Concepts of Caring - Diversity, Oppression and Social Functioning Person in Environment Assessment - Essay Example

Caring Concepts of Caring November 30, 2012 Concepts of Caring Introduction Emma, a teenager who is 12 weeks pregnant has presented to the hospital with abdominal pain. The problem is that Emma does not want to receive care. What is the staff to do? Emma is suffering from pain and the nurses need to find out if the baby is doing well. The nurses will need to figure out a way to get Emma and her friend to trust you, so that you can examine her and the baby. The caregiver will see what they have learned when dealing with patients that do not want to communicate with staff. When you first enter the treatment room you introduce yourself and state the reason why staff members are there and in telling Emma this information the nurse should show good eye contact. The staff must look at the use of their body language as well. According to (Justice, 2006) the staff must watch how they use body language and more importantly the way the voice is used. “These are known as linguistic, non-linguistic and paralinguistic communication skills. The staff must watch their tone, pitch, and loudness. The staff must also watch their body posture, proximity and facial expressions. All of these features are very necessary to make sure that the staff comprehends what is going on in the case.” The staff must show that you know what you are doing right from the start or you will not make any progress with the patient. In your immediate observation of the patient the staff will notice that she is highly anxious. The other subjective signs could be that she could be holding the abdominal area. Emma could also be crying or yelling out. The staff has to build a rapport and gain trust with the patient in order to gain the basic information you need to gain a diagnosis. The staff will need to feel confident in their decisions, for example if you would decide to call her parents about her location and her problem. The staff will have to decide about the issue of confidentiality and informed consent. Remember In the medical profession or any profession ‘Do No Harm’. Emma will need to be handled with care body, mind and soul. She needs to be told what to do to bring understanding of her physical and emotional health even if she doesn’t want to hear it. Psychological Theories In working with Emma the staff can use Maslow’s Hierarchy of Needs and go through the steps of the hierarchy for Emma’s case and it could look like this: 1. Physiological needs- To be able to address her complaints of abdominal pain and the health of her baby. 2. Safety needs- To keep her and her baby safe from hurting her due to her anxious feelings. 3. Belongingness and Love needs- She has a friend, but is not sure on who she wants to trust with what is happening to her. 4. Esteem needs- She may feel bad about herself for becoming pregnant, running away from home and what is happening to her at this moment. 5. Self-Actualization- The nurses can try to teach and tell her that it is not her fault that her parents separated, if that has happened. The nurse can also try to teach her that running away is not the answer to any problem. The nurse must try to talk to her about the abdominal pain she is feeling could mean. When she starts to calm down she will realize that it is just not her but her baby who needs her to care for herself. (Myers, 2004) In trying to help Emma the nurses will need to show empathy to her and maybe they can share with her some of what they may have gone through as a teenager. The staff can share some of the good and the bad choices that they may have made. The staff nurses may get Emma to talk about herself just enough to make her comfortable, so you can begin your assessment for example, about her family history. Let her know that she counts in this life and her baby’s life. This idea follows the Humanistic theory set by Maslow and Rogers. When continuing your physical assessment of Emma you can begin to notice things like how she communicates whether verbally or nonverbally. When she first entered the hospital she is very anxious and does not want care, but slowly you can see how her nonverbal behavior like not making eye contact. She is trying to figure out what is going on. When she does make eye contact she may be saying “Please help me.” When the staff has maintained eye contact and they can continue to build rapport with the patient they can. According to (Flanagan, 1997)” the staff gain the patients confidence so that she can go about maintaining treatment coherence, quality and integrity.” She was accompanied by a friend in the ambulance, so she did want help but she is not sure on what kind of help she needs at the moment. She is concerned about her stomach pain that could be why she is so anxious and again why she may have to be persuaded to receive care from the hospital staff. She is feeling very uncertain. In working with adolescents in the nursing profession you must understand that she is mainly fearful of what is immediately happening to her and