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In my personal experience as a child nurse as well as a parent in real life, I usually experienced my children (girl of 6 years and boy of 16 years) to have a normal childhood where they played freely outside without any fear of getting hurt of being involved in any unsocial actions. This is because I thought getting hurt while playing is simple and need in life to help the children be prepared for dealing with pain. However, on analysing the childhood experience of my cousin’s children who lived in a densely populated area it was seen that the children were mostly allowed to remain indoors. This is because my cousin fear that getting hurt while playing outside could lead the children to experience unnecessary trauma and pain which they would not be able to manage and needed not required to be processed in such a small age of 5-6 years. The other experience faced by me regarding childhood of my children is that I along with my husband were and is currently highly responsible and mutual in making time like John and Maria in the case study to look after both the children even one reached 16 years of age. This is because we though it is the duty of the parent to manage the children from all aspect until they reach minimum 18 year of age. However, in one of my neighbour’s case, who were real and direct parents to the children, I found that they acted similar to the ex-wife of John and her partner by avoiding taking care of the children much after they reached the age of 12 years. They were usually found to leave their children in the house to remain socially active with their friends.
The article by Darbyshire (2007) mentioned through one of the themes that the death of childhood has occurred as currently more support towards indoor play is provided to the children compared to letting them play outside. This is because people are thinking “indoor child” to be good and responsible while “outdoor child” to be a symbol of social threat for others. The statement mentioned by Darbyshire (2007) is true because in the UK it is seen that currently children are playing outside on an average of 4 hours compared to their parents who spent a minimum of 8.2 hours outside for playing when they were children (childinthecity.org, 2018). Moreover, it is not only limited to UK but also in Seattle, US where it is mentioned that 50% of the pre-schoolers lacked parent-supervised outdoor activity in play session each day. However, the reason for the statement mentioned by Darbyshire (2007) is not agreed. This is because I think the children are avoided to play outdoors due to lack of access to enough playground and resources and not due to the thought that playing outdoor is vulnerable for them or make them have inappropriate interaction. It is evident as in the UK, it is reported that at least one public playground in the locality is closed each week and there has been 44% decrease in the funding for arranging outdoor safe playgrounds for the children (API, 2019). In another recent study by Nursery World, it is mentioned that 3/4th of the parents are reporting lack of adequate playground is leading them to make their children remain confined in home and play indoor than outdoors (Gaunt, 2019). Thus, it can be seen that the environmental situation is leading children to remain play indoors and lose their childhood and not due to the thought that outdoor play activities are harmful or make the children become symbol of social threat.
The attachment theory is essential concept to be understood by the children’s nurses because it leads them to determine the bond present between the children and their parents with whom they are emotionally related from the birth. Moreover, it is essential for them to understand the concept regarding the way attachment with parents leads to development of secured and safe feeling among the children. In addition, attachment theory is essential to be understood by the child nurses so that they can predict how a child is going to react in care only from a stranger and a stranger accompanied by a familiar individual who is their parent or carer. It leads the nurses to realise the importance of involving the parent with them in caring for the child rather than caring alone for the child (youtube.com, 2009; Crittenden, 2017).
The work of Bowlby and Robertson created great influence in the field of children nursing by explaining the importance of parents to be directly and actively involved in planning and implementation of care for their child. This is evident from the Bowlby’s first major study, where 14 affectionless children who were brought for psychiatrist treatment due to being thieves. Bowlby’s identified that 12 of these 14 children suffered prolonged separation from their parents due to hospital admission in the early years that led them to become affectionless out of the lack of required love they required during the early stage. Bowlby mentioned that children before 6 months of age and after 3years if separated from them their parents have least detrimental impact on the minds of the children but within this age group it is essential that they remain close to their parents. This is because during this age the children develop the most urge and need of close affection and love from their parents to grow. Robertson also concluded the importance of parents to be present in caring for children by reviewing the children under care during the World War where their parents are forced to leave them to participate in the war. It was mentioned by Robertson that children in company with their mother expressed better health performance and less psychological trauma compared to those who were separated from their parent. This research information led the staffs and management in the hospital understand the importance of presence of parents with their child during hospitalisation and normalised the routine of active involvement of the parent in caring and planning care of the children in hospital (Alsop-Shields & Mohay, 2001).
