Child Health Nursing - Essay Example

Critique of the Strengths and Limitations of Child Health Nursing Child health nursing has its strengths and limitations like nursing in any otherspecialty. In chronic childhood conditions, where there is prolonged suffering of the children, both the patient and the family suffers. Child health nursing can be a challenge in such situations. The common childhood chronic conditions that a practitioner may come across are asthma, mental retardation, cerebral palsy, autism, attention deficit disorder, muscular dystrophy, cystic fibrosis, sickle cell anemia, diabetes, arthritis, and congenital heart disease. Chronic illness in children can be an important barrier to sustained maternal employment. This signifies the fact that even if the mothers are healthy and able to work, chronic distressing illness of the children can make it very difficult for them to get and retain a job (Smith, L.A., et al., 2002). Combination of chronic illness and lack of a health insurance can result in serious lapse in fulfillment of healthcare needs. Added to that, there might be associated financial constraints to obtain medications that have been prescribed. The accuracy of parental reports about their child's suffering and actuality of use of healthcare should be examined critically and with caution. The child health nurse is required to assess the healthcare needs of the child with great and constructive caution. In addition, chronic condition over a prolonged period of time can generate fatigue and reduced enthusiasm on the part of the parents, and this added to reduced contact with the healthcare providers may lead to underestimation of the problems. The child health nurse is responsible to consider all these factors while planning and delivering care in such a situation (Newacheck, P.W., McManus, M., Fox, H.B., Hung, Y.Y., and Halfon, N., 2000). The child health nurse often encounters behavioural and emotional problems in children with chronic illness. It may be due to disease, peer pressure, or due to some unknown factors. The child health nurse has a great role to play in such situations to help these children cope up and adjust with the stresses of childhood illness. The disease parameters, such as, severity of illness and functional disability can be correlated with the coping mechanism and its success (Wallander, J. L., Varni, J. W., Babani, L., Banis, C. B., & Wilcox, K. T., (1988), but it will be wise for the child health nurse to be aware of the fact that the stress response to chronic illness and the psychological distress suffered out of it can be modified by healthy peers and other family factors. The illness can be so severe that it can jeopardise the functional status of the suffering child to the extent that it can limit or interfere with the child's sleeping, eating, communication, energy, and mood. The attempt at psychological adjustment on the part of the child in these situations may be manifested as behavioural problems, and the child health nurse may be the first person to encounter these. These may take patterns of aggression, noncompliance, rule breaking, and lying (Eyberg, S. M., & Ross, A. W., 1978). To be a successful child health nurse, the practitioner needs to be conversant with these psychological manifestations and the techniques to appease these. This may become crucial in management, since otherwise, there may be absolute noncompliance and failure of management (Johnson, E.S., 1969). If this happens in the homecare setting, the nurse is supposed to create a working empathetic relationship as well as is expected tolerate this stress of finding a fruitful way to the hearts of both the patient and the worried family. It will be pertinent at this point to state that the child health nurse, in order to meet the healthcare needs of children, will use the skills inherent in nursing. It needs innovative methods to utilize these skills (Cowan, T., 1997). The nurse should expand and update knowledge in her specialty. The more the nurse demonstrates her knowledge, the physician will be more aware of the skills of the nurse. These skills may be expanded in the area of ambulatory child healthcare. To seek the opportunity of independent as well as cooperative decision making, the nurse would need to demonstrate proficiency and competence in patient management, and that may be viewed as a limitation in the ambulatory care setting in the filed of child health nursing. If it is seen from another aspect, in this complex setting, the nursing assessment may serve as the baseline diagnosis and thus can contribute to the comprehensive child health nursing (Hunter, M., 1976). To accomplish this, the child health nurse should be equipped with enough clinical and theoretical knowledge on different aspects of child health. She should be skilled in extracting a physical and developmental history from the parents and the family. She will have to perform a systematic paediatric health appraisal, a complete physical examination, and a developmental evaluation. After the assessment, she needs to confer with the family regarding a scientific understanding of the problem that the child is suffering from and the other issues associated with this. The building up of rapport is crucial, and that does not come with the education only, that needs experience. For this, the nurse would need to work collaboratively with the paediatrician and other members of the child health care team (Casey, A., 1996). Other than these, the nurse would identify resources in the community that might help the family and would institute guidance to the parents about how to access and utilise these resources. Most importantly, she is in charge of identifying the technologic, socioeconomic, and family influences in expression of a chronic disease in a child, and her most difficult task is to earn confidence of the family and educate them on the disease the child and on the effect the family are suffering from. Critique of the Strengths and Limitations of Gerontological Nursing Current provision for care of the elderly in hospital setting and socially in the community is mainly shouldered by effective nursing provided by expert gerontological nurses. The unfortunate fact is that there is a gross structural and functional misalignment of primary healthcare teams, acute hospital care teams, community care resources, and social services available for the aged (Department of Health, United Kingdom 1994). Gerontological nursing is not an exception to this, and it is an active part of the care. To coordinate an effective user-friendly care for the aged, the need of the hour is partnership in action and modernisation of the available social services (Department of Health, 1998). The long-term gerontological care is no longer dependent on hospital long-stay wards, rather it has been shifted on to the hands of community nurses and residential homes. This area chronically suffers from inadequate resources in terms of healthcare