Definition and Model of Family Theory and Management of an Acute Pediatric Incident - Case Study Example

Definition and model of Family Theory and management of an acute pediatric incident Family: A basic unit of Society: Family is a basic social unit of a society which is most beneficial to upbringing and nurture of children. The Tasmanian Family Institute adopted definition of the family as: “A family is a unit of people connected by natural genealogical links (most basically consisting of a father, mother and their children), or in a means which morally and legally replicates these natural genealogical links, such as through adoption.” A genealogical basis to family is necessary and it is referred as blood relation by Australian bureau of statistics (Corbett, 2004, p4). Within this ideal genealogical link between parents and Children, the latter are raised by their parents. However it is not always so as many times the state removes children from their biological parents viz. in cases of drug abuse, violence etc. In such cases the children should be raised in households giving the family environment. The family originates after voluntary union between a man and a woman known as marriage. But currently the meaning of marriage may undergo a possible change since to legally accommodate same sex marriages, the marriage may be defined as voluntary union for life between two people while excluding others (Corbett, 2004). The arguments of alternative family definition is picking up heat in view of, particularly, same sex marriages. But probably every grouping can not be taken as a family. With this social background about family, I proceed on to a definition of family based on health care as referred in detail by Bomar (2003) and O’Brien et al (2007) and discuss an acute incident which I handled recently. . Bowen’s System theory of Family: System’s theory and family was conceived by Bartalanffy and later developed by Murray Bowen (Bomar, 2003, p100). The system is composed of many interacting elements and is distinct from the environment in which it is present. It is a concept taken from definition of system biological and physical sciences. Open system exchanges energy from surrounding while a closed system is isolated from surroundings. A system tries to remain in steady state or maintains homeostasis. Similarly the family has members who are interconnected and interdependent. When there is change in the wellness of one family member entire family is affected (O'Brien et al, 2007). Just as the system is closed or open, the family has hierarchies and relationships such as mother-child; family-community etc. family also has to maintain stability and is affected by stresses arising within and outside of the system. This family system perspective helps nurse to see the effect of individual’s illness or a stressor, on the whole family. Bomar (p102) finds Bowen’s family system therapy, based on the system theory, highly encouraging. Here family members are encouraged to examine processes in past and present and choose how they will behave in future. The nurse acts as teacher and coach suggesting ways for removal of family dysfunctions, if any. For a model of family, Neumann’s system model for family nursing intervention is preferred by me. It is a health oriented model. Health is taken as a scale of wellness and illness. Neumann defines family as association of two or more persons who maintain a common culture. The main aim of the family is continuance. Family, for Neumann, is an open system which has family members as subsystem. In Neumann’s model family system strives for equilibrium as the internal and external stressors threaten health. To identify the stressors threatening the client, which is a family in this case, nurses assess these through five perspectives: physiological, psychological, socio-cultural, developmental and spiritual (Bomar, 2003). These perspectives concentrate on state of body and its function, mental state and emotions, relationships, important incidents during lifespan and spiritual beliefs. Nurses seek agreement of their assessment with the family and fulfill their goal by helping client to move towards optimal wellness. Friedemann on the other hand considers family as social system that has a goal to transfer culture to its members. She assumes following in her framework: The family and civil system provides physical necessities and safety promoting personal growth, emotional bonding. Central to Friedemann’s model are stability, control, growth and spirituality of family (Bomar, 2003). I preferred Neumann’s family model since the central theme of this is health, which I understand well and also trained academically in health care. Secondly, the five perspectives for a nurse to consider while delivering family therapy are clearly defined and cover all aspects of emotional and physical well being. Friedemann’s model, on the other hand is strongly focused on emotions, culture and relationships which is more of a social perspective and health goals are somewhat obscure in it.   