The innovation in the care of the sick children and adolescent in the study Alsop-Shields & Mohay (2001) will influence the care of Sophie while being hospitalised for treatment regarding bronchiolitis in the way that her mother Anna will be allowed to stay in the hospital by her side to provide her care. Moreover, her mother Anna would be communicated by the nurses caring for Sophie to decide the plan and direction of care in collaboration with the nurses that would be most suitable for her speedy recovery. The Children Act 1989 mentions that the parents are to be communicated on behalf of the child to access valid consent for treatment which are in the best interest of the child (legislation.gov.uk, 1989). Thus, the law is to be followed to consult with Anna to have valid consent in delivering care to Sophie while in the hospital. The Health and Social Care Act 2008 mention that families are to be included in deciding care for the patient for their health and well-being (legislation.gov.uk, 2008). In this context, Anna is to be legally included by the nurses caring for Sophie to decide the care to be delivered to her by consulting with her mother (Anna).
The role of the child nurses includes administration of direct healthcare procedures and medicines mainly to the children from birth to below 18 years of age according to the prescribed care plans (Lines et al., 2017). However, the adult nurses mainly have the role to provide treatment to people of any age group over the adolescent stage (Raymond et al., 2017). The child nurses also have the role to assess and observe the vital signs of the patients who are mainly children and develop communication with the family members and children to determine their medical care (Lines et al., 2017). However, the adult nurses have role to mainly communicate the adult patients in considering and understanding their needs and demand of care and at time the family member are involved in developing the care plan for the adult patients (Raymond et al., 2017)
The child nurses work alongside the health professionals like Paediatricians and Paediatric nutritionist to provide care and support to the children. The role of the Paediatricians is to screen, diagnose, prevent and manage health condition of young individuals as they are specialist in offering care and advice regarding health and illness of the children (Goulet et al., 2019). They enhance the work of the child nurses by informing them about the way each child is to be cared to ensure their well-being (Goulet et al., 2019). The role of the Paediatric nutritionist is to determine the diet to be referred to the children as per their health condition to meet their health needs and demands to make them become healthy (Chiara et al., 2020). They enhance the work of the child nurses by informing them about the nutritious food to be provided to the children and in what amount to ensure the well-being of the children and make them healthy (Chiara et al., 2020).
The philosophy of Children’s Nursing is mentioned in the website of the Royal College of Nursing (RCN). The benefit of philosophy of Children’s Nursing is that it acts as a framework for the nurses to determine the responsibility of care to be taken by them and goals of care to be met for the children in appropriate manner (RCN, 2019). One of the philosophy of Children’s Nursing is that the right of the children is to be respected. This is to be done by providing them appropriate information regarding care as per their age and understanding so that they can make informed participation and provide informed consent regarding their care (RCN, 2019). This indicates that the child nurses caring for Sophie are to inform the care to be provided according to her level of understand and age. This is required to make her feel involved in taking decision for own care apart from her mother which would also indicate value toward her opinion, in turn, making her feel respected out of being valued.
Family is referred to group of one or more parents who are living with their children as a unit in the society (Wikle and Hoagland, 2020). There are different types of family like nuclear family, extended family, step family and others. The traditional family is one in which two parents and their own children are present (Almulla and Polimeni, 2020). John and Maria with their child Daniel is regarded as a nuclear family. The extended family is the one in which two or more adults are living in the same linked either by marriage or by blood with the relatives present in the family home in supporting them to raise children (Wikle and Hoagland, 2020). The step-families are one in which separate families merge together to live as a unit (Almulla and Polimeni, 2020). For example, the family of John's ex-wife is a step-family to her partner who is not directly linked with the children of John's ex-wife but is living with her and her two children Abigail and Matthew.
