Tim was admitted to hospital for an operation to correct an orthopaedic condition called congenital hip dysphasia (CDH), this is described by Dr Jeffry .W. Hull as “a developmental (ongoing) process, variable in manifestation and not always detectable at birth
CDH involves a dysphasia, or abnormal formation of the hip joint occurring between foetal life and maturity as a result of instability
The hips are not dislocated at birth, but if a dislocation occurs, then the complications of the dislocation - malformation of the hip socket, twisting of the thigh bone (femoral anteversion), and hip muscle shortening (contractures) will develop.” (ref: ).
Tim was admitted to the Orthopaedic paediatric ward where two days before his operation to prepare him medically and psychology. Tim was explained the precidure in a language he would understand, the parents were also prepared to promote a degree of autonomy, for example Tim made a informed decision, he chose to have a gas induction in the anesetic room rather than a intra venius induction, this aliveated what may have been un-nessasary stress and upset.
To asitain Tim’s individual needs a admission assessment took place, this is a important tool which covers many categories such as the physiological history of the patient as well as the psychological needs such as sleep patterns eating habits, religious needs, phobias, relationship with parents, play preferences. In the admission assessment it came to light that Tim was no longer in communication with his biological father and referred to his step father as father, he was phobic of needles, and his family were a Christian denomination called Jehovah Whiteness, this religious belief would have implications in the treatment that Tim would and would not be given.
The assessment also brought into light that he had self image issues cimcuventing thas from a large amount of scar tissue from a prevous operation , the combnation of his hipdysplasia and the
Apart from the normal religious needs of a Christian such as a place to pray Johavah Witnesses believe that it is a act against Jehovah (god) to have any blood product i.e. a blood transfusion for will be denied access to heaven– “That ye abstain from meats offered to idols, and from blood, and from things strangled, and from fornication: from which if ye keep ourselves, ye shall do well. Fare ye well.” (ref: bible- Acts 15:19-21,28-28) and “Moreover ye shall eat no manner of blood....in any of your dwellings. Whatsoever soul it be that eateth any manner of blood, even that soul shall be cut off from his people.” (ref: bible -Leviticus 7:23-27). Although this could cause controversial risks during and post surgery which were fully explained to Tim and his mother and father, the patients rights to be respected as a individual are taken foremost., although, it was noted that if he chose to have blood and his parents disagreed, as he was assessed to be Gillick Competent , “children under 16 are not automatically presumed to be legally competent to make decisions about their healthcare. However, the courts have stated that under 16s will be competent to give valid consent to a particular intervention if they have “sufficient understanding and intelligence to enable him or her to understand fully what is proposed”(sometimes known as “Gillick competence”). In other words, there is no specific age when a child becomes competent to consent to treatment: it depends both on the child and on the seriousness and complexity of the treatment being proposed.” (ref: seeking consent working with children. Department of health )
Fortunately Tim did not need any blood products .
Post operation Tim’s mobility was greatly affected so I assisted in helping with a lot of his personal care such as washing dressing and going to the toilet, the emphasis on empowering Tim by getting him to as much as he could with out help. Due to his age he preferred a male helping rather than a female nurse this was requested in the initial admissions assessment as he felt uncomfortable with females including his mother particiating in his day to day care. Tim was placed in a ward bay with three girls so extra care was given to protect his dignity during these tasks.
Throughout the admissions assessment and day to day care planning I feel I respected Tim as a individual by following the nursing process taking into account his family backround.
