Está en la página 1de 8

EXTEND YOUR CARE

“There is only one best child that every Mother has”


-My teacher

Nurses have great privilege to have knowledge of psychology, sociology and


anthropology which they utilize to assess and plan the care of patients and their family
members. Nurses have additional role to optimize surroundings where treatment is
carried out and healing occurs.

Children account for 40% of total population in developing countries and they
are more vulnerable for diseases because of their immature immune system and risk
taking behaviors. Children, who are not efficient enough to complain, often give
vague presentation for their many problems and discomforts. They may show
withdrawal, apathy, fear, sleeplessness and refusal to feed and many more. Parents
taking care of children easily identify that their child is not well.

These kinds of presentation may not be troublesome for nurses who encounter
thousands of similar children everyday, but it worsen the emotional status of parents
and force them to imagine various unwanted events that they try to ignore. Parents
may themselves present with various physical and mental symptoms. Nurses need to
identify the problems of parent for wellbeing of their little patients.

Think of the parents of sick child, waiting outside the ward of any hospital,
obviously their child is sick, they are out of their home leaving their other children at
home, who are taken care by others. Their job is at risk, and they have stopped
earning. As a whole their family homeostasis has altered. The situation further
worsens when child’s symptoms exacerbate or physician explains poor prognosis of
their child. They are scared of unexpected out comes of child’s disease. They find it
very difficult to adjust in new situations. Their decision making ability, coping ability
is challenged. They are unable to cope with all these stressors.

Here, all of us will agree that their problems are jejune and they are in need,
they need some one to listen, some one to support, some-one to guide them. But who
will do that? It’s none but the nurses. Nurses are been trained for providing
comprehensive care to the patient and their family members.

We are expert in observation of child’s condition and writing the reports of


children under care. We write the conditions of child at every possible interval
including intensity of pain, diet, sleep, their participation in treatment and so many
others, buts it is sorry to say that we don’t have even a single line space in our record
specific to explore how parents and feeling, what are their problem, how are they?

Hence, it is the times to refresh the idea of all of us that parents are integrated
part of child’s treatment; none can treat the child alone. Without participation and
wellbeing of parents, who used to take care of the child and will be caring here after
too, our nursing care plan will remain incomplete. Thus it is equally important to
develop specific strategies for the parents at the same time and practice
simultaneously.

It is understood that nurses have very limited time and lots of assignments to
accomplish in any work setting as we are not able to meet standard nurse patient ratio
in clinical settings. Nurses have many children to care at once, they can not
compromise the child care and most of the time they are juggling with many task. But
still it can not justify the ignorance of the parents.

We have preoccupied idea that parents of sick children always come with
economical problems and there nurses can not do anything. It is true that most of the
parents have economical problem as treatment cost is approaching higher and higher
day by day. Specially, when their child is admitted in Critical Care Unit or
hospitalized for longer periods, many parents encounter economic crisis.

In the most of the hospitals, it is the doctors and administrators who can avail
the financial support to the parents and nurses carry very limited authority. Nurses in
such condition should be able to assess the economical condition by asking selective
limited questions, observing their life style and living conditions. Here nurses are
expected to perform their role of advocate and liaison between authority and parents.
Nurses can aware the parents about various sources of economical supports,
institutional policy for such parents. Nurse can suggest parents to approach
appropriate channel for deduction or free treatment. Nurses can help parents to
approach the respective authority and assist in follow up. At the same time nurses can
teach the various methods of saving extra expanses. Guiding them to find cheap
accommodation in hotels near by or Dharamsala, guide them to find hotel which is
cheap and serves safe food, or advise if they can cook themselves, nurses can make
significant contribution. For these nurses have to have good orientation to hospital
policy, social agencies working in the same field and the facilities available in the
Hospital complex or outside the hospital.

