Introduction: Health care is not just centered on treatment of diseases and maladies but also focused on providing proper care for children or persons who suffer from chronic or genetic health problems. At such times proper nursing and care is of vital importance.
PART 1:
(A). Cerebral Palsy is a disorder that affects a person’s ability to move or hold a position for extended periods of time. It is a disorder that a person is born with and in most cases it can be diagnosed within the first year of a child’s life.
Occurrences: If one reviews the statistics of Cerebral Palsy, one would find that approximately 33000 Australians of the total population suffer from CP. As per current statistics, on an average two babies are born every day with CP.
Causes and Risks of CP: The actual cause of Cerebral Palsy is as yet unknown. Doctors and research believe that certain occurrences or events might occur during the stage when the baby’s brain is still in the process of developing which leads to this disorder. Mostly cerebral palsy occurs either before the birth or in very early childhood. Other factors include infection, vascular episodes such as strokes or even a head injury.
- Bleeding at any stage of the pregnancy
- If the gestational age of the child is less than 32 weeks
- A family history or any relative with cerebral palsy
- Recorded maternal infection during pregnancy
- Smoking or drug abuse
Types of CP: There are four main types of cerebral palsy cases which depend on which part of the brain has been affected by the disorder.
- Spastic Cerebral Palsy: results in stiffness or tightness of the muscles and is the most common form of cerebral palsy.
- Athetoid Cerebral Palsy: term used for uncontrolled movements or erratic movements.
- Ataxic Cerebral Palsy: rarest form of CP where the child or adult exhibits unsteady or shaky movements and lack of control over the motor movements.
- Mixed Type Cerebral Palsy: occurs when more than one type of pattern is observed and no one pattern is dominant. (Gross P, Leeder S, Lewis M, 2003).
Clinical Manifestations: Manifestation of cerebral palsy can differ from person to person. It can be limited to one part of the body or one limb or one arm or it could affect the whole body:
- Muscles are too floppy or stiff
- Spastic reflexes in addition to stiff muscles
- Stiff muscle with normal muscle reflexes
- Lack of coordination in muscular movements
- Tremors or involuntary movements or extremely slow movements
- Difficulty in walking such as a crouched gait, scissor like gait or walking on toes
- Drooling or problems with swallowing
- Delay in development of speech ability (Ford J et al., 2003).
Prognosis and Long term Outcomes: Most people who suffer from cerebral palsy experience a normal life span although those with severe forms of CP might experience a shorter life span. Long term effects of CP include:
- Increase in intensity and severity of spasms
- Shortening of muscles and increase in contractions
- Joint problems
- Muscle tightness
- Increase in intensity of back pain
- Emergence of incontinence and increase
(B). 1. Children suffering from chronic ailments need to adjust on a number of counts – physical, psychological and social. Parents need to modify their form of support as the child grows to help them adjust to the environment.
2. Children suffering from chronic ailments find it difficult to adjust to a normal school environment. This can be attributed to one of two reasons – their need for constant care and supplements or because of absence for long durations from the school due to treatment.
3. In order to select the eight articles for this essay, a number of websites hosted by the Australian government that gave details of research conducted and web journals with original research reports were consulted.
4a. In Australia represents almost 16% of the children that are encountered in general practice suffer from some form of a chronic disease. Chronic diseases present an even bigger challenge not just for the child but also for the family. The child not only needs to accept and come to terms with living with a disease throughout his life but also needs to make social, psychological and physical adjustments. One of the best ways to help a child with chronic disease adjust is to care for the child at all times so that the child does not develop any feelings of abandonment, separation or fear about the procedures that he does not understand. (Ford J et al., 2003).
Another is social skills training which has been found to have a protective effect on children and teens. For children who suffer from chronic diseases that have a physical impact, remediation and rehabilitation have been found to have a very successful physical as well as psychological impact. Family therapy and group therapy can help the child and teen focus on social adjustment and also provide an opportunity for ventilation of suppressed emotions and feelings. Another important factor that parents need to focus on is pain management. This is vital for helping the child adjust physically with the disease. Pain perception is addressed by helping the child understand and learn how to regulate or modify his perception of pain and modifying the child’s environment to improve pain behavior.
