| Popis: |
Suomalaisilla lapsilla yli 20 %:lla on ainakin yksi pitkäaikaissairaus, ja yli 5 %:lla todetaan kasvuiän lopussa pysyvä vamma tai sairaus. Täten olisi kiinnitettävä enemmän huomiota siihen, miten perheet selviävät lapsen sairauksien, diagnosoinnin ja hoidon henkisestä kuormituksesta. Perhekeskeisyyttä on pidetty perinteisesti terveydenhuollossa tapahtuvan hoitamisen periaatteena, vaikkakin sen toteutumisessa on ollut puutteita. Tutkimuksen tarkoituksena on kuvata, miten terveydenhuollon ammattilaiset voivat edistää perheen terveyttä lapsen sairaalahoidon aikana. Tulosten mukaan sairaanhoitajat toimivat kolmella eri tavalla hoitaessaan perheitä: systemaattisesti, selektiivisesti ja tilannesidonnaisesti. Systemaattisesti toimivat hoitajat kohtasivat kaikkien perheiden todellisuuden: he vahvistivat vanhemmuutta, huolehtivat lapsen hyvinvoinnista, auttoivat perhettä purkamaan tunnekuormaansa, tukivat arjessa selviytymistä sekä rakensivat luottamuksellista hoitosuhdetta perheen kanssa. Selektiivisesti toimivat hoitajat valikoivat perheet, joiden he olettivat tarvitsevan apua ja joihin he siis paneutuivat työssään. Tällöin perheiden hoitaminen perustui hoitajien käsitykseen perheen tilanteesta ja avun tarpeesta eikä perheen yksilölliseen näkökulmaan ja tilanteen määrittelyyn. Tilannesidonnaisessa hoitotyössä lähtökohtana oli hoitaa eteen tulevat tilanteet hyvin. Tämänkaltainen toiminta ei edellyttänyt perheeseen tutustumista eikä systemaattista tiedon keruuta perheen tilanteesta, minkä takia myöskään tilanteiden kärjistymistä perheissä ei pystytty ennakoimaan. Hoidon kohteena pidettiin lasta. Perhettä kohdanneisiin tilanteisiin puututtiin vain, jos lapsen turvallisuus oli uhattuna. Selektiivisesti ja tilannesidonnaisesti toimivat hoitajat sivuuttivat perheen todellisuuden. He eivät kokeneet tarpeelliseksi perehtyä perheen muuttuneeseen tilanteeseen eivätkä aktivoineet perheen voimavaroja. Tällöin hoidon lähtökohtana oli hoitajien käsitys perheen tilanteesta ja avun tarpeesta. On syytä pohtia, miksi osa hoitajista huomioi perheen yksilöllisen tilanteen ja avun tarpeen kohdaten perheen todellisuuden, ja miksi osa hoitajista sivuutti perheen todellisuuden nojautumalla omaan käsitykseensä perheen tarpeista. Kaikki perheenjäsenet eivät aina koe tarvitsevansa apua terveydenhuollon ammattilaisilta. Perheen terveyden edistämisen lähtökohtana ovatkin perheen yksilölliset tarpeet, halu tulla autetuksi ja perheen ja terveydenhuollon ammattilaisten avoin ja vastavuoroinen yhteistyö. Promoting health of a somatically and chronically ill child's family - an action research on a paediatric ward The purpose of the research was to build a substantive theory of promoting family health during the child s somatic chronically illness, as well as assess and promote family nursing on a pediatric ward by means of action research. Action research took a critical, participatory approach that acted as the basis of theory development. The aim of the development was to create an intervention to the nursing which would promote the health of the family. The data consisted of 31 family interviews (n=82 family members), nurses (n=40) group interviews (n=9) and observation of the interaction between families and nurses (84 h). The data were collected in pediatric wards in two different hospitals where chronically ill children below the age of 16 are being cared. One of the wards was a target unit of family nursing development, and from the other ward, data were collected in order to confirm the validity of the results and to ensure the anonymity of the participants. Data analysis was based on the grounded theory -method with its straussian approach applied. Cooperation between the researcher and the nurses resulted in a family consultation intervention in the nursing. Family consultations were applied in the target unit for 10 months, after which the nurses (n=17) described their experiences of the functionality of the intervention in practice in essays they wrote. Head nurses (n=2) were interviewed about the same subject. Essays and interviews were analysed by using deductive content analysis -method. Nurses faced family s reality or they bypassed it during the child s illness and the hospital stay. When the reality of a family was faced, the basis of the nursing was family s individual situation and need of help. When the family s reality was bypassed, the basis of the nursing was the nurses view on the situation of the family and their need of help. Nurses who worked systematically faced family s reality. Systematically operating nurses faced the family s reality since they observed the changes that had occurred within the family s health and their effects on the whole family, not to mention that they activated family s resources. Changes occurred in the functions of the ill child, the siblings, the parents and their relationship as well as those of the whole family during the child s illness and the hospital stay. The families expected the nurses to reinforce parenthood, look after the child s welfare, share the emotional burden, support everyday coping and to create a confidential care relationship. Systematically operating nurses promoted above-mentioned constituent systems of family health. Family consultation -intervention, which was developed in the research, enhanced systematically performed nursing. Selectively and situation-specifically operating nurses bypassed family s reality, for neither did they observe the changes that occurred within a family, nor did they activate the resources of a family. Furthermore, they promoted constituent systems of family health only randomly. In that case the basis of the nursing was the nurses view on the situation of the family and their need of help. According to the results, parents of a chronically ill child need help in reinforcing parenthood, sharing the emotional burden as well as in everyday coping. Nurses have particularly good possibilities to respond to this need by facing the family s reality during the child s illness and the hospital stay. It is necessary to consider why some of the nurses regarded the individual situation of the family to be the basis of their work and why some nurses bypassed family s reality by considering their work s very basis to be their own view on the family s situation and need of help. Family-centred care was a central guiding principle in both children s wards concerned. The substantive theory built in the research strengthens the knowledge base of family nursing science by making the promotion of families health a more visible part in the nurse s work. In the future the theory must be tested and developed further in different contexts and with various patient groups. In the research, family consultation -intervention was created in cooperation between the researcher and the nurses. In the research, family nursing was also developed while applying the methods of action research. The functionality and the stability of the family consultation in nursing, as well as its application on different nursing environments and the effects of consultation on families health give indication for further research. |
