THERAPEUTIC INTERPERSONAL RELATIONSHIPS

WITH CHILDREN ADOLESCENTS AND THEIR FAMILIES

NU2061 AssignmentBy

Courtney O’Shea 114339736Uchechukwu Ogbene 114302291

Emily Campbell 11443357823rd September 2015

How do you establish a therapeutic relationship with Sean and his family?

IDENTIFY SEAN IN THE LIFE SPAN MODEL

• 10- 19 yrs.• marked by normal growth &

development of secondary sex characteristics

Development tasks and motivation

SELFIMAGE - acceptance by schoolmatesSEXUALITY – reluctant to share personal issues with nurseIDENTITY – Independence

NOT MEETING Privacy, trust and clear & distinct boundaries leads to conflict within age group

Reaction: Rebellion(Erikson, 1963 cited in Antai-Otong & Wasserman, 2003)

applied to any life-changing situation, not just death•Sean & death of friend•Family’s grief to diagnosis•Assess coping

congenital diseases and mental health issues

Family Stress model(Conger and Collegues, 2000)

Blaming,Argumentativeness

Ill child&

uncooperativeness

Anxiety,fear,guilt

congenital diseases and mental health issues…Contd. Avoid personalising stress reaction, display empathy &

understanding, and set limits.

Establish Therapeutic Relationship with Sean

Empower and ease apprehension

• Provide options and choices about treatment and care.

• Including him in planning of care

• updating him in all aspect of care

Health education programme for the self management of medical condition.• Promotes independence, self

efficacy, lower morbidity (Antai-Otong & Wasserman, 2003).

Patient centred care Establish early forms of

interaction with him to build trust, security and safety

• effective & age appropriate communication skills. Be a friend to Sean

•Listen to and honor his perspectives and choices. -Strengthens Dignity

&Respect(Schlucter, 2014)

• Develop friendship through, humour, play and bibliotherapy

FAMILY CENTERED CARE

proactively involvement in decision-making process

• Improved family satisfaction when needs are anticipated and supported (Schlucter, 2014).

Care Core Concept Build a level of transparency about the process,sharing information

and Communication that are affirming and useful. • Reduces anxiety and stress• Builds trust between family and nurse

Creating a Healing Environment

Building rapport through simple nurse action

•“hello, Good Morning!!!!!”

• Giving family caregiver time off for hobby

• The nurse bringing food to the patient instead of the HCA

Recognizing & acknowledging emotional, social and financial disorder

• Initiating therapeutic communication at stressful moment

what are the verbal and non-verbal skills you will use in the interactions?

Cool!! awesome!!

Egan’s SOLER model for non-verbal communication

• Reciprocity: Taking turns – interest & engagement. Implementing silence

Empathy, understanding, caring, pain, and distress all involve communication, and non-verbal behaviours are the main ways to communicate caring (Walker et al, 2007).

Effective eye contact convey interest, engagement, certainty and high self-esteem.

• Fixed eye contact – uncomfortable & threatening.

• Body posture and gesture: Leaning forward signals interest and engagement ( Caris- Verhallen et all. 1999).

• Personal, social and public space

• Facial expression indicates the emotional state of the individual- joy distress, fear.

Q3 What barrier to effect communication do you need to focus on to help this family?

barriers problems solution

New nurse on ward

“inexperienced”

Young- relatable

Lack of trust Questioning nurses

competency

Trust building exercises for

Sean & family

Sean resisting care

Causes health risks and family to panic

reminding Sean through therapies, the importance of treating his CF

Therapies available to build trust and acceptance of treatment

Play therapyUsing play to comfort Sean’s fears regarding transplant and the death of his peer.Play intervention therapies have shown results of improving child’s opinion of transplants and given child realistic goals and achievements (gold et al, 2014).

Bibliotherapy [proven positive effects on child’s behaviour (Montgomery, P & Maunders, 2015).

What community supports is available for this family?

financial emotional

Activities

Taking the focus from Sean’s illness and targeting his life and activities of daily living

Yes, taking medication and receiving treatment is an element of his daily life but it doesn’t have to be the only one…..

Exercise Grant Scheme The purpose: provide financial assistance to PWCF for gym membership fees, purchasing exercise equipment, fitness lessons etc (Cystic Fibrosis Ireland)

Facilities in cork

Mardyke arena personalised gym program?

