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Role Of The Family In Care Of Ill Child

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INTRODUCTION

Everyone comes from a family, whether young or old. The family is the back bone of the society; this means that the role of the family in the care of the sick child cannot be underestimated hence the topic. The aim of the paper is to update the paediatric nurses’ knowledge on the role of the family in the care of the sick child.

In Ghana, especially rural Ghana, children are considered as gifts to the whole family and community at large. Their sick health also affects the whole family and community at large.

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Family centered care has become a cornerstone of paediatric practice, however its effectiveness is not known. No single definition exists, rather there is a list of elements that constitute family centered care. However, it is recognized to involve the parents in care planning for a child in health services (L. Shields, J. Pratt, J. Hunter. 2006)

Studies have shown how maternal deprivation and separation anxiety expressed by children are detrimental to a child’s recovery in the hospital.

Striving effects have been made to develop family centered care, promote normality of the family unit and continue with the normal routine of the child’s life within the limitations of the hospital environs and the child’s illness. Expectations of the parental roles in the hospital need to be identified and expressed from both parents to establish an understanding that would ultimately be the best for the child (Sarah J Palmer 1993).

BODY OF WORK

The role of the family in the care of the sick child in the community includes but is not limited to the following:

  1. Making the sick child comfortable
  2. Feeding the sick child
  3. Treating the sick child at home
  4. Seeking medical care
  5. Allowing the sick child to play
  6. Providing the health needs of sick child

Making the Sick Child Comfortable

The paediatric nurse educates the family to do the following: Provide emotional support by sitting with the sick child, holding the sick child ‘s hand, singing and reading for the sick child, making a comfortable bed and ensuring adequate rest and ensure a quiet environs by putting off or lower the volumes of television set and other devices that cause irritations and keep the child warm when the room is cold and vice-versa depending on the child’s sickness. Also make sure to clean, bathe and change the child when he/she soils self. Breast feeding on skin to skin enhances bonding hence emotionally comforts the child, cuddle or piggy backing the child when he/she cries. Children are emotionally tender and when care is not taken during their ill-health, they tend to develop ill psychological attachment towards care providers and caregivers which has negative consequences in their adult life (e.g. You once received a painful injection as a child, you grow up to dislike nurses and injection)

Touch, hug, hold hands, massage the child to indicate love and care. Elevate the child’s head on bed if the child has cold.

Feeding the Sick Child

Educate family to give fluids in bits at frequent intervals as the sick child can tolerate, all kinds of fruit juices e.g. mango, watermelon, orange, bananas and also giving porridge can be encouraged to hydrate the child and also improve appetite and emphasize on exclusive breast feeding for babies under six months. Encourage the family to serve the sick child with foods that are nutritious and easy to digest e.g. cooked cereals, mashed yam with eggs, bananas and other foods that would not upset the child’s stomach. Spicy foods such as pepper, ginger, garlic, clove should be minimized in child’s food if it cannot be eliminated completely. If the child’s condition abhors certain food, it should be made known to the family to appreciate and practice what is being taught them.

Warm light soup (low in pepper and other spices) for the child if he/she would be able tolerate, since this would help boost the child’s appetite. Endeavor to serve favourite meals of the child, serve foods dressed or garnished to be attractive and serve foods such as mashed kenkey.

Feed the child slowly and patiently encourage the child to eat but do not force the child

Give extra meals or snacks every day response to the recovering child’s increased hunger

If the child has diarrhoea serve clear fluids, such as water, broth (for children over 1 year) or electrolyte solution, to prevent dehydration (avoid juices and soft drinks – the sugar can worsen diarrhoea): a normal diet that includes such binding foods as rice, ripe bananas and cooked veggies.

If the child has constipation serve prunes or prune juice to stimulate bowel function: high fiber foods such as fresh apples, oranges, carrots and celery: water to keep stools regular.

If your child has a fever serve a regular diet but since feverish children generally eat very little, add dips, sauces or butter to increase caloric density of every bite and give plenty of plain fluids as well as exposing the child to the environment for heat to be lost through convection and evaporation.

If the child has a sore throat serve hot non-caffeinated tea with honey (but only for children over 1 year) and high- caloric ice cream smoothies.

If the child has a stuffy nose serve warm foods, such as chicken soup which acts as a vaporizer loosening nasal mucus. (Betty S. Wang from Parents magazine)

Treating the Sick Child at Home

Thirdly the role of the family in treating the child at home is to serve prescribed medication correctly and timely to the sick child. The nurse should advice parents or family members to always assist the child in taking the medication and praise the child when done. Educate the family not to give the child over the counter medicines without seeing a trained pharmacist. Indiscriminate use of over the counter medicines can cause more harm to the child.

Children with G6PD are supposed to use medicines on prescription. If the child’s status is not known and you give over the counter medicines, it could result in complications.

Giving over the counter antibiotics also increases antibiotic resistance and parents must be educated to avoid those acts “to be safe than sorry”. Encourage the family to keep the home clean and free from irritants or any activity that would cause the child’s conditions to worsen.

