Family Centred Care

Child Present Condition

Thomas was administrated to the paediatric ward with a complaint of reducing oral intake that causes reduced wet nappies and cough with a wheeze. Thomas also has tachypnoea and diagnosed with acute asthma. The article presented by Fergeson, Patel and Lockey (2017), discussed that many factors are associated with acute asthma that includes chest tightness, tachypnoea and difficulty in lying down. The article also discussed that some acute asthma also disturbs the normal oral intake of the individual that cause fluid imbalance. The patient is also diagnosed with cerebral palsy and he was born at 32-week gestation. The article presented by Stavsky et al. (2017), describe that cerebral palsy is a kind of motor disability and it resists the movement of the body. Cerebral palsy is considered to be the abnormality in the muscle tone that limits the physical activity of the individual. The cerebral palsy directly disturbs the development of the foetal brain and alters its foetal development. The treatment that is provided to Thomas includes 1litre of oxygen to improve oxygen saturation and he also administrated with once-only medicine salbutamol. The article presented by Ullmann, Caggiano and Cutrera (2015), discussed that salbutamol is considered to involve in relaxing the muscle present in the airway and it also improves the airflow that provides relief to the patient. It is involved in reducing coughing, chest tightness and shortness of breath and wheezing.

Patient and Family Centred Care in Paediatric Care

Patient and Family-centred care is the new approach in the healthcare system to improve the care procedure. The health care sector is shaping their care plan, policies and facility design to improve the day-to-day interaction among patient and their family member. The care that is according to the patient current condition increases the chances of early response toward intervention that eventually improve health status. The incorporation of patient and family centred care is seen to provide a great improvement in the health status of the individual as it provides a more familiar environment to the patient and care process is tailored according to the patient current situation. This process requires the collaborative effort of the patient, family, physician and staff to improve the quality of care provided to the patient. Some principles should be followed during the family-centred care to improve the healthcare experience of the individual. According to Rawson and Moretz (2016), the first principle includes respecting the child and his/her family members so that they can feel equally important. The second principle states that healthcare associate should respect the diversity of the child.

They should understand the different belief, values and culture of the patient and his/her family. The third principle states that an individual should recognize the strength of the child and his/her family to face a difficult situation. The fourth principle state individual should provide the choice to the child and his/her family regarding the care procedure. The fifth principle indicates that the individual should provide flexibility in the different policy, procedure and practise related to the organization to provide care according to the cultural belief of the child. The sixth principle indicates that the information shared with the patient should be honest and unbiased to improve their understanding of the health status of the child. The seventh principle discussed that an individual should be involved in providing formal and informal support for the child and his/her family to help them. The eighth principle states that there should, be a collaboration between the family of the child and healthcare professionals to improve the care process. The ninth principle indicates that healthcare should be involved in empowering the child and his/her family to build trust and confidence in the health of the individual. These principles will help the nurses to provide accurate care to the child that will improve his/her health outcome.

The Stressor of The Hospital

The discomfort of the child is the first stress that the family of the child face as he is not comfortable during the therapy and he is crying. When the nurse tries to put on the mask that is necessary to improve her health, he always pulls off the mask and shows his reluctant behaviour toward the therapy. He is not comfortable with the oxygen therapy that is why he does not want it continued and pull off the mask. The reduced oral intake is also one of the stressors as it will directly impact the health status of Thomas. The family of Thomas will also get stressed if Thomas continues to be reluctant toward oral intake as it can directly lead to electrolyte imbalance. One of the stressor to the parents is that hospital staff is unable to provide comfort to the child and he is recently diagnosed with cerebral palsy. The pain of the child will directly influence the mental status of the individual and in future, it will further increase his discomfort. The mother of the child was unable to see Thomas in pain that directly affect her mental status.

