Assignment: Application of Pediatric Growth and Development Essay

Assignment: Application of Pediatric Growth and Development Essay

Assignment: Application of Pediatric Growth and Development Essay

The patient who has been selected for this research paper is John, an eleven-year old child, admitted to the pediatric ward due to dehydration secondary to gastroenteritis. The patient had been in the unit for one day. However, the nurses were having difficulties in administering medications to him. According to them, John is afraid of needles. He cries loudly whenever a nurse with a needle approaches him. He also ran out of the unit when he was informed that he was to receive due medications. The nurses also reported that he is highly anxious whenever he sees any healthcare staff in his room. John’s behavior has affected the care he is receiving since he missed intravenous medications in the morning due to his fear of needles alongside healthcare providers dressed in hospital attire.

Needle phobia is one of the problems that are witnessed among children and adolescents visiting institutions of healthcare. According to Orenius et al. (2018), needle phobia is the fear of transfusions and injections. Statistics shows that approximately 3.5 to 10% of the population is affected by it. Needle phobia decreases with increase in age. However, it remains the most diagnosed problem among children (19% in those aged between 4 and 6 years and 11% among those aged between 10 and 11 years) (Orenius et al., 2018). Needle phobia presents a significant dilemma to the healthcare providers since it violates the principle of doing no harm or suffering to the patient (Karlsson et al., 214). Therefore, it increases the need for the adoption of interventions that would minimize or eliminate the phobia, hence, the selection of this child.

According to Erickson’s theory of development, individuals go through eight stages of development. They include trust versus mistrust (birth to 12 months), autonomy versus shame and doubt (1-3 years), initiative versus guilt (3-6 years) and industry versus inferiority (6-12 years). It also includes identity versus role confusion (12-18 years), intimacy versus isolation (20-40 years), generativity versus stagnation (40-60 years), and integrity versus despair (above 60 years) (Dunkel & Harbke, 2017). John is in the industry vs. inferiority stage of Erickson’s theory. According to Erickson, this stage of child development is characterized by the child comparing himself with their friends or peers and sees how he measures up. The child can either be self-confident and have pride or feel inferior to others if they do not measure up to their expectations. The child develops pride as he accomplishes most of their aspirations such as sports, family life, and academics. The child will develop low self-esteem if he perceives that he does not measure up to the level of the peers. Therefore, inferiority complex might arise if the child continues to have repetitive negative experiences as they interact with the peers.

Social interactions play an important role in this stage. A child learns to interact with others and feels proud of his accomplishments. He develops a strong self-concept if he/she develops the needed competencies in undertaking their expected roles. Specific aspects should be considered in the child’s learning environment to facilitate successful transition in this stage. One of them is praising the child on small accomplishments and giving the attention he needs in undertaking activities such as reading, solving problems, and drawing. Teachers and parents should also not equate acceptance as well as love to achievement. Instead, unconditional support should be offered to children who experience the challenge of inferiority complex.

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Erickson identified in his theory that the first stage of one’s development is referred as trust versus mistrust. This period begins at the time of birth and ends when a child reaches 1 year. The children interact with their environment and learn to trust their parents. Trust develops when his or her fundamental needs of survival are met. This stage demands that the caregivers demonstrate significant

sensitivity and responsiveness to the needs of the infants, as a way of developing their trust. Erickson discovered that mistrust arises when the caregivers become insensitive and unresponsive to the needs of the infants. Such behaviors make the infants become anxious and fear the adults they interact with in their environment (Kropf & Greene, 2017). John appears to have mistrust issues based on the behavior he shows towards the nurses. He does not trust in the care that they provide him in the institution. The lack of trust implies that his early childhood stage might have failed to build his trust towards adults. The type of play activities that a child should engage in during this stage include talking and singing to him, responding to his vocal expressions, and offering colored age-appropriate toys for play.

The second stage of child’s development according to Erickson’s theory is autonomy versus shame and doubt. This stage begins when the child is one year old and ends at three years. The child learns to achieve independence. H/she struggles to do most of the activities for him/herself. Children develop confidence if they navigate this stage successfully. However, self-doubt arises when the child fails to develop the needed independence in becoming initiative. Parents should promote successful navigation of this stage through encouraging the child to engage in activities such as toilet training and enabling them to have control over toy preferences, selection of clothes, and food choices. They should also demonstrate faith in the abilities of their children as a way of building their sense of confidence and autonomy (Kropf & Greene, 2017). It can be seen from the case study that John demonstrates shame and doubt towards the nurses. He doubts them, and is therefore, not only fearful of the needle but also to the nurses too. Some of the play activities that the children can engage in this stage include toilet training, garden activities, and games that develop their imaginative abilities. It is important that parents communicate with the children in a non-judgmental manner to show that they understand their feelings. Children should also be encouraged to express feelings and assisted in the selection of choice of words that demonstrate respect and cultural awareness.

