.. ysical 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 wasnt the time to spend with Joshs 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 Joshs 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 wasnt 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 didnt benefit Josh at all. The activity specialists were only part time, and they didnt work weekends. Maybe employing them as full time and over the weekend with better funding would help provide a suitable care programme for children Joshs 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 Joshs 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 mums 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 Joshs 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 childs 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. Bibliography Beck CM, Rawlins RP, Williams SR (1993) Mental health psychiatric nursing, an holistic life cycle approach ,CV Mosby Brunner LS, Suddarth DS (1991) Manual of Paediatric nursing, Lippincott nursing series Department of health, white paper, welfare of children and young people in hospital, (1991) Harvey S, Tucker A (1990) Play in hospital, Faber and Faber Hull D, (1990) Community Paediatrics, Churchhill livingstone Johnston DI (1989) Essential Paediatrics, Churchhill lvingstone UKCC (1996) Guidelines for professional practice. Yura H (1988) the nursing process, Appleton & Lange Con, Aaron.