It is always easy to work with the parents who are optimistic, helpful and read
to follow your instructions, especially when they appreciate your service rendered to
the child. Occasionally parents may become difficult who is demanding,
confrontational, angry, uncooperative, try to overlook contribution of nurses and
sometime blame the nurses for additional complication that child develops in the
course of treatment. In this condition role of nurse becomes more challenging.
Following some fundamental principles of therapeutic relationship and
communication nurses can prevent the crisis of parents as well as themselves.

UNDERSTAND THE PARENTS


Parents, who have low self esteem, low self confidence and less social
support, become hopeless very often. Nurses should obtain detail history of socio-
economic status of family, social supports and coping abilities of parents by
observation. The nurse should understand that the situations parents are facing in
troublesome to them. The overwhelming reactions of parents are obvious for all the
parents whose child is sick and admitted in the hospital. Nurses on the basis of their
background knowledge and observation, should be able to justify the complains and
demands made by parents. At the same time nurses should be able to recognize the
parent who may express and exhibit misleading situations to gain the extra attention
and support from health team members and the Hospital.

Giving a verbal approval that we have understood their problem and that is
genuine to some extend, gives the relief to the parents that their complains are reached
and approved. They become more compliant to the treatment provided to the child.
TREAT PARENTS AS A PERSON
Everybody in this world is unique individuality of the human being remain
intact even after death. Parents are person before father or mother of child with hernia
or leukemia. Personal recognition of the parents’ sooths them and it shows our
concern towards child too. Realize that they have their own recognition; don’t give
them new state of being a parent of sick child. Recognition with their name, surname
or respective prefix decrease their feeling of guilt and incompleteness which all
parents develop, specially when the child is chronically sick and likely to have long
term morbidity.

BE EMPATHIC
It is an ability of nurse to identify and understand unexplained needs of
parents. Nurses keeping themselves in parents position identify how she/he would
have felt and reacted being a parent of sick child. It helps nurse to realize that parents
were not like this before and they need special attention and support. At the same time
nurses can formulate specific strategy to help parents by knowing what they aspect
and may meet their needs.
ALWAYS GIVE HONEST PRAISE
Parents working hard throughout day and night give you lots of opportunity to
praise them.
Parents, because of sickness of their child, real or potential limitation of child,
unexpected outcomes of treatment, they often blame themselves and develop feeling
of incompleteness, guilt and found themselves failed to become good parents. They
isolate themselves. These behaviors further constrain the parents to be good mother or
father.
Nurse giving some commend action and positive strokes like “You are very
caring parent, you really work hard”, “You made good decision to bring the child in
casualty on time, many parents fail to do so”, “Your child likes you so much” can
unite the hearts of parents. Praising the parents not only boosts the nurse parent
relationship but also makes parents more enthusiastic and helps them to perform
better parenthood skills.

On the contrary, false praising can damage relationship and shows nurse’s
incompletion. Parents may loose the faith on nurses.
AVOID BLAMING THE PARENTS
It is very easy to blame parents for not able to provide basic care, not being
compliant, bringing child late to medical service and so as for many other regions. But
we should not forget that all parents love their children and they do their level best for
the wellbeing of their children.

In this particular situation most of the parents are emotionally labile, find
difficult to set their goals and can not perform their tasks efficiently. Blaming parents,
even if they are suitable for the situation, it is not going to help anyway rather it will
demoralize the parents and enhance sense of guilt and frustration.

BRING OUT PARENT’S STRENGTH


“Yes, 9 can do” is the feeling which can enable human being to fly unlimited.
Nurses identifying the strengths of parents and aware them with their strengths,
simply by reminding how unwisely they have decided in very critical situations, how
hard working and compensating they are towards treatment and care of child, nurses
can remind their all successful attempts the made earlier towards child wellness.

