The report summarises the health care intervention of Enuresis. Poppy, a seven year old girl suffering from Enuresis and has come to a stage where she does not want to socially interact with people because of her disease. Poppy has never been entirely dry at night and worry all the time due to her wetting problem. Enuresis is a urinary incontinence condition that is characterised by loss of bladder control. Children of age five or older wet their beds and develop the signs of disease occurrence. The factors responsible for bedwetting in children are slow maturing bladder, smaller urine holding, genetics, lack of sensing bladder fullness because of deep sleep. Enuresis is a urinary incontinence health problem, which is common under 3 years of children. However, if the problem continues to older age group children, then it may lead to development of behaviour disorder as well. Bedwetting can have significant development of social, psychological, and emotional effects on children and their family members as well. Treatments associated with bedwetting or enuresis may includes alarms, behaviour interventions, health promotion, and family support. the report will addresses the problems, issues, and symptoms associated with Poppy. It will summarise the medical interventions that would be implemented for the betterment and promotion of healthy living.
Enuresis is a urinary incontinence condition that is characterised by loss of bladder control. Children of age five or older wet their beds and develop the signs of disease occurrence. Enuresis is a urinary incontinence health problem, which is common under 3 years of children. The National Institute for Health and Care Excellence, the Paediatric Society of New Zealand, the American Academy of Child and Adolescent Psychiatry, and International Children’s Continence Society have developed the guidelines for the evaluation and management of nocturnal enuresis (Tu, & Baskin, 2019). Bedwetting can have significant development of social, psychological, and emotional effects on children and their family members as well. Treatments associated with bedwetting or enuresis may includes alarms, behaviour interventions, health promotion, and family support. The community child health service provider must adopt the good approach to help children and families with bedwetting problems. Family member must provoke and help poppy to go to washroom and may tell before wetting.
Health promotion strategy need to be adopted by caregiver or family member. Poppy’s parents must keep a calendar of wet and dry days of Poppy and set a toileting schedule of her. This will help in making the mental schedule in Poppy’s mind to go for urination. Nocturnal enuresis can be managed by primary care of family members that help in health promotion of children as well. The members must adopt education, reassurance, motivational therapy, enuresis alarms, and medications to reduce the frequency of bed wetting (Scheffel, DeSimone, & Davidian, 2017). The motivation therapy doene by parents is a positive reinforcement system and is a proper responsible training must given to their children (Scheffel, DeSimone, & Davidian, 2017). Poppy’s mother must provide a rewar system or a star-point chart on those days when Poppy remains dry all the night. Poppy’s mother also provide rewards to her when she received the particular standard of star on her chart schedule. Some of the exercise an also be introduced in Poppy’s daily activities such as bladder-stretching exercise, retention control training, and stop-start training (Sinha, & Raut, 2016). These exercise help in increasing functional bladder capacity for proper urination procedure. The rational behind this intervention is that the scheduling, time-table wil help Poppy to set her urinating timings, as time passes, she will develop the habit of urinating. The time set for urination is before sleeping, and one within sleep, these timings help her to urinate properly.
Psychiatric disorder or mental stress is more common in children suffering from enuresis as compared to non-neurotic children (Sinha, & Raut, 2016). Children suffering from enuresis develop other risky psychiatric health problems such as anxiety disorder, cognitive tempo, introvert, obsessive, sluggish, shyness, posttraumatic disorder, social phobia, aggressive, mood disorder, and attention deficit hyperactivity (Birdal, & Doganglin, 2016). Poppy has also developed the same psychiatric characteristics of shyness, social phobia, and worrying about bed wetting. However, these symptoms can be controlled and reduced through the effective implementation of measureable strategies. According to Zhou, Lu, Shi, & An (2019), behaviour interventions act as first line treatment with high quality efficacy. The strategies adopted under this interventions includes reward system, fluid restriction training, bladder training, lifting children up, dry-bed training, and alarm setting. These interventions help in reducing the stress or anxiety among children. Poppy has developed certain behaviour issues, thus require a proper training on voiding urination, thus this will help her to make herself relax and comfortable. The rational behind the implementation of behaviour training is that these trainings will help Poppy to control the efficacy, relapse rate, and reducing the frequency of bed wetting. These interventions were also reported with higher efficacy and lower relapse rate in early literature as well (Zhou, Lu, Shi, & An, 2019).
