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samson elective presentation midwifery pptx
- 1. DEPARTMENT OF NURSINGEDUCATION, LEADERSHIP & RESEARCH MNS 310: NURSING ELECTIVES A REPORT ON NURSING ELECTIVES IN PEDIATRICS WARD AND LABOUR WARD IN JOOTRH, KISUMU COUNTY, KENYA SUPERVISORS: MRS. ROSEBENTER OWUOR MRS. FRANSISCA MIBEI ADMISSION NO: NUR/00011/019 DATE: 22/10/2024 SCHOOL OF NURSING
- 2. PLACEMENT AREA • Duringmy nursing elective, I had the privilege of working at Jaramogi Oginga Odinga Teaching and Referral Hospital, commonly known as JOOTRH, in Kisumu County, Kenya. • I was placed in both the pediatric ward, called Obama Ward, and the labour ward. • I chose JOOTRH because of its extensive range of healthcare services, particularly in maternal and pediatric care. • The high patient volume provided a great learning environment, offering real-world exposure to cases that enriched my clinical skills. • JOOTRH’s mission is to provide accessible, responsive, and quality healthcare through innovation, training, and research.
- 3. BACKGROUND • The LabourWard at JOOTRH is led by a nursing officer and handles over 7,000 women annually. • The department’s primary goals include providing safe maternal and child care, reducing maternal and perinatal mortality, and mentoring students like myself. • The ward’s services range from admitting expectant women, managing the first stage of labor, assisting with deliveries, conducting post-maternal reviews, and auditing maternal and perinatal deaths. • Obama Children’s Hospital, located near JOOTRH, was founded in 2007 by the Kenya Medical Research Institute, or KEMRI. • It’s a specialized pediatric hospital that serves children from various regions, including Kisumu and the lake regions. With 80 beds and about 70-100 weekly admissions, the hospital provides free care for children under five. • Obama Children’s Hospital has partnered with organizations like Safaricom and KEMRI to improve services and conduct research, with a current focus on conditions such as hemophilia and sickle cell disease
- 4. Justification • I chosethe Obama Children's Hospital and the Labour Ward at JOOTRH for my elective placement due to the unique learning opportunities they offer in maternal and pediatric health. • These departments provide hands-on experience and exposure to a wide range of health conditions that align with my career aspirations in nursing. • Obama specializes in treating complex pediatric conditions such as cancer and asthma, making it an ideal environment to deepen my understanding of managing critical childhood diseases. • The hospital’s involvement in research on conditions like sickle cell disease and hemophilia offers me invaluable insights into evidence-based practice. • The Labour Ward offers an in-depth look into the labour process, providing hands-on experience with both spontaneous and surgical deliveries.
- 5. Objectives in thepediatric placement • To apply the Nursing Process in the management of patients with medical conditions in Pediatric Ward at JOOTRH, Kisumu County, Kenya • Specific Objectives • Admit and discharge a pediatric patient. • Assess and collect subjective data using Gordon's functional health patterns. • Conduct a comprehensive physical exam and assess growth and development. • Demonstrate competence in using IMCI in triaging and managing a sick child. • Apply the nursing process in the management of various conditions in the pediatric ward. • Prepare and administer medication in the pediatric ward. • Assess the nutrition status and demonstrate skills in meeting nutritional needs. • Assess oxygen needs and administer oxygen to a pediatric patient
- 6. Objectives in labourward broad objective • To acquire and demonstrate appropriate knowledge and skills in management of labor complications of labor and the newborn Specific Objectives • Obtain comprehensive history with emphasis in obstetric and gynecologic history. • Perform complete physical examination with emphasis on abdominal assessment to mother in labor. • Monitor the progress of labor using a partogram. • Apply nursing process in management of women with normal labour. • Correctly perform an episiotomy if indicated, repair and teach client on episiotomy care. • Perform newborn resuscitation and identify high risk neonates. • Identify high risk conditions in the newborn and appropriate nursing interventions.
- 7. Work plan • Ireported to the facility on 23rd September 2024 through the JOOTRH training school where I had submitted introductory letter for the placement. • The director of nursing services approved my latter for placement. • I introduced myself and reasons for my placement I then presented by objectives to the nurse in charge of pediatric ward. • The pediatric ward in-charge gave me an orientation to the ward. She made a duty rota for the one week placement. • I took part in the processes of admitting and discharging patients, for nursing diagnosis made use of Gordon's functional health patterns, and performed complete physical examination as part of assessment of growth and development • I was able to effectively carry out sick children’s triage and management under Integrated Management of Childhood Illness (IMCI) guidelines
- 8. Work plan • Applyingthe nursing process allowed me to create tailored care plans for various conditions. • I gained valuable experience in preparing and administering medications while ensuring adherence to safety protocols • I also addressed all levels of nutritional assessment, fluid and oxygen requirements and education of families on relevant health information • During placement, I enhanced skills, gained confidence in clinical assessment and family interaction, and completed all objectives, demonstrating further education and creativity in patient care
- 9. Work plan • Iconducted physical examinations, focusing on abdominal assessments to identify normal and abnormal findingsI conducted physical examinations, focusing on abdominal assessments to identify normal and abnormal findings • I monitored labor progress using partograph, documenting key metrics that allowed for timely interventions • I also learned to recognize complications such as fetal distress and maternal hemorrhage, developing my ability to respond effectively in emergencies. • I managed women experiencing normal labor using nursing process by developing individualized care plans • I learned how to use the WHO labour care guide which is a tool that aims to support good quality evince based respectful care during labour and childbirth • I demonstrated creativity in patient care by employing innovative teaching methods, such as using visual aids for breastfeeding education.
- 10. Case • A 24year old mother, para 0 + 0 gravida 1 LMP 14/1/2024 EDD 21/10/2024 GBD 39 weeks 2 days wth preeclampsia • The mother come as a referral from Dawa Front Healthcare with elevated blood pressure (166/112). She reported of epigastric pain on examination there ws no pallor jaundice and dehydration mother had bilateral lower limb edema • Abdominal examination • Vaginal examination cervical os closed • Plan obstetric ultrasound, start induction and lab works • Investigations urinalysis protein +++ OBS U/S Single viable IUP in cephalic precentation at 39 wks 6 days
- 11. Management • Inductiion withmisoprostal • Magnesum sulphate loading and maintainence dose • Monitor blood pressure every 30 minutes • Evaluate frontal headache after 30 minutes of nursing intervention • Recommendations • Enhance infection control by making sure aseptic treatments, like chlorhexidine, are available and by practicing good hand hygiene. • Make sure there is a sufficient supply of medical supplies, such as IV fluids and catheters. • Increase the number of trained staff in the maternity unit.
- 12. Conclusion • In conclusion,this elective placement has been transformative in my development as student nurse. • The combination of hands-on experience and theoretical knowledge has enriched my clinical practice and prepared me for future challenges in nursing. • I am confident that the skills and competencies I have gained will significantly enhance my nursing career.
- 13. References Bennett, V. R.,& Brown, L. K. (2020). Myles textbook for midwives (16th ed.). Elsevier. Ministry of Health. (2021). Maternal and child health guidelines. Government Press. Ministry of Health, Kenya. (2022). Basic Pediatric Protocols for Ages up to 5 Years (5th Edition). Ministry of Health. (2014). Integrated Management of Childhood Illness (IMCI) Training Course: Participant's Manual. Nairobi World Health Organization. (2020). Maternal and perinatal health: A WHO perspective. World Health Organization. WHO. (2021). Guidelines for neonatal and maternal care in high-risk settings. World Health Organization.