Interventions

The first intervention that can be provided to Thomas is the psychological intervention that wills him to distract from the pain and help him to reduce the discomfort. The article presented by Coakley and Wihak (2017) discussed that psychological therapy helps the child to reduce the discomfort and pain that will eventually help the family mental status. The psychological intervention helps the child to improve his/her cognitive, behavioural and biobehavioural aspect that is associated with the discomfort. The therapy includes positive self-management statement, graded exposure to the treatment and relaxation therapy to improve the care session of the individual. Another intervention that can be used with Thomas to improve his oral intake is to manage his diet according to a proper dietician so that slowly he can start his intake that will support his health. The article presented Kerzner et al. (2015), discussed the technique that can be applied to improve the intake of the child. The first step that should be used is to avoid the distraction during the mealtime to improve the concentration of the child toward food. The second technique that includes the staff should maintain a pleasant attitude toward child during mealtime.

The third technique includes age-appropriate food that will improve child nutrition intake and should be interesting. The fourth technique includes periodically introduce new food to increase the interest of the child toward diet. The last intervention includes providing the child the time to choose food so that he can eat what he wants to eat. The cerebral palsy of Thomas is also one of the major concerns and physiotherapy plays an important role to decrease the chances of complication occurs due to cerebral palsy. It helps the individual to maintain normal movement and improve his/her lifestyle. The article presented by Das and Ganesh (2019), discussed the use of psychotherapy to improve the lifestyle of the individual suffering from cerebral palsy. The article discussed that many aspects are included in physiotherapy that are constraint-induced movement therapy, neurodevelopment therapy and cardiorespiratory training.

Patient-Family Centred Care Principles in The Care

The nurse can increase the participation of the parents and provide the decision making authority for the care procedure of the child. The increased discomfort of Thomas can be reduced if a family member can indulge with him as he is just 3 years old and at the early learning stage. If the nurses can provide time to time health status information to the parents it can help them to understand the current situation that can be utilized to decide the care process of Thomas. The article presented by Aarthun, Oymar, Akerjordet (2019), describes the importance of participation of the parent in the care process directly affect the health the status. The increasing involvement of the parent in the care process provides the patient with a homely environment that is more easily adapted and when the child finds parent indulge in his/her care than chances of discomfort reduce that directly improve the health status of the individual. Healthcare associates are expected to assist the parent during the decision-making process as they are invulnerable state and they require help to decide for the care process. The nurse can provide accurate knowledge to the parents to increase their understanding of child condition that can improve their decision-making skill that can be applied to improve the health status of the child. The increasing participation of the parent in the decision making help the parent to choose the best intervention for their child according to their best understand that reduce the burden over the healthcare-associated

The nurses are expected to show respect different belief of the individual who is involved in the care process. The family of the patient should also be respected and healthcare professional should provide cultural accurate care to the patient. During the tough condition faced by Thomas as he is so young and unable to understands the reason for his discomfort. The nurses should help Thomas and his family to face a difficult situation and to work in collaboration to improve the health outcome of the patient. The direct interaction of the nurses with the patient and family increase their credibility toward patient health and satisfaction so they should work with respect and dignity to improve health experience of the patient. According to Hsu et al. (2019), the family of the patient should be equally respected by the healthcare associate and there should not be any discrimination over the different belief of the individual. The nurses should treat the parent of the patient with dignity and respect to improve their experiences. The information regarding the patient health status and intervention should be provided to the parents so that can equally participate in the patient care and understand patient health requirement. Nurses can also work in collaboration with the parent during the nursing care plan to improve the understanding toward the child and this will also improve the nursing plane to be more tailored according to the patient because parents are directly involved.

Discharge Education

The discharge process of the pediatric follow multiple steps as a child is more susceptible to acquire infection due to their weak immune system and during the discharge, health care associate is required to follow the step to ensure proper working procedure. The article presented by Berry et al. (2017), discussed the framework of the discharge process that should be applied in pediatric care. The first step includes discharge process should be consulted with a family member and the caregivers to understand the current situation of the child. The second step includes the set goal of the discharge that should be discussed with the parent. The third step is to assess the resources that are required for the discharge that includes proper care facility, equipment’s, follow-up chart and diet plan to improve the health status of the individual. The fourth step includes the understanding issue that can affect can health status of the child and keeping all possible control measure to reduce the chances of further complication. The fifth step includes discharge plan that should be included with all the necessary information that should be followed writhe child to improve health status and educating parent regarding the important point that should be considered during care process of the child. The sixth point includes follow-up after discharge to ensure that there is no chance for a further complication to the child that should be addressed.

