NRSG257 Child Adolescent And Family Nursing

Introduction

A nurse’s knowledge and perspective work together to provide quality care to the enrolled patient in the nursing process (Clark, 2015). This study is an example to understand the impact of a nurse’s knowledge, guidance, understanding and perspective in providing quality care to the case-patient. The case study patient is a 14-years age adolescent name Sue, who is an indigenous girl living in the remote location with her family. The study involves pathophysiology, developmental study, care requirement and impact of hospitalisation on Sue case from a nurse’s perspective. 

Pathophysiology of provided case study patient

A clear understanding of the science behind any disease or issue helps the professional nurse to provide a better care and healing with targeted goals of patient care management (Wessels, 2011). In the present case, patient Sue is a 14-year adolescent girl suffering Acute Rheumatic Fever (ARF) that is an outcome of her uncontrolled and mismanaged streptococcal infection identified by repeated episodes of streptococcal pharyngitis.  According to Webb, Grant & Harnden (2015) description, ARF is a serious condition or consequence developed typically 2-3weeks after streptococcal pharyngitis. This situation is most common in children involves neurologic, rheumatologic and cardiac manifestations.  However, Carapetis et al. (2016) indicated that early recognition and treatment of streptococcal pharyngitis minimises the risk of developing ARF.

The infectious agent streptococcal pharyngitis infects the back of throat covering tonsil region. This infection leads to a sore throat, fever, red tonsils and lymph nodes abnormalities. The bacteria possess ability to invade the pharyngeal mucosa creating an inflammatory reaction. This bacterium possesses the ability of Beta-haemolysis causing haemolysis of RBC in blood agar giving it the name group A beta-haemolytic streptococci (GABHS). This virulence occurs due to M-protein present in S.pharyngitis peripheral cell wall. At the tissue level, the T cells (helper t cells and cytokine Th17) getting exposed to this M-protein causes cross-reaction with similar epitopes (molecular mimicry) on the human cardiac laminin and myosin creating a risk to rheumatic heart disease (RHD) (O’Meara et al. 2015).

The S.pharyngitis infection is generally controlled with antibiotics but uncontrolled infection at the cellular level creates inflammatory reactions in joints, heart, central nervous system and subcutaneous tissue. The earliest and common feature of S.pharyngitis infection in tissue is migratory arthritis identified by pain in joints ankles, knees, shoulders or elbows resulting in Acute Rheumatic fever at the tissue level (De Dassel, Ralph & Carapetis, 2015).

Further, Irlam et al. (2013) indicated that molecular mimicry occurring due to S.pharyngitis infection leads to tissue injuries results in rheumatic fever. In the present case, Sue suffered S.pharyngitis infection 2 years back further getting involved in secondary prophylaxis program as per instruction from her local health clinic. However, she missed her antibiotic (Benzathine penicillin G IM) treatment appointment many times escalating her risk to develop ARF or RHD. Further, Sue developed a sore throat and acute joint pain in elbows, knees, ankles and shoulders followed by temperature is 38 degrees C. Her condition highlighted a risk of Acute Rheumatic Fever as per assumptions of remote clinic medical officer. As per S.pharyngitis infection pathophysiological study, Sue’s history of S.pharyngitis infection followed by mismanaged treatment along with present signs and symptoms clear indicates a consequence of ARF in her case.

The nurse’s role in delivering developmental appropriate nursing care for case study patient

Growth and development study for the patient

The case study patient Sue is a 14-year age indigenous girl living in the remote location of Australia. She is presently in her adolescence stage of growth and development where physical, social, psychological and emotional changes are most sensitive along with initiation of puberty (Sigelman & Rider, 2014). As per Sigmund Freud theory of adolescent development psychosexual development in adolescence stage dominates the overall development of people irrespective of environmental factors trying to control emotional, social and behavioural changes. Therefore, adolescence is the most sensitive stage of human development influenced by psychosexual development leading to puberty. The adolescent requires special attention from people around them in the clinical scenario as well (Anglin, 2014).

The age between 14-18years in considered as middle adolescence. The major development changes for girl involves, physically her completing growth spurt, cognitive involving the development of reasoning, less self-focus, better planning and decision making power with evaluation of personal values, abilities and interest. Further, social development milestones involve exploring self-identity, developing societal perspective, gender stereotyping and self-concept (London et al. 2014). According to Masten (2014) information on G. Stanley Hall’s theory of the biogenetic psychology of adolescence, puberty involves “storm and stress”. The overall change in the physical, emotional, psychological and social status of life leads to stress and storm that affects their response to life situations.

