Sociopolitical Knowing in Caring for a Disabled School Age Child
The authors describe how they employed the perspectives of two extant nursing theories, Roy and Orem, in understanding the complex needs of a school-age child who required tube feeding during school. In addition, they explain how sociopolitical knowing was skillfully used by the school nurse to effect positive change in both the health and the school experience of the school-age child.
Danielle is a 12
year-old girl whose condition required her to have a feeding tube. She has
limited verbal capacity and is confined to a wheelchair. She attends a regular
school that also accommodates children with very mild to more severe
disabilities. Although Danielle is not able to actively participate in many
school activities, attempts were made to include her in classroom activities
such as lessons, stories and games. She is also helped to join other children
for recess, art, and library time. The school nurse worked hard to give every
child an equal chance at having or at least being exposed to normal school
experiences. One milestone the nurse accomplished was arranging for Danielle to
eat lunch in the cafeteria with all of her peers, where previously she was taken
somewhere else to be fed in privacy. Eating with her peers proved to be a very
positive experience for both the child with the disability and for her peers.
Both Roy’s and Orem’s theoretical models provided guiding perspectives for our nursing actions. Callista Roy’s (Roy & Andrews, 1999) theory was applicable because it discusses the person-environment interaction in reference to “the human ability to adapt” (Haynes, Boese & Butcher, 2004). An adaptation goal for Danielle involved assisting Danielle’s assimilation into the school environment by helping her to participate in daily activities with her peers, while still meeting her special needs. The school nurse used available resources to help Danielle adapt and have as close to normal school experiences with her peers as possible. Dorothea Orem’s (2001) Self-Care Deficit theory also fit with our case study because it deals with people who are unable to fully care for themselves. Orem’s framework of nursing engagement as a “partly compensatory system” provided a perspective for offering the patient physical and psychological support while guiding, doing for, and creating an environment that supported Danielle’s development.
However, providing for a supportive environment for Danielle could not have been accomplished without the use of the nurse’s sociopolitical pattern of knowing (White, 1993), given the controversy over mainstreaming disabled children. Once it was determined empirically that it could be beneficial (Martin & Bat-Chava, 2003; Thomson & Lilli, 1995), and ethically that the child should be taught in normal learning environment despite some risks, the nurse used sociopolitical savvy to effect this change in school procedure. The nurse had to educate and negotiate with various social groups (school personnel, parents, students, general community, and Danielle herself) about disabilities to facilitate Danielle’s successful integration into the school environment.
Haynes, H., Boese, T., & Butcher, H., (2004. Nursing in contemporary society. Issues, trends, and transition to practice (pp. 88-93). Upper Saddle River, New Jersey: Pearson Education, Inc.
Martin, D., & Bat-Chava, Y., (2003). Negotiating deaf-hearing friendships: Coping Strategies of Deaf Boys and Girls in Mainstream Schools. Child: Care, Health, and Development, 29 (6), 511-521
Orem, D.E. (2001). Nursing: Concepts of practice (6th ed.) St. Louis: Mosby.
Roy, C., & Andrews, H.A. (1991). The Roy adaptation model (2nd ed.). Stamford, CT: Appleton & Lange.
Thomson, D.J., & Lillie, L., (1995). The effects of integration on the attitudes of non-disabled pupils to their disabled peers, Physiotherapy, 81 (12), 746-752.
White, J. (1993). Patterns of knowing: review, critique, and update. Advances in Nursing Science, 17 (4), 73-86.
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