Assessment 2: Nursing Care of Karam with Appendicitis and Family

This report addresses the nursing care of Karam, a seven-year-old refugee boy diagnosed with appendicitis. It focuses on pain management strategies, acknowledging the challenges in assessing pain in children and the importance of using pain scales, verbal communication, and age-appropriate explanations. The report emphasizes the need for culturally sensitive care, especially considering Karam's and his parents' limited English proficiency. It highlights the significance of involving an interpreter, utilizing visual aids, and incorporating family-centered care principles. The report also discusses the application of the United Nations Convention on the Rights of the Child, ensuring non-discrimination, the child's best interests, and the right to healthcare. Effective communication strategies, including involving the parents and considering cultural beliefs, are also discussed. The report concludes by emphasizing the need for holistic care that considers the child's developmental stage, respects their rights, and involves the family in all aspects of care, including decision-making and collaborative management. The report references relevant literature to support its recommendations.

Assessment 2 Template
Clinical Scenario – Written Report
Student Name and I.D.
Introduction
This assignment will be discussing the second scenario of Karam a seven-year-old boy with a 24-
hour history of abdominal pain. He was diagnosed with appendicitis and was taken to theatre
directly upon admission for appendicectomy. The patient was accompanied to the emergency
department by his father, Saad. Karam lives with his mother Jamal, his father Saad and two
younger sisters. They are refugees from Syria and have stayed in the country for one year. Karam
speaks and understands English as he has joined a school, but his parents have a limited
understanding of the English language. This report will, therefore, address priority nursing care of
Karam and communication needs that need to be discussed for both the patient and family
members.
Nursing Care
The one specific aspect of nursing care for Karam is pain that is related to the post-operative
procedure or appendicectomy (Mello et al. 2016 pp.12-18). Pain is an unpleasant sensation
experienced, mainly due to tissue damage or nerve damage. The severity of the pain is ain rating in
children can be challenging as they are not able to express exactly how they are feeling. It is also
affected by their developmental milestone. The nurse can, therefore, use a pain rating scale to
determine the severity of pain. The Wong-Baker faces pain rating scale uses facial expression to
rate pain on a scale of 0-10. A score of 0 is given when the child is smiling, and this shows that the
child is pain-free. A score of 10 is given when the child is crying and irritable, and it is an
indication that the child is in a lot of pain (Polomano et al. 2016 pp.1505-1519). The nurse can also
use verbal communication as school-going children can verbalise when in pain. Pediatric pain
management can sometimes be difficult due to their understanding, and it is much dependent on
the developmental age and stage of the child.
Children are greatly affected by psychological pain based on how they interpret the pain they are
feeling. Therefore, the nurse should use different approaches when providing nursing care such as
administration of analgesics (Lee, Rashi, Thomson and Cordingley 2019 pp.e12952). The nurse
can explain to the child the cause of the pain and his condition in a simple language that the child