Enuresis is a common childhood problem, which require a proper learning and health promotion strategies from parents to children. Through proper learning and diseases awareness, child an develop the habit to consciously control and easily co-ordinate with his/her bladder. The factors responsible for bedwetting in children are slow maturing bladder, smaller urine holding, genetics, lack of sensing bladder fullness because of deep sleep (Tu, & Drutz, 2019). Health promotion and disease awareness is one of the top most prioritise intervention. Parent must keep in mind that eurenesis is not children fault, they should not punished because of bed wetting. Although, parents should encourage the children about regular urination during day and before going to bed. They must aware children about good pee habits and bad pee habits.
This develops the sense of responsibility among children and also the adoption of good pee habit among them because of reward system. Remind the child to empty his/her bladder before bedtime and help them to locate toilet easily and make them comfortable about toiletry items and regular toileting (Tu, & Drutz, 2019). Self-awakening therapies, and motivational therapies, education trainings also help children to learn and now more about the toileting habits. Poppy’s mother must provide educational training to her that will help her to learn good and bad pee habits. Cartoon images, attractive pictures must be kept in Poppy’s room, which will provoke her to adapt the toileting habits. The rational behind thee approaches is to keep the child aware about what is going on and what to do. Poppy is in Paediatric age group, she will learn educate easily through colourful charts, training, and presentation. Through this, she will adapt and incorporate the new toileting habits and will further reduces the bed wetting frequency.
Proper communication is a Vitol approach between children and parent. Communication with parents help children to feel comfortable and to come to a conclusive decision if suffering from any problem. Poppy being the sufferer of enuresis must inform her parents and her family of what she feel. At the age of seven, she must co-operate with her family and found the solution of the problem. Proper communication will help Poppy’s mother to address the issue and develop a realistic approach to solve the problem. Open communication is one of effective approach that help in voiding improvement and proper urination (Boston children’s hospital). Good communication has tremendous positive effect on the health and behaviour of children as it help in boosting child confidence, self-esteem, moral support, and sense of proactive characteristics.
From the above it can concluded that, Enuresis is a common problem among childhood age. The health problem is characterised by bed wetting frequency, at the age above five. It is one of the chronic condition that has a significant effect on quantity of life of children, families, and friends. The health problem responsible for the onset and development of psychiatric or behaviour issues as well. Poppy developed similar characteristics of bed wetting, shyness, aggressive, and social phobia. Due to her disease condition, she never go out with her friends for night stay. However, with the implementation of proper health care interventions, Poppy has maintained her bedwetting frequency and has adopted good pee habits. Intervention that can adapted by the registered nurse or family members includes enuresis treatment intervention, behavioural interventions, communication strategies, and health promotion.
Treatments associated with bedwetting or enuresis may includes alarms, behaviour interventions, health promotion, and family support. These interventions help in developing the sense of responsibility among children and also the adoption of good pee habit among them. Remind the child to empty his/her bladder before bedtime and help them to locate toilet easily and make them comfortable about toiletry items and regular toileting. The adoption of these interventions may help patient to adapt the good qualities of toileting and redues the frequency of bed wetting. The principle behind the intervention and rational is that it is a collaborative approach and responsibility of every family member to make their children leart good habits.
Boton children hospital. Retrieved from https://thriving.childrenshospital.org/bedwetting-treatment-starts-with-open-communication/
Birdal, S. & Doganglin, B. 2016. Behaviour problem in children with Enuresis. Turk Paediatric, 51, 142-147.
Drutz, J., & Tu, N. 2019. Patient education: bedwetting in children (beyond the basics). Retrieved from https://www.uptodate.com/contents/bedwetting-in-children-beyond-the-basics
Scheffel, E., DeSimone, E., & Davidian, M. 2017. Bed-wetting: Approaches to nocturnal enuresis in children, Pediatrics, 42, 32-35.
Sinha, R., & Raut, S. 2016. Management of nocturnal enuresis – myths and facts. World Journal of Nephrology, 6, 328-338.
Tu, N., Baskin, L. 2019. Nocturnal enuresis in children: Management. Retrieved from https://www.uptodate.com/contents/nocturnal-enuresis-in-children-management
Zhou, B., Lu, J., Shi, P., & An, Y. 2019. Advances in treatment of nocturnal enuresis in children. Evidences to clinical Practices, 1-10.
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