If your child is ill, the most important thing to do is to listen to them; if they say they don’t need to be in bed, they probably don’t. They might feel better on the sofa, the following will help them feel more comfortable:

  • Keep the room airy without being draughty. If the room is too warm, they’ll probably get worse.
  • Give your child plenty fluids to drink. For the first day, do not bother about food unless they want it. After that, attempt giving food in bits and encourage them to have nutritious drinks like milk.
  • Try to give your child time for quiet games, stories, company and comfort.
  • Sick children get very tired and need plenty of rest. Encourage your child to doze off when he or she needs to perhaps with a story read by you or on tape or CD.
  • Never fall asleep with a sick baby on the sofa with you, even if you are both exhausted. This increases the chances of sudden infant death syndrome (SIDS).

When dealing with children’s minor accident, many general practitioners, minor injury units, walk in centers and pharmacies are equipped to deal with minor casualties, such as cuts or items trapped in the nose or ear.

Seeking Medical Care

Fourthly, seeking medical care as a role of the family in caring for the sick child involves:

  • Family should watch out for danger signs that the child exhibits such as fever, lethargy, poor feeding, convulsions or persistent diarrhoea and vomiting
  • family checks the child’s temperature and if high, give paracetamol syrup and then visit the nearest health post as soon as possible.
  • family asks if the child can speak to tell if there is pain and which part the pain is originating from.

According to Steven C. Porter of University of Toronto in his article “How to Cater for the Sick Child”, take the child to hospital when you see the following signs:

  • Fever: If the child has temp of 39◦C (102.5F) or more.
  • Breathing seems labored: If your baby of less than two months is breathing very fast (more than 60cpm, between two months to one year >50cpm, from one year to three years >40cpm). An older child with labored breathing that does not resolve with rest or if accompanied by severe chest in-drawing and nasal flaring.
  • Vomiting everything that the child eats or unable to feed in neonates. Babies or children with a bad cough will probably also vomit intermittently because the two impulses are connected by the same nerve. children with the flu also vomit. Symptoms that warrant the same – day attention: if a child is vomiting so much that bile starts to come up (i.e. bright green or bright yellowish discharge), or if they are vomiting blood. If she hasn’t been able to drink in many hours or hasn’t urinated in the previous 8 to 12 hours.
  • Injuries: Is it broken? When a child hits her head, there are a few things to consider. If there is numbness or bruise, pain and crying or possibly even vomiting once. If you treat with ibuprofen (note: ibuprofen is contra indicated in babies less than 3 months) and in an hour the child may feel normal. In case of the child with head injuries appear to be getting worse. Also if the child vomits more than once on head injury or when the pain getting worse or if vision, hearing or walking seen off or if he/she can’t use the limbs properly. (All injuries should visit the physician for neurological assessment). Babies of 3 months and below, when they hit the head hard enough to get a visible bump should visit the physician that day.

Allowing the Sick Child to Play

Advice the family members that in as much as the sick child needs to rest, minimal exercises such as playing with favourite toys, walking around under supervision can be tolerated and are free from injuries and hazards. Vigorous activities should be avoided or delayed until the child is fit enough to play without supervision. Children use play to develop their talents and potentials hence allowing them to play even when they are ill, is good for them to continue to develop their talents uninterrupted.

According to Ana G (2016), daily playtime is good for all children, even those who are under the weather. Encourage your kids to play, even if only for the distraction from the symptoms of the illness. Dolls, blocks and stuffed animals are all good choices. Your child can also do a puzzle or play a card or board game. Take it up a notch and play with your child. Let your child be your guide in how long you play and what to play.

2.6 Providing the Health Needs of the Sick Child

It is the duty of every parent in Ghana to provide the basic needs of their children, this includes health care. In Ghana, parents must take their children under 5 years for routine immunization during child welfare clinics.

In Ghana, all children under 18 years are exempted from paying premium on National Health Insurance Scheme. This goes a long way to ensure that the health care needs of the children are covered.

Educate family to know their child when well or unwell. Advice on the importance of registration of their child under the National Health Insurance Scheme.

Payment of hospital bills and purchase of prescribed medications.

Provide psychological support to families with children with disabilities.

RELEVANCE OF THE FAMILY’S ROLE IN THE CARE OF A SICK CHILD TO PAEDIATRIC NURSING IN GHANA.

The family will be bridging between the sick child and the health care team. In paediatric nursing the family is seen as the basic support for the child, the importance of the family is seen very well when using the principles of strength based nursing and family centered care. Since the child cannot do everything by himself, especially during sickness.

Family participation helps the nurse to work efficiently in collaboration with the family in attending to the needs of the sick child because information needed for the plan of care is easily made available when family is included in the care of the child and because constant involvement in the planning process makes it easy to implement.

The nurse is able to effectively practice family centered care (FCC) and this helps in upholding of their culture and beliefs. This goes a long way to reducing conflict between health care systems and the family.

Family presence makes the sick child feel loved, this psychologically affects the child making recovery faster and easier.

