TABLE OF CONTENTS

Introduction......................................................................................................................................3
Discussion........................................................................................................................................3
Consent.........................................................................................................................................3
Communication............................................................................................................................5
Verbal.......................................................................................................................................5
Non verbal................................................................................................................................6
Care and compassion...................................................................................................................7
Understanding patient’s illness....................................................................................................7
Understanding patient’s fears and worries...................................................................................8
Justification of examination and correct imaging modality.........................................................9
Use of immobilization................................................................................................................10
Manual handling issues..............................................................................................................11
Radiographer image interpretation.............................................................................................12
Conclusion.....................................................................................................................................12
Reference List................................................................................................................................13

Introduction

A four year old patient has been presented to imaging department and suspected with having the

supracondylar fracture by falling onto the elbow. The child is in significant discomfort and is
tearful while his parents are quite upset and worried about this condition. It is a challenging

scenario for the health care provider because childcare involves many practical problems and

issues which can compromise the quality of care delivered, if not addressed effectively. In this

regard, the underlying report is aimed at analyzing the practical problems which may be

experienced and the possible solutions regarding how they might be minimized while

considering the importance of quality physical and psychological care for patients and the

importance of preventing the ethical issues.

Discussion

Consent

In health care sector gaining consent before providing care or examining the patients holds

substantial importance. Consent of the patients or his parents is an ethical requirement and its

negligence can cause ethical and even legal consequences. When treating the adults or the

patients of 16 years or over, gaining the consent of the patient before the treatment is necessary.

But as the patient is a 4 year old boy who has suffered a fracture, gaining consent is still an

ethical requirement, but in this case, consent is to be gained from the parents. According to the

rules by NHS the consent in such circumstances should be gained from the mother, father,

legally appointed guardian, local authority designated for the child care, or a person with the

residence order covering a child patient. Under these guidelines, the mother and father are to be

asked for the consent before treating the 4 year old boy (NHS, 2016).

In this scenario, gaining the consent of the parents of the child is significantly important but the

practical problem can occur in case the parents do not appear to act in the best interest of the

child. Moreover, another problem is that parents must be involved psychological treatment but if
they deny, the parents’ right of consent cannot be questioned. If a request for treatment is

overruled by the parents or they disagree that certain treatment must be given it will not be the

best course of action exhibited by them. In this scenario, the health are professional can

encountered an ethical dilemma and can face many challenges to proceed (Henkelman & Everall,

2001). In few countries such as some states in United States does not require the consent of the

parents or the guardian but only in some specific medical conditions such as prenatal care,

substance abuse, mental health care etc. But in the current scenario, the professional eventually

need the consent of the parents, and have to overcome the problem of ethical dilemma (Jackson,

Burns, and Richter, 2014).

In case of such problems of inability to gain the informed consent of the problem, some

initiatives can be taken to minimize the adverse consequences. The problem can be minimized

by using the mediation and coordination. The nurses can play this role to change the decision of

the parents and can help the parents in understanding the importance of treating the child and the

consequences of not treating supracondylar fracture and its seriousness for the overall health of a

very young boy. The heath care professionals can also take the time to sit with the parents and

set out the detailed context and the adverse consequences of their decision and what are the

alternative choices they can consider. Provision information can help the parents in making

informed decision and parents advocacy can support patients to cope up with the trauma so that

that can take a decision in best interest for the child (Tabak, and, Zvi, 2008).

Communication

Verbal

The communication between the health care worker and the patients holds substantial importance

for both the physical and psychological health. The child is suffering from the fracture in and it is
significantly important to communicate with him to provide the proper care and to listen to what

he is feeling. But the biggest practical problem which takes place is that the child is only 4 year

old and he might be unable to effectively communicate with the nurse or the doctor. It is even

more difficult to make him understand the message conveyed to him as he is tearful. He cannot

effectively communicate what he is going through and nor can he understand effectively and

here, the involvement of the parents is significantly important who can easily understand he

working and can communicate (Purvis, 2009). But the involvement of the parents during the

communication can also increase the problem of handling the distraction and the boy may not be

willing to interact with caregivers (Papathanasiou & Kourkouta, 2014).

To improve the communication with the patient, the health officials have to develop a

therapeutic relationship with the child suffering with the pain of fracture and building the right

relationship can help in gaining the confidence of patient from the first moment. Courtesy and

kindness is significantly important as the patient must be comfortable and a peaceful

environment must be provided so that he must not panic or feel hesitated to communicate and to

listen what has been communicated (Papathanasiou & Kourkouta, 2014).

