Managing Emotional Reaction In Pediatric Acute Lymphoblastic Leukemia: An Essay.

Case Study of a 12 years Old Child Suffering from Acute Lymphoblastic Leukemia

Discuss about the Effects of Pediatric Acute Lymphoblastic Leukemia.

Managing emotional reaction in patients and families is a very complex situation for the nurses. Serious disease and acute illness are the source of great distress for the patients and family members. When the patients are children, stress of the family members increases. Family members can experience many negative emotions, when the patient is being treated in the intensive care unit (ICU). Most of the families are involved in providing some level of care to the patient, but the role of nurse is very important. This paper will focus on the case study of a 12 years old child, suffering from acute lymphoblastic leukemia. Emotional reaction while providing care to children is very obvious. This emotional reaction could be momentary for the nurse, but is very important for effective care delivery and patient satisfaction.  With the help of Gibb’s reflective cycle,

During my placement in the pediatric cancer center, I was working under the supervision of RN to provide care and support to 12 years old boy suffering from acute lymphoblastic leukemia (ALL), his name as John (pseudonym). He had been admitted to the hospital after his condition got worsened and he was not able to different physical activities. The diagnosis of the cancer was very overwhelming for the parents. Parents were always present with the boy to take care of him. I found that parents and child were frightened with the treatment. John was admitted to the hospital for the purpose of chemotherapy. Central venous catheter was inserted and parents were concerned about the pain and discomfort of their child.

I inserted the central venous catheter under the supervision of the RN. Doctors regularly visited the patient and I was assigned to provide closed and patient centered care. John was very young to go through this problem and I had emotional concern about his condition. His parents were always worried for him and have queries about chemotherapy. Emotional and behavioral problems can be seen in the children with such aggressive treatment and similar problem was noticed in the case of John. Acute lymphoblastic leukemia has become one of the most frequent malignancies in children. According to the study of Nazari et al (2014) ALL can influence the psychological state of the children and can result in involuntary change in the attitude of parents.

One day when he was in his room with his parents, and RN had just left the room after regular checkup, John started crying and displayed aggressive behavior. John also tried to remove his central venous catheter. Parents tried to control him and I rushed immediately towards him. I controlled him with great difficulty and tried to pacify him with emotional support. I also comforted the child and explained him that everyone there is to help him and make him feel better. I also informed him that his condition can be regulated and he must support towards the treatment. The result of this situation was that during the aggressive behavior John wounded his left hand from the side table, but after providing him comfort and emotional support, he a pacified and ensured not to repeat it further.

Handling the Emotional Reaction and Coping Skills Development

Before this situation I was little confused and anxious, as this was the first time I was providing close care to the child with sever life threatening disease. I felt that I may not be able to handle the situation very well in the absence of my supervisor. I was alarmed with this situation that this situation could have caused great harm to the patient. His parents were also emotionally disturbed and were unable to control him. I felt that the negative emotions displayed by the patient were due to fear of the treatment, anxiety about his condition and frustration about not being able to live a normal life (P?aszewska-?ywko & Gazda, 2012). All these disturbing and difficult situations have resulted in the mental consequences in the child. I was concerned that he may try to do such things again and may harm himself. Parents were also devastated by the incident. They felt emotional disturbed and helpless. They required emotional and psychological support, so that they could provide better care to their son (Firoozi, Besharat, & Boogar, 2013). However, after the situation I felt emotionally concerned about the child and also confident that providing appropriate support at the time of emotional reactions patient and family members of the children with serious illness require more comprehensive support from the professionals (Duchoslav, 2010). Currently, I believe that depression and aggressive behavior are common in children with severe conditions and their family members are also vulnerable towards providing appropriate support to their child (White, 2015). Therefore, as a practice nurse, it is my duty to support individuals for improving patient outcomes and adherence to treatment. I also felt that some children can talk about their feelings, while others could not. In order to connect emotionally it is important that nurse should become an empathetic listener and supporter towards children and family members (Cantrell, & Ruble, 2011).

This incident was extremely challenging for me, as this was my first experience of providing nursing care to children in acute care setting. The most positive aspect of this incident is that it helped me to enhance my nursing practice and displayed the importance of emotional support. Coping with stress can be very difficult for the children with serious illness. Therefore, it was also important to apply the secondary coping style which includes accepting the situation and the stressors (Compas et al, 2012). Another positive aspect of the situation was that, I learned that providing emotional support and managing the emotional reactions in family members helped the child in passive coping (White, 2015).

