- Kathleen Gaule
Nicolls indicates that the psychological skills should be routine provision. Discuss this statement using a case study from clinical practice. Discuss the relevance of psychology and how it is applied and integrated into a case study. Identify the medical and nursing problems and the related pathophysiology to set the context of the case study. (1000 words.)
Psychological care refers to an approach of looking after the ill, (in this case also the parents) and should be integrated with nursing to provide an organised and practical psychological content to overall care. Krigger et al (2007). They also state it represents a big step towards meeting the requirements of truly holistic care. As mentioned it requires an organised approach with various skills and objectives and to deal with psychological issues arising from the event of illness. Firstly for psychological care there has to be an awareness. Secondly intervention and thirdly refer on if necessary for therapy. Nicolls states that it should be common provision’ in hospitals. He also states that common psychological reactions to illnesses include shock and even post-traumatic stress, confusion, distress and loss of self-worth, lowered self-control and even a collapse into dependency.
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Kevin (not his real name for the purposes of confidentiality) was a term +10 day baby. Spontaneous vaginal delivery. His birth weight was 3.2kgs. Apgar score was 9 at one minute of age and 10 at ten minutes of age. He cried at delivery, no resuscitation required just dried and suctioned. He was pink and given to mother for skin to skin. He was her first baby. At fifteen minutes of age baby was on the breast and sucking. All was well. At 30 minutes of age, mother’s partner noticed that the baby while still on the breast was not sucking and not breathing. He immediately called for help. The neonatal team came immediately. Cardiac massage was given, the baby was intubated and ventilated, and adrenaline 1:10,000 was given by three individual doses via the endotracheal tube. He was transferred to the neonatal unit. A team decision was made to start the baby on cooling as per cooling guidelines. Umbilical arterial and venous lines were inserted and he was commenced on morphine. Pancuronium (muscle relaxant) was withheld initially so the team could observe if there any abnormal movements. Continuous monitoring functioning was commenced. His mother Mary (not her real name) came down to the unit accompanied by her partner shaken and shocked at the fact that her baby had been taken away from her so suddenly. She went from euphoria the birth of her first baby a beautiful baby boy to a lifeless baby cold to touch in a cooling supported by a life support machine with bags of intravenous fluids, syringes and pumps. This for her was so surreal.
After initially explaining to Mary how we were actually nursing Kevin being continually aware that it was pretty much going over her head but as Drewery in his article states ‘repetition is the prime influence in memory’ None of the team at this point could actually tell her what had happened because we did not know. We as a team were also shocked as to what happened. We tried to internalise the situation. The baby was pink, was at the breast and sucking. What happened?
Each time Mary came to the neonatal unit she would spend long periods of time there sometimes on her own sometimes with her partner or family members. She appeared vague as if everything was going over her head and it was to a certain degree. Emotional and psychological care was paramount for her at this stage. By day four it was clear that Kevin would not survive without the ventilator, psychological preparation for that was of vital importance. Communication with the parents seeing exactly at what point each of them were at and bridging that gap. To build a bridge from where they were at that point and helping them cross that bridge metaphorically speaking where they needed to be without them falling. That was a huge challenge for us as a team. According to Egan (1998) Attending, Listening and Understanding are the three basics in communication skills. Attending which is being present for the person or persons. Listening which must be active listening as this will encourage the clients to talk and how they feel and what is going on for them at that present time. Egan (1998) also states we have to listen to nonverbal cues as very often as in this case the present was familiar (at least the baby was present) as opposed to the prospect of change. They appeared to have understood the consequences of withdrawing ventilation but their body language clearly stated they did not want it to happen
The bond of attachment had already formed especially with Mary. As Bowlby (1989) states ‘attachment is a close emotional bond between infant and the care giver in this case between infant and mother. She said very little initially how she felt, just asked very appropriate questions regarding Kevin. It was difficult nursing him as we both knew the outcome but on the other side she had built up a relationship with us. One of trust one that had been formed on the basis of been open and frank with her and she with us. We left them decide when they wanted to withdraw ventilation. This bridge was built and crossed. The initial conversation about withdrawing treatment went completely over their heads, but as mentioned earlier Repetition is the prime influence in memory. Dewey (2012). Traumatic news sometimes cannot be processed. One can proceed to the responses of grief: denial, anger, bargaining and finally acceptance. According to Krigger et al (2007) grief often manifests itself with features similar to depression and it is vital as health care professionals can distinguish between the two, as this may require professional help example counselling or psychotherapy. With this particular case the parents had very good family support.
In conclusion I agree from my experience of dealing with this particular case and other cases also that psychological care of a patient and in this case the parents is paramount. They must be treated in holistically, physiologically, psychologically and spiritual care is also of great importance. Holistic care is central to nursing and also intuitive. As Wynne (2013) describes palliative care is ‘an approach that improves the quality of life of patients and their families facing life threatening illnesses’. One has to care in a way that counts one has to be emphatic and kind also to look after one’s own needs to ensure that psychological care is of routine provision.
Dewey J (2012) Psychology and Social Practice. (Electronic) 407444, 1-43
Egan G (1998) The Skilled Helper 6th Brooks/Cole.
Krigger K,, McNeely.JD., Lippmann M.(2007) Dying, Death and Grief. Helping Patients and their Families.
Santrock J. (1989) Child Development 6th Brown & Benchmark.
Wynne L. (2013) Spiritual Care at the End of Life.
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