Pediatric Nursing Essay, Research Paper

For the purpose of confidentiality the name of the case study, has been changed

(UKCC 1996) The aim of this essay was to select a client, the client in this

case being a ten-year-old boy with cystic fibrosis, in a hospital setting. To

assess the holistic needs of that client, using Beck, Williams and Rawlings

?The five dimensions of self?, (Beck 1993) Josh has lived with cystic

fibrosis for 7 years ?People with CF suffer from chronic lung problems and

digestive disorders. The lungs of people with Cystic Fibrosis become covered

with sticky mucus, which is hard to remove and promotes infection by bacteria.

Many people with CF require frequent hospitalisations and continuous use of

antibiotics, enzyme supplements, and other medications. Born and living in hull

59 miles away, Josh has to be admitted to this ward every two months for

treatment, when admitted he generally remains in hospital for three weeks. Josh

has no father, but has a mother who is very protective and takes a keen interest

in his care. His mother who works as a sales assistant in a small shop in hull,

travels with Josh every two months and stays with him for the duration.

Intellectual Dimension Education has been provided in hospital for many years,

the 1944 education act stated that ?all children should be educated according

to age, ability and aptitude? (Hull 1989). One of the problems with having to

attend the ward every few months is the lack of schooling Josh received, and

increased chance that he will get behind in his schoolwork. This is why it is

extremely important that education and homework should continue in hospital. The

teacher on the ward that I worked came to see the children at 9am until 12pm

Monday to Friday, spending around 15mins with each child. Having spoken to the

teacher she said that she has to find each child?s level, and work from that.

This has its benefits, giving the child the one to one tuition, however in

Josh?s situation, he wasn?t very well, and didn?t feel particularly

motivated. The last thing he felt like doing was schoolwork. The teacher did

nothing to motivate Josh, she would explain what he had to do, and then leave

him until the following day. As soon as the teacher had gone, he would put the

work down and do something else. It was left to the nurses on duty to motivate

him to do his work, which during busy periods was quite difficult, so regardless

of the teacher being employed by the hospital, I don?t believe in Josh?s

case it was very useful. Making it a little more interesting would have helped,

and spending more than fifteen minutes to actually sit and go through the work,

would not only ensure that he did the work but gave some contact with another

person Emotional The emotional state of the child is also a crucial element in

development and health. According The Department of Health, ?We now have a far

greater knowledge of how children develop both emotionally and physically. With

that understanding has come an awareness of the emotion vulnerability of the

child and the effect which early experience can have on later development,? (DOH

1991) Josh?s mother was very anxious about Josh and about her job, she was

finding it incredibly difficult to hold onto jobs that allow her the time she

needs to spend with Josh every few months. To help with the accommodation aspect

of her living temporarily in Leeds, there is a building for families called

Ecclesley house, which is situated in the grounds of St James hospital. It

enabled parents to be close to there children and to have all the comforts of

home. This is not only hugely beneficial for the parent but also for the child.

It was especially advantageous for Josh and his mum, who came all the way from

Hull. It was important to allow mum to be able to ask any questions she wanted

and to have those questions answered in a clear legible way. It was important to

allow mum to have as much hands on care for Josh as possible, giving her some of

the responsibility of care for Josh. This is known as family centred care,

?Family centred care can be described as a multi-faceted concept incorporating

interaction between child, family and nurse, to provide holistic care,?

(Brunner and Studdarth 1991). ?Providing an opportunity for the family to care

for their hospitalised child under nursing supervision,? (Brunner and

Studdarth 1991). Family centred care is a key factor in maintaining emotional

support for the child. Physical Josh had many physical needs whilst in hospital,

some that he needed to stay alive and some to keep a sense of normality. One of

the symptoms of Cystic Fibrosis is the prevention of ridding mucus from the

lungs; if this is not helped or assisted then it can lead to breathing

difficulties and infections, even death. The physiotherapists, who were based on

the ward essential part of Josh?s treatment, without them he would have most

certainly died. Josh required four sessions of physiotherapy a day. This was a

routine Josh had to get used to as part of his ongoing treatment. The

physiotherapy was very hard going and at times seemed quite ruthless, there were

a number of occasions when he fought against the treatment. ?Often the child

will manifest anger, fear and other emotions by resistance to chest

physiotherapy. Allowing the child to engage in physical activities within his

physical tolerance could redirect these feelings as well as to improve

respiratory function.? (Harvey 1990). Unfortunately there were no activities

Josh could have taken part in that were of a physical nature within the ward.