4b. Chronically ill children also need support on all fronts to help them adjust to the school environment. This happens because either the child has been absent from the school for an extended period of time or because he needs extra care even during school hours. In such cases all people in the environment of such a child – the staff at the school, classmates, teachers and the child himself play an important role in the adjustment process. The classmates also need to be made aware of the reasons why the child would receive special attention. Teachers need to be made aware of the schedule of treatment to help the child in the learning process and so that treatment does not interfere with the learning. Academic concerns should also be identified. (Dwyer JM, 2004).
5. There are several factors that impact a child’s ability to be able to adjust with his or her disease. The child should not, at any stage, be neglected or maltreated because more children die of neglect than because of the actual disease they are suffering from. Other factors that can affect a child’s ability to adjust with his disease or to adjust with his prognosis also include the risk factors associated with it and the individual’s resistance. The areas of influence include the degree to which the illness impairs and affects the child’s bodily functions. If the effect is spread over a large part of the body then the child would find it difficult to adjust easily.
Involvement of the brain also makes adjustment difficult. If the brain is damaged then a lot of functions of the body including motor movement, speech, memory etc get affected. The nature of the illness also has an impact on the child’s ability to adjust. If the illness is very severe and even life threatening or the treatment involves long hours of therapy then again it would be difficult for the child to adjust. If the disease constantly interferes with the child’s other aspects of life like school or social life then the child would find it very time consuming and emotionally difficult to adjust with his disease. Family, as mentioned in several places, plays the most important part in the child’s adjustment process. If the family is supportive and does not let the child feel abandoned or neglected at any time then the child would find it easy to come to terms with his or her illness and may also be able to adjust with it over time. (Duckett SJ, 1998).
6. There are certain heath promotion and maintenance strategies that schools can employ for children with chronic illnesses:
Visiting Teacher Service: Schools can provide a visiting teacher service for students who are not able to attend school regularly because of their illness or chronic condition. Visiting teachers work with the students to help them cover up lost ground. Apart from educational help, visiting teachers also provide advice and support to school going children and also their families. This kind of a service or program would be very beneficial if monitored and initiated by the school authorities. (Menadue J, 2003)
7. For a child who is suffering from cerebral palsy, these strategies would be very useful and affective. Since cerebral palsy affects a child’s motor skills, his ability to attend school and to participate in normal activities would be greatly hampered. At such times, the child would be in greater need for attention not just at home but also in school. At school, the child would be in need of a support group and for extra study hours to help in improving understanding. For students with cerebral palsy a student health support plan would be very effective in educating the staff and teachers about the needs of the child and also about the treatment schedules. Similarly visiting teacher service will help them get individual attention from teachers and improve their level of understanding. Student welfare coordinators will be able to extend the required attention that cerebral palsy patients need in a school environment. So these strategies would be very effective for helping a child with cerebral palsy adjust in a school environment.
8. Parents of children who suffer from cerebral palsy need to be aware of the implications of the illness and the intensive care that they will have to provide to the child throughout his or her life. In such cases, parents who are educated and are aware of cerebral palsy find it relatively easier to accept the situation and take the correct course of action. The most important role that education would play with cerebral palsy is identifying the delay in motor responses in your child which is the first indication of this illness. Parents who belong to a medical background or those who are educated enough to identify the delay of the child in achieving motor milestones, would be able to get the illness diagnosed at the right time. If parents are not aware then their first reaction is that of panic which often leads to delay in administering treatment. However, once the diagnosis is made getting educated and understanding in detail about the prognosis and the therapy the child would need is important.
References:
Duckett SJ (998). Economics of hospital care. In: Mooney G and Scotton R, eds. Economics and Australian health policy. Sydney, Allen & Unwin: 93–4.
Duckett SJ (2004). The Australian health care system. 2nd edn. Melbourne, Oxford University Press.
Dwyer JM (2004). Australian health system restructuring – what problem is being solved? Australia and New Zealand Health Policy, (6): –6.
Easthope G et al. (998). Acupuncture in Australian general practice: practitioner characteristics. Medical Journal of Australia, 69: 97–200.46
Health systems in transition Australia Esterman AJ, Ben-Tovim DI (2002). The Australian coordinated care trials: success or failure? The second round of trials may provide more answers. Medical Journal of Australia, 77: 470–47.