The other stage according to Erickson’s theory is initiative versus guilt. This stage begins at three years and ends at six years. A child develops a sense of control over their world in this stage. Play and social interactions influences the child’s abilities of being assertive in this phase. Children should have the abilities to plan as well as achieve goals in their social interactions in the school. Children who demonstrate self-planning activities navigate this stage successfully and become initiative, ambitious, and responsible. They also become self-confident and have a better understanding of the sense of purpose in their lives. However, children who become unsuccessful develop feelings of guilt (Greene, 2017). John appears to have unsuccessfully navigated this stage. He fears the needles and healthcare providers, which demonstrate a lack of self-confidence, mistrust and guilt. Some of the play activities the child can engage in this stage include sensory exploration with sand and engaging in creative arts such as painting for the development of fine motor skills. Parents should be non-judgmental in their communication. They should help the children understand their abilities. They should also acknowledge the progresses their children make.

Industry versus inferiority is the other stage of Erickson’s theory of development (6-12 years). The child compares their abilities with those of their friends in their learning environment. The self-comparison determines whether the child becomes proud of his/her accomplishments or feels inadequate and inferior to others. Inferiority complex might develop due to continuous or repetitive exposure to negative experiences. The consequences of such exposure include feelings of shame, fear, guilt, and mistrust towards others (Greene, 2017). John appears to experience inferiority issues. He does not trust the healthcare providers. Therefore, it is essential that play activities such as exposure therapy to the things he fears is provided. Social interactions should aim at building the child’s self-worth and esteem. Non-judgmental communication should be used at home and schools to foster feelings of pride and accomplishments. Lastly, social interactions should focus on competency development rather than competition among the peers.

The other stages of development according to Erickson’s theory are identity vs. role confusion, intimacy vs. isolation, generativity vs. isolation, and integrity vs. despair. The identity vs. role confusion stage is characterized by the child trying to develop a feeling of self. Intimacy vs. isolation stage mainly focuses on forming successful relationships. Generativity vs. stagnation entails the adults finding the purpose in the society and contributing to others’ development. Integrity vs. despair is the last phase where adults reflect their lives and either become proud of their accomplishments or regret them. Therefore, it determines the manner in which one ends his or her life. One is likely to end life a bitter person if the life goals were not achieved.

Nursing Diagnosis

Fear of the unknown as evidenced by patient’s nervousness on seeing nurses and tearing on seeing needles.

Goal

To help alleviate patient’s fear towards the nurses and needles within three days of the child’s stay in the unit

Interventions Planned

The interventions that were planned included role-playing, distraction, and desensitization

Actual implementation of Interventions

1. Role-playing- I role-played with the child on the roles of a nurse in administering injections and handling of toy needles. I used this approach to reduce the child’s anxiety during the actual administration of medications.
2. Distraction- I engaged the child in activities that diverted his attention while the medication was being administered. This included asking questions such as those related to their favorite food, songs, and teachers.

• Desensitization- the use of this approach entailed assisting the child to understand the situations leading to his anxiety, training him on relaxation during injection, and desensitizing the previous experiences by reinforcing positive behaviors.

Patient’s Response to Play

The patient was highly involved in role-playing. He expressed significant interest in holding the toy needles and demonstrating how the nurses have been injecting him. He also participated in injecting some of the nurses in the unit using the needle toys.  The patient was happy to engage in the play and it helped him in managing his fear towards the needle and nurses. The use of distraction was also effective. The child was participative in singing his favorite songs during the administration of medications. This helped him in diverting his attention away from the injections and the nurse. The use of desensitization was not effective. The patient was not ready to engage in reflection and using it to address his fear. The ineffectiveness of this approach could have been due to his age.

Evaluation

The patient was able to tolerate needle injections and nurses by the end of three days. He was able to communicate with the nurses without fear. His level of anxiety during the administration of medications was also reduced. The nurses reported that they were finding it easy for them to administer medications since parental involvement was minimal. Therefore, I believe the interventions were effective. The use of desensitization as a play of managing needle fear should explored in relation to use in pediatrics.

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