A Case Study: Pediatric Burns Four year old Joe had scalding burn injury as hot liquid spilled accidentally over his right shoulder, stomach and part of thigh and neck. In the prehospital setting, at his home, his burned clothing was removed gently and where it had stuck by cutting around the burn. Watch or other objects from burn extremities were removed and the burning process was stopped by sterile saline-soaked gauze, moderately cooled to around 12°C (53.6°F) applied to the burned tissues of Joe. Ice application was avoided to rule out hypothermia. Soothing analgesics viz. Acetaminophen and nonsteroidal anti-inflammatory drugs were given to ease out pain and anxiety (Morgan et al, 2000; Thomas et al, 2003). His airway passage was already maintained with chin-lift jaw thrust technique in prehospital setting and he was transferred to burn unit of the hospital immediately where the staff was alerted in advance. Following nursing diagnoses were made and immediately carried out for appropriate outcomes (Thomas et al, 2003, p483): Alteration in fluid and whether it is insufficient for body requirement: Outcome: Patient will have required cardiovascular activity as shown by alertness and vocalization appropriate for age. Heart rate, blood pressure and urinary output normal for age and administration of correct amount of intravenous fluid. Alteration in skin integrity: Outcome: Patients would have adequate skin covering as shown by application of antimicrobial agents and wound management. Alteration in Thermoregulation: Outcome: Patient will have normothermia as shown by normal body temperature and absence of shivering. Knowledge deficit related to burn injury prevention: Outcome: 1. The family and patient would learn to prevent burns. 2- The family would be given counseling if child maltreatment is suspected or confirmed. Joe’s burns were nearly 20% Body surface area burns (BSAB) and hot liquid scalded his right shoulder, stomach and parts of thigh and right side of neck. His airway passage was already maintained. Fortunately Joe did not suffer much inhalation injury and endotracheal intubation was not required, however, respiratory effort was supported by high flow oxygen for some time. The pain and anxiety was managed by anti anxiety medication and acetaminophen and codeine were administered as his mother did not approve for IV morphine Browne et al (2006). Tetanus prophylaxis was also administered to Joe. Resuscitation of IV fluids was required to restore vascular volumes. IV replacement fluids were given @ 3-4ml/kg/hr multiplied by % BSAB. Lactated ringers solution was chosen for Joe, as it is close to body fluids. Half of total volume was given in first 8 hr and remaining half in next 16 hr (Browne et al 2006; Thomas et al, 2003). For wound care, all blisters were removed and 1% silver sulfadiazine was used as topical agent on wounds of burn. It provides moisture which is necessary for wound healing and is also antimicrobial. Child was sedated so once a day dressing was sufficient. Role as family counselor and nursing advocate: I informed the family frequently about child’s condition and obtained their support. Emotional support to child and the family was provided and to soothe their nerves, the father and mother of the child were encouraged to touch and hold the child in unburned areas. As the nursing advocacy refers to behaviour of a nurse towards her patient where she helps him disclose his liking and dislikes and respects his autonomy. A nurse also supports the patient (parents in this case) to make appropriate choices and preventing others from breaching upon patient’s (or family’s) autonomy. The Australian code of ethics clearly mentions that nurses inform their patients prior to taking decisions. I explained all procedures and treatments and chosen those with which family felt comfortable. (Elliott et al 2006; Thomas et al, 2003). The importance of prevention of burns at home was also emphasized by counseling to both the parent. Parents often misjudge burn safety and overestimate their child’s knowledge of burn safety. They think it is all right to put the child in their lap while drinking tea or coffee. Prevention should focus on adult supervision when child is in kitchen or bathroom. And dangerous items should be kept away from children. Homes need to be child proof and child friendly. A first aid kit should be readily available in areas where burn injuries may occur. Riddick-Grisham (2004, 655). What more should have been done: Since there was obvious relationship tension, both parents should have been asked to come and tell how exactly it happened. How come little Joe was alone in the kitchen where he spilled a pan of hot water over him! I hesitated in reporting the matter of child neglect to social services due to following: I, being a new entry in the burn centre, was not appropriately trained and educated in such matter. Though intuition of child neglect was there but my lack of experience did not give me opportunity to assess sign and symptoms of neglect accurately. I also feared that if I report the matter the family may take the child away from care thus jeopardising his well being (Piltz & Wachtel, 2009, p97-98) . Though I attempted to give best care to Joe and calm down the anxiety and nervousness of his mother but preventing child abuse or neglect is also a necessary duty which I need to learn from my mentor and certainly from experiences. References  Bomar, Perri J 2003. Promoting health in families: applying family research and theory to nursing practice, 3d edn, Elsevier Health Sciences Browne, NT, Flanigan, LM & McComiskey, CA 2006, Nursing care of the pediatric surgical patient, Jones & Bartlett Publishers   Corbett, A 2004, What is a Family?: and why it Matters: Achieving a Workable Definition, Tasmanian Family Institute. Elliott, D, Aitken, L & Chaboyer, W 2006, ACCCN's Critical Care Nursing, Elsevier Australia, 2006 Morgan, ED, Bledsoe, SC & Barker, J 2000, ‘Ambulatory Management of Burns’. American Family Physician. From http://www.aafp.org/afp/20001101/2015.html [25 May 2009] O'Brien, P, Kennedy, WZ & Ballard, KA 2007, Psychiatric Mental Health Nursing: An Introduction to Theory and Practice. Jones & Bartlett Publishers. Piltz, A & Wachtel, T 2009. ‘Barriers that inhibit nurses reporting suspected cases of child abuse and neglect’. Australian Journal of Advanced Nursing, Vol. 26, no 3. 93-100. http://www.ajan.com.au/Vol26/26-3_Piltz.pdf [25 May 2009] Riddick-Grisham, S 2004, Pediatric life care planning and case management, CRC Press Thomas, DO, Bernardo, LM, Herman, B & Emergency Nurses Association 2003, Core curriculum for pediatric emergency nursing, 2nd edn, Jones & Bartlett Publishers. Read More