Please respond to at least 2 of your peer’s posts. To ensure that your responses are substantive, use at least two of these prompts:

• Do you agree with your peers’ assessment?
• Take an opposing view to a peer and present a logical argument supporting an alternate opinion.
• Share your thoughts on how you support their opinion and explain why.
• Present new references that support your opinions.

Please be sure to validate your opinions and ideas with citations and references in APA format. Substantive means that you add something new to the discussion, you aren’t just agreeing. This is also a time to ask questions or offer information surrounding the topic addressed by your peers. Personal experience is appropriate for a substantive discussion and should be correlated to the literature.

Qiana’s Response

Question 2: Conflicting Patient History

When parents provide conflicting information that is relative to a child’s care and development, it makes it difficult to assess the actual factors relevant to the patient’s care and development, as well as their home life. Since 80% of diagnoses are based on the provided history (Burns, Dunn, Brady, Starr, Blosser, & Garzon, 2016), this issue creates the conflict of not knowing the correct history and is likely a result of the parental relationship and the living arrangements. Waller (2012) found that “cooperative co-parenting is less likely” when parents that were unmarried separate after the child’s birth, or if they were never together in the first place. So, while it may be tempting to believe the mother, because she seems to be with the patient for the majority of the week, we cannot automatically discount what the father is reporting.

A place to start, with the idea of “family as unit of care” (Burns, et al., 2016), is more assessment of the family life and relationships. While she is with mom during the week, is she really with mom? Or does mom work a lot and the child is in someone else’s care? Is there an issue with a custody battle? Is there smoking in the home? In the presence of any of these situations, it is still possible that there are components of both histories that are correct and relevant. In this case, I think that providing treatment for the child could be mostly unaffected, depending in the severity of the infection. Using the model for clinical decision making (Burns, et al., 2016), I would communicate the assessment data and focus on teaching and prevention, in conjunction with the prescribed treatment. I think we can only document the concerns of both parents and teach them from there, careful to monitor for symptoms and patterns that coincide with both reports.

References

Balestra, M. L. (2016). Liability in emergency departments and disciplinary exposure for nurse practitioners. The Journal for Nurse Practitioners, 12(2), 80-87. doi:http://dx.doi.org/10.1016/j.nurpra.2015.09.003

Burns, C. E., Dunn, A. M., Brady ,M. A., Starr, N. B., Blosser, C. G., & Garzon, D. L. (2016). Pediatric primary care. (6th ed.). St. Louis, MO: Elsevier. ISBN: 978-0-323-24338-4

Waller, M. R. (2012). Cooperation, conflict, or disengagement? Coparenting styles and father involvement in fragile families. Family Process, 51(3), 325-42. doi:http://dx.doi.org/10.1111/j.1545-5300.2012.01403.x

Samantha’s Response

Question #1

The family is a dynamic social system that is usually the most powerful and constant influence shaping a child’s development and socialization. The child looks to the family dynamic for emotional connections, behavioral constraints, and modeling that affect the child’s development of self-regulation, emotional expression, and expectations regarding behaviors and relationships (Burns et al., 2017). Changes in one family member’s behavior affect everyone else in the family unit. Divorce or the separation of parents can be an emotionally taxing and complex event for families and can result in significant emotional disruption and disequilibrium for all family members (AACAP, 2017). The practitioner must be aware of developmentally appropriate vs. inappropriate behavior to identify additional needs. Divorce is an ongoing process rather than a concrete event; thus, the assessment of the child needs to be monitored not only at office visits, but by the parents and close family members. Children may perceive this event as a dramatic and painful time in their lives, typically resulting in grief, due to the perception of divorce as a loss of the family as the child has known it (Burns et al., 2017). Behavioral changes are an expected reaction as the child attempts to adjust to the changing family situation. Children and parents tend to make a more successful adjustment if there has been a stable parenting foundation in the child’s early years, if parents provide warmth and praise for the child through the divorce, and if the child knows that both parents will remain involved in their lives (Burns et al., 2017). The process of divorce is less stressful on the child and family if the parents remain civil and focus on the needs of the child (AACAP, 2017).

Anticipatory Guidance

The first recommendation to the parents is to prepare the child for the breakup before is happens. Children who are appropriately prepared may cope better with the separation and change in family structure (AACAP, 2017). Discussions should focus on supporting the child’s needs for reassurance and stability, not on blame, recriminations, or the parent’s needs (Burns et al., 2017). Key issues that need to be discussed with the child includes new living arrangements and visitation, what the meaning of divorce is, assure it was not their fault, explain what the new family dynamic will be once the divorce is complete, reassure the child they will be cared for and loved by both parents, and encourage them that appropriately expressing emotions such as sadness, anger and disappointment is normal (AAMFT, 2018). The parents need to understand that consistency is key, to maintain a similar structure between both houses including discipline to provide security for the child. Inform parents of self-help workshops and support groups that the parents can attend with the child to help with the transition (Burns et al., 2017). Finally acknowledging grief and assessing for the need of mental health referral. The child and family should assess for abnormal or unhealthy coping mechanisms and should seek help for concern. A 6-year-old may show open grieving and feelings of rejection or being replaced; whiny, immature behavior; sadness; fearfulness (Burns et al., 2017). The goal of health education for children and parents experiencing divorce is to help restore a sense of wholeness and integrity in children’s lives.

AACAP. (2017). Children and Divorce. Retrieved from https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Children-and-Divorce-001.aspx (Links to an external site.).

AAMFT. (2018). Children and Divorce. Retrieved from https://www.aamft.org/Consumer_Updates/Children_and_Divorce.aspx.

Burns, C. E., Dunn, A. M., Brady, M. A., Starr, N. B., Blosser, C. G., Garzon (2017) Pediatric Primary Care. [VitalSource Bookshelf]. Retrieved from https://bookshelf.vitalsource.com/#/books/9780323243384/ (Links to an external site.)

Edited by Samantha Barrios on May 7 at 2:23pm

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