Non verbal

The verbal communication cannot provide the psychical or psychological help alone; instead it

must be accompanied by the non verbal communication. As per a study the psychological health

of a child during the treatment influences his/her physical recovery and that psychological health

is facilitated by the physical contact and non verbal communication such as touching ,

comforting, caressing, facial expression of courtesy and gestures. All of these non-verbal

communications are very important to treat the boy as he must feel affection and safety and

allow the nurses or doctors to check and treat his supracondylar fracture (Martinez, Tocantins,
and, Souza, 2013). But there can be many practical problems when communicating with the boy

with non verbal communication. The first problem can occur due to the difficulty in

understanding the non verbal communication due to his age. There are some child patients who

feel comfortable with touching and caressing, where as there are some children who feel insecure

by being touched by those they do not recognize. Moreover, the lack formality with the boy can

cause distortion of information and excessive sue of gestures and facial expressions and confuse

the child and adversely influence the quality of care (Ali, 2018). This problem can be minimized

by using the non verbal techniques which could deliver the benefits of facilitating the

communication with the child while maintaining safe physical distance so that he must not feel

uncomfortable. The key strategies could include the use of appropriate tone of voice, relaxed

body posture, calm facial expressions, and use of eye contact. These initiatives can help in

changing the patient’s perception and he will allow effective communication which will be

effective for his psychological as well as physical health (Martinez, Tocantins, and Souza, 2013).

Care and compassion

Care and compassion are directly linked to help the child recover from the trauma of falling on

the elbow and getting it fractured. But in doing so the probability of facing the challenges is very

high. The child’s age is only 4 years due to which, the parents are significantly concerned and

child is shattered in tears. In such scenario, the distraction caused by the parents can be a huge

challenge which can eliminate the chances of successfully providing the compassionate care. It is

an ear of information explosion and due to excessive technological interference in medical care;

the parents might not trust the healthcare service provider and may question their quality of care

and procedures. These type of challenges and completely compromise the ability of healthcare

provider to facilitative the psychological impact on fracture on the patient (Qidwai, 2017). In the
regard, the compassionate care can be delivered by exhibiting empathy towards the patients and

well as his parents and actively listening to her complaints instead of showing the reaction.

Maintaining proper eyes contact and using proper non verbal use to gain the trust of patient or

the parents and improve he patient’s adherence to the treatment (Qidwai, 2017). Another relevant

report can be incorporated to propose sound opinions, according to the report the compassion is

very important when it comes to childcare and that is only possible by overcoming the

challenges of lack of trust by parents, excessive information, distortion etc. In order to provide

the valued care and being compassionate in understanding the physical recovery needs of

patients and psychological healthful the parents, relationship building practices, dignity, respect

and empathy are compulsory (NHS, 2013).

Understanding patient’s illness

The child is suffering from supracondylar fracture, which is a difficult to analyze physical

condition. It is a fracture of distal humerus above elbow joint. This fracture is transverse and is

above lateral and medial condyles as well as epicondyles in the body of a child. This type of

fracture is rare in the adults and it usually experienced by children. As the child is in panic, it

might become challenging to quickly understand the severity of the fracture which requires his

proper diagnosis and X-rays (Kumar & Singh, 2016). To understand the illness of the child, not

only medical assistance will help, but there can be some strategies that can help in gaining more

information. The best initiative to reduce this problem is by communicating with the parents and

understanding the foe by which the child fell on the elbow and what was the surface. As child is

unable to communicate properly, the best source of information will be communication with

parents by comforting them with verbal and non verbal communication and building a

relationship of trust and empathy. This information can help in decideing the dose and potency of
the medicine which can dircetly influnce the physical recovery from the fracture (Papathanasiou

& Kourkouta, 2014).

Understanding patient’s fears and worries

Gaining understanding of a child’s fears and worries and have significantly positive impact on

facilitating his/her psychological disturbance posts the injury. But as per a study conducted in

2016, the biggest challenge is that instead of reducing the fear and worries of the children in

health care settings, there are high probabilities of making them more anxious and traumatic.

This finding of the research is quite applicable in the scenario under discussion. The child is of

four year who is suffering with high pain of fracture in elbow and any attempt to understand his

fears and worries and further increase the anxiety and trauma. Understanding the fears can help

in case of treating the adults as they feel better by talking about their painful experience, but in

case of the kids, they might feel offended and more anxious when talk about or listen to their

painful experience and may exhibit violent behavior which can further damage their physical

health. As the boy is having supracondylar fracture, any mistake can lead to violent reaction and

he can further harm himself (Lerwick, 2016).

But understanding the fears and worries of the patient without increasing the anxiety is

significantly important. This problem can be reduced by understanding what is expected by the

patients, recognizing the common fears of the child by observing his reactions, using the CARE

principles and making the family members empowered which can reduce the ameliorate risk of

the traumatic responses and anxiety (Lerwick, 2016). The healthcare providers can also reduce

the risk of trauma and anxiety faced by the children by controlling the environmental factors.

The child can find ER quite frightening and may estimate the threats and seriousness of his

condition. In addition to this, when treating the child he must not be separated from the parents
considering his age and these initiatives can collectively help in controlling the factors which can

increase the traumatic stress (Children's Hospital of Philadelphia, 2018).