can understand. The nurse should also explain in simple terms the benefits of pain relief
medication and what will happen if they don't take the drug. Most of the school-going children do
not like taking medicine. The nurse should, therefore, use a language that is not suggestive of
choosing either of taking the drug or not. Even though the patient has a right to refuse medication,
children have no understanding of the consequences. If they refuse, therefore, the nurse should try
other ways. This includes giving the child the drug with their favourite drink. The nurse can also
distract them with something they love most. Exposing the child to a different environment can
also help the child accept to take the medication. Involving the parent is also very important. This
is because children trust their parents more and therefore involving them can help a lot (Sing,
Cheung and Wong 2015 pp.419-428).
Incorporating the principles of the United Nations Convention on Rights of the child (UNCRC) in
providing nursing care is essential in the management of young children (Fenton-Glynn, 2019).
The main principles are non-discrimination, best interests of the child, right to life, survival and
development (Lundy and Byrne 2017 pp.52-70). Karam is a refugee, and therefore, according to
UNCRC, they should receive health care without discrimination just like any other child in the
country. Respecting a child's privacy and confidentiality is also essential to the child as it also
promotes respect from others. Child's best interest should always be considered so long as it does
not cause harm to the child or anyone else. Karam refused to take medication but based on this
scenario. This can be disadvantageous to the child. Therefore any other appropriate way can be
used to make sure he benefits from the intervention. Every child has a right to life and survival.
Providing proper health care to the patient such as appropriate pain management, infection
prevention, proper nutrition and also psychological support is crucial for physical, mental and
psychological development. Child education concerning his health is also essential in development.
Collaborative management is also vital in order to foresee ant challenges that may arise and
therefore prevent them from occurring (Fraser and Stasa 2017 pp.24-37).
Communication
Communication is a crucial aspect of healthcare. The main problem in communication, according
to this scenario, is the language barrier between the patient's parents and the health care provider
and also the developmental age and stage of the patient. For effective communication to occur the
sender of the information should be able to relay information through a medium, and the recipient
acknowledges the receipt of the knowledge and understanding through feedback (Austin and
Pinkleton 2015). Any problem in any stage of communication interferes with effective
communication. Karam's parents have minimal knowledge of the English language. Karam, on the
other hand, is still young to synthesise and understand everything that is explained to him
adequately (Smith and Ford 2013 pp.92-94).
This can be overcome by involving an interpreter who can understand both English and Karam's
parents' language. However, the parents should know about the interpreter for patient's privacy and
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confidentiality (Schwei et al. 2016 pp.36-44). Having a healthcare provider as an interpreter would
be more convenient. The interpreter would be able to explain to the parents what is required for the
continued care of the patient upon discharge. This is very important as if the message is not well
delivered, it can cause consequences and even complications to the patient. If an interpreter is not
available, the patient can be told to translate to his parents' information given since he speaks and
understand English. This will also be advantageous as the patient is involved, and privacy is
considered. On the other hand, patients understanding can be improved trough showing him
pictures or a simple video of what it should be done upon discharge. A practical example will also
help more (Ikram, Essink-Bot and Suurmond 2015 pp.422-427).
According to Hill, Knalf and Santacroce (2018 pp.22-33), patient and family-centred care can be
incorporated in this scenario through following the principles required. The nurse should consider
patients dignity and respect by ensuring patients privacy when performing any procedure. Cultural
beliefs should also be considered when giving care to the patient. For example, some communities
prefer same gender healthcare provider attending to them; the patients wish they should be
regarded as if it is possible. The nurse should always introduce themselves to the patient and
explain to the patient what he or she is going to do (Patane and Forster 2017 pp.44-50). On
decision making, the healthcare professionals should respect the patient's final decision after a clear
explanation to both the patient and the parents. Effective communication can also be incorporated
into patient care. The nurse should listen to what the patient and the parent are saying clearly and
clarify if needed. Any information that needs to be told to the patient and relatives should be
delivered at the right time in a language that is easily understandable. The privacy should also be
considered when giving information (Roue et al. 2017 pp.F364-F368).
The patient and relatives should be involved in patient care. The patient should be encouraged to
do as much as possible and also the parents to participate where they can. This will make care
easier upon discharge and increased independence. Family members are also involved in decision
making on the patients' health. Their views should also be considered, and clear explanation be
given if need be. Collaboration is also important. Involving different healthcare professionals help
to take care of the patient holistically. The family members can also come with ideas and personal
experiences which can be helpful to the patient. Their feedback is also vital in improving patient
care. If all these are considered, then holistic care to both the patient and the family members is
promoted (Di Prospero and Leahey 2016 pp.S7-S8).
Conclusion
Each patient needs care basing on different factors. Developmental age and stage affect the
approach to healthcare. Young children have different understanding and interpretation of different
situations; therefore, they should be handled with care. They should also be respected, and their
rights are considered when giving an intervention or performing a procedure. There should be no
discrimination and child's interest should always be appreciated. Barriers in communication can be
consequential. Therefore appropriate intervention like an interpreter in case of language barriers is
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needed for the message to be sent and understood clearly. Finally, the family members and
relatives should be involved in patient care, and also their needs should be considered.
References
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Fenton-Glynn, C. ed., 2019. Children's Rights and Sustainable Development: Interpreting the
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Fraser, J & Stasa, H 2017, 'Child rights in Australia', in J Fraser, D Waters, E Forster & N Brown
(eds), Paediatric Nursing in Australia: Principles for Practice (2ndedn), Cambridge University
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Hill, C., Knafl, K.A. and Santacroce, S.J., 2018. Family-centred care from the perspective of
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Differently”: A Qualitative Investigation into the Differences and Similarities of Pain and
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