Katie Booth
HFN2001
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Jonah
Introduction
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The World Health Organisation states that asthma is the ‘most
noncommunicable disease among children’.
Asthma is a condition that inflames the passages to the lungs, restricting the
amount of oxygen the body receives, 235 million people suffer from asthma
worldwide and low-income countries are shown to hold the most deaths related
to asthma (WHO, 2017).
In the UK 1 in 11 children suffer from asthma, with an asthma attack occurring
in the nation every 8 minutes, prevalence in the UK for children with asthma is
the highest in the world and 14 children aged between 0-14 died as a result of
in 2016 alone (Asthma UK, 2016).
‘Appropriate management of asthma can enable people to enjoy a good quality
of life’ The World Health Organisation (2017)
This paper is going to discuss Jonah, a six-year-old male with acute asthma
from the age of 4. It will examine the ways in which Jonah’s asthma can be
managed from several approaches in the different aspects of his life. It aims to
include the nursing practice along with a framework from which the nurse can
use as a guide (Yura and Walsh 1978). To enable the encouragement of
Jonah and his family to live a healthier existence in support of his asthma
management health surveillance and health promotion will be involved (WHO,
2018). Culture, housing, religion and race are all examples of sociological
aspects (Parse,2015) that can hinder asthma management therefor they will be
discussed along with the psychological effects the chronic illness can have on
asthma sufferers (Nutting, 2015) and if Jonah were presenting with those
symptoms, what actions the nurse would take to ensure he is fully supported.
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Nursing practice
To enable effective care of Jonah and manage his condition appropriately the
problem-solving ‘Nursing Process’ known as A.P.I.E (assess, plan, implement,
evaluate) (Yura and Walsh 1978), will be implemented to give Jonah’s care
structure. To give focus the ‘12 Activities of Daily Living’ model (Roper, Logan and
Tierney 2000) will be implemented in conjunction with Anne Caseys ‘Partnership
in Care’ model (1988). Together enabling the inclusion of Jonah’s family and
using triadic interaction (Dalton, 2003) throughout his care, consequently
safeguarding continuity of care and creating an individual enhanced care plan that
is subsequently family-centred (Corlett and Twycross, 2006). There are 12
activities that exist in the Daily Living model although concentration will be placed
on the biological aspect (Nursing Theory, 2016) of ‘breathing’ due to Jonah’s
condition.
Jonah is a 6-year-old male who has experienced regular asthma attacks over the
course of 2 years and has twice needed secondary care. Various actions can be
taken to identify the problem. The British Thoracic Society (2016) state that
children who suffer from asthma should have their weight and height measured
annually, therefore during the assessment phase Jonah’s growth will be
measured and plotted on the centile. To collect a symptom score Jonah and his
parents will be asked to fill the ‘Children’s Asthma Control Test’ or ‘Asthma
Control Questionnaire’ (BTS, 2016) together, encouraging a family/nurse
partnership. As monitoring pulmonary airflow is essential in the management of
asthma (Burkhart, Reyans, Oakley, 2012), a peak flow measurement will be taken
and scored against the guidelines and to also have a point of reference. Peak
flow measurement is also practical as Jonah can perform this himself at home
(Callahan, Panter, Hall, Slemmons, 2010). The Current use of asthma technique
and management will be recorded along with frequency of prescription requests.
It is known both of Jonah’s parents smoke, they have a dog, damp is in the
bedrooms and heating is unreliable which could mean the house may be
relatively cold at times - all of which are home environmental factors that may
trigger asthma attacks (Tzeng, Chiang, Hsueh, 2010).
In reference to planning Jonah’s care the aim is to reduce the amount of asthma
attacks he has, in the hope by doing so Jonah and his family can prevent future
attacks occurring and/or pre-empt when an attack is foreseeable.
To implement this plan Jonah and his family will be given a peak flow diary and
asked to record readings after each time he is exposed to any of the potential
asthma attack triggers (Nursing Times, 2009) in his home environment. Home
visits, will be arranged weekly over 1 month to assess the peak flow
measurements together with Jonah and his family to analyse what is causing a
change in his pulmonary airflow. In doing so we can remove the trigger, for
example if Jonah’s parents avoid smoking in the family home or perhaps the pet
dog could be kept out of Jonah’s bedroom (Asthma.org, 2016).
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After one-month Jonah’s care plan will be evaluated. Such questions will be
asked; was the goal to determine the trigger of Jonah’s asthma attacks found? If
so, were they removed and is it attainable. Was the Partnership in Care model
effective? Do Jonah and his parents feel they were involved in his care enough
and do they feel hold enough knowledge to continue it. If the answers to these
questions are negative a new modified care plan will be required, and the nursing
cycle continues.