and availability of social services. The gerontological nurse stays in the buffer zone, where the decisions about care is the result of a hierarchy directed by the doctors who have sparse time for a professionally less lucrative assignment in the residential homes. On the contrary, most of the patients in a residential home often have multiple chronic illnesses and significant impairments leading to both physical and mental disability. The nurse should be committed to delivery of effective and consistent chronic care so that acute situations do not arise (Fulmer, T., Flaherty, E. & Medley, L., 2001). The mounting costs of hospital care and often compromised economic conditions of this group of patients, hence, promotes the multidisciplinary team to ignore the most important member, the patient and his choice and satisfaction about the care, and the nurse in this setting often is forced to remain silent due to the hierarchy and is compelled to provide silent assent for fitness of discharge, mainly to make a bed vacant. A premature discharge from the acute hospital care setting shortens the length of the hospital stay, but that again subjects the clients to the risks of missing a real rehabilitative plan and inordinately entering the care home often without a specific management plan (Young, J., Robinson, J., and Dickinson, E., 1998). In most of the cases, the nurse here behaves as a passive observer because she has her expertise to offer in this problem, and nobody listens to her. The keys to managing chronic illness in the elderly are active surveillance and timely interventions. Research has shown that gerontological assessment and baseline management of trifle health issues in the early phase with preventive approach directed against disabilities and dependence can improve healthcare outcome and save money which is the issue here (Wagner, S.L. et al., 1998). Those who are habituated to deal with acute medical problems and those who are involved with treatment that needs technical interventions can hardly provide time and patience to foster and lead programmes that encourage health maintenance, deal with safety issues, and probe the social situations that can permeate into a disability (Snape, J. and Santharam, M.G., 1997). This may give rise to another option that can be a strength in gerontological nursing. The increased community workload can be deliberated to the nurses who can form a structured partnership with the gerontologists and other specialists. Indeed, the nurses in this field with appropriate training and education can provide the initial contact point for these patients. Since this demands a continuous and consistent relationship with the patient and the family, the nurses can provide baseline comprehensive medical care including health promotion, effective management of chronic diseases, and education and advices for the conditions that an aged person may experience. The nurse has the opportunity to sense a danger or an upcoming acute event. She can be the proactive manager of the chronic state, so that acute events do not spring up. This has inherent benefit of reduced use of hospital resources. Her role becomes that of a watchdog who has sharp insight and predictive capability of a disaster, so she can assume care or contact a specialist or a general practitioner at that point. This potential partnership would allow development of gerontological care nurses, generate innovative care pathways and plans, sustain the vigil for earlier sensing of complications, and provide vistas for home care where family and society can be involved in active acre, and the care would be essentially individualised (Lockhart-Wood, K., 2000). The limitations on the other hand are many. The nurse who proposes to do this must be well-equipped to handle the very special and specific needs for these patients. She must be adequately trained, both theoretically and practically with focused clinical experience in gerontology. This is a long-drawn process, and not always possible by all who aspire to help the care of the aged. The nurse must have management skills and ability to diagnose and differentiate conditions that appear mild and subtle but actually are harbingers of a serious upcoming event. To allow for a complete all round care, she must have enough knowledge of pharmacology and pharmacotherapy to be able to assess the prescription of the patient. She must have adequate knowledge of polypharmacy, drug interactions, adverse effects of medications. She must be able to assess whether the patient is abusing any drugs or using any herbal or over-the-counter medications. She must have enough patience and time to promote health in these people; she should be able to inspire the caregivers at home (Mezey, M., and Fulmer, T., 2002). The nurse should be able to recognise cognitive or sensory deficits and their manifestations in such patients. All such things if made possible, the nurse can solve the problems inherent in the gerontological practice in liaison and collaboration with the other members of the interdisciplinary team, but that that is a tough task to achieve. References Casey, A., (1996). Child Health Nursing. Paediatric Nursing; 8(6): 3. Cowan, T., (1997). Child Health Nursing. Professional Nursing; 13(3): pp. 196-197. Department of Health, United Kingdom (1994). The Challenges for Nursing and Midwifery in the 21st Century (The Heathrow Debate), London. Department of Health, (1998). Partnership In Action: New Opportunities For Joint Working Between Health And Social Services. London: Stationery Office, 1998. Eyberg, S. M., & Ross, A. W., (1978). Assessment Of Child Behavior Problems: Validation Of A New Inventory. Journal of Clinical Child Psychology, 7, pp. 113-116. Fulmer, T., Flaherty, E. & Medley, L., (2001). Geriatric Nurse Practitioners: Vital To The Future Of Healthcare For Elders. 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Pediatrics; 105: pp. 760-766. Smith, L.A., Romero, D., Wood, P.R., Wampler, N.S., Chavkin, W., and Wise, P.H. (2002). Employment Barriers Among Welfare Recipients And Applicants With Chronically Ill Children. American Journal of Public Health; 92:pp. 1453-1457. Snape, J. and Santharam, M.G., (1997). Inappropriate Acute Admissions From Nursing And Residential Homes. Age Ageing 1997;26: pp. 320321. Wagner, S.L., Davis, E.H.C., Gouthous, L.,Wallace, J., LoGerfo, M., and Kent, D., (1998). Preventing Disability And Managing Chronic Illness In Frail Older Adults: A Randomized Trial Of A CommunityBased Partnership With Primary Care. Journal of American Geriatric Society; 46: pp. 11911198. Wallander, J. L., Varni, J. W., Babani, L., Banis, C. B., & Wilcox, K. T., (1988). Children With Chronic Physical Disorders: Maternal Reports Of Their Psychological Adjustment. Journal of Pediatric Psychology, 13, pp. 197-212. Young, J., Robinson, J., and Dickinson, E., (1998). Rehabilitation For Older People At Risk In The New NHS. British Medical Journal;316: pp.11081109. Read More