I found that children undergoing cancer treatment are less physically and psychologically capable than other healthy children (Duchoslav, 2012). This incident was very important in brining changes to mu nursing practice. I learnt that emotional closeness to the seriously ill children is very important to control their behavior. The nurses in the acute care settings are mainly focused towards reducing the physical symptoms of the patients and the emotional factors are often neglected (P?aszewska-?ywko & Gazda, 2012). The realistic hopes of the cure in the palliative care for children come through providing emotional support (Waldman & Wolfe, 2013). Palliative care is to support child as well as families that should be consistently applied regardless of the status of the disease. The negative situation about the incident was that child hurt his hand. However, I hold his hands and asked him to keep calm. Parents of the child also reported that daily functioning is more stressful for them as well as their child than uncertainty of the child’s condition (Compas et al, 2012).

Providing Emotional Support and Managing Emotional Reactions in Family Members

Research has demonstrated that providing emotional closeness and support to the patient can be very stressful and nurses may feel emotionally unprepared to care for such patients (Ek et al, 2014).  Different care giving is required for the patient with serious condition. Such patient and their family members are emotionally demanding. Family care givers may feel helpless, distressed and guilty (Ek et al, 2014). Effective response to emotional demands of the patient and family members can reduce the physical suffering of the patients. Oncology staff must play the significant role in providing emotional, physical and spiritual care to the patients with serious illness. Strong therapeutic bonds can work as an appropriate approach to control aggressive behavior and emotional reactions of the children suffering with cancer. It was found that primary control measures were effective in increasing coping efforts in the patient (Cooper & Brown, 2015).

Looking back at the incident I feel that emotional support and coping skills development in the case of John should have been applied earlier. Children are the most vulnerable patients. Serious illness like cancer can be a great barrier to their development (Firoozi, Besharat, & Boogar, 2013). Such children and their families require more support and care. If any such situation will occur in future, I believe that it would be important to clarify the emotional concern of the parents.  They will be informed about their child’s condition and will also be educated about various psychological, social, and emotional problems that child might undergo. Empowering the parents is very significant part of providing emotional care to the children. Parents will also be encouraged to ask questions, as they might have many emotional queries. Managing the emotional reactions of children and their family members significantly requires support of the nursing professionals.

Conclusion

Paper is based on providing the reflection of a clinical experience. The incident is about the 12 years old John, who is suffering from lymphoblastic leukemia. Incident covered in the paper is about the aggressive behavior of the child. Gibb’s reflective cycle is used to analyze various aspect of this experience. Gibb’s reflective cycle helped to understand the various aspects of the clinical incident and how it can be controlled in futures. Emotional reactions are common in cancer patients and their family members. Therefore, quality nursing practice requires focusing on child’s needs and empowering parents to help their children in coping.

References

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Cooper, S. L., & Brown, P. A. (2015). Treatment of pediatric acute lymphoblastic leukemia. Pediatric clinics of North America, 62(1), 61-73.

Compas, B. E., Jaser, S. S., Dunn, M. J., & Rodriguez, E. M. (2012). Coping with chronic illness in childhood and adolescence. Annual Review of Clinical Psychology, 8, 455-480.

Duchoslav, R. L. (2012). The Effects of Pediatric Acute Lymphoblastic Leukemia on Social Functioning: An Investigation Into the First Year of Treatment.

Duchoslav, R. L. (2010). The effects of pediatric acute lymphoblastic leukemia on social competence: an investigation into the first three months of treatment. Graduate Theses and Dissertations, 549.

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Nazari, S., Koupaei, M. T. S., Shafiee, A., Kashani, Z. H. G., Bahraminia, E., Ansari, M., & Alipour, A. (2014). Emotional/Behavioral problems in children with acute lymphoblastic leukemia: a case-control study. International journal of hematology-oncology and stem cell research, 8(2), 14.

P?aszewska-?ywko, L., & Gazda, D. (2012). Emotional reactions and needs of family members of ICU patients. Anaesthesiology intensive therapy, 44(3), 145-149.

Waldman, E., & Wolfe, J. (2013). Palliative care for children with cancer. Nature Reviews Clinical Oncology, 10(2), 100-107.

White, L. (2015). An exploration of the value of reflective practice for child care and family support service provision (Doctoral dissertation).