Child and Family Nursing Practice

In nursing care, the involvement of the family may lead to better health outcomes since they are the immediate caregivers of a patient. Therefore, a family nurse works through a sophisticated care system, where they provide to patients across all demographics. They engage both patients and family members to create a vital and valuable family-centered care. This essay illustrates the role of a family nurse in caring for an asthmatic patient – Cooper, a five years old asthma patient. In his readmission to an emergency care unit, nurses note incorrect use of an inhaler, defiance of the patient, withdrawal of his sister, reluctance of his mother to leave him in the hospital. From that, family education and psychotherapy are identified as the major recommendations.

Recommendation One: Family Education

Renee may lack understanding regarding asthma condition. Firstly, she is administering Cooper’s medication without a spacer. Therefore, Renee could be administering a wrong dose unaware. Besides, she claims that Cooper does not like the spacer as the primary reason for not using it. Thirdly, she has let Cooper be defiant and rough, not pushing him to behave normally. Again, she fears that pushing him to do things is aggravating the asthmatic condition.

Spacers are critical components in the administration of inhaled medications. According to a recent study, patients who used spacers when administering inhaled medications had better outcomes than those who had failed to use spacers effectively (Kofman & Teper, 2018). Spacers ensure that inhaled medication does not end up in the stomach or the mouth, but it is channeled into the lungs (Kofman & Teper, 2018). It increases the usability of the inhaler and reduces side effects such as oral thrush. Spacers are mandatory for asthmatic patients aged below five years (The National Asthma Council Australia, 2020). Therefore, Renee’s reason is invalid, and she seems not to know this information.

Also, Renee avoids pushing her son into doing things, fearing that his symptoms will worsen. However, she seems to miss the similarities between asthma and other conditions, such as anxiety. While studies have found that stress and anxiety may lead to shortness of breath, they do not primarily worsen the symptoms of asthma (Thoren & Petermann, 2000). Others conclude that anxiety has no direct effect on asthma (Kofman & Teper, 2018). Nevertheless, Renee has inadequate healthcare knowledge, which necessitates family healthcare education.

Therefore, a nurse ought to prioritize family education about the prognosis and management of asthma. This is critical especially because family members are the immediate caregivers at home. A study on chronic illness found that effective family care leads to reduced complications and good self-management by the patient (Figueiredo et al., 2018). On the other hand, the lack of it leads to mistakes that could endanger a patient’s life or increase the cost of healthcare. Therefore, the nursing team ought to educate Renee concerning essential family care for Cooper.  The process will involve providing necessary nursing skills such as administration of medication, basic prognosis such as identifying factors that aggravate asthma symptoms and recommend correct tools for the caregivers, such as components and types of inhalers.

One of the viable nursing interventions is the provision of healthcare education and resources. Through healthcare education, the nursing team will teach Cooper and his family members the importance and use of various medical aids such as inhalers. That way, Renee will appreciate the purpose of the spacers in an inhaler. She will also be taught about care skills that ensure patients follow the recommended diagnose and medications without defiant and anxiety. This will change Cooper’s reluctance to use the spacer and encourage Renee to follow the correct care. Both Cooper and his family will receive resources such as guides, manuals, and asthma management and care materials manuals for homecare. Besides, they will be referred to the local community family nurse, from whom they will attend scheduled diagnosis follow up, and introduce to asthma management communities. Some communities are available online, such as www.asthma.net/community/. These will help in isolating the most effective asthma management strategies from the success stories of community members.

A nurse may evaluate the effectiveness of this intervention by collaborating with the community family nurse, who would clinically assess Cooper’s health outcome. Indicators would be a relapse of the asthmatic condition and his relationship with family members. A low recurrent rate of symptoms should indicate better health management, meaning that Renee would have understood the prognosis and management of asthma.  Obedience and fairly social behavior would mean that Renee has adopted effective parental control over his son, maintaining adequate family healthcare and management for asthma.

Recommendation Two: Family education and psychotherapy

From the case study, Renee has shown reluctance to leave Cooper in the hospital each time he was admitted, due to possible guilt. This is in inline with the observation that Cooper is not at ease in the presence of nurses, and he is mostly loud and rough in the hospital than at home. David does not prefer that situation; rather, Renee should remain with Ella at home, while Cooper continues with his admission in the hospital. Also, Ella seems withdrawn from Renee. Therefore, her reluctance to leave Cooper at the hospital suggests that she is the guilt of something, or she has insecurities. 

Guilt is common for patents with children with chronic illnesses. According to Smith, Cheater, & Bekker (2013), parents with chronically ill children undergo grief, which manifests through feelings such as anger, fear, guilt, and denial, among others. While the pain of the effects of the illness is felt through the family, members who spend more time with the sick person are affected much. For instance, Renee spends the most time with Cooper; thus, she is more likely to reveal emotional attachment than David, who is less often at home (Yogman & Garfield, 2016). From a parenting perspective, parents always want their children to succeed and be in good health. When children suffer, for instance, due to illness, parents may end up blaming themselves (Guite et al., 2018). The guilt is associated with the healthcare demands of their children being higher than they can provide, or as Smith, Cheater, & Bekker (2013) calls it, being powerless. Besides, parents worry about making the right healthcare and parenting decisions and mitigating deterioration of their children’s symptoms.

