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Nursing Patients With Acute Illness

Case Scenario 1

In this case scenario, a six-year-old asthmatic boy is admitted to the hospital for an acute episode of exacerbation of his chronic disease. The process of hospitalization can be quite impactful on the patients as well as their family members on emotional, physical and well as psychological levels. The role of a nurse is vital in reducing the effect of hospitalization on Chaz and his family.

Impact on Chaz:

For Chaz, being in the hospital is a fearful feeling, as he will remember the previous time he was in the hospital for care of asthma (Miftah et al, 2017). A small child-like Chaz, is fearful of getting injections and has fear of pain or fear of the unknown. As both of Chaz's parents are working and he has been taken care of by his grandmother, he would feel fear of loneliness due to separation from his family during the period of hospitalization. It may even lead to trembling and lack of compliance with the treatment in the absence of the family member. The child may also exhibit various defence mechanisms in this scenario, such as depression, lack of appetite, and denial (Perera & Abeysena, 2019).

Coping Strategies

According to the Australian Nursing and Midwifery Board, it is the role of providing patient-centred care, which means in case of Chaz, the care must be centred around his needs, such as, understanding, playfulness and friendliness, ease from the state of illness (NMBA, 2016). For instance, using a playful method to interact with him and educating him about his condition, prompting him to meet other kids who face similar challenges as his so that he does not feel scared or lonely. A nurse must always respect his dignity and privacy, nudging Chaz to make well-informed decisions in his treatment plan, ensuring that he feels in the position of making wise decisions. In patient-centred care, the decision making involves the active participation of the patient, which in turn increases the ownership of the management and also results in positive clinical outcomes. A nurse, by increasing her playful interaction with the child is capable of forming a therapeutic relationship, which is a necessary skill in exhibiting competency in the area of clinical nursing practice. Building a therapeutic relationship with Chaz will decrease his loneliness and anxiety and reduce the feeling of fear as he develops trust with the nurse providing him care (Silva, Silva, & Leite, 2016).

Another important coping strategy involves the collaboration of patients in the treatment (Mattos dos Santos et al., 2016). This can be done by increasing the visiting hours of the parents and asking them to help Chaz to understand the process of hospitalization. The parents can be asked to bring his favourite toy so that he can remain calm and engaged with his toy and does not miss his home and family during the duration of hospitalization.

Impact on his Family:

A parent goes through a lot of guilt when their child is admitted to a hospital because of developing a chronic illness (Stremler, Pullenayegum, & Parshuram, 2017). The parents feel that they have been inadequate in providing the best care for their child and also start feeling depressed. In the case scenario, as both the parents are working, it is highly likely for the parents to feel guilty due to their inability to spend time with Chaz and look after him. They question their capability of effectively raising Chaz and find faults with themselves and blame themselves for their lack of time to spend with Chaz. Furthermore, they often ask themselves questions such as "why it has happened to him again?", "what I do wrong?", "Why was not I there when he well sick?" and finding faults within themselves (Jones & Lynn, 2018). The mother is more vulnerable to hone the feeling of guilt as she feels that the illness of the child has resulted due to her absence of maternal love as she reprimands the child too often and punishes the child whenever the child does something which is not good for this condition. Another factor that causes guilt in parents is that they feel unable to relieve the pain of the child (Loewenstein, Barroso & Phillips, 2019). As parents take the onus of caring for the child, they forget to dissociate themselves from the identity of being their superheroes to mere parents depending on the hospital staff and infrastructure for improving the health of their child. They feel guilty of not being able to answer the questions for Chaz related to his condition and restriction which impacts his routine life of indulging in sports activities like other children and how he would improve.

Coping Strategies

The nurse should provide adequate information to the parents regarding the condition of the child and also provide them with the detailed instructions which can help them in taking care of the child in a more effective way (Mattos dos Santos et al., 2016). The parents should be counselled regarding the condition as well as treatment so that they are fully aware of the condition, with its risks and precautions and do not feel guilty, but instead feel more responsible in caring for the child. According to the NMBA, (2016), it is the role and responsibility of a nurse to promote family health by ensuring that their child is in good care and by reducing the separation time with the child. This will reduce the anxiety caused by guilt in parents and reassure them that they are providing the best care for their child. The nurse can also share the emotional burden of the parents by listening to them and addressing all their concerns about the health and treatment outcome outcomes of Chaz (Perera & Abeysena, 2019). The nurse should build a positive attitude and help the parents to cope with the situation in a healthy way. 

References for Impact of Hospitalisation on A Child and Their Family

Jones, C. W., & Lynn, M. R. (2018). Blogs written by families during their child's hospitalization: a thematic narrative analysis. Journal of pediatric nursing, 41, 110-116.

Loewenstein, K., Barroso, J., & Phillips, S. (2019). The Experiences of Parents in the Neonatal Intensive Care Unit: An Integrative Review of Qualitative Studies Within the Transactional Model of Stress and Coping. The Journal of perinatal & neonatal nursing, 33(4), 340-349.

Mattos dos Santos, P., da Silva, L. F., Bastos Depianti, J. R., Gallindo Cursino, E., & Ribeiro, C. A. (2016). Nursing care through the perception of hospitalized children. Revista brasileira de enfermagem, 69(4).

Miftah, R., Tilahun, W., Fantahun, A., Adulkadir, S., & Gebrekirstos, K. (2017). Knowledge and factors associated with pain management for hospitalized children among nurses working in public hospitals in Mekelle City, North Ethiopia: cross sectional study. BMC research notes, 10(1), 122.

NMBA, 2016. Standard of Practice and code of ethics in Nursing. Retrieved from https://www.nursingmidwiferyboard.gov.au/Error/404.htm?item=%2frejected-by-urlscan&user=extranet%5cAnonymous&site=nursingmidwiferyboard&url=%252f...%252fdefault.aspx%253frecord...

Perera, N., & Abeysena, C. (2019). Effectiveness of providing health education to caregivers of hospitalized children with asthma for the prevention of recurrent attacks: a quasi-randomized trial. Journal of Asthma, 1-9.

Silva, T. P., Silva, Í. R., & Leite, J. L. (2016). Interactions in the management of nursing care to hospitalized children with chronic conditions: showing intervening conditions. Texto & Contexto-Enfermagem, 25(2).

Stremler, R., Haddad, S., Pullenayegum, E., & Parshuram, C. (2017). Psychological outcomes in parents of critically ill hospitalized children. Journal of Pediatric Nursing, 34, 36-43.

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