Ethical and Philosophical Aspects of Nursing Children and Young People

Gosia M. Brykczynska, Joan Simons

• Publisher: Wiley-Blackwell
• Year: 2011
• Print ISBN: 9781405194143
• eBook ISBN: 9781444392043
• Edition: 1
• Topic: Medicina
• Subtopic: Infermieristica pediatrica

Ethical and Philosophical Aspects of Nursing Children and Young People

"A crucially important text, which brings together many different philosophical aspects and ethical issues in children's nursing practice."

From the foreword by Fiona Smith, Adviser in Children and Young People's Nursing, Royal College of Nursing

Nurses and healthcare professionals are constantly faced with ethical and philosophical dilemmas when working with children in everyday practice. Ethical and Philosophical Aspects of Nursing Children and Young People is a comprehensive text on the ethics and philosophy behind paediatric nursing, that reflects some of the contemporary issues encountered while working with children and young people.

This important new book provides a philosophical and historical analysis of the subject, looking at a review of sociological and political theories concerning the nature of childhood, and providing a critical analysis of contemporary notions about childhood. It then goes on to look at moral theories and their application to paediatric nursing practice, ethical issues when caring for children of all ages, from infancy to adolescence. It looks at issues of disabled children, confidentiality, mental health issues, children's rights, and pain management. With case studies and activities throughout, this book will enable students and newly qualified nurses both to understand philosophical concepts and issues but also to articulate their own reflections and observations on these subjects.

• Written by children's nurses for children's nurses.
• With contributions from internationally recognised experts in the field.
• Reflective scenarios, further reading, extensive referencing, case studies, guided questions, and resources throughout.
• Includes the following four appendices: The Royal College of Paediatrics and Child Health (RCPCH) Guidelines on withdrawal of treatment; a summary of the United Nations Convention on the Rights of the Child; The International Council of Nurses Ethical Code; and the RCPCH Guidelines for the conduct of ethical research.

Part I
The Philosophical Foundations of Caring for Children and Young People

What do you think makes a good nurse?

Someone who talks to you and not just your Mum. (Girl 10yrs)

A good nurse is when they do what they are told and be nice and gentle. (Boy 8yrs)

Comforting, kind and caring, a nice warming smile. (Girl 11yrs)

A nurse that is nice and talks to you, one that informs you of what’s going on and one that is calm. (Girl 14yrs)

Someone who is nice to their patients. (Girl 11yrs)

1
Histories and Philosophies of Childhood

Gosia M. Brykczyńska

Introduction

Is this a holy thing to see
In a rich and fruitful land,
Babes reduced to misery,
Fed with cold and usurious hand?
William Blake (1757–1827, in Warwick 2000 p.71)

These words of the poet Blake were written almost 200 years ago but as this book is going to print, the British public are reeling once again from the disclosed information concerning the family life of baby Peter Connelly, better known to the public as Baby P. As increasingly more information is being made available about the case of Baby P, what is emerging is the extent of the entrenched relentless repetitiveness of generational abuse and neglect and the social fragility and personal inadequacies of the adults concerned. As Andrew Anthony wrote in his investigative report for The Sunday Observer:

The savagery was the culmination of generations of abuse and dysfunction, a dreadful violation that was far from inevitable but that had none the less been incubating for decades. The scene of the crime itself seemed to contain all the potent symbols and sordid realities of the feckless, desensitised version of contemporary life.

(Anthony 2009)

At the same time as details of Baby P’s life were being put into the public domain, we were being informed about the systematic abuse carried out over 30 years ago by the carers of children in the Haut de la Garenne children’s home on the island of Jersey (Byers 2008), while in April 2009 the death of an 11-year-old schoolgirl, Shano Khan, following physical punishment from her primary school teacher sent shockwaves across the Indian subcontinent (BBC News 2009). Meanwhile in the USA, a young woman who was kidnapped as a child has turned up after many years with a tale of confinement, abuse and brainwashing (Moore 2009). No wonder contemporary parents feel justified in saying that they will never let their child out of their sight, stating, I will not let my children ever play or be alone. Finally, a 14-year-old girl in Holland is attempting to be the youngest yachtswoman to circumnavigate the globe. She is contesting the verdict of the courts that she is too young for such feats and should be attending school instead (Watson 2009).

The question to ask is whether childhood was ever any different for children; that is, were children treated differently in the past? Indeed what did past generations think about children and youngsters? Are our present-day concerns about the quality of life, as experienced by the children of Great Britain and around the world, overly excessive and verging on sentimentality and overprotectiveness? Finally, and most crucially, does the way that we think about childhood influence the way we interact with children – a major concern for all those who work with children (Postman 1982; Druin 1996; Mayall 2002; Jenks 2005; Darbyshire 2007; Towner 2008; Layard & Dunn 2009). This chapter will attempt to address some of these issues giving a general outline of the history of childhood in Europe while acknowledging some of the more prevalent theories, philosophies and models of childhood, and how these may affect our approach to the care of children and young people.

