Pediatric Nursing 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 childs level, and work from that. This has its benefits, giving the child the one to one tuition, however in Joshs situation, he wasnt very well, and didnt 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 dont believe in Joshs 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) Joshs 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 Joshs 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 Joshs ph …