Health surveillance and Health promotion
Health surveillance is a baseline for gathering data, known as epidemiology, to
enable the provision of tailored care to the public, such data gathering can
anticipate public health emergencies and enable customised care districts (WHO,
2018). The ‘Bradford Healthy Hearts’ campaign is a good example of
epidemiology. Bradford was found to have one of the highest death rates due to
cardiovascular disease in England and therefor a campaign was run involving
primary and secondary care providers to educate the people of Bradford, and how
they can reduce the risk of heart disease, (Bradford Healthy Hearts, 2018). In
association to Jonah, health surveillance could be carried out by aiming to
discover the link between smoking and no-smoking parents and the amount of
asthma attacks their children suffer.
The ‘Bradford Healthy Hearts’ campaign is also an example of health promotion,
through education and promotion the public were provided with the knowledge to
look after their heart and make their own decisions, empowering individuals. On a
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wider scale the UK also increased the tax on unhealthy products such as alcohol,
tobacco and food high in salt, sugar and fat (WHO, 2018), to encourage a
healthier society and discourage the establishment of unhealthy habits.
Both Jonah’s parents smoke therefor this would be an opportunity for the nurse to
mention the Stop Smoking Service from the NHS and offer the free smoking
cessation available (NICE, 2012). The child nurse could also support Jonah in
selfcare management by providing him with the skill to manage his own inhalers
and provide good inhaler technique (Murray, O’neil,2016)
The Health Belief Model (1975) looks at why people may choose not follow advice
of health professionals. This includes an individual’s perception on how at risk
they are, some take an attitude of ‘it won’t happen to me’. They may then not
know how serious an illness is and ‘play down’ the severity. People with busy
lives may think they do not have time or do not see it as a priority. The individual
may not want to change, for example smoking may provide that person with a
reason to go to the shop to purchase tobacco and could be the only chance they
get to interact with society (Becker, 1975).
Sociological aspects of health and ill health
Applied science supports nursing practice as it enables the nurse to treat the
patient, this holistic approach is richer in information as it acknowledges all
aspects of the patient’s life (Parse,2015). Sociological aspects can include,
gender, class, environment, education, stereotyping, finances and lifestyle, all of
that can affect an individual’s health, (WHO, 2018).
Financially Jonah’s family are struggling, and their house needs repair, the
heating is unreliable, and mould is in the bedrooms, as previously mentioned
these environmental factors in the home can have a negative effect on Jonah’s
asthma management. Jonah and his family are council property tenants, the local
housing association can be contacted to arrange for the boiler to be fixed
(Gov,2018). This will have a could have a positive effect on Jonah as cold air can
act as an asthma trigger (Nursing Times). The WHO (2018) surmises that lower
socioeconomic house-holds are more likely to smoke than those who are wealthy.
It is believed that 10% of their income is spent on tobacco alone. Smoking
cessation would not only benefit the three children in the household from a
respiratory perspective but a financially positive perspective also.
Psychological aspects of health and ill health
Illness can have a negative impact on an individual’s mental health, the outcome
from this can be an alteration in behaviours such as; mood swings, withdrawal,
loss of appetite and other signs for concern, that if not treated or go unnoticed
could lead to depression (Nutting, 2015). As Jonah suffers with a chronic illness, it
would not be surprising to see any of the behaviour changes stated.
Nutting also states that a child who is suffering from a chronic illness such as
asthma, may also suffer psychological and emotional difficulties.
A study has found that children who visited a hospital suffering from asthma were
significantly less active and were obese in contrast to those who suffered from
other conditions (Glazebrook, McPherson, Macdonald, Swift, Ramsay, Newbould,
Smyth, 2006). Being less active could indicate that asthmatics may be
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experiencing isolation during physical exertion activities. Rubin, Coplan and
Bowker (2009) state that social isolation in children can cause them to be more
inclined to; actively seclude themselves, suffer from anxiety and establish social
fear.
However, a report by Letitre, de Groot, Draaisma and Brand (2014) found that
children who have well controlled asthma showed no difference in anxiety
depression or low self-esteem than those children they encountered who do not
suffer from any illness, surmising that the reason for psychological problems in
children with asthma in previous studies may have been due to studying those
who had inadequate asthma control.
If Jonah was suffering from psychological issues due to his ill health, the primary
concern would be to get his asthma well controlled as the previous study has
shown that well managed illness can ensure a negative impact is not made on a
child’s mental health. A referral to CAHMS (child and adolescent mental health
service) (DoH,2014) may be necessary depending on the severity of how Jonah
feels and through discussion with his parents. Also, if Jonah is suffering isolation
due to asthma and the link to obesity, a referral to his G.P. maybe made with the
recommendation of a dietician’s involvement creating a multi-disciplinary team
around Jonah.
Conclusion
In conclusion the association is evident between poverty and its link to the
inability to manage chronic illness effectively, the living conditions and unhealthy
habits linked to those who live in poverty has presented. As a result of poor
asthma management, a link was made, mental health issues can develop as a
result, indicating that those who suffer from chronic illness that are from a much
wealthier background may have better living conditions and are less likely to have
unhealthy lifestyles, resulting in well-controlled asthma and as a bi-product
chronic illness related mental health issues are not presented (Rubin, Coplan and
Bowker, 2009).
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