CHILD INSIGHT:
INTRODUCTION:
I spent the day in Nuclear Medicine, so that I could gain an experience into children’s nursing. The Staff were expecting a few children in today for investigations. The Patient that I have chosen is a 15 year old female, whom I have given the name of Jo to guard against confidentiality, in accordance with the code of professional conduct (NMC 2002.)
Jo had been suffering with increased intermittent severe pain at one anterior aspect of the 11th and 12th rib since August 2002 – so she was here today to have a bone scan.
There are no single or correct ways in which you should treat/communicate with a child. A nurse should develop sensitivity to the nature of each child’s individual characteristics and relate them to the child’s own world. All children behave and communicate differently in the presence of different people.
Children under 2 years are best communicated through their parents. Children under 7 cannot see a link between medical procedures and cure. They also find it hard to imagine internal mechanisms in the body; they are only interested in what they can see on the surface. For children under 9, it is best to communicate with explanations which can be related to what they can see and touch with help from parents too. Over 12 year olds show concern for internal disease processes they are capable of imaging the sinister implications of pain. They would usually appreciate an opportunity to discuss such worries and should be encouraged to do so, (Taylor et al 1999 p64)
Jo has come in with both her parents and as she is 15 she is classified as being an adolescent. Adolescences is said to begin at the start of puberty, as stated by Wilson and Waugh (1999 pg 428.) “The age of puberty varies between 10 and 14 years and a number of physical and psychological changes take place”– see appendix 1. As stated by Fergusson et al (1998 p8) “Adolescence is the period of development between childhood and adulthood,” It is important when caring for an adolescent that you give them privacy and ensure they can socialise with peers. Trust is an essential part of communication and this is what has to be gained when looking after them.
BONE SCAN WITH ADOLESCENT:
Jo’s appointment in Nuclear Medicine was at 9.15 am. She sat in reception with her mum and dad and looked a little nervous, which was probably due to the unfamiliar surroundings, different environment and being anxious about the scan. My main clinical skill used is communication. Dennison maintains that “communication with a young person requires the same skills as with any patient, putting the patient at ease, active listening, open-ended questions, giving enough time for replies”, (1998 p552).
It is important that any Nurses or health professionals introduce themselves so that the patient can gain a little trust in the relationship with the staff. According to Hathaway et al (1993 p87) “to establish a comfortable and trusting relationship the physician should strive to present the image of an ordinary person who has special training and skills”. According to Dennison (1998 p552) “they also need to be aware that trust has to be established if their advice is to be accepted”. The Sister and I introduced ourselves and took Jo through to the room, who was accompanied by her mother. Preparing the environment prior to starting any intervention can help to reduce any anxiety regarding the procedure – e.g. drawing up injection before the child comes into the room. We needed to weigh her so we knew how much radioactive solution she would need.
I asked Jo if she knew what a bone scan entailed and explained any parts that she did not fully comprehend. By talking to her directly, this immediately identified an interpersonal relationship with her. I needed to ask her if she was pregnant or breast feeding, and so I showed her the question rather than saying it aloud. This gave her some confidentiality, which is very important when dealing with adolescents. Dennison (1998 p552) has stated that “young people need clear assurances that their parents will not be told about the contents of their consultation”. It was a very important question to enquire about as we needed to put a radio active solution into the body in order for the bone scan to work.
I asked Jo which arm she would prefer having the injection in and she preferred her left, yet was not too keen on having it without a local anaesthetic. I got out Cryogesic (Ethyl chloride) spray, which numbs the area where the needle is going to go in. This spray does not have to be prescribed. The sister then put the tourniquet on the arm and put the butterfly needle in and injected the radioactive solution (MPD.) I then asked Jo to drink a litre of fluid and to come back in three hours time to have the scan – this is so that the injection can be taken up into the bones. Once she had had the injection she seemed much more comfortable.
Jo came back on time. I called her in for the scan, for which she came in alone. I explained to her that it would involve her lying very still on a bed and that a camera would move over her body slowly, but would be very close to her. She seemed happy enough and I asked her whether she had any further questions, to which case she replied no. It has been shown by Hathaway et al (1993 p87) that “in communicating with an adolescent, the physician must be especially sensitive to the patient’s developmental level, recognising that physical appearance and chronologic age may not give an accurate assessment of cognitive development. Talking to a teenager as a child or, at the other extreme, as an adult, may interfere with communication and cause the patient to lose confidence in the provider”. This did not happen, Jo appeared to be happy with how she was being spoken to and this was shown by her verbal responses and her body language which I observed. The scan lasted 15 minutes. Jo was very brave, lying still and did not appear frightened or distressed.
I learnt a lot from this experience, especially about how to talk to an adolescent, treating her as a young adult. I gained trust by introducing myself clearly and in maintaining confidentiality. The way to communicate with adolescents is by using clear language with no medical jargon and in giving them time to ask questions if they wished to. I also learnt that a lot of health professionals are not familiar with a young person’s vocabulary. According to Campbell and Glasper (1995 p136) “Prying and asking embarrassing questions should be avoided.” More often than not adolescents reveal their own feelings or bring any concerns up by asking questions to the health professional.
I feel this will help me in my nursing care towards adolescents in the future, as they could come on to any adult wards in the future. This will give me a better understanding of how to communicate with them.
I confirm that this care summary relates to an individual cared for in this placement by_________________ (your name)
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REFERENCES:
CAMPBELL S, GLASPER E A (1995) Whaley and Wong’s children’s nursing. Barcelona: Mosby.
DENNISON C (1998) Get through to the young. Practice Nurse. 20th Nov. 16(9) p549-53
HATHAWAY W, HAY W, GROOTHUIS J AND PAISLEY J (1993) Current pediatric diagnosis and treatment. 11thed. East Norwalk: Appleton and Lange.
NURSING AND MIDWIFERY COUNCIL (NMC) (2002) Code of professional conduct. London: NMC.
TAYLOR J, MULLER D, WATTLEY L AND HARRIS P (1999) Nursing children psychology, research and practice. 3rd ed. Cheltenham: Stanley Thornes Ltd
WILSON K AND WAUGH A. (1999) Ross and Wilson anatomy and physiology in health and illness. 18thed. Edinburgh: Churchill Livingstone.
FERGUSSON R, MARTIN E, STIBBS A, McFERRAN T (eds) (1998) Oxford dictionary of nursing. Oxford: oxford university press.
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