Foley M (2000). The changing public–private balance. In: Bloom AL, ed. Health reform in Australia and New Zealand. Melbourne, Oxford University Press: 99–4.
Ford J et al. (2003). Reproductive health indicators Australia 2002. Canberra, Australian Institute of Health and Welfare.
Frommer MS, Rubin GL (2000). Evidence-based health care. In: Bloom AL, ed. Health reform in Australia and New Zealand. Melbourne, Oxford University Press: 307–324.
Furler J et al. (2002). The inverse care law revisited: impact of disadvantaged location on accessing longer GP consultation times. Medical Journal of Australia, 77(2): 80–83.
Gardner H, McCoppin B(989). Emerging militancy? The politicisation of Australian allied health professionals. In: Gardner H, ed. The politics of health: the Australian experience. Melbourne, Churchill Livingstone: 303–348.
Glover J, Harris K, Tennant S (999). A social health atlas of Australia. Vol : Australia 2nd edition. Adelaide, Public Health Information Development Unit, University of Adelaide.
Griew R et al (2004). ‘On our terms’: the politics of Aboriginal health in Australia. In: Healy J, McKee M, eds. Accessing health care: responding to diversity. Oxford, Oxford University Press: 257–302.
Gross P, Leeder S, Lewis M (2003). Australia confronts the challenge of chronic disease. Medical Journal of Australia, 79(5): 233–234.
Hall J (998–999). Five country survey shows rising dissatisfaction with health care systems. Healthcover, 8(6): –5.
Ham C (998). Lessons and conclusions. In: Ham C, ed. Health care reform. Buckingham, Open University Press. 9–40.
Healy J (998). Welfare options: delivering social services. Sydney, Allen & Unwin.
Healy J (2004). The benefits of an ageing population. Canberra, The Australia Institute.
Healy J, McKee M (2004). Delivering health services in diverse societies. In: Healy J, McKee M, eds. Accessing health care: responding to diversity. Oxford, Oxford University Press: 35–369.
Health Insurance Commission (2004). Annual report 2003–04. Canberra, HIC.47Health systems in transition Australia.
Howe A (1998). The economics of aged care: achieving quality and containing costs. In: Mooney G, Scotton R, eds. Economics and Australian health policy. Sydney, Allen & Unwin: 37–53.
Hughes AD (2004). Towards an outcomes-based system. Australian Health Review, 28(): 3.
Hurst J, Jee-Hughes M (2000). Performance measurement and performance management in OECD health systems. Paris, OECD.
Industry Commission (997). Private health insurance. Report No. 57. Canberra, Australian Government Publishing Service.
Kewley TH (973). Social security in Australia: 1900–1972. Sydney, Sydney University Press.
Lapsley H (2000). Quality measures in Australian health care. In: Bloom AL, ed. Health Reform in Australia and New Zealand. Melbourne, Oxford University Press. 282–292.
Lewis J (2000). From fightback to biteback: the rise and fall of a national dental program. Australian Journal of Public Administration, 59: 84–96.
Lin V, King C (2000). Intergovernmental reforms in public health. In: Bloom AL, ed. Health reform in Australia and New Zealand. Melbourne, Oxford University Press: 25–263.
Lofgren H (2002). Generic drugs: international trends and policy developments in Australia. Working Paper No. 0, Pharmaceutical Industry Project Equity, Sustainability and Industry Development. Melbourne, Centre for Strategic Economic Studies, Victoria University of Technology.
Lyon K (2000). They said it couldn’t be done: contracting for veterans’ hospital care in Australia. In: Bloom AL, ed. Health reform in Australia and New Zealand. Melbourne, Oxford University Press: 223–234.
Mathers C (994). Health differentials among adult Australians aged 25–64 years. Health Monitoring Series No . Canberra, Australian Government Publishing Service.
Mathers C, Vos T, Stevenson C (999). The burden of disease and injury in Australia, AIHW Cat. No. PHE 7. Canberra, Australian Institute of Health and Welfare.
McKee M, Healy J, eds. (2002). Hospitals in a changing Europe. Buckingham & Philadelphia, Open University Press.
McLennan AH et al. (2002). The escalating cost and prevalence of alternative medicine. Preventive Medicine 2002, 35: 66–73.
Menadue J (2003). Healthcare reform: possible ways forward. Medical Journal of Australia, 79(7): 367–369.
