Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Building Trust to Work with Children after a Severe Traumatic Accident

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Building Trust to Work with Children after a Severe Traumatic Accident

Article excerpt

This article reports the findings of a grounded theory study that explored what acute care nurses do to promote the recovery of children who had severe injuries caused by a traumatic accident. For the purpose of this study a traumatic accident is defined as an unintentional accident that results in severe injury requiring hospitalisation and on- going rehabilitation. The participants in this study were Registered Nurses working in acute care wards that received patients from Emergency Department or a Paediatric Intensive Care Unit.

The implications of new technological interven- tions preventing death (Melvin, Lacy, & Swafford- TenEyck, 1998) and continued advancement in medical technology has further increased survival rates, increasing the challenges for acute care wards to promote optimum health outcomes for the child and their family. Within paediatric nursing, children and their families are the health care con- sumers (Lee, 2007). The current study uncovered the significance of a trusting working relationship between nurses, children and their family being essential to optimise the recovery of the child.

The study reported in this paper found a univer- sal dearth of literature related to rehabilitative nursing practice in the acute care setting of paediatric hos- pitals. Literature purports that trust is the necessary foundation for nurses to work with their patient, in this case the child and family (Caron & Bowers, 2000); yet a concept analysis of trust by Johns (1996) and Hupcey, Penrod, and Morse (2001), failed to identify how nurses work with patients to build trust.

The research reported here sought to explore how acute care paediatric nurses work with a child and his or her family to promote rehabilitation. The topic was prompted by the first author's experience of working with children recovering from severe acci- dental trauma in a small rehabilitation centre. The first author recognised the importance of earlier nurs- ing rehabilitation practice to optimise the recovery of the child and family. The most significant finding was the need to 'build a trusting working relation- ship' with the child and family. The research find- ings describe how the participating nurses developed this relationship. There is a paucity of contemporary papers explaining how nurses build trust.

Background

Acute care and rehabilitation nursing are practised in different settings; they are not usually considered the same, yet the promotion of the child's recov- ery underpins both. Pryor and Smith (2000, p. 3) stated 'nurses can and should practice rehabilitation across all settings regardless of the patient's diag- nosis or prognosis'. From the authors' experience the medical model of care dominates the acute care setting whilst rehabilitation theory governs how nurses work in the rehabilitation setting.

The reconstruction of life occurs from the moment a child enters the health care system (Edwards, 2001; Melvin et al., 1998). Initially nurses are involved with monitoring the child's changing signs of altered health status and prevent- ing stress, such as pain, that may hinder the child's recovery. Nurses collaborating with the family and health care team are integral to working with the child and family to build a trusting relationship.

The nurse needs to create an environment which obtains a 'snapshot' of the child and family prior to the accident. This snapshot of how the family was prior to the accident provides the goal for the interdisciplinary team when planning and work- ing with the child and family (Pryor, 2002). Thus, acute care nurses work differently with each fam- ily depending on the individual family's journey, which may include: The cause of the injury, their pathway to the ward, characteristics of the individ- ual family, and the developmental age of the child. Nursing practice that reflects the concepts of fam- ily centred care and partnership enables the nurse to understand the needs of the child and family. …

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