Self-Care Behavior Assessment of Fragile School-Age Children: An Application of Orem's Self-Care Framework

INTRODUCTION: Fragile children who were once called; “terminal cases” nowadays are able to live, due to technical advances; although they are requiring permanent assistance. This study aimed to identify the levels of self-care behavior of school-age medically fragile Jordanian children. METHODS & MATERIAL: A cross-sectional design using Orem self-care behavior questionnaire to measure the level of self-care behavior of 96 medically fragile children in capital city (Amman), who hospitalized at least once at the affiliated hospitals.  RESULT: 63. 3%, n=61 children had high level of self-care behavior with overall mean = 62.3 SD=20. ANOVA and Tukey’s post hoc comparisons of the three groups indicate that the level of self care behavior at the late school age 12-14 years old (mean = 71.56, SD = 4.71) and the early school age 6-9 years (mean = 67.05, SD = 4.73) reported significantly higher than the middle school age 10-12 years old (mean 66.95, SD = 4.37), p = .001. A round half of the children complaining of respiratory disease 42.7%, n=41. CONCLUSION: Performing nursing interventions and providing proper discharge plans for school age children and home care for medically fragile children will be based according to the self-care behavior level.

School Nursing and Population Health: Past, Present, and Future

School nursing is grounded in population health. The school nurse role is often viewed as providing episodic care to individual children, and more recently, highly skilled care to chronically ill and medically fragile children. However, the true value of school nursing is in health promotion and illness prevention. School nurses engage in population health practices such as screening; prevention of communicable disease through hygiene and immunization; prevention of injuries; and promoting health through education. As we enter the 21st Century, school nurses are embracing their roots as change leaders who improve the health of children, families, and communities. This article reviews the past and present of school nursing to offer insight about this role in the context of population health, and concludes with a look to the future.

A MULTIDISCIPLINARY APPROACH TO MEDICALLY FRAGILE CHILDREN

Progress is determined by motivation and motivation is determined by confidence. In managing children with multiple deficits, it is necessary to extract underlying obstacles in order to make therapy most effective. The client, a ten year old girl presents with significant fear of movement. She presents with multiple fractures secondary to distal renal tubular acidosis and osteopenia. After confining herself to bed, post orthopedic surgery, she was referred to the Director of Programme of Circle of Care, a center catering to children with special needs and promoting inclusion. Individual and parental counseling along with movement and art instruction yielded mobility and improved management of activities of daily life with moderate support from equipment and family members. As a result of collaborative work and systemic awareness, client was able to exit her state of immobility and become independent in problem-solving. A multimodal approach accounts for the physical impairments as well as the social limitations presented in a child. Multidisciplinary approach with importance on counseling makes therapy effective and progress visible particularly in children who present with multiple or frail disorders/diseases.