Nurse Practitioner Advocacy in families with a Child with a chronic illness ADHD
Attention Deficit Hyperactivity Disorder (ADHD) has been attracting much public attention during the past three decades. This disorder is related to the children, young people, and the adults who exhibit a lack of persistence in their activities which need their cognitive participation. The ADHD patients show tendency to shift from one activity to another before completing it. Most often, these activities are disorganized, and are excessive. The chronic difficulties in controlling the impulses, attention, and moderate activities are observable in social contexts, such as homes and schools. The ADHD was extensively researched, with a wide range of topics relating to the infants, younger children and adolescents. But, there were not enough studies pertaining to the effect of ADHD on the family, their experience, and the nurse practitioner advocacy in families that have a child with chronic ADHD illness (Goodwillie, 2013). Therefore, this paper aims to address this problem and the stigma jeopardizing the patient’s social identity.
According to the American Psychological Association (APA) (2013), about 15 million children in the USA are vulnerable to some sort of a mental health disorder. Though there are controversies about its characterization, ADHD is included in the mental health disorder list. ADHD causes considerable functional impairments to the children at home, at school, and with peers. Furthermore, 21% of children belonging to the age group of 9 to 17 years, are prone to diagnosable mental or addictive disorders that result in minimal impairment. More children are at risk of emerging disorder, due to biological and other reasons, as well as the challenges that are faced at home, schools, or the neighborhoods (APA, 2013).
The effects of ADHD on the family
Children suffering from ADHD, and other related disorders, often put the parents in awkward situations due to their many abilities and disabilities. It is difficult to understand how much of their behavior measures the nature of the condition of the disorder, and how much is negative. For the parents, the knowing of a child’s inadequacy feelings is itself painful. Therefore, the parenting approaches must have clear and concise instructions. It should be flexible and is capable of nurturing a child’s gifts and interests. In this context, Lench, Levine, & Whalen (2013), state that the level of strain and conflict faced by parents should be correlated to the analysis by the parents about the child’s behavioral issues. Other studies have revealed higher levels of dysfunction in families having children affected with ADHD (Foley, 2010). The symptoms and behaviors of ADHD could impact upon the life of the child, and also can cause dysfunction for the parents and siblings of the child. A recent study has revealed that the parents had painful experiences of living with children diagnosed with ADHD (Goodwillie, 2013). According to the study, the parents were having compassion for their children with ADHD. They explained the difficulties and hurdles they encountered while parenting such children. For them, it was more challenging than raising children without the diagnosis. The relationships in such families were mostly strained, and dominated by high levels of stress. Parents revealed that they felt exhausted, having no external supports and that the extended family and the healthcare professionals were critical about their parenting, which eroded their confidence (Goodwillie, 2013). It is relevant to note, here, that the Mental Health Strategy for England has issued specific instructions, as to how the Government should work with all sections of the community, by stipulating that “taking a life course approach” must improve the mental health and welfare of the population. Therefore, it is imperative that the nursing and other health professionals should learn about the impact of ADHD in maintaining the family relationships, as well as their mental health (Goodwillie, 2013).
However, these approaches will become more complicated when the parents also have ADHD or other problems, like marital issues, financial difficulties, or quarrel between the siblings (Ward, 2016). There are several reasons for the children with ADHD to affect parental outcomes. The birth of a disabled child could generate an unexpected shock to the relationship. This will lead to conflicts in the parents’ family set up, and could impose a higher level of psychic impacts on the parents than in the families that have ADHD affected children. However, a family having a child with ADHD can also create positive outcomes in the parents’ relationship, by bringing the family closer. Additionally, the prospects of caring for the ADHD child can affect the decision of a parent about dissolving the relationship too. Thus, the total impact on the risk of marriage dissolution will be either negative or positive (Kvist, Nielsen & Simonsen, 2011).
Recent researches prove that the families having ADHD children are totally different from the non-ADHD families. In the ADHD families, there will be typical relationships and differences in parenting styles. However, these differences will in no way reveal that the ADHD families are performing poorly than the non-ADHD families. As the ADHD children require more attention, it is the family members who devote additional time and energy to them. Most often, it is the siblings who lose time and energy. Sometimes, this can bring jealousy in them and can result in delaying things for the siblings. To deal with all these problems, the parents require even more time and energy (Ward, 2016).
Children with ADHD used to get into conflicts with the siblings, because, firstly, the ADHD children tend to insist and argue more than the non-ADHD ones. Secondly, the non-ADHD children, usually, get exhausted from their dealing with the ADHD sibling’s inappropriate behavior. There is less chance that the children realize that the ADHD is nobody's fault. The result of these issues is frustration, strain, and exhaustion for all in the family. Since the ADHD is primarily a genetic problem, most families can have multiple members with ADHD. Sometimes it is limited to a parent and child, but in other cases it may go to two siblings. The multiple-ADHD families encounter major challenges than the single-ADHD ones. Moreover, the children who suffer from the hyperactive type of ADHD will face distinct problems than the inattentive ADHD children (Ward, 2016).