During the discharge process of Thomas, there will be multiple points that are to be instructed to the parent to reduce the chance of further complication. The parent will be educated about the lifestyle activity that should be included in Thomas daily routine to improve his health. The article presented by Zanello et al (2015), discussed different aspect that should be included in the conversation with the parent during the child discharge. The first aspect if informational continuity that includes providing the parent information regarding the different technologies that is utilized in the hospital to improve the health status of the individual. The second include management continuity that provides the parent with the information regarding the different technologies that should be applied in home to provide care to the child. The third aspect includes relational continuity that includes the collaboration of the parent. Child and healthcare provider to form a therapeutic relationship that will improve the health status of the child. The fourth aspect discussed empowering the family to increase their ability to care for their children by providing proper care and management training. The last aspect discussed that nurse should educate the parent regarding the right attitude that should be followed to improve the health status of the child.

References for Family Centred Care

Aarthun, A., Øymar, K. A., & Akerjordet, K. (2018). Parental involvement in decision-making about their child's health care at the hospital. Nursing Open, 6(1), 50–58. https://doi.org/10.1002/nop2.180

Rawson, J. V., & Moretz, J. (2016). Patient- and Family-Centered Care: A Primer. Journal of the American College of Radiology, 13(12), 1544–1549. DOI:10.1016/j.jacr.2016.09.003 

Berry, J. G., Blaine, K., Rogers, J., McBride, S., Schor, E., Birmingham, J., Schuster, M. A., & Feudtner, C. (2014). A framework of pediatric hospital discharge care informed by legislation, research, and practice. JAMA Pediatrics, 168(10), 955–966. https://doi.org/10.1001/jamapediatrics.2014.891

Coakley, R., & Wihak, T. (2017). Evidence-Based Psychological Interventions for the Management of Pediatric Chronic Pain: New Directions in Research and Clinical Practice. Children, 4(9), 1-18. https://doi.org/10.3390/children4020009

Das, S. P., & Ganesh, G. S. (2019). Evidence-based Approach to Physical Therapy in Cerebral Palsy. Indian Journal of Orthopaedics, 53(1), 20–34. https://doi.org/10.4103/ortho.IJOrtho_241_17

Fergeson, J. E., Patel, S. S., & Lockey, R. F. (2017). Acute asthma, prognosis, and treatment. Journal of Allergy and Clinical Immunology, 139(2), 438–447. DOI: 10.1016/j.jaci.2016.06.054

Hsu, C., Gray, M. F., Murray, L., Abraham, M., Nickel, W., Sweeney, J. M., Frosch, D. L., Mroz, T. M., Ehrlich, K., Johnson, B., & Reid, R. J. (2019). Actions and processes that patients, family members, and physicians associate with patient- and family-centred care. BMC Family Practice, 20(35), 1-11. https://doi.org/10.1186/s12875-019-0918-7

Stavsky, M., Mor, O., Mastrolia, S. A., Greenbaum, S., Than, N. G., & Erez, O. (2017). Cerebral Palsy-Trends in Epidemiology and Recent Development in Prenatal Mechanisms of Disease, Treatment, and Prevention. Frontiers in pediatrics, 5(21), 1-10. https://doi.org/10.3389/fped.2017.00021

Kerzner, B., Milano, K., MacLean, W. C., Berall, G., Stuart, S., & Chatoor, I. (2015). A Practical Approach to Classifying and Managing Feeding Difficulties. PEDIATRICS, 135(2), 344–353. DOI:10.1542/peds.2014-1630 

Ullmann, N., Caggiano, S., & Cutrera, R. (2015). Salbutamol and around. Italian Journal of Pediatrics, 41(Suppl 2), A74. https://doi.org/10.1186/1824-7288-41-S2-A74

Zanello, E., Calugi, S., Rucci, P., Pieri, G., Vandini, S., Faldella, G., & Fantini, M. P. (2015). Continuity of care in children with special healthcare needs: a qualitative study of family's perspectives. Italian Journal of Pediatrics, 41(7), 1-9. https://doi.org/10.1186/s13052-015-0114-x

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