iiii ,ii;fi.u-.,!!()irt;>lj iMiifn Following the death of Laura Davies in Pittsburgh, who underwent six multiplei!fc . - biirroj, -wTun will 1 .•r,i..j m \i organ transplants, it was intended that this editorial would discuss the role of

clinical nurses in the counselling of parents of children undergoing high-techintervention. While I was considering the content of the editorial my owndaughter, aged 3, was poked in the eye by my young son, 18 months. Thishappened at 6.30 a.m. when they were playing together. She complained that her

^ ..... eye was really sore, but I initially expressed little concern, saying that it was' obviously an accident and not to make so much fuss. An hour later, however, her

-' eye was still causing her distress. I tried to examine her eye closely and it• ' ' ' appeared that she had got some damage to her cornea.' Obviously, I then suffered all the anxieties that most parents experience when' one of their children is hurt. After discussion with my husband we both agreed' that we would have breakfast and if her eye did not appear to be better after that I

would take her to the eye hospital. She was unable to eat any breakfast and was- clearly in considerable pain.

Our experience at the eye hospital was, in my opinion, of an extremely highquality. We arrived at the emergency clinic where there was a bell with a noticebeside it saying, 'please ring and a nurse will come and attend to you'. The nurseimmediately came out, introduced herself and asked us what the problem was. Iexplained that while playing my daughter appeared to have had an accident; thenurse then turned to my daughter and said, 'Come through into this room and Iwill give you a badge'. She proceeded to give us a small sticky badge which said'Look after your eyes', this was stuck on to my daughter's cardigan and sheimmediately relaxed. The nurse then took simple details from me, having ensuredthat my daughter was sitting comfortably on my knee. The nurse then explainedto both my daughter and myself that she would be putting some drops in mydaughter's eyes that would enable us to see whether there was any damage. Mydaughter was not very keen on having this done but the nurse pointed out that ifshe lay on the couch and looked up she would see a lot of clowns on the ceiling.My daughter was delighted to look at the clowns and proceeded to lie down andresponded quite reasonably, keeping still while the drops were put in her eyes.During the time that the nurse was administering these drops she talked to my

, t , . daughter about the clowns on the ceiling and explained that they had been putthere just for children like her.

The nurse then showed me the damage to my daughter's cornea which wasstained in green. She immediately explained that this was, in fact, a minimal

, problem which should rapidly heal itself. She stressed, however, that I had donethe right thing to bring my daughter to hospital and reassured me that I had notwasted her time. She explained that it would be necessary to use some antibioticeye ointment to ensure that the eye did not become infected over the next 48hours. She then gave my daughter a poster with a teddy bear who had an eye

' ' •"'' patch suggesting that this could be coloured in when we got home to remind us of* our visit to the eye hospital. At the bottom of the drawing it said,'I was good at

the eye hospital and now I can colour in my bear to remind me of my visit there'.The nurse then explained to me that if my daughter continued to complain of

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2 Editor ial • t - i :r. ; W f s«-.*-<u/',i,i»idO\,) \ii<i >6 *

pain after 24 hours I should take her back to the clinic. In the meantime shesuggested that I give her a simple paediatric pain-killer, regularly for the rest ofthe day. At no time did the nurse make me feel guilty for the fact that thisaccident had happened but she did remind me that it may be wise to cut myyoung son's nails as we both agreed that this was probably what had caused theinjury.

I have described this event which, to my mind, demonstrates how successfullya clinical nurse can be the lead professional in care. This nurse worked as anautonomous practitioner and merely informed the doctor on call by telephone ofthe action she had taken prior to discharging us home. I was more than delightedthat my daughter was treated by a nurse who was immediately available rather

•J than having to wait for an extended period of time for a niedical opinion.•f I have tried to consider as to what were the key components in the encounter! which made it of high quality. There seemed to be three areas: the structure ofJ; the clinic with the clowns on the ceiling and the children's stickers used by the

clinical nurse to reassure my child; the rapid response when we arrived in theclinic; and the skilled interpersonal techniques used by the nurse which resultedin a reduction in my own anxiety. She explained the situation at a level

• understandable to both myself and my daughter throughout the encounter. As a4-; parent I felt involved in my child's care, particularly when the nurse showed me

the damage to the eye. In addition to providing me with information the nursefi used a health-education approach by reminding me that I should cut my son's

nails to prevent a similar accident re-occurring. Throughout , I felt supported bythis nurse even though I was distressed by my daughter 's discomfort and pain.T h e outcome of this care was that my daughter telephoned her grandfather in the

•» evening and said what ar; exciting experience she had had and how she had seen! clowns on the ceiling and that her eye did not feel so bad any more. She has

coloured in her bear and it is now on the wall in her bedroom. These positiveoutcomes were achieved because of the nurse's competence in managing the out-patient experience.

T h e original intention of this editorial was to try to explore the importance ofnurses involving parents in partnership when caring for very sick children. T h ecase that I have given illustrates that partnership is equally important when achild has only suffered a minor accident. My daughter left the unit feeling thatthe injury she had sustained was clearly an accident because she was given apacket of four jelly babies and told to share these with her brother. Sherationalized that her brother would not have been sent any jelly babies if he hadbeen a guilty party! Th i s kind of compassionate family-centred care is central toquality nursing practice.

Editor MARY WATKINSTor and South West .,, , • ..

College of Health Studies, , . it..,Plymouth