SECTION ONE

Historians’ craft or how historians put together the evidence

…Winds of summer fields
Recollect the way,
Instinct picking up the key
Dropped by memory.

Emily Dickenson (1830–86, in Brinnin 1960)

Most contemporary scholars of the history of childhood are quick to distance themselves from the work of Philip Ariès (1962) and his assertion that the notion of childhood is a modern invention, and from his assertion that historically children were either not considered in the greater scheme of things or that when they were noted, they were taken advantage of and often abused. It would appear that social, cultural and religious practices of adults conspired to create an image of childhood which, to the twenty-first century observer, looked as if the children permanently lived in suboptimal conditions, were socially disregarded and most certainly were not included in the familial affairs of adults. Adults did not seem to be concerned with the fate (or even the existence) of children. However, contemporary research undertaken by historians of childhood and family life tends to disagree with this extremely bleak picture (Shahar 1990; Cunningham 1995; Hanawalt 1995; Alexandre-Bidon & Lett 2000; Orme 2003, 2006). True, for very many people – if not the majority of people at times – life was hard and brutal. Additionally, life expectancy was low, especially for women, and many children died at birth or prematurely from hunger and infectious diseases. But this harshness of life was shared by everyone (Shahar 1990). It was not specific to children and when life was a bit more bearable there are plenty of evidences that children led a most interesting and varied life (Opie & Opie 1959; Keville-Davies 1991; Kiste 2003; HICD 2006; Orme 2006). There is also plenty of evidence that there was an accepted and well-understood concept of childhood from antiquity up to the present times – even if for most of recorded history the beneficial aspects of childhood, as we know them today, were limited to the ruling classes and the better off children in society. Rebecca Krug (2002) states that by the late Middle Ages there were three Latin definitions relating to that time of life measured from birth to adulthood, namely – infantia for infancy; pueritia for childhood and adolescentia for adolescence. Hardly evidence for an absence of a concept!

To the delight of historians of childhood, various individuals, and by no means all of them famous and wealthy, have managed over the course of the centuries to write down for posterity memories of their own childhood experiences (Holliday 1995; Gold 1997; Fox & Abraham-Podietz 1999; HICD 2006 among many). Many writers in the course of their narratives mention various aspects concerning childhood or the life of children. Hidden away among texts and letters about other matters, they have commented on issues pertinent to our understanding of the lives of children. From the richness of these documents, diaries, novels and tracts, an image emerges of the life of children and the nature of childhood as experienced by children in the distant and near past (Zimler & Sekulovic’ 2008). What is also clear is that while for many children, as for many adults, life was indeed extremely hard, disease was rife and food was scarce, there was not necessarily as much widespread, wanton and vacuous violence and hatred directed specifically at children as some commentators would have had us believe (Aries 1962). Of course violence directed at children has unfortunately always existed, and it may have been more prevalent or even more accepted as an inevitable social phenomenon in the past (Hanawalt 1976; Rahikainen 2004); however, it is crucial to remember, as already noted, that violence directed at children still exists today (Amnesty International British Section 1995).

In the process of describing the nature of childhood from the past it is therefore necessary to be careful to avoid unqualified generalisations. The very combination of grinding poverty, lack of parental education and the obligatory and culturally condoned invisible labour of most working women conspired against most of the urban and rural poor in all but preventing them from demonstrating appropriate familial affection and concern for the welfare of their children (Shahar 1990; Cunningham 1991). Unfortunately, almost all of the conditions that were once suffered by European children are still tolerated by some children somewhere around the world today.

Just as in cases of war, where it is accepted wisdom that histories of battles are recorded by the victors, so the vast majority of descriptions of childhood and its events are written by those who have survived into adulthood. The maturation process from childhood to adulthood involves, however, some necessary selectivity of remembered and recallable facts, a phenomenon which Matthews (1994) calls childhood amnesia, and which Catriona Kelly (2007), in her excellent account of the life of Russian children in the waning years of Imperial Russia and through the unbelievably harsh years of the Soviet system, considers as selective ‘evocations of the “boxes” or “envelopes” in which children lived’ (Kelly 2007:13). No doubt we do tend to predominantly remember the best and the worst of our childhood experiences – and it is often because of such subconscious selectivity of facts, which overly highlights and emphasises certain events, that we unwittingly in the process skew all our remaining memories. The concern here is not for the well-documented psychological trauma following an unpleasant event – the recollection of which is pushed back deep into the subconscious, resulting in various degrees of mental distress – but, as Matthews (1994) and Kelly (2007) so eloquently point out, the simple and natural growing-up amnesia that is necessary if humans are to function as well-adapted adults. Shahar (1990:5) also observes that: ‘… As for the writing of adults it is well known that they have difficulties in reliving some of their childhood experiences on the conscious level’, since they inevitably describe experiences ‘through the filter of selective memory’.

