Introduction
Different children cope differently when exposed to the stress of hospitalisation. When children have been separated from familiar figures following an admission at the hospital, this may cause them to become emotionally upset (Bonn, 1994, p. 21). The most vulnerable group is children of between 6 months and 4 years of age (Dustagheer, Harding & McMahon, 2005). To help alleviate such emotional upsets, primary health care providers have now embraced the concept of family-centered care. The principle behind this concept is that the presence and contribution of the parents and the family of a sick child is vital in order to address the holistic and psychosocial needs of the child. This also helps the child to cope with the strange hospital environment. The current case study examines the effect of hospitalisation on Roger, a 3-year-old child admitted to the pediatric ward with a diagnosis of gastroenteritis. The case study shall also endeavor to outline the family centred care concepts with respect to the child and his family, along with a demonstation of how FCC can be incorporated into nursing care provided to Roger.
Coping with the stress of a hospitalized Child
Different children cope differently when exposed to the stress of hospitalization. When children have been separated from familiar figures following an admission at the hospital, this may cause them to become emotionally upset (Bonn, 1994, p. 21). The most vulnerable group is children of between 6 months and 4 years of age (Dustagheer, Harding & McMahon 2005). Roger falls in this group because he is 3 years old. Virginia, the 19-year-old mother to Roger is unmarried. Her cousin Gerri has offered her accommodation, along with her son. They also share the house with Gerri’s two children, aged ten and seven years. Roger’s absence from these familiar faces may cause him to become emotionally upset. When a child has been hospitalized, both the child and the family are engulfed by a potential crisis. Roger will be okay since his mother shall be accompanying him during his time of admission at the hospital. However, he will still be very upset since the hospital environment is unfamiliar to him. In addition, the infectious diarrhea that he has contracted makes him feel uncomfortable, further aggravating his emotional upset.
Family Centred Care
According to Paliadelis et al (2004), ‘family-centred concept’ are terms used in reference to the way in which families of hospitalized children, along with significant others, may be included and involved in the provision of healthcare to the children in question. A majority of the paediatric wards in developed countries claim to be ‘family-centered’. What this means is that these wards have embraced a philosophy that recognizes parents as central to the existence of the child. As such, in making important decisions about the kind of care to administer to a child, the input of parents is vital (Shields, 2001).
Family centered-care has gained popularity in as far as the health of a child is concerned. Family centred care recognizes the uniqueness of each family and as such, it regards the family as one of the constants in a child’s life (Galvin, Boyers, Schwartz & & Jones, 2000, p. 625). Accordingly, the presence and contribution of the family towards the child’s treatment becomes vital. Family centred care favors an approach that endeavors to meet the holistic and psychosocial needs of the child (Hutchfield, 1999, p. 1182). Previously, the approached gave priority to the biomedical aspects of the child’s illness. However, the approach now endeavors to cultivate a relationship with the sick child and the family as well, in addition to forging collaboration with them.
It is important to ensure that the nurse attending to a child is experienced and that he/she has sufficient skills so that he/she can satisfactorily teach, empower, and support the family during this difficult time of having to grapple with the illness of their child (Newton, 2000, p. 166). In the case of Roger, the nurse attending to him must be sufficiently knowledgeable about Oral Rehydration Therapy, by virtue of having handled similar cases before. In addition, the nurse should also be skilled enough to administer hydration to Roger either intravenously or via a nasogastric tube. The nurse could assume the role of a dominant player and gatekeeper by virtue of his/her knowledge and experience in deciding the kind of care that Roger ought to receive, and in the participation of the mother in the whole process of treating her son.
In the past, when a child was hospitalized, parents and relatives would remain mere spectators as they watched the professional nursing staff assume the role of attending to the sick child. At the moment, the hospital setting encourages an extensive involvement of parents in this process. The presence of parents is thus crucial. The concept of family-centred care hinges on the premise that “the family is who it says it is” and as such, nursing interventions should be geared towards incorporating all the significant individuals. Failure to meet the needs of the family regarding the care given to the child, along with not involving them in the health care provision may result in a more challenging and longer hospitalisation process. In the end, the child’s care could suffer. Primary care givers, parents and families of a sick child have come to expect that in making vital decision regarding the delivery of care to a sick child, they need to be actively involved.
On the other hand, it is not always that parents are actively involved in the delivery of health care to their sick children. As Kristensson-Hallstrom (2000, p.1029) observes, this may e the case because even as paediatric nurses maintain that they are committed to family-centred care, this is not always reflected by their practices. Similar sentiments have also been echoed by Galvin et al (2000) by observing that ‘within the hospital culture there may be resistance to incorporating the patient and family into decision-making and involvement with care’ (p. 625). Separately, Hutchfield (1999) also discovered that family-centred care is nothing more than an idealistic notion and that even as nurses advocate for embracing the family-centred care concept, in reality, they appear to ‘regulate the amount of parental participation in the child’s care’ (Espezel & Canam 2003, p.35).
Once children have been hospitalised, the expectation is that they shall receive expert nursing care (Oermann & Lukomski, 2000, p. 67). As such, there is the need to ensure that the consistency of nursing practice has been enhanced not only for the benefit of the hosptalised child, but for the benefit of the family as well. One way through which nurses can incorporate family-centred care into their nursing practice is by embracing appropriate and effective communication techniques in dealing with the hospitalised child and the family as well. In the case of Roger, the attending nurse can
Incorporation of FCC into nursing care
The nurse should introduce him/herself to Roger and his mother. Then, he/she should try to explain to Roger that the nursing staff, together with his mother, shall be involved in helping to make him feel well again. Involving Roger’s mother in the treatment procedure will without doubt give her a certain sense of control over the condition of her son. This will ultimately make her feel more comfortable and by extension, make Roger feel at ease. The nurse should try to stress to Roger’s mother that since she knows her son best, it is important therefore that she becomes actively involved in planning for the care that he receives. The nurse should state how he/she is looking forward to working with Roger’s mother. However, the nurse should also be careful to ensure that he/she clearly spells out his/her role and responsibilities and if need be, set limits.
The nurse could also seek the opinion of Roger’s mother regarding the medication given to her son. For example, Roger’s admission orders shows that the Oral Rehydration Therapy (ORT) commenced in ED should continue, and hydration can only be given intravenously or via a nasogestric tube in case the ORT is not successful. This is one area that the opinion of the mother can be sought through the assistance of the attending nurse. For example, the nurse could try to demonstrate to Roger’s mother the two hydration techniques and based on this, ask her opinion regarding which of the two methods she would be most comfortable with in case it became necessary for her son to be given hydration.
Conclusion
When children of between 6 months and 4 years have been admitted to a paediatric ward, it becomes hard for them to cope with the stress associated with the hospital environment. To help such children cope with the stresses involved, primary care givers have made it almost mandatory for parents and families to be with the child around the clock as he receives treatment. This is the family centered care concept in practice that recognizes parents as central to the existence of the child. Nurses can incorporate family centred care into their nursing practice while attending to such children by embracing appropriate and effective communication techniques in handling the children, parents, and the family. They should also involve parents in the care plan for their child.
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