Viewing Volume 6 Issue 1 Spring 2003
Stress:- As a result of loss of parental role.
Nursing has long been considered a stressful occupation and the NHS reforms, plus changes in the profession have produced constant and increasing pressures on nursing staff. Many of the stressors to which nurses are exposed are intrinsic stressors such as dealing with dying patients and death itself, (Cooper & Mitchell 1990) exposure to various medicinal and antiseptic substances; (Dionne 1990) shift work (Estryn, Behar, Fonchain, 1986), working with new sophisticated technology, (Fitter 1987) and physical factors such as unpleasant odours, warm temperatures, insufficient ventilation, (Lunn 1973) excessively high noise levels, ( Jacobson & McGraw 1983),communications with parents, (Armstrong 1994). Stress is defined as “an adaptive response, mediated by individual differences and/or psychological processes that is a consequence of any external (environmental) action, situation or event that places excessive psychological and/or physical demands on a person” (Ivancevich & Matteson, 1990). By this the author understands that stress is not determined by the event itself but by the way in which we respond to it.
Within a Paediatric High Dependency Unit (PHDU), stress, loss and communication are extremely closely linked. The fact that a child is admitted to P.H.D.U., for whatever reason, will cause inevitable stress to the family. The family’s routine becomes disrupted while much of their focus will be on a critically ill child. Parental stress and role loss is a normal and expected response and staff need to be aware of the effects that stress may have on parents. In order to identify and alleviate stress the nurse must be able to communicate effectively with both the child and family. Therefore, the communication skills of the nurse play a vital role in the care of the critically ill child and family.
Meads (1934) influential thinking about roles and symbolic interaction believed that knowledge of self and others develops simultaneously, both being dependant on social interaction, self and society represent a common whole and neither can exist without the other. One of the stressors for parents in P.H.D.U is role reversion, that is ‘giving up the role of parents of a well child and taking on the role of a parent of a sick child’ (Riddle et al 1987). This role reversion involves feelings of loss related to Bowlby’s theory of attachment (1973). Kolb’s (1984) cycle of learning comes into being with every admission to PHDU. The concrete experience, because each family involves the staff openly in a new experience. Observation and reflection which encourages staff to reflect and learn from the experience. The formation of abstract concepts enables staff to understand the observation and integrate them in sound theories. The future action plan enables the staff to plan cares to achieve satisfactory results, all these cycles interact with the roles in play throughout the child’s stay.
In order to communicate fully nurses must understand that each family is unique and therefore standardised family centred care may be inappropriate. The staff need to identify and meet the needs of the family on an individual basis, to allow the parents to alter their social relationships. Until the parents are able to alter their identity to fit their new roles, the stresses of a different socially constructed world are sometimes too great. At first they must ‘feel like fish out of water’ (Strawbridge 1993). But with support they adapt to their new role, the surroundings, and the machinery becomes less intimidating. They gain confidence in this role and participate more in the child’s care and gain an understanding of procedures which empowers them to communicate more. Human interaction, distance and closeness are highly relative to their role. By altering their role, stress is usually decreased, communication increased and a relationship formed. They have to shape their performance to fit into the space the unit leaves for them in that role.
The needs of each family differ and each require intervention to complement and enhance the parents coping strategies. One of these strategies is empowerment, as a social process of recognising, promoting and enhancing the parents abilities to meet their own needs; solve their own problems and utilise resources in order to feel in control of their own lives.
The mechanisms needed to cope with these consequences are far reaching and include the importance of regular information exchange; flexible visitation; good staff-parent communication; reinstatement of familiar parental roles; parent participation in cares, which all contribute to the recovery of the child and maintenance of the family unit.
Parents report that the hospital experience in itself is stressful, because they find it difficult to have a sense of power in a setting where practice is hierarchical and medical needs are the prime objective.
The consequences of family stress and loss may be subdivided. The initial boundary ambiguity which relates to the crises caused by the uncertainty of their child’s condition. This involves them understanding and seeking information on the child’s condition. The parents coping patterns, which shows their relationship with the ill child, siblings and each other. Most parents feel that participating in the child’s care is important and feel helpless when their parenting role is being fulfilled by nursing staff. Parents allow others to care for siblings, so as to normalise the siblings experience and provide mutual support for each other. The outside family resources relate to the external relationship with staff who are giving information and providing primary care. The functioning of the family as a whole is when the family struggle to maintain its boundary and keep itself as a unit.
Within a PHDU environment and regarding parental needs as an extension of caring for the child, stress is far from beneficial. This is encapsulated by a statement by Kasper and Nyamathi (1988) that ‘Children, parents and PHDU nursing staff members benefit when parental needs are met; parental role performance is enhanced, staff and parental stress are decreased and parent-staff relationships are improved’.
By:
Abridged version of an article by
Angela Trinder, March 1999.
VOLUNTEERS WANTED.
The Grief Centre – Manchester Area Bereavement Forum is looking to strengthen its management team by recruiting suitably experienced voluntary committee members.
We are based in East Manchester and a registered charity. MABF was formed in 1993 and has almost 100 members. The organisation is seeking people with management experience to join a fourteen strong committee. We are looking for people with good strategic skills, Knowledge of fund raising applications and who posses the knowledge and know how of running and developing the organisation.
The role within the organisation suits both the young career professionals looking to broaden their experience and the more mature executive looking to give something back to the community. Computer literate people with experience in marketing and event management would be especially helpful to us. It would be expected the non-executive members would give a minimum of ½ to one day per week.
For further information, contact: ‘The Grief Centre’ 0161-371-8860
Or e-mail us on: grief@mabf.org.uk
By:AT
Web Site: www.mabf.org.uk
New Book
A Candle for Lisa – by Debbie Ruskin
Lisa Ruskin was born prematurely with serious heart defects. Debbie later learned that Lisa’s organs had been retained by the hospital pathology department. This book is an account of the fight to discover the truth and to overcome grief.
ISBN 1 873378 78 5 £4.95.
By:SB
North West Child Bereavement Network
The North West Child Bereavement Network had a successful meeting held @ Francis House on 3/2/03. It was attended by 15 representatives from diverse areas of the north west who come in contact with bereaved children.
Our guest speaker was Joanne Oxton, Child Bereavement Manager for Central Manchester Children’s Hospitals who was involved in the impact of organ retention. She gave an informative presentation on ;
Why did it start?
What is organ retention?
Who is involved?
The role of The Retained Organ Commission and what the future holds.
These meetings have proved a good resource and educational support for all those involved.
The next meeting is 20th May 2003 @ Booth Hall Hospital Orthodontic Seminar room at 1pm.
If you wish to register an interest in this group please contact the office for further information.
By:AT
DIARY DATES 2003
Committee Meetings.
Thurs 20th Mar.
AGM Thurs 8th May.
All members welcome
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ANNUAL CONFERENCE
Friday 5th September 2003
‘Personal Traumas’
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