will be blaming herself. As the nurse in charge the staff must remember that Emma is still very young for what is happening to her body at this time. The staff must find a way to let her help herself. The staff nurse can talk with her about her interests and if she was ever in the hospital before. When she does start to talk the staff nurse must remember that adolescents must learn that they are important, that they have values, they need to make relationships that last. According to (Nichols, 2010), “ the client/patient are assumed to be the experts on their own situations.” She did this with her friend on the ride in the ambulance, and that they must emancipate from the parents and in time find a job. They will need to work out these problems. The adolescent must want to have their parent(s) involved that is why you must teach Emma about confidentiality and informed consent and that staff will not tell them till she wants you to tell them, and Emma is ready to tell them. When Emma’s trust in the nurses is there the staff can then begin their physical assessment and finish the history and try to explain to her that due to the abdominal pain she is experiencing she may need surgery that is why we need you to cooperate with us here in the hospital. “ This pain could be letting you know that the patient could be having a tubal (ectopic) pregnancy, a separation of the placenta, preterm labor or it could be appendicitis, ulcer, or pancreatitis even though it is not related to the pregnancy it could still be very serious.” (Pillitter, 1992) That is why we need Emma to allow us to help her. We would also like her permission to call her parents if anything would happen to her in the hospital. In working to get Emma’s history the nurses can ask her if she is or was still in school, or if she had to work. If she were still in school and living with her parents what did her parents do that made her leave her home. You can find out her address and find out if she came from a wealthy section of town or from a poorer section of town. If Emma came from a poorer part of the town you can ask her about her education, more about her family life that could explain about her nutritional intake and what kind of food was available in the home. You can also ask about her parents’ employment. Do they work full time, part time or even seasonal jobs? Staff can ask if anyone else may live with the family at this time. If Emma was from a wealthy family maybe the parents are too busy to pay proper attention to her and she became independent too soon. On working with this case the staff will have to ask themselves about their own ethics and morals in order to help this patient no matter what her condition is at the present time. Emma could feel that people are always looking at her and then start wondering about her family life and begin asking questions about what is really important at this exact moment and not getting the right answers she ran away. Emma is not the first one to have a baby out of wedlock. In dealing with the ethical dilemma this case presents the staff cannot state their own ideas. One must not have Cultural Tunnel Vision when dealing with these types of cases. “One must have more than one set of cultural assumptions, must be sensitive to others, must be able to evaluate and to accommodate the behaviors of others, and must have different ways of thinking, makes adaptations and will also make alternatives to find a solution to the presenting problem.” (Corey, 2011) When Emma may feel the stigma of teen pregnancy this may have helped along the feeling of anxiety when she was entering the hospital. She has to learn how to cope and this may have been the only way she could think of at the time. She needs to feel that she does not need to be embarrassed by her condition or of her family whoever they may be. Emma needs to feel that she will not be rejected by the people in her life at this time. She needs to know and feel that she has the power to make decisions, but can still ask for help. The staff can learn that “culture is shared beliefs and assumptions interact with shared values and produce shared norms that drive shared patterns of behavior.” (Egan, 2007) Staff understands this knowing that this could happen in their lives somehow. Emma knew what kind of person she is and knows that she has morals and knows the difference between right and wrong. Emma has learned through socialization that she can have friends; she knows where to go if she feels she has any problems. This is also a good point to see if you can call her parents. The staff can tell her that the nurses could be sure that the parents would like to know about their daughter. The staff nurse can try to explain to Emma that this could bring balance back to her life and she would not have to feel anxious or overwhelmed by her current situation. Staff would like to be fair to them and all involved. Maybe Emma was feeling anxiety not just due to having abdominal pain, but because she is not quite sure how the baby will affect her life and her family’s life. She might not feel that 9 