Ali Case Study
Recommendations 1-5
1. Play Therapist
2. Perspective
3. Procedure steps
4. Familiarise
5. Speak to Cyrus
Perspectives
Ali- Scared, anxious, upset, determined to be independent, seeking control, frustrated at being treated like a child
Cyrus- worried, desperate for help, upset, feeling alone/ like a failure, protective, hesitant.
Nursing team- half empathetic for Ali, half annoyed, think we should get it over with.
Ethics
The ethics surrounding this case are in the consideration of consent. Since Ali is refusing the treatment out of fear and a lack of information rather than making an educated decision to refuse the procedure, my recommendations are based on mitigating his fears, and educating him on the procedure
Barriers/ solutions
1. A play therapist or VR goggles may not be available. If this is the case, and it is not possible to wait for one, some of the distraction techniques may be available in their absence. For example, fidget toys, movies on the ward iPad, conversational distraction, breathing techniques.
2. There may not be an appropriate non-clinical room to speak to Ali in. If this is the case, and one is not to be soon available, Ali can be taken into a cubicle in the urgent treatment sector, where a curtain can be pulled all the way round, and Ali can be made to feel confortable and relaxed.
3. An education mannequin may not be available, but an appropriate education video, or step by step photos that have been reviewed before hand, may be shown to Ali in order to familiarise him with the events that will take place, and let him gain a sense of control in knowing exactly what will happentohis body and when. He should also be told that he can stop the procedure at any time.
4. It may not belossible to have the procedure performed by people that Ali met at his last appointment, but everyone present in the procedure room should be introduced to Ali, both by name, by occupation, and by role in the event, to give Ali security and knowledge of what is happening, and who will do what.
How my role will change
Student- It is likely that I would not be in the room for Ali's procedure, as I am not familiar to him and would not be involved in the procedure, as I am not qualified to take blood in paediatrics, and introducing me despite this could overwhelm Ali. This is why it is my recommendation to keep involved personel to a minimum.
Newly Qualified- In this scenario, since I was involved with the case, it would be more likely that I would step into the role of speaking to Ali and Cyrus, as well as performing the procedure, to provide one recognisable and trustworthy point of contact and ensure a safe and familiar environment and provide Ali with the sense of control and awareness.
Strengths of this Plan
The strength of this plan is that the main barrier- Ali's non-compliance- should be resolved by the reassurance and education components of the recommendations.
Supporting families in challenging situations: Studies
1: The efficacy of non-pharmalogical pain management for 2-19 year olds with needle related pocedural pain. Systematic review.
2: Parental experiences in managing a childs procedural pain. Systematic review.
Transitioning through conflict: Studies
1. Systematic review into adherence in adolescent cancer
2. Study into understanding strategies for infants, children, adolescents and adults to reduce procedural anxiety
Study 1 Weakness
Few trials in this study focusses solely on adolescence, but this does not make the study inapplicable, as many studies did include data from adolescents, and Ali is somewhat between categories at the moment, having only just entered puberty, so the data should still be representative of his experience.
Study 2 weakness
This study may be weakened since it is based in paediatric and neonatal intensive care units, however most of the procedures examined were also common in emergency departments, such as venepuncture and cannulation, making the evidence generalisable.
Study 3 weakness
This study focusses on teenage cancer patients, and while Ali does not suffer from the same chronic health condition, the same emotions and need for control are relevant, making the results applicable in this scenario.
Study 4 Weaknesses
This study was limited to vaccines, but did generally focus on needle phobias, so still is applicable in this scenario.