Jane says that she has to go to the toilet sometimes every hour so she goes about ten or eleven times a day this would be caused by the bladder contractions as the bladder would be able to hold less and so she would need to go more often. Jane has said that she is often surprised that not much comes out when she feels like she is “bursting” to go this is because the bladder is prevented from becoming full so small amounts come out. Josephine has had to change the bedclothes on Jane’s bed twice on a couple nights because Jane did wet more than once a night because of frequent bladder contractions. The size of the wet patch changes this is because she may have wet the bed a couple of times without waking up to it. Jane wakes the majority of the time after wetting because she climbs into her mum’s bed. She says she feels like she is always “bursting” to go when she experiences bladder contractions. Jane’s functional bladder capacity should be roughly 240ml for her age the contractions would cause her bladder to hold less than it was potentially able to. Jane says she sleeps well and mostly only wakes after she has wet the bed.
The physical care needed for the child is to encourage the child to in general to have bladder training this is done by having six to seven drinks daily (up to two hours before sleep) and six to seven voids a day (about every two hours or at break times at school) this will get the bladder used to being full and voiding some children have different reactions to squash e.g. orange, blackcurrant and lemon maybe because of their high levels or artificial colours and sweeteners BUPA (2004). A small drink before bed if needed so there is less fluid in the body and so less likely for the child to wet during the night. The child needs easy access to the bathroom so if they wake in the night they are not discouraged by the distance to the toilet also if there is a light left on as the child might be afraid of the dark. Encourage the child to go to the toilet twice before bed about half an hour apart this will help the child to void as much fluid they have in their body as much as possible.
The child may also take oxbutynin but Josephine is reluctant for the child to take it because of the side effects it may cause she wants Jane to try bladder training first of all. Watanabe et al (1994) have shown sixty seven to one hundred percent success rate on the combination of bladder training and oxybutynin.
The nursing process started with the initial assessment when Jane was admitted to the clinic. The planning part of the process involves what course of treatment to take in Jane’s case teaching Jane how to train her bladder. The implementation part of the process involves the bladder training at home for about four weeks. On the second visit to the clinic the analysis of the treatment did it work for Jane has it improved. Also on the second visit to the clinic we would evaluate the treatment then reassessment then Josephine may have to think about medication.
Jane has been put on the waiting list for the alarm which has a success rate of sixty seven to seventy five percent Forsythe W I et al (1989) while Van Londen, A (1993) has found that this enabled ninety eight point five percent to become dry. When Jane gets the alarm she may not wake for the first week so Josephine might have to wake her until she get used to waking up in the night. Josephine rewards Jason when he turns his alarm and completes the void in the toilet then when he returns to bed re setting the alarm. As Jason takes responsibility for his alarm he has a greater understanding of what is happening and in helping he is getting used to waking up in the night and going to the toilet.
The clinic nurse also explained to Josephine to wake Jane when she goes to bed and asking her if she want to go to the toilet this scheme is similar to Azrin N H et al (1974) where the parent wakes the child three hours after falling asleep and asking the child to go to the toilet this would ensure there is very little fluid that might be voided later on in the night causing a wet bed. If it was a dry night then Josephine then reduces this time the next night by fifteen minutes. If Jane has a wet night then the time stays the same. This waking schedule works by lengthening the amount of time that Jane can go without voiding during the night. This waking schedule combined with the alarms is said to be the most effective in dry bed training Richard J Butler (2000).