The understanding of the family influences the care given to children by the child nurses in the way that the nurses understand which individuals in the family are to be interacted and involved in direct care and decision making of care plan for the children to ensure her enhanced health and well-being (De Massis et al., 2018). For example, in case of Abigail, it is seen that she is still directly in contact with her biological father John who is concerned regarding her health. In this situation, the understanding of the family condition would lead the child nurses to understand that it is better to involve John rather than partner of John's ex-wife in care decision making for Abigail. This is because the child nurse understand that Abigail is closer to her biological father rather than her mon’ partner who does not take care of her or show concern regarding her health.
The key points made by the parents when their children are in hospital for care are as follows: They mention the staff are to know and be sensitive to the different family structure the child belongs to and according plan the care to provide the children so that it fits to ensure their improved health and well-being (youtube.com, 2011). All the aspect of the family is to be considered in delivering care to the child as they are integral part of the family which mean that all the family member’ views are to be considered in deciding care for the child (youtube.com, 2011). The care to be provided to the child is required to create long-term benefits for them to ensure they have an enhanced health and well-being in the progressing life with age. The staffs are required to avoid looking down on the parent and require empowering the parent to feel hope in creating positive intervention for the child to ensure them better future health (youtube.com, 2011). The parents are to be effectively consulted in deciding care for the child as they think they know the best for their children (youtube.com, 2011). The parents are to be allowed to make query regarding their child’s care to understand what is been executed and determine whether or not it would benefit the health of the child (youtube.com, 2011).
The interpretation of the information entered for Abigail is that she has BMI weight of 26.7 which indicate that she is overweight according to her weight and stature.
In the case of Abigail, regarding her weight she along with her family is required to focus on her intake of healthy diet and inclusion towards performing physical activity to shed the extra weight to become normal. This is because healthy eating helps to avoid addition of extra fat in the body and physical exercise helps to shed the extra weight by creating demand of energy in the body (Poti et al., 2017). In regard to constipation, Abigail is to be asked to drink increased amount of water. This is because constipation develops due to dehydrated stare of the body as a result of lack of drinking of enough water (Boilesen et al., 2017). She is to be advised to drink at least 8 glasses of water each day (Boilesen et al., 2017).
The consequence of overweight would be that she would become obese and develop risk of additional health issues such as diabetes, cardiovascular disorder, high blood pressure and others at an early age (Chu et al., 2018).
The discussion in the video and audio clips led me to understand that unhealthy eating that is avoiding vegetables and depending on fast food along with lack of physical exercise is mainly responsible in all cases for the rise of weight. The individuals mention that developing health eating accompanied by simple exercise such as walking, running and others are helpful in reducing extra body weight. They mentioned gradual setting of goals to progress in executing physical activity helped them in losing weight (healthtalk.org, 2019). This helps me regarding Abigail to understand that way she is to be motivated to perform physical activity and helps me to use the information in the clips as evidence to be used to influence her in avoiding unhealthy eating to have better health and achieve normal body weight.
API 2019, Children are indoors too much and need more playgrounds, say parents, Available at: https://www.api-play.org/posts/children-are-indoors-too-much-and-need-more-playgrounds-say-parents/ [Accessed on: 2 March 2021]
childinthecity.org 2018, Children spend half the time playing outside in comparison to their parents, Available at: https://www.childinthecity.org/2018/01/15/children-spend-half-the-time-playing-outside-in-comparison-to-their-parents/?gdpr=accept [Accessed on: 2 March 2021]
Gaunt, C., 2019. Parents blame lack of playgrounds for child health problems, Available at: https://www.nurseryworld.co.uk/news/article/parents-blame-lack-of-playgrounds-for-child-health-problems#:~:text=The%20lack%20of%20outdoor%20play,children%20who%20have%20problems%20sleeping. [Accessed on: 2 March 2021]
Alsop‐Shields, L. and Mohay, H., 2001. John Bowlby and James Robertson: theorists, scientists and crusaders for improvements in the care of children in hospital. Journal of advanced nursing, 35(1), pp.50-58.