Justification of examination and correct imaging modality

In the current scenario the medical which requires imagining modality and justification of

examination is the supracondylar fracture and the patients is a kid due to which there is no room

for making the mistake. But there are many barriers and challenges to the practice of

justification. The biggest challenges to the justification of examination and risk to the correct

imaging modality includes the medical dominance, and the workplace culture. Overcoming these

issues holds substantial importance as they can have direct and significant impact on the physical

recovery of the child under care.

In this regard, the best solutions to reduce the adverse consequences of this problem includes the

changes into the workplace culture, increased radiographic research, and clinical history taking

which can collectively improve the accuracy and justification. In addition to this, the imaging

department must follow the clear guidelines when taking the decisions (Vom, and Williams,

2017). Another key initiatives that must be taken to facilitate the patient and his family is that

the radiographer must serve as an apparent gate keeper who must facilitate the patients and

should be capable of informing the fundamental principles of the radioprotection and serve as

gate keeper between the unjustified ionizing radiations and the patients himself (Vom, and,

Williams, 2017).

Use of immobilization

The immobilization in this underlying scenario is quite challenging. It is significantly difficult to

rest the boy on the bed for a certain period of time during the treatment, and fixation of the
plaster. The biggest challenge is that the patients is a child and the pressure to minimize the

repeat rate is very high as he cannot physically and psychological handle the radiography and

plaster again and gains. There might be difficulties in getting him to the right position. Infant

who has to face the radiographic technology is unable to understand its importance and he is

unable to cooperate and even cannot get the simple verbal directions in such panic situation.

Another challenge is successfully completing the imaging and radiography with minimum

movement during the examination and ensuring the patient’s safety and comfort (Dashti, Al-

Abbad, Faleh,  and Al-Ostath, 2012).

In this regard, the medical professionals must use the age-appropriate skills of communication,

and must have the proper educational and training so that they could effectively respond to the

situation. The gentle and protective restrictions could be used such as the pads and devices for

ensuring the correct position and in this regard, preparing the child as well as the parents is

equally important. Immobilization can also be used by anticipating the need of the attendance of

the parents who could hold him still and ways to prevent the restrain could also help. The

sedation is also an option but careful assessment must be done by clinical team to ensure that

adequate relief has been given and these sedatives can not only reduce the pain but can also help

in reducing the anxiety and fear (Freeman, 2012).

Manual handling issues

The manual handling issues are the biggest problems which may be experienced when treating

the 4 year old patient in imaging department. The boy has fallen directly into his elbow which

has led to supracondylar fracture. In this situation the patients is already afraid and in tears, here,

handling him manually for laying him down and positioning him for the imaging is significantly

challenging. First of all the boy can cry more if handled inappropriately, secondly he is having a
fracture at a very young age due to which the case is significantly sensitive as any mishandling

can cause severe consequences and adverse influence on his health. Another challenge is that the

parents are already worried about his situation, and their interference or any interruption during

the manual handling can make it difficult to treat the child and complete the imaging modality.

In these circumstances, the best initiative is ensuring child safety by only using the trained nurses

and medical helpers. The medical staff should also stay in compliance with the safety guidelines

which are associated with Magnetic Resonance Imaging and must exhibit their professional

responsibilities to ensure the safe X-Rays or MRI. To avoid the legal issues against the medical

staff such as claims for mishandling of the child or maltreatment, the medical staff must operate

under the legal frameworks such as the European Union Physical Agents Directive (Lipton,

2013).

Radiographer image interpretation

Radiographic image interpretation is basically the evaluation of the radiological tests in order to

assess appropriateness and clinical merit based on the information of patients. Correct imaging

modality and image interpretation is significantly important because it is the technology that is

based on using the radio waves as well as magnetic field for creating the images of the tissues

and organs of the patients. In case the image is interpreted wrong, the risk of repeat test increases

and it can also cause inadequate treatment delivery.

The correct imaging interpretation is very important as it will determine the treatment for the

child. Due to the importance of correct imaging interpretation, only trained technical,

engineering and medical staff must perform it. In addition to this, the radiation protection

regulations and measures given by World Health Organization must be followed, and the reliable
supplies, electric power, consumables, spare parts and clean water must be used so that righ

interpretation can be proposed (WHO, 2018).

Conclusion

The underlying report has conducted a detailed discussion of the various practical problems

which can be explained when providing the medical care to the 4 year old boy presented to

imaging department and supracondylar fracture has been suspected. There could be many

challenges and practical problems such as gaining consent of the parents, effectively

communicating with the 4 years old boy who cannot properly understand and neither can clearly

talk due to his age, challenges of care and compassion, difficulties in understanding the

illnesses, the issues of understanding the patient’s fears and worries, justification of the

examination and correct imaging modality, the issues in manual handling , use of

immobilization, and the issues in radiographer image interpretation. All of these issues can

influence the child’s physical and psychological health and all solutions must be under the

ethical frameworks. Despite many problems, all of these challenges can be minimized by

supportive strategies and initiatives discussed, but success of the proposed strategies is depended

upon the compliance with legal and ethical frameworks and responsibility to deliver the optimal

quality childcare.

APA Formatted
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