Social means the sort of interpersonal relationships, social reactions, and activities of independent living a certain person or group of people have Tanya A McFerrran (2003). Developmentally Jane needs to relate to her peer group and be apart of a social group e.g. be able to go to sleepovers on school trips and other activities children do as they grow up. Jane said that she had always wanted to go on sleepovers but felt worried that she would have an “accident” and her friends would find out that she wet the bed. Jane thought it was weird that she has never had an “accident” at her dad’s house. Parents also need to know that they are not alone they are not the only parents with a child with enuresis. Josephine like to have dinner parties with her friends but is worried about the smell and the effect it has upon the bed and the bedclothes that she might keep having to buy new sheets duvets and mattresses which she would not be able to afford. Josephine can sometimes smell urine as she walks up the stairs and is afraid her friends will do too. Jane has a good relationship with Jenny her older sister who is unaware of Jane and Jason’s enuresis and now is getting on more with Jason. Jason gets on well with Jack who knows about the enuresis but pretends he does not. Jenny wants to have sleepovers but as she shares a room with Jane Josephine is reluctant to let her
All children need to feel accepted as part of a group maybe Jane could have a sleep over at her house this would help her social development and if she has an accident it would be easy to cover it up. Children are less likely to have an accident if they are not at home because they feel less at ease with their surroundings and more aware of the enuresis, so if Jane did not wet the bed at her dad’s she is less likely to wet the bed at a sleepover. Josephine could open a window to get an airflow around the house and use a strong air freshener in their bedrooms to reduce the smell in the house. If Josephine encouraged the children to drink more the urine would not be so concentrated and therefore would not smell so much. There are covers that Josephine could put upon the mattresses to protect them and then she would not have to buy new ones so often also if she could not afford this the clinic nurse suggested to her that she should use cut open bin bags and lay them under the sheets to protect the matresses. Jenny could have a sleepover in the living room saying to her friends that her room is not big enough for a sleepover.
Tanya A McFerrran (2003) Culture is the customs and civilizations of a particular group in this case a family. Every family is different and each family has slightly different opinions on everything this would include diet and enuresis. The way a child is treated when they wet the bed has an impact on the child's self esteem. If the parents or other close family view enuresis as embarrassing the child could.
The NMC (2002) states that a registered nurse must team include the patient or client, the patient’s or client’s family in the care. This would involve talking to the child making sure that they understand what is happening and also that the family understand what is happening and what can be done to promote health.
Family centred care would seem to be a central element of children's nursing (, ). Documents published by the Department of Health () and the ) promote family centred care as the underpinning philosophy for the care of sick children, and yet offer little insight into what the term actually means. It would, therefore, seem important to explore this phenomenon in an attempt to clarify its nature.
Psycology is the study of behaviour and its related mental processes Tanya A McFerrran (2003). Josephine told the clinic nurse that Jane used to hide the wet pyjamas because she was aware that most of her friends did not wet the bed. Jane needs to understand that enuresis is nothing to be ashamed of that other people still wet the bed like her. Jason said he felt he is not up to the same developmental milestones as anyone else and is behind everyone in the year. Jane just thought it was unfair why it had to be her. On Jason’s admission to the clinic when he was 6 both Jason was wearing nappies during the night this would not help his self-esteem.
The psychologically of the child needs to feel normal, that they are not the only one that has it before Jane’s admittance to the clinic her mum told her that her brother has it her dad did have it and she was not the only one and she did not need to hide her pyjamas when she had a wet night. This will boost Jane’s self-esteem and her confidence that she will become dry by telling her that her dad did have as well will illustrate that she can become dry just like her dad. Josephine has shown Jane the website for Education and Resources for Improving Childhood Continence (ERIC) which has input by other enuresis suffers so that there are other children that have enuresis to reinforce the fact that it is not an unusual condition. Josephine and John now understand not to punish either child for wetting the bed and to reward them for a dry bed this will help them understand that by wetting the bed they have not done something wrong and it will encourage them to have a dry night. Robinson L M (2004) views her opinion that punishment has no role in the treatment of nocturnal enuresis. The impact on self-esteem and on the emotional health of the child is significant enough without the added insult of punishment for a problem beyond his or her control. Punishment can be subtle and unrecognised by an otherwise well-meaning parent.
Josephine has stopped giving nappies to sleep in, on Jason’s admittance to the clinic she stopped Jane from wearing nappies at age five and gave them “special” pants that they could wear to bed Robinson L M (2004) states the most common psychological problems from enuresis are embarrassment, anxiety, loss of self-esteem, and effects on self-perception, interpersonal relationships, quality of life, and school performance. Heap J M (2004) also believes that they are low achievers in the school system.