Gaa clubs

Music lessons

Leisure plex

Transplant Assessment/Review and Transplant Grant Scheme

assistance towards incidental expenses (accommodation, meals and transport) incurred to members and their families who must travel for transplant assessment, transplant and follow-up phases(Cystic Fibrosis Ireland).

CF Ireland offers a counselling referral service to members who wish to speak with a professional outside of the hospital environment to work through their concerns and difficulties(Cystic Fibrosis Ireland).

SOCIAL AND DISTRESS SCHEME

GRANT: provide financial assistance to CF patient representatives to attend and participate in Cystic Fibrosis specific conferences and training courses.

http://anamcara.ie/

How has this family adapted to Sean’s situation?

Adapting to medication regimen

parents learn to integrate their child’s intensive treatment and daily care into their everyday lives and family routine (Hodgkinson and Lester, 2002).

Positive approach

Sean Cystic fibrosis

Cystic fibrosis

Sean

Getting help

•CF team and Cystic Fibrosis Ireland are sources of information

•Nurse practitioners assist with transplant anxiety,

not to over-protect still normal child who happen to have CF. Consequently they will be naughty sometimes

Managing Work

dad

schoolingsister

Q7 What role do the media play in how adolescents are perceived, if any?

Portrayal of Chronic illness: disability

mental health

Self-image

Power of Advertising

overweight 

Social media

Q 8 What role can Children’s nurses play in promoting the rights and needs of this family?

NURSE ADVOCATE: Advocating for children’s rights and their families rights

NURSE EDUCATOR NURSE ADVICER NURSE fACILITATOR

CONCLUSION

Knowledge of the life span model, family structure and patient & family centred care contribute to a therapeutic relation with patient and family.

Andersen, C, & Dolva, A 2015, 'Children's perspective on their right to participate in decision-making according to the United Nations Convention on the Rights of the Child article 12', Physical & Occupational Therapy In Pediatrics, 35, 3, pp. 218-230, CINAHL Plus with Full Text, EBSCOhost, viewed 1 October 2015.

Cystic Fibrosis Ireland (2014) Grants & Support Services For People with Cystic Fibrosis

Cystic Fibrosis Ireland (2014) A GUIDE FOR PARENTS OF CHILDREN DIAGNOSED WITH CYSTIC FIBROSIS

Gold, K, Grothues, D, Jossberger, H, Gruber, H, & Melter, M 2014, 'Parents' Perceptions of Play-Therapeutic Interventions to Improve Coping Strategies of Liver-Transplanted Children: A Qualitative Study', International Journal Of Play Therapy, 23, 3, pp. 146-160, CINAHL Plus with Full Text, EBSCOhost, viewed 1 October 2015.

Lerret, S, Transplantation& Stendahl, G 2011, 'Working together as a team: adolescent transplant recipients and nurse practitioners', Progress In, 21, 4, pp. 288-298 11p, CINAHL Plus with Full Text, EBSCOhost, viewed 13 October 2015.

McCullough C., & Price J. 2011) 'Caring for a child with cystic fibrosis: the children's nurse's role', British Journal Of Nursing, 20, 3, pp. 164-167

Montgomery, P, & Maunders, K 2015, 'The effectiveness of creative bibliotherapy for internalizing, externalizing, and prosocial behaviors in children: A systematic review', Children & Youth Services Review, 55, pp. 37-47, CINAHL Plus with Full Text, EBSCOhost, viewed 1 October 2015.

Quittner, A, Goldbeck, L, Abbott, J, Duff, A, Lambrecht, P, Solé, A, Tibosch, M, Bergsten Brucefors, A, Yüksel, H, Catastini, P, Blackwell, L, & Barker, D 2014, 'Prevalence of depression and anxiety in patients with cystic fibrosis and parent caregivers: results of The International Depression Epidemiological Study across nine countries', Thorax, 69, 12, pp. 1090-1097

Schlucter, J 2014, 'Patient- and Family-Centered Transitions From Pediatric to Adult Care', Pediatric Nursing, vol. 40, no. 6, pp. 307-310 4p.

Sheehan, J, Hiscock, H, Massie, J, Jaffe, A, & Hay, M 2014, 'Caregiver Coping, Mental Health and Child Problem Behaviours in Cystic Fibrosis: A Cross-Sectional Study', International Journal Of Behavioral Medicine, 21, 2, pp. 211-220 10p, CINAHL Plus with Full Text, EBSCOhost, viewed 13 October 2015

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References