In spite of what stated above, it is important to know that the ADHD is very common in all communities. It is known that between three and six percent of children do have ADHD. So far, most of the families across the world have dealt with ADHD successfully. They have evolved their own daily routines and planning to overcome the challenges. Nevertheless, the parents still need to learn more about ADHD and its treatment. This includes new behavior management techniques, and gathering knowledge about the legal rights of children with ADHD. It is better to target one or two inappropriate behaviors at one time at home and school, so that it would help the parents not to be overwhelmed at seeing the several behaviors of the ADHD children (Ward, 2016). In addition, there should be increased efforts to improve the parent adherence to behavioral interventions for the children who are prone to the ADHD disorders (Clarke, et al., 2015)
The role of the NP in advocating for families, having children affected with ADHD.
The National Organization of Nurse Practitioner Faculties (NONPF), in collaboration with the American Association of Colleges of Nursing (AACN), facilitated the development of population specific competencies for the NPs. The Psychiatric-Mental Health NP Competencies stipulates that the NPs should seek opportunities to decide on the health policies for reducing the impact of stigma during the treatment of mental health problems and other psychiatric disorders. The nurses should participate in community and population oriented programs that are meant to enhance mental health, and reduce the risk of mental health problems and psychiatric disorders. They must advocate for patient and family medico-legal rights, and collaborate with inter-professional colleagues regarding advocacy and policy issues at all platforms to lessen the health disparities, if any, thereby improving clinical outcomes for those who are affected with mental health problems and psychiatric disorders (Population-Focused Nurse Practitioner Competencies, 2013).
Family Support
The family of the child suffering from ADHD are affected negatively due to daily frustrations inherent in the disorder. The affected children can get into problems at school, and can become violent and destroy things. It is quite challenging for those parents, with the children having no behavioral control and ability to understand instructions. The mental health professionals can counsel the family members and help them in managing the behaviors associated with ADHD. Individual counseling will improve the self-esteem of the children, as well as the parents. By utilizing the assistance of supportive professionals and family, these children can become productive. The nurse practitioners working in the primary care and pediatric settings are required to help the children with ADHD in their daily practice (Kelly, 2003).
The Nursing Practitioner, should have proper knowledge about the Impact of ADHD on family relationships, and explore personal and professional prejudices about the diagnosis. They must listen to the parents and fix an opportunity to discuss the issues without the presence of the child. They must find out the concerns for the child’s safety impact upon the parenting style, and focus on the family background to unravel the factors that support the parents. Early interventions, with a rational outlook will improve the future outcome for ADHD children (Goodwillie, 2013). While doing so, the behavioral interventions should be supported with medical treatment to bring better results (Pelham, 2016).
Nurses who work in primary care are the main point of contact with the health system, parents, infants and young children. They are in the best position to know the cultural, socioeconomic and family background of the children’s parents. Proper understanding of the broad determinants of health, combined with community development skills, makes the nurses qualified for supporting healthy child development, in all settings. Nurses have major roles in the care of their patients in performing advocacy, as they have the most interpersonal contact with the patient. With that, they can liaison between patient and family as well as other departments. But to perform this, the nurse must become knowledgeable about the patient’s care and possess a working relationship with the team members (Nurses Advocating for Patients, 2016). Rehabilitation professionals also do advocacy work adhering to ethical guidelines and competency frameworks. Knowledge about the influence of policies and texts will empower the practitioners to perform effectively within the system for supporting the disabled (Ng et al., 2015). However, the degree of needs generally overlaps the potential of the primary care practice settings (Shonkoff & Garner, 2012).
Stigma
Stigma, which is associated with the mentally disabled is evident at all levels of society, and therefore, steps should be taken to reduce stigma as it relates to continuing care (World Health Organization Report, 2003). ADHD is a commonly diagnosed disorder in child- and adulthood, affecting all facets of social life. Therefore, ADHD patients are at high risk of yielding to stigma, prejudices, and discrimination. It is an underestimated risk factor, affecting treatment efficacy, symptom escalation, life satisfaction and the well being of the ADHD patients. To cut it short, stigma mirrors the expression of false assumptions between a section of people, unfriendly characteristics, and behaviors (Mueller, Fuermaier, Koerts & Tucha, 2012).
Conclusion
The ADHD is a disorder related to the children, young people, and the adults who has no persistency in their activities. Their difficulties in controlling the impulses, attention, and moderate activities can be seen in the social contexts, such as homes and schools. More children are at risk of this disorder, due to biological and genetic reasons. The challenges they face at home, schools, or the neighborhoods also contribute to this. The children affected with ADHD, often put the parents in awkward situations. The mental health professionals can counsel the family members and help them in managing the behaviors associated with ADHD. Individual counseling will improve the self-esteem of the children, as well as the parents. By utilizing the assistance of supportive professionals and family, these children can become productive.
References
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