ASSIST TO SET ACHIEVABLE GOALS


Recovery from illness takes several steps and may many days. Some children
may remain physically or mentally compromised, who may need long term care and
behavioral therapies. It is impossible to achieved complete recovery of child and some
morbidity may remain permanently.
Even in hospital, parents in particular situation may not be able to appreciate
any improvement in the child that may cause additional anxiety and frustration among
parents. Nurses helping the parents, can provide anticipatory guidelines which enable
parents to decide what to observe in the child as an improvement. Nurses can help
parents to formulate their tasks in small measurable activities. With that they will be
able to perform well and anticipate improvement. Nurses should explain the parents,
according to their level of understanding, how children are improved and how they
have helped child in his/her recovery. This will give additional motivation and
encouragement to the parents. The parents can develop strategies for child as well as
for themselves.
PROVIDE SOCIAL SUPPORT
Some Hospitals have separate Social Service Unit which functions to help the
helpless and poor patients, listen to the complains and always look forward to help
needy in the Hospital. The department helps them to overcome day to day problems in
the hospital. If such facility is available, nurses must refer the needy to such service.
With their therapeutic communication skills make parents feel together as a family in
the ward. Nurse can introduce parents of other patients who can be helping each other
and attain the child in their absence for short time. They share their idea and coping
strategies.

It the same time appropriate cheerful expression of the nurses can enhance the
feeling of support and caring to the parents and children.

ORIENTATION TO THE WARD


Orientation is the basis procedure performed in all wards during admission.
Awareness of surrounding, rules and regulations of the hospital, visiting hours, diet
scheme should be explained to the patents so that they can work
more efficiently with confidence.

PARTICIPATE PARENTS IN PLANNING AND RENDERING CARE TO THE


CHILD
Parents are generally trained to provide basic care to the child and are more
accepted by children. Parental participation in child care may be beneficial for nurses
too. Participation of parents in planning and rendering care to the child, satisfy the
parents to the greater extent and they feel more responsible and wrathful. Similarly
the bonding between child and parents improve. Parents can see their child improving
or detouring and can makeup their mind to accept fore coming days. Similarly parent
will learn and develop confidence to take care of child at home.

PREPARE THE PARENTS HOME CARE OF CHILD


Almost all children get discharged with some additional needs that parents are
expected to meet. Parents of child with special needs may not be physically or
mentally prepared to render care to the child at home. It is nurses’ responsibility to
trained them, make them perform some essential procedures and ensure that they will
be able to meet the needs of child at home.

Before discharge nurse should explain parents about medication, follow up,
side effects and emergencies, special precautious at home.

DEVELOP THE HOPE


Hopeful parents can care the child better while child is hospitalized. Explain
exact condition of the child to parent in pleasant way, use suitable words. Assess the
tolerance of patents. Decide for extend of disclosure that parents need on the basis of
hospital policy, readiness of parents and condition of the child. Gradually, explain the
unexpected outcomes and limitations that child may have. Explain in such a way that
they can assimilate positive aspects of outcome rather than complication and
limitations of child. Explain, all children do not develop complication but chance is
always there. Don’t give false assurance. Prepare the parents to accept the limitation
that child has and explain the future course of actions. Specifically explain the
activities child can perform rather than inability of child. Develop positive thoughts in
parents.

DO NOT PRESENT YOUR PERSONAL PROBLEM


I am already late, my duly completed half an hour earlier; through out the
night I am standing, I have to go home also, are frequent statements made by the
nurses. These statements may evoke the feeling among parents that the nurse caring
their child is overload and is not able to provide complete care to their children.
Parents are already loaded with thousands of problem. They are not the right person to
listen your personal problems. At the same time it prevents two way communication.

VERBALIZE THE PATENTS AND SET THE LIMITS


Some parents are very submissive and speak outside the ward and gain the
false support of other visitors. Nurse should verbalize the parents to find their problem
and refer to supervisor or other related departments like nursing services, Medical
superintendent office. Nurse must aware the parents about their limitations as well.
Limiting the over anathematic parents who trouble the nurse work efficiently, should
be the last approach towards the parents.
These were the some of the tips force thousand, that nurses can identify from
their experience and observation- Being a “good nurse” as parents express later may
be excellent contribution towards profession as well.