In that perspective, it is clear that Renee does not want to leave Cooper since she would be guilty of withdrawing her attention on him. Cooper is loud, uncontrollable, and withdrawn from the nursing team, probably because he does not receive attention as he is used to at home. Ella is withdrawn from Renee since she mostly cares for Cooper, which is an attention crisis inpatient care (Bagnasco et al., 2013; Yogman & Garfield, 2016).

The nursing goal for this recommendation is to change Renee’s attitude towards asthma. This is from the observation that she had biased her attention and care to Cooper than Ellen due to self-blame. According to Bagnasco et al. (2013), parents’ knowledge and perspective influence the relationship they have with sick children and other family members. Thus, nurses ought to educate Renee concerning the implications of patient care alongside with prognosis and management of asthma in recommendation one. That way, she will be understanding the severity and seriousness of her son’s symptoms to give him adequate and effective care. Besides, she will not self-blame for her son’s readmission. This goal is essential since if Renee does not change her perception of her son’s condition, she will aggravate other social issues such as the poor relationship with Ella and David and the increased uncontrollability of Cooper.

Nurses may achieve this goal through family education and therapies. First, one has to appreciate that the self-blame is mostly psychological (Uche, 2014). When a child is sick, it often happens automatically that parents want to do everything in their means to restore their child’s health. Besides, feelings of anger, fear, guilt, and denial affect the parent psychologically (Chen & Miller, 2007). Thus, through psychotherapy, Renee will eliminate self-blame and guilt. Secondly, family education deconstructs all the wrong perceptions and paradigms concerning the illness (Darling-Hammond et al., 2019). Therefore, Renee will understand better the factors that would aggravate Cooper’s symptoms, unlike pushing him to the right behaviors. She will also understand the severity of the illness and handle the dyad growing between her Ella and David. Besides, Renee may find resources such as a glossary for caregivers in the community library or The ARCH National Respite Network (www.archrespite.org/).

I would evaluate the success of this strategy in the follow-up diagnosis. Expected results are an increased connection between Ella and Renee and her ability to relax and let the nursing team assess Cooper. Also, Cooper should be more obedient and less defiant.

In conclusion, Renee appears to lack understanding regarding asthma condition, is reluctant to leave Cooper in the hospital each time he was admitted, due to possible guilt. Educating Renee about prognosis and management of asthma and changing her perception towards the management of Cooper’s health immediate goals. They are achieved through family education and psychotherapy, and the success of these strategies evaluated by the health and relational condition of Cooper and his family members in the follow-up diagnosis.

References

Bagnasco, A., Petralia, P., Furnari, S., Ghio, S., Calza, S., & Sasso, L. (2013). Paediatric nurses’ perception of the child-family dyad’s autonomy in managing a chronic disease situation: the experience of an Italian Paediatric Department. Journal Of Preventive Medicine And Hygiene,, 54(2), 124-129. Retrieved 31 August 2020, from.

Chen, E., & Miller, G. (2007). Stress and inflammation in exacerbations of asthma. Brain, Behavior, And Immunity, 21(8), 993-999. https://doi.org/10.1016/j.bbi.2007.03.009

Darling-Hammond, L., Flook, L., Cook-Harvey, C., Barron, B., & Osher, D. (2019). Implications for educational practice of the science of learning and development. Applied Developmental Science, 24(2), 97-140. https://doi.org/10.1080/10888691.2018.1537791

Figueiredo, S., Lima, L., Silva, D., Oliveira, R., Santos, M., & Gomes, I. (2018). Importance of health guidance for family members of children with sickle cell disease. Revista Brasileira De Enfermagem, 71(6), 2974-2982. https://doi.org/10.1590/0034-7167-2017-0806

Guite, J., Russell, B., Homan, K., Tepe, R., & Williams, S. (2018). Parenting in the Context of Children’s Chronic Pain: Balancing Care and Burden. Children, 5(12), 161. https://doi.org/10.3390/children5120161

Kofman, C., & Teper, A. (2018). Usefulness of Nonvalved Spacers for Administration of Inhaled Steroids in Young Children with Recurrent Wheezing and Risk Factors for Asthma. Canadian Respiratory Journal, 2018, 1-5. https://doi.org/10.1155/2018/3095647

Smith, J., Cheater, F., & Bekker, H. (2013). Parents’ experiences of living with a child with a long-term condition: a rapid structured review of the literature. Health Expectations, 18(4), 452-474. https://doi.org/10.1111/hex.12040