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Reflecting on a learning process is not always an easy task as it requires staying objective to the case and never forgetting about personal preferences. My practice at the private clinic promoted an understanding of mental risks and needs of younger patients and their families. It is not enough to gather clinical findings and examine vital signs. It is important to be ready for multiple emotions, fears, and uncertainties and collaborate with other professionals.
One of the last cases where a 5-year-old boy has needle phobia, and injection anxiety shows that the development of certain practical skills like compassion, communication, confidence, and attention is required to achieve positive outcomes and reduce the level of anxiety.
The decision to use cognitive-behavioural therapy (CBT) is based on several factors, including parental support, nurse assessment like chief complaints, pain scale, or a review of systems, theoretical and practical knowledge, and even personal feelings. Therefore, this reflection is not just the evaluation of my nursing skills and practical achievements, it is a story of my personal growth as a medical worker and the peculiarities of recovery process among young patients with mental health issues.
I think that a learning process about any health concern should begin with giving clear statistical data to realise the scope of the chosen topic. According to O’Brien, Harvey, Howse, Reardon, and Creswell (2016), the majority of mental health problems usually begin at early ages and affect more than 13% of children. It means that more than 10 million paediatric patients need to treat such diseases as anxiety, depression, anger, bipolar disorder, or paranoia. Unfortunately, the list of mental health problems is long and complex, and a learning process should be effective enough to cover all these issues.
One of the most important lessons was the recognition of the role of primary care practitioners and nurses in managing patients’ diseases. Having an opportunity to see a patient at different periods, medical workers may recognise the presence of a mental health problem and help parents choose the right direction and advance a child’s well-being (O’Brien et al., 2016). Such a level of responsibility and expectations made me I feel very proud and confident in the decision to connect my life with mental health nursing field. I thought that it was my prior responsibility not only to follow the prescriptions of doctors but try to develop my observations and give recommendations. I had to be ready to communicate with patients, listen to them, distinguish their needs, and create an environment to promote recovery.
In the case with the allergic boy, immunotherapy was an essential part of treatment that lasted about five years. Injections had to be given every 6-8 weeks to achieve the desired effect. Boy’s phobia of needles turned out to be a serious obstacle for the medical staff. As a nurse who had to give him injections regularly, it was my high priority to find a solution, make a fast decision, and understand how to help the boy.
Any nurse has to follow a plan and remember about the improvements after case evaluation. My task was not only to do the injection for a kid and report on his reactions. I was responsible for his emotional and mood changes and attitudes toward needles and associated outcomes. My behaviour was critical for the boy’s and his family’s understandings of the issue and its effects on the quality of life. As a nurse, my learning was based on the evaluation of the current situation, work with outside sources and medical experts, and thoughtful decision-making.
Clinical Decisions and Specific Contents
Every clinical decision has a considerable effect on nursing practice. In the case of a 5-year-old boy, it was necessary to deal with several allergens with the help of immunotherapy that included injections. The patient had needle phobia and negatively reacted to any type of injection. I did all injections, and it was my responsibility to help the boy get over his anxiety and receive every procedure with no fear.
The beginning of immunotherapy was associated with a number of emotions and negative responses like tension, tears, or fainting (Cook, 2016). Each time, my decision whether it touched upon his treatment plan or his direct participation in treatment was a solid contribution to his recovery. I learnt that an effective solution to one problem at the present moment could improve the quality of life in the future.
The main thing that I discovered during my learning process and taking care of the patient was the importance of shared decision-making in nursing care. It could influence many clinical decisions and promote new mental health outcomes. On the one hand, patients may follow the prescriptions and complete the recommendations without demonstrating their concerns or fears. Nurses have to understand this choice and support patients.
On the other hand, some patients would like to perform a distinct role in choosing appropriate treatments and protecting their health. This situation was observed during my communication with the boy. Parents were interested in every aspect of a treatment process and wanted to help. They were ready to learn and identify as many options as possible for their child to deal with allergies. My decision on cognitive-behavioural therapy for managing the kind’s needle phobia was based on the attitudes of parents toward their child’ health conditions, needs, and worries.
Cognitive-Behavioural Theory and Its Impact
In the patient’s case, despite being involved in child care, parents were not able to give a clear reason why the kid was afraid of injections. They denied past negative experiences with needles but mentioned that almost every vaccination during the first years of life was associated with tears and cries. However, the parents usually explained such outcomes as the change of the environment, new people, or unpredictable feelings.
Needle phobia is observed among many children and adult patients, and there is no definite opinion about its causes and the most effective treatment effects (Cook, 2016). Patients could demonstrate various reactions to needles’ use in therapy. One day, the boy fainted during the first two minutes after he saw the needle for immunotherapy. The next few days, slight tachycardia was observed without the possibility to normalise the condition. Therefore, treatment of this mental health problem had to cover different behavioural and emotional aspects. After a thorough analysis of recent clinical findings, I succeeded to identify cognitive-behavioural theory (CBT) as one of the possible interventions to be applied to the case of needle phobia.
