Paediatric Nursing Teaching Session: Reflection and Analysis

Critically analysing a teaching session which has been undertaken in practice for a child or young person.

This reflective essay explores and analyses a teaching session carried out with a young person within a paediatric nursing setting, in order to evaluate positive aspects of the session, skills involved and skills developed on the part of the nurse during the session, the effectiveness of the session, and the ways in which this activity could have been improved to better meet the needs of the client. The client chosen is a 13 year old girl with Type 1 Diabetes, who, having made the decision to become independent in her glycaemic control and in managing her condition, was admitted to the children’s ward after a hypoglycaemic episode.

The focus of the session was on re-educating the client in good practice in self-administration of insulin. Up until the period shortly before her admission, her mother had been administering BD insulin injections before school and in the evening. The client, who shall be called Sheila for the purposes of this essay (the name has been changed to protect confidentiality), had asserted her independence and demanded to be allowed to carry out our own injections, unsupervised, but after the hypoglycaemic episode, the question was raised whether or not she was able to draw up the correct dose. Therefore, the session was set up to allow Sheila to revisit the correct procedure for drawing up and delivering the correct dose of insulin in the correct manner. Confidentiality has been maintained throughout this essay by anonymising the personnel involved, and by ensuring no identifying details are used at any point. The importance of the teaching role within paediatric nursing will be discussed in the light of this activity and experience, and some recommendations for good practice will be drawn from this.

The client chosen provides an interesting case because this is a young person who can be viewed as being in transition, between childhood and the onset of adolescence, asserting more maturity and independence in her management of her chronic condition, and so needing to be treated and interacted with in ways more similar to those usually used with adults. This presents a challenge for the paediatric nurse, because one key aspect of educating for health is to engage with the client on the appropriate level, and to avoid alienating the client (Agnew, 2005). This is a fundamental component of all nursing care, acting as both the human face of medicine and as a teacher or coach who acts to “take what is foreign and fearful to the patient and make it familiar and thus less frightening” (Benner, 1984 p 77). Approaching a young person such as Sheila requires skill in terms of using typical teaching approaches but adapting them to meet her individual needs as a person, according to her own perception of who she is and her levels of independence. Benner (1984) suggests that there is a need to use tone of voice, humour, and the nurse’s own attitudes in meeting these needs. Knowles et al (2006) state that “evidence-based, structured education is recommended for all people with diabetes; tailored to meet their personal needs and learning styles” (p 322). In this instance, planning the session required the nurse to draw upon knowledge of teaching processes and principles gleaned from her own study and research, clinical knowledge about the skill to be taught, and personal attributes which would (it was hoped), avoid patronising the client or alienating her(see Appendix for teaching plan). However, this author anticipated that there would always be some distance between nurse and client, because the nurse, no matter how skilled or capable in communication, might still represent an older authority figure to whom they might not necessarily ‘relate’ very well. Understanding this, the approach to the session was clearly and consistently hinged upon basic principles of learning, incorporating aspects of adult learning in order to attempt to be more appropriate for Sheila’s learning needs. There is some debate about the differences between learning in children and adult learning, or whether there are, indeed, any differences (Rogers, 1996).

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