months will be enough time to make the necessary emotional or physical changes and still be trying to figure which to deal with, for example living on her own, getting married, or stay living with her parents and then finding a job and still being able to stay in school. Emma may be wondering if she will be able to adapt to be a parent and how this will affect her relationship with her parents when the baby is born. She also has to deal with her boyfriend if he is still present. Emma will also need to learn how to deal with stress in a better way. In the nursing care plan the staff can write a suggestion for the patient to seek assistance that will help her with her stressful situation and that she will realize her potential at being a parent herself. The staff can suggest this with” empathy, being genuine, and showing an unconditional positive regard an these are all about of building trust with the patient.” (James, 2003), when in nursing or counseling staff can use Person-Centered Counseling and the beliefs of Carl Rogers. Emma’s Ethics Emma is not a bad person for becoming pregnant at 16. She was raised by parents who cared, but Emma was looking for something her family could not offer her at this time. The nurse should not assume what could be happening in the family. As the nurse this would not be an ethical thing to do the “staff must get informed consent to proceed” with the care. (Corey, 2011) The nurse cannot make the decisions for her and she must fully understand what is happening to her and that is the nurse’s job to do. The nurse can be called a Patient Advocate to come and talk with Emma to try and make things easier to understand about her situation. Emma may need to talk to someone other than the nurse who may understand better of what is occurring in her life. The advocate can maybe see what is missing for Emma. Emma and her advocate can again talk about informed consent and privileged communication. The advocate can also teach Emma about the other services that are open to her when she leaves (discharged) from the hospital.(Corey, 2011) The important thing is to get Emma stabilized physically, so that she can learn to care for herself socially, educationally and economically. Conclusion In this paper about Concepts in Caring the patient named Emma, a 16 year old pregnant girl has to learn that it does not matter what socioeconomic status she comes from, what level of education she may have or what even what kind of family you may belong. Emma needed care and it is up to the nurse to figure on how to give this care. In this scenario the nurse can use the concepts of Humanistic psychology with Maslow and Rogers. The staff will learn about ethics, morals that they may have or not. The nurse will learn about being an advocate and about confidentiality, informed consent and privileged communication. All of this information will fall into place when nurses do their nursing care plan that will include Emma’s Physical and History, nutritional history, whether she would benefit from attending parenting classes for her and/or the father of the baby if is going to be involved. We learned that Emma is human who does not need to be ashamed to live in her community. Some questions that Emma can think about could be 1. How can I teach my child what she needs to know? 2. How will I support this child if I decide to keep it and raise it? Or will I put the child up for adoption? Do I want to be updated on the growth and development of the child by the adoptive parents? How will my attitude affect my unborn baby? Attitude is one thing that can be changed through education and what will be occurring in her life. We are all teachers.(Cormier, 1991) The staff must not let the stigmatization of various problems stop us from caring for various people. We must learn how to be assertive and be able to provide proper care and not label them. Everyone has the right to care no matter their family, employment or lack of, religion or even politics. We all go through changes and have to make adaptations. That is what nursing is all about helping people to make better changes in our lives and our patients lives. References Appleby, George A.; Colon, Edgar & Hamilton, Julia. Diversity, Oppression and Social Functioning Person in Environment Assessment and Intervention, Chapter 13 Ableism: Mentally and Emotionally Challenged People. 2nd edition, Allyn and Bacon 2007 Balswick, Jack O. & Balswick, Judith K. The Family A Christian Perspective on the Contemporary Home, Chapter 16 Through the Stress and Strain on Family Life 3rd edition Baker Academic 2007 Corey, Gerald; Corey, Marianne Schneider & Callanan, Patrick. Issues and Ethics in the Helping Professions; Chapter 3- Values and the Helping Relationship Eighth edition Brooks/Cole Gengage Learning 2011 Corey, Gerald; Corey, Marianne Schneider & Callanan, Patrick; Issues and Ethics in the Helping Professions; Chapter 8- Professional Competence and Training; Eighth editon Brooks/Cole Gengage Learning 2011 Cormier, William H. & Cormier, L. Sherilyn. 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