Noah Case Study
Noah recommendations 1-5
1. Provide/ Distract
2. Listen/ Perspective/ Boundaries
3. Valdiate
4. Reassure/ Ethical
5. Reassess/ Communicate
Noah- Perspectives
Triage nurse- frustrated at interruptions
Reception staff- upset at verbal abuse
Louise- Frustrated and scared at Noah not being seen quickly
Noah- Ethics
We have an ethical duty to treat in accordance with clinical necessity, not through who is most vocal or who shouts at the staff members. For this reason we need to speak to Louise and set boundaries about what is acceptable in the waiting room.
Noah- Barriers/ solutions
1. A private space may not be available to speak to Louise in. This recommendation is still worth attempting, possibly by waiting until the triage room is empty/ a treatment room becomes available, as this talk will provide Louise significant reassurance and lessen her anxiety, and bring order back into the waiting room.
2. A member of staff may not be available to sit with Noah. This recommendation is still worth attempting, if this means seeking out a student or waiting for one to become available, as it will allow Louise temporary respite from looking after her sick child, and give her the space to express herself and allow her to feel heard. This should deescalate the conflict. If she was attempting to both communicate and look after Noah at the same time, this may be overstimulating and frustrating, and worsen the conflict.
3. Louise herself may be a barrier to these recommendations if she is inconsolable and uncommunicative. This can be overcome by patient and active communication techniques, such as calm body language, validation of feelings, paraphrasing what she has said and repeating it back to her noncondescendingly, sympathetic facial expressions and eye contact etc. Since her furstration stems from fear, rather than solely anger, it should be easier to reason with her.
Noah- How my role will change
Student- It is likely that I would be the one sitting with Noah, as I am supernumary and have less urgent responsibilities as the qualified nurses. Additionally, observing the conversation with Louise might be detrimental to the purpose of the meeting, as she may feel ambushed, overstimulated, or ganged up on.
Newly Qualified- In this scenario, since I was involved with the case, it would be more likely that I would be the one speaking to Louise and carrying out these recommendations, since she had already met me, and building rapport may be easier on the foundation of the therapeutic relationship I had already started to build.
Noah- Strengths of this Plan
The strength of this plan is that the main barrier to completing the plan should be sidestepped by the plan. Calming Louise down, empathising with her and treating her with the humanity that so easily lost in the emergency department waiting room will result in the smoother treatment of her son, when the time comes.
Noah- Supporting families in challenging situations: Studies
1: Semi-structured interviews on parental experiences in the ED
2: The treatment that families face during their time in the ED
Noah- Transitioning through conflict: Studies
1. The impact of ED waiting times and physicality on physical/ verbal violence
2. Conflict management strategies in the ICU
Noah- Study 1 Weakness
Study was set in Australia, where specific paediatric emergency departments are a new occurance, so some of the study participants had the experience of the paeds ED tainted by the fact that they were just grateful to be in an appropriate environment for the child. However, the parts of this study that are applicable to Noahs case are how the staff members treated the families, which was overwhelmingly positive, and revealed the factors that improved the overall experience. This makes the findings transferable to the treatment of Louisde, and useful for the staff members working this case.
Noah- Study 2 weakness
This study was conducted in South Africa, which could pose cultural differences that threaten the applicability of the study to this case. However, the study explored how the families were treated, and the fear they felt for their child. Since the love for a child is an internationally common phenomenon, these results still apply to emergency departments in the UK, meaning that the findings are useful to those working Noah's case.
Noah- Study 3 weakness
While this study was conducted in adult emergency departments, child emergency departments have the same tensions, if not more, due to the factor of parental advocacy and protectiveness. This means that the findings are still applicable, and useful to someone working in this situation.
Noah- Study 4 Weaknesses
While this study examined ICUs, the same conflicts occur due to the nature of the high intensity care delivered in acute environments such as ICUs and emergency departments, making the findings applicable in this case, and useful to someone working in this situation.
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