Kassam-Adams et al. (2015) indicated that adolescent patient care is a critical phenomenon because all the clinical medicine aspects work against their physical, psychological and social developmental changes. These changes in adolescence produce specific disease patterns, unique communications, unusual symptoms and management challenges for nursing care. Hence, working with adolescence patient is a difficult task for nursing professionals. However, studying about correct nursing skills that are essential to deal with adolescence patients indicate some specific challenges. The very first challenge is to maintain a healthy clinical relationship with the patient for this specialised communication skills should be adopted by the professional nurse. These skills are like involving personally with patient adolescence and helping them to manage those challenges (Leifer, 2014). Further, implementing standards of effective adolescence consultation and proper adult consultation with their family members. In the present case, Sue is a teenage girl suffering, therefore, for effective nursing care, proper communication norms are required to be followed by the involved nurse (Hockenberry, Wilson & Rodgers, 2016).

According to Masten (2014) studies, another consideration that nurse’s need to maintain while handling an adolescence patient is managing their privacy and personal integrity while performing physical examinations. Every nurse should take care of this sensitive issue while taking care of teenagers in their working zone. Another studied clinical skill for the nurse is to treat adolescence patient irrespective of their dynamic background. All the patients should be treated equally to ensure social and psychological stability in case scenario. The case study patient is a remote location indigenous Australian suffering critical disease situation in her adolescence stage of life. The professional nursing care in her case should involve proper clinical skills explained in this section to provide satisfactory patient care (Slee & Shute, 2014).

Criteria for providing family centres care nursing care

Family centred care is an approach to deliver healthcare by indulging in partnership with patients their families as well as other individuals linked with the patient concerning their health. Family centred care is an essentially adopted approach to ensure proper pediatric and adolescence care ensuring safety an security for issues like consent, complains etc. More than 20% of hospital admissions are generally adolescents that need different criteria for treatment (Noble et al. 2015). According to Donovan et al. (2015) studies a proper Adolescent care model is required for treatment of teenagers because of factors like age, puberty and sensitive stage of development. The provided case study patient, Sue is a teenager indigenous girl living in the remote location of Australia suffering indications of Acute Rheumatic fever. Therefore, this situation also requires a proper adolescence care model for treatment.

Baird et al. (2015) studied the most popular care model used for adolescence family centred care in Australia. This care model is divided into four sections that works successfully to meet the adolescence family centred care requirements. These four sections are principles, caring together for patients, improving and managing the hospital together.

The principles

This section involves assurance of zero harm, dignity, respect, information confidentiality, child and youth protection policy, participation and collaboration with family for the decision-making process in healthcare (Clark, 2015).

Caring together for patients

The pediatric and adolescence care providers need to assure complete participation of the patient and their families in the care process as per the principles of healthcare. The families bring a rich collaboration of knowledge, personal understanding, values, beliefs and experiences that work together for helping the children in the recovery process (Leifer, 2014).

Improving hospital together

This involves the participation of families and patients in improving care services through surveys, feedback, interviews, group discussion etc. designed specifically for paediatric care patients. Further, reporting safety and risk concerns, family Internet page, daily family interactions etc. are also helpful to implement improvement in care process (Clark, 2015).

Managing hospital together

This section involves functionality at management level where patient and their family is involved for the decision-making process in certain specific situations like consent, complaints, care plans, service delivery and personalised program development. The most common method to achieve this is by the representation of consumers at community advisory committee that reports to RCH committee. This approach provides a more interactive approach for involving the consumer in developing personalised and customised care process in contemporary medical care structure (Leifer, 2014).

Impact of hospitalisation on child and family

The impact of hospitalisation on child and family varies as per their present scenario and personal approaches (Turchi et al. 2014). In the present case, Sue is an adolescence indigenous girl living in the remote location about 800km away from required medical services in her case. She is living with her single mother and 6 younger siblings. ARF is a major health issue in poor-nation and indigenous population in this resource-rich nation (Smith, Swallow & Coyne, 2015). Therefore, as per case scenario, hospitalisation would surely be a tough process for Sue and her family.

It would be physically exhausting for Sue family to manage her hospitalisation because closest hospital is 800km away, therefore, it would result in a physically and financially stressful situation for Sue and her family. Further, Davidson et al. (2017) ARF is a painful disease that leads to physical stress and emotional consequences in children creating life-threatening situations. Sue is suffering S.pharyngitis infection that can also spread to her younger siblings via contact, respiratory, urinary release (Smith, Swallow & Coyne, 2015).

Further, Coyne, Hallström & Söderbäck (2016) indicated that adolescence body and mind is completely developed for coping skills and emotional strength to cope up with consequences of diseases. The outcomes like loneliness, scared feeling, depression and anxiety are common psychological outcomes of serious hospitalisation in early ages of life. Davidson et al. (2017) indicated that indigenous Australian generally face discrimination during hospitalisation that can also be possible with Sue and her family because they belong to the indigenous community living in the remote location of Australia.