The fear of needles is based on some discomfort and pain, and it is not a surprise that many children suffer from injection phobias from time to time. Orenius, Säilä, Mikola, and Ristolainen (2018) admit that these mental health problems could show a certain decreased with age, but the promotion of cognitive management of emotions cannot be neglected. CBT was found effective in treating different mental health disorders, including the boy’s anxiety.
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There are many strategies that nurses could use to apply this theory to practice. In regards to the case under consideration, first, it was necessary to provide the patient and his parents with enough information about the nature of his disease and the role of immunotherapy. Psychoeducation is a good chance to underline the reasons why needles are not dangerous. Second, cognitive reconstructing should help to identify and replace negative thoughts with new positive, realistic goals. Exposure and activation of behavioural changes were two important stages in treatment and my nursing practice.
To avoid treatment refusal, patients have to be provided with several alternatives and explanations. Immunotherapy has to be combined with psychological treatments to develop pathological fear response and control the subjective experience of fear (Orenius et al. 2018). I identified three components to discuss the boy’s phobia of needles. I guided thoughts and changed irrational beliefs about the pain associated with needles, stimulated positive behaviours and provoked situations when needles were used without any discomfort being experienced and promoted effective physical responses through relaxation and regular breathing.
I was responsible for the explanation of every new technique and expected outcomes in immunotherapy and phobia treatment. CBT has a number of benefits, including the possibility to treat mental health disorders when alone medications or therapies do not work or to restructure thoughts and change feelings. However, such obligations as full commitment to the process, the presence of confronting emotions, and the inability to address past experiences but focus on current problems only can limit the work of nurses.
Being a nurse means being ready for a number of tasks to be completed in a short period with total respect and recognition of patient needs. During this course, the necessity to promote mental health among younger patients made me think about my future development of a career as a nurse. My case was a good source of information about the multimodal approach to nursing. The mental health risks of the patient included the possibility of phobia progression and the inability to continue immunotherapy against allergies. It was expected to reduce the level of anxiety connected with injections and follow an immunotherapeutic plan of care.
The unexpected outcome was parental involvement in CBT with a burning desire to learn more and support both the child and nurse in communication. CBT was relevant to the case because it was necessary to provoke changes from several perspectives simultaneously. The patient could benefit from my knowledge of this theory and skills used because I was able to improve his attitudes toward injections, give several reasonable explanations, and support him during each step taken.
To strengthen the chosen interventions, I addressed the web and found several recent discoveries and evidence. Orenius et al. (2018) admitted that more than 60% of children were afraid of needles, and my goal was to explain to the child that there was a chance to deal with that fear and become better than other children. Cook (2016) underlined the role of distractions like television or interactions with family or friends. In retrospect, I would probably add watching TV as a practice to distract the patient and complete the intervention. Every injection could be associated with a new episode of his favourite animation in addition to the already chosen parental support and relaxation techniques.
To be a successful nurse, it is necessary to focus on life-long learning and constant improvement in my skills and knowledge. The end of this course does not mean the end of my education, and I have to identify new goals in the chosen field. The contents learned helped me recognise mental health issues among younger patients as a global concern for nurses to deal with. My future nursing practice can be based on the analysis of treatment techniques used in different parts of the world.
Every culture or nation is characterised by unique features, specific languages, and traditions. Nurses should never demonstrate their prejudice or biases to some groups of people. Therefore I want to direct my future learning to the evaluation of cultural diversities in mental health issues. In the case with the 5-year-old boy, no attention was paid to his cultural roots and traditions. However, it was possible to improve his attitude toward needles if I used several histories or myths that did not contradict his beliefs and prove my awareness of his needs. Trust is the key to success in managing mental health issues in children.
In general, my learning and practice at the private clinic become a serious contribution to my professional development and personal growth. Paediatric patients with mental health risks and needs have to receive special attention from general physicians, nurses, and medical practitioners. My achievements in treating needle phobia along with immunotherapy against allergies prove that the completion of multiple tasks and attention are direct responsibilities of nurses. Regular collaboration with families and medical workers, a constant need of gaining new knowledge and searching for evidence, and application of theories and practical skills are the key points in nursing learning that can never be neglected.
Cook, L. S. (2016). Needle phobia. Journal of Infusion Nursing, 39(5), 273–279. Web.
O’Brien, D., Harvey, K., Howse, J., Reardon, T., & Creswell, C. (2016). Barriers to managing child and adolescent mental health problems: A systematic review of primary care practitioners’ perceptions. British Journal of General Practice, 66(651), 693–707. Web.
Orenius, T., Säilä, H., Mikola, K., & Ristolainen, L. (2018). Fear of injections and needle phobia among children and adolescents: An overview of psychological, behavioural, and contextual factors. SAGE Open Nursing, 4, 1-8. Web.