Crittenden, P.M., 2017. Gifts from Mary Ainsworth and John Bowlby. Clinical Child Psychology and Psychiatry, 22(3), pp.436-442.
legislation.gov.uk 1989, Children Act 1989, Available at: https://www.legislation.gov.uk/ukpga/1989/41/contents [Accessed on: 2 March 2021] legislation.gov.uk 2008, Health and Social Care Act 2008, Available at: https://www.legislation.gov.uk/ukpga/2008/14/contents [Accessed on: 2 March 2021]v v v
Lines, L.E., Hutton, A.E. and Grant, J., 2017. Integrative review: nurses' roles and experiences in keeping children safe. Journal of advanced nursing, 73(2), pp.302-322.
youtube.com 2009, The Strange Situation - Mary Ainsworth, Available at: https://www.youtube.com/watch?v=QTsewNrHUHU&feature=youtu.be&ab_channel=thibs44 [Accessed on: 2 March 2021]
Chiara, F., Maria, B., Laura, D., Sandra, R., Leopoldo, S. and Giovanna, A., 2020. The case/care manager in eating disorders: The nurse’s role and responsibilities. Acta Bio Medica: Atenei Parmensis, 90(Suppl 11), p.17.
Goulet, O., Hojsak, I., Kolacek, S., Pop, T.L., Cokugras, F.C., Zuccotti, G., Pettoello‐Mantovani, M. and Fabiano, V., 2019. Paediatricians play a key role in preventing early harmful events that could permanently influence the development of the gut microbiota in childhood. Acta Paediatrica, 108(11), pp.1942-1954.
Raymond, A., Lee, S.F. and Bloomer, M.J., 2017. Understanding the bereavement care roles of nurses within acute care: a systematic review. Journal of clinical nursing, 26(13-14), pp.1787-1800.
RCN 2019, Paediatric nursing: a philosophy of care, Available at: https://journals.rcni.com/nursing-standard/paediatric-nursing-a-philosophy-of-care-ns.6.48.32.s39#:~:text=Respect%20the%20right%20of%20children,in%20decisions%20about%20their%20care. [Accessed on: 2 March 2021]
Almulla, M. and Polimeni, B., 2020, May. Conceptual Drawings as Explorative Tools: Tracing the Evolution of the Extended and Nuclear Family Houses in Kuwait. In INTERNATIONAL SYMPOSIUM: New Metropolitan Perspectives (pp. 384-395). Springer, Cham.
De Massis, A., Frattini, F., Majocchi, A. and Piscitello, L., 2018. Family firms in the global economy: Toward a deeper understanding of internationalization determinants, processes, and outcomes. Global Strategy Journal, 8(1), pp.3-21.
Wikle, J.S. and Hoagland, A., 2020. Adolescent interactions with family and emotion
youtube.com 2011, Family Centred Care at The Children's Hospital at Westmead, Available at: https://www.youtube.com/watch?v=rxiswGvZxZQ&feature=youtu.be&ab_channel=CHWPartnershipPFCC [Accessed on: 2 March 2021]
Boilesen, S.N., Tahan, S., Dias, F.C., Melli, L.C.F.L. and de Morais, M.B., 2017. Water and fluid intake in the prevention and treatment of functional constipation in children and adolescents: is there evidence?. Jornal de Pediatria (Versão em Português), 93(4), pp.320-327.
Chu, D.T., Nguyet, N.T.M., Dinh, T.C., Lien, N.V.T., Nguyen, K.H., Ngoc, V.T.N., Tao, Y., Le, D.H., Nga, V.B., Jurgoński, A. and Tran, Q.H., 2018. An update on physical health and economic consequences of overweight and obesity. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 12(6), pp.1095-1100.
healthtalk.org 2019, Health and weight (young people), Available at: https://healthtalk.org/health-and-weight/overview [Accessed on: 2 March 2021]
Poti, J.M., Braga, B. and Qin, B., 2017. Ultra-processed food intake and obesity: what really matters for health—processing or nutrient content?. Current obesity reports, 6(4), pp.420-431.
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