Conclusion

The essay completely works to understand, analyse and evaluate the provided case study patient situation. The patient, Sue is suspected of Acute Rheumatic Fever, which is basically a severity of streptococcal pharyngitis infection as per the pathophysiology of disease study. Further, nurse role in delivering nursing care is understood and established for the provided case, as per the growth and development study, setting family centred care criteria and impact of hospitalisation on the patient and their family.

References

Books

Anglin, J. P. (2014). Pain, normality, and the struggle for congruence: Reinterpreting residential care for children and youth. Routledge.

Clark, M. J. (2015). Community health nursing. Prentice Hall.

Hockenberry, M. J., Wilson, D., & Rodgers, C. C. (2016). Wong’s Essentials of Pediatric Nursing-E-Book. Elsevier Health Sciences.

Leifer, G. (2014). Introduction to Maternity and Pediatric Nursing-E-Book. Elsevier Health Sciences.

London, M. L., Ladewig, P. W., Ball, J. W., Bindler, R. M., & Cowen, K. J. (2014). Maternal & child nursing care. Pearson.

Sigelman, C. K., & Rider, E. A. (2014). Life-span human development. Cengage Learning.

Slee, P. T., & Shute, R. (2014). Child Development: Thinking About Theories Texts in Developmental Psychology. Routledge.

Journals

Baird, J., Davies, B., Hinds, P. S., Baggott, C., & Rehm, R. S. (2015). What impact do hospital and unit-based rules have upon patient and family-centered care in the pediatric intensive care unit?. Journal of pediatric nursing, 30(1), 133-142.

Carapetis, J. R., Beaton, A., Cunningham, M. W., Guilherme, L., Karthikeyan, G., Mayosi, B. M., … & Zühlke, L. (2016). Acute rheumatic fever and rheumatic heart disease. Nature reviews Disease primers, 2, 15084.

Coyne, I., Hallström, I., & Söderbäck, M. (2016). Reframing the focus from a family-centred to a child-centred care approach for children’s healthcare. Journal of Child Health Care, 20(4), 494-502.

Davidson, J. E., Aslakson, R. A., Long, A. C., Puntillo, K. A., Kross, E. K., Hart, J., … & Netzer, G. (2017). Guidelines for family-centered care in the neonatal, pediatric, and adult ICU. Critical care medicine, 45(1), 103-128.

De Dassel, J. L., Ralph, A. P., & Carapetis, J. R. (2015). Controlling acute rheumatic fever and rheumatic heart disease in developing countries: are we getting closer?. Current opinion in pediatrics, 27(1), 116-123.

Donovan, L. A., Wakefield, C. E., Russell, V., & Cohn, R. J. (2015). Hospital-based bereavement services following the death of a child: A mixed study review. Palliative medicine, 29(3), 193-210.

Irlam, J., Mayosi, B. M., Engel, M., & Gaziano, T. A. (2013). Primary prevention of acute rheumatic fever and rheumatic heart disease with penicillin in South African children with pharyngitis: a cost-effectiveness analysis. Circulation: Cardiovascular Quality and Outcomes, 6(3), 343-351.

Kassam-Adams, N., Rzucidlo, S., Campbell, M., Good, G., Bonifacio, E., Slouf, K., … & Grather, D. (2015). Nurses’ views and current practice of trauma-informed pediatric nursing care. Journal of pediatric nursing, 30(3), 478-484.

Masten, A. S. (2014). Global perspectives on resilience in children and youth. Child development, 85(1), 6-20.

Noble, K. G., Houston, S. M., Brito, N. H., Bartsch, H., Kan, E., Kuperman, J. M., … & Schork, N. J. (2015). Family income, parental education and brain structure in children and adolescents. Nature neuroscience, 18(5), 773.

O’Meara, W. P., Mott, J. A., Laktabai, J., Wamburu, K., Fields, B., Armstrong, J., … & Pan, W. (2015). Etiology of pediatric fever in western Kenya: a case–control study of falciparum malaria, respiratory viruses, and streptococcal pharyngitis. The American journal of tropical medicine and hygiene, 92(5), 1030-1037.

Smith, J., Swallow, V., & Coyne, I. (2015). Involving parents in managing their child’s long-term condition—A concept synthesis of family-centered care and partnership-in-care. Journal of pediatric nursing, 30(1), 143-159.

Turchi, R. M., Antonelli, R. C., Norwood, K. W., Adams, R. C., Brei, T. J., Burke, R. T., … & Levy, S. E. (2014). Patient-and family-centered care coordination: A framework for integrating care for children and youth across multiple systems. Pediatrics, 133(5), e1451-e1460.

Webb, R. H., Grant, C., & Harnden, A. (2015). Acute rheumatic fever. Bmj, 351, h3443.

Wessels, M. R. (2011). Streptococcal pharyngitis. New England Journal of Medicine, 364(7), 648-655.