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Treating children as people : exploring nurses’ practice to preserve children’s personal integrity McPherson, Gladys I.

Abstract

Serious illness and hospitalization threaten children's sense of self and alter their ability to act on their own behalf. Personal integrity, conceptualized as the capacity to sustain a sense of self and to live in congruence with one's own intentions and desires, is fundamental to being human. Children, like all people, strive to develop and maintain personal integrity. Because nurses care for children at times when their personal integrity is threatened by illness and its treatment, they are in a position to act to preserve children's sense of self and support their sense of personal agency. Nurses' work in preserving children's personal integrity when children are ill and hospitalized was the focus of this project. This qualitative research project was guided by the methodology of interpretive description. Accounts of practice with seriously ill children were elicited from nine pediatric critical care nurses. Five of these nurses were interviewed twice. For these nurses, work to preserve children's personal integrity entailed practices that address four threats to children's sense of self and their personal agency. These threats are obj edification, loss of control, separation and isolation, and physical pain and intrusion. The participants' enactment of practice to preserve children's personal integrity was greatly influenced by personal, relational and environmental factors. In particular, practices to attend to children as fully human beings often competed with other priorities in the practice arena - specifically the priorities of saving/fixing children's bodies, and facilitating efficient system functioning. The nature of work that attends to the human element of care in particular moments of practice were determined by (a) the nurse's commitment to attend to the child's personhood, (b) the nurse's knowledge of the child, and (c) the nurse's personal agency. Each of these determinants is a complex and dynamic influence. Moral distress occurred when, for a variety of reasons, the participants were unable to practice in congruence with their beliefs about the humanness of seriously ill children and about their responsibilities as nurses. The findings of this study point to a need to draw attention to the issue of children's personal integrity when children are ill and hospitalized. To do this, nurses need to develop a language that is powerful and compelling in the communication of these concerns.

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