The love and care a family gives to their sick child help the child to feel accepted and strives well, and this helps reduce the length of stay in the hospital and also the number of times this child could have been hospitalized hence reducing the pressure on health care equipment.

Reduces the tendencies for legal actions against the nurses since the parents will fully be involved in the care of the child.

It enhances the teaching and compliance in the care of the child since they take part in the decision making to help reduce relapse.

According to Palmer S. J. (1993), parental involvement in their child’s care in the hospital has undergone great change over the last century. Studies have shown how maternal deprivation and separation anxiety expressed by children are detrimental to a child’s recovery in hospital. Efforts for family-centered care are highly advocated now. The success of parental involvement is dependent on both parents’ and staff’s attitude, enthusiasm and willingness to work together.

The Inger Kristensson-Hallstrom study, “Strategies for Feeling Secure Influence Parent Participation in Care” states that parental security is almost equally distributed among three given alternatives: security derived from trusting that professionals know how to take care of the child; security derived from having control over what is happening to the child; and security derived from being the one who knows the child best. Depending upon the strategy chosen, parents want to participate at different levels in their child’s care. The results indicate a relationship between parental participation and their estimation of their child’s pain.

THE IMPACT OF ILLNESS ON GHANAIAN CHILDREN AND THEIR FAMILIES.

Late identification and reporting of a child who is ill can lead to the child infecting others in the home and community especially with communicable diseases.

Parents spend most of their time with the sick child which may result in reduced income or job lose which in turn reduces the financial strength of the parents to afford certain medicines or procedures for that same child.

The siblings of the child who is ill experiences emotional difficulties as a result of the separation from the ill child and parents.

There are additional burdens on the siblings, taking over the roles of the ill child such as assisting with household responsibilities, acting as a companion for the ill child, caring for younger sibling and family pets. (white et al…2017)

Marital issues/divorce.

Families who do not perform their roles well for the ill child may lead to increase morbidity and mortality

The child will not miss out on school as child will recover faster. There is reduced absenteeism in school when parents play active roles in the care of their ill child.

Children feel secured having their family being part of their care which increase their trust in them throughout life.

They are always happy to see their family around them in time of need.

When serious illness or disability strikes a person, the family as a whole is affected by the disease process and by the entire health care experience. Because each person in a family plays a specific role that is part of the family’s everyday functioning, the illness of one family member disrupts the whole family. When a family member becomes ill, other family members must alter their lifestyle and take on some of the role function of the ill person, which in turn affects their own normal role functioning. When a working parent is up most of the night trying to console a child with ear infection, the parent not only loses sleep, but must either arrange for emergent child care or take a day or more off from work.

Long term illness, even in the most stable and supportive families, brings changes in family relationship. Illness produces disequilibrium in the family structure until adjustment can occur. (http s://www.euromedinfo.eu/impact).

According to Martinez Montila, J. M, Amandor Martin, B., & Guerra Martin, MD (2017). Family coping strategies and impacts on family health: a literature review. Emfermeria Global 16(3),592-604 stressful events like another unusual physical and or psychological demand cause an anxious state of the family system altering the dynamic equilibrium of the family system. Hence the importance of the family unit having good coping strategies to cope different stressful events and thus optimally keep family functioning and therefore family health.

CONCLUSION

Taking care of your ill child can be an overwhelming and tiring experience. Cut yourself some slack, take it easy and focus on helping your child to stay comfortable.

Recent research has confirmed parent’s desire and expectation to participate in their child’s care and shown how the nature of their participation has evolved. The attitudes and activities of healthcare professionals are both barriers and facilitators to parent participation.

Further research is needed to examine how parents’ expectations differ between specialties, acute and chronic care and ways of facilitating parent participation

During the course of the study it came out that both nurses and parents or family were integral part of health system. As the nurses provide all the quality care to the child the family provides for the emotional and psychological aspects of the health for the child.

As nurses struggles with medical and nursing procedures with increasing number of ill children, neglecting effective communication and timely briefing on the progress of their children, parents see the silence from the nurses has been neglected to the back stage. Parents also experience intermittent burn out and coping mechanisms are broken down. This sometimes results in lack of trust between care givers and family.

In Imelda Coyne’s article (26th June, 2013) on families and health-care professionals’ perspectives and expectations of family-centered care: hidden expectations and unclear roles. Four key themes were identified; expectations; relying on parents help; working out roles; and barriers to family centered care. Nurses wholeheartedly endorsed it because of the benefits for families and their reliance on parents’ contribution to the work load.

There was minimal evidence of collaboration or negotiation of roles which resulted in parents feeling stressed or abandoned. Nurses cited busy workload, understaffing and inappropriate documentation as key factors which resulted in over reliance and hindered their effort to negotiate and work alongside parents.

The study concluded that families are willing to help in their child’s care but they require clear guidance, information and support from nurses. Hidden expectations and unclear roles are stressful to the families. Nurses need skills training, adequate resources and managerial support to meet family’s needs appropriately to establish true collaboration and to deliver optimal families centered care.

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