Perhaps this would have helped. Josh did take a liking to a fire engine that was

on the ward, which he used to race around the ward with and crash into

everything, quite violently. The only feedback at the time was ?Stop It!!?,

he is very young for his age, certainly too young to be playing with fire

engines.? I believe the nursing staff failed to see the link between this and

the physiotherapy sessions. I believed Josh was very scared and frightened by

what was happening to him. His mum, was getting increasingly anxious, with

regard to Josh and her job in Hull. Josh would have easily picked up an

atmosphere, perhaps even felt guilty about his mum, and was finding no

reassurance from her. The team that should have intervened with this situation

was the nursing staff, who are a very important part of Josh?s physical well

being. It was essential for the nursing team, to explain treatment, give him

information, but not overwhelm him with facts. Sitting and listening to Josh,

was equally as important as talking to him. Listening to his fears and feelings.

Spending time one to one, was what Josh wanted a lot of the time, which was

difficult when the ward was busy, but this is one of the times when family

centred care was found to be useful. his mum spent a lot of time with Josh,

during the times she went for food or home for some rest we would step in and

spend that time with him. This worked well, however the problem was that there

wasn?t the time to spend with Josh?s mum, to explain and resolve her

anxieties. This was a problem because as much as the nursing staff were

reassuring Josh, his mum was inadvertently creating anxiety, stress and possibly

guilt. The one to one care the nursing staff were giving was wasted. If the

nursing team had allocated more time to spend with both Josh and his mum

together, then a lot of the anxieties and stresses of both mother and child

could have been alleviated. Social The social care of Josh was extremely

difficult; there were four other patients on the ward with Cystic fibrosis, all

around Josh?s age. Unfortunately because of the nature of CF, each had to be

isolated from other CF patients, because of the risk of cross infection. This

was very distressing for Josh, as he loved to play with friends, make friends,

and talk with friends. This made Josh very angry and frustrated with the Nurses,

and his mum. The hospital ward tried to create a state of relative normality for

Josh whilst on the ward, but according to the National Child development study

?isolation from friends and peers has an important impact on future

relationships, and socialization,? (Hull 1990). This was a problem that

wasn?t raised as an issue within the ward. I suggested that they write to each

other, and that we would help with any reading and writing he needed, this

seemed to work, and was great fun. There was a strong onuses on play on the

ward. ?Through play the child learns about his/her environment, through the

process of assimilation or through the practice of skills,? (Harvey 1990).

?Children develop, intellectually, emotionally, physically and socially

through a series of sequential stages? (Johnston 1988). The play requirements

vary according to their age and/or developmental level. Play helps form their

own identity, to exercise control, to adapt their particular culture and to

develop inter personal relationships. ?Deprived from play a child is a

prisoner shut of from all that makes life meaningful, play is not merely a means

of learning the skill of daily living, but gives the impulse to create and

achieve?. (Harvey 1990). Children in isolation, such as Josh, have particular

difficulties. They are not only away from home, but also in an unnatural, lonely

and alarming situation with no opportunity to play with the other children. Play

programmes are essential to compensate for the loss of independence and

companionship. Play is also one of the ways in which a child may develop the

capacity to deal with the stresses and strains of life as they press upon him.

It acts also as a safety valve, allowing him to re-live and often come to terms

with fears and anxieties that become overwhelming. This failed Josh whilst he

was on the ward. The onuses on the ward were either the very young children or

the adolescents. So I believe this didn?t benefit Josh at all. The activity

specialists were only part time, and they didn?t work weekends. Maybe

employing them as full time and over the weekend with better funding would help

provide a suitable care programme for children Josh?s age. Spiritual One of

the noticeable problems with Josh was that he always behaved when with the

nurses, however as soon as his mum arrived he would throw tantrums. One of the

factors the nursing staff and all other agencies working on the ward should have

ensured was Josh?s self-esteem. Being isolated, Josh could have easily felt

rejected by his mum and by the ward. Children who experience repeated rejection

and other negative emotions ?will eventually develop low self esteem and a

poor self image? (Hull 1990). Children with low self-esteem often behave badly

in front of the person they need reassurance from; in order to have it confirmed

that they really are bad. Perhaps this was the reason why he only behaved badly

with his mum, because he felt guilty and blamed himself for his mum?s

anxieties. Conclusion There were many agendas raised in the care of Josh, the

main aspect I believe to have been ignored was the communication between the

nursing staff and his mum. She showed a keen interest in his care yet was not

properly explained the facts by the nurses. If more care had been given in

explaining and listening to his mums worries and concerns, then a lot of

Josh?s emotional problems could have been helped and eased. There was enough

interaction between the nurses and Josh, but very limited interaction between

nurse and mother. There were also enough signs within his behaviour to indicate

him not being happy, and worried, which were never noticed. Fighting against the

physiotherapy, going over the top crashing the fire engine. I believe family

centred care to be extremely important in the care of paediatrics; however there

is a fear that the nursing profession can take for granted the role of the

family in the hospital. It is true that the parents are the best managers of

their child?s care, but it must be remembered that, the parents are not

professional nurses, and need the information from the professionals, who have

had the training, knowledge and the experience in dealing with diseases such as

Cystic fibrosis.

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