Meanwhile, adults writing about their own childhood often apologise to their readers for sounding boring or sentimental, as Heywood (2001) observes in his study of the history of childhood. Philip Larkin (1922–85) articulated this feeling succinctly in the poem Coming adding that he saw his own childhood as ‘a forgotten boredom’. Fortunately, historians do not rely solely on what has been written and spoken – such as autobiographies, biographies, novels, school textbooks, medical records and physicians’ accounts, judgements handed down in court cases, the legal system itself, parish council and foundling home accounts and such others – to create an image of childhood past (Keville-Davies 1991). To the historian of childhood, childcare professionals and subsequent generations of casual readers, everything from the past is of potentially of great interest and sometimes descriptions of the most simple aspects of daily life seem to later generations of readers to be exotic and worthy of comment (Keville-Davies 1991).

In the recent past, dedicated historical linguists have even managed to retrieve from encroaching oblivion, children’s playground lore and language by studying the oral traditions of children’s games, which included children’s rhymes and children’s slang. Researchers began to describe and record the existence of these children’s games and their accompanying doggerels, many of which were on the verge of being lost to present generations of scholars and future generations of children (Opie & Opie 1959). The celebrated work of the Opie’s in the UK is part of this long scholarly tradition, both in Europe and in the USA, of documenting and recording children’s songs and games and is part of the rich and growing scholarly body of knowledge concerning the welfare and social life of children. The little song that the children in Lydney, UK, composed in the 1950s to the tune of Frère Jacques speaks more to us about the children’s attitude to school meals at the time, than any lengthy dissertation on the nature of children’s diets:

What’s for dinner? What’s for dinner?
Irish spew, Irish spew,
Soppy semolina, soppy semolina,
No thank you, no thank you.

(Opie & Opie 1959:162)

Historians and antiquarians also look at and collect ancient domestic artefacts such as children’s furniture, for example, high chairs or cradles, toys and children’ s books, clothes, books on advice to parents, etc. They also examine depictions of children in portraits and paintings, on carvings and on ornaments or as illustrations in ancient manuscripts and in historical books and primers intended for children’s use (Shahar 1990; Keville-Davies 1991). Together with archaeologists and anthropologists, historians attempt to reconstruct ancient dwellings, and they study the layouts of ancient homes and children’s institutions (including foundling hospitals and institutions for orphans and workhouses) to judge and evaluate the nature of the space put aside for children’s use. Many ancient artefacts can be seen today in general museums, from Egyptian dolls in the British Museum to Roman sandals in the London Museum. There are also museums dedicated to childhood, such as the rightfully acclaimed Museum of Childhood in London’s East End and the Foundling Hospital Museum in Coram Fields, which stands near Great Ormond Street Hospital for Children in central London built at the insistence of nineteenth-century philanthropists and social reformers. Additionally, a trip today to a stately home or a reconstructed Anglo-Saxon village or medieval castle would not be complete without a glimpse of the ancient child’s world. This multi-pronged and interdisciplinary approach to assessing the life of children from the past has enabled scholars of childhood to recreate ever-more accurately the social history of family life and paint detailed pictures of forgotten childhoods (Keville-Davies 1991; Cunningham 1995).

It is only fairly recently, however, that we have begun to ask children themselves about their lives and their childhood experiences, and started to listen to what children have to say (Mayall 2002; Alderson 2008; Layard & Dunn 2009). It is only recently that we have begun to value what children have to say, as evidenced by adults taking seriously the Sixth article of the United Nations Convention on the Rights of the Child (UNCRC), and to listen to the child’s own tale be it for legal or for social purposes. This legal obligation can sometimes be difficult to sensitively put into practice, as evidenced by the potential trauma that a 4-year-old witness had to undergo at the Old Bailey (Criminal) Court in London while giving testimony against her abuser (Bennett & Fresco 2009). As Katherine Bennett comments in a fairly comprehensive (American) overview of the use of CCTV in American courtrooms for cases involving young children:

… protecting the rights of accused persons while guarding against the potential of the criminal justice system to do harm to the child victims of crime continues to be a balancing act.

(Bennett 2003:268)

We urgently need to find more sensitive and appropriate ways to listen to what children have to say – since for too long we have assumed they were incapable of objectivity or of reliably recognising the difference between truth and fantasy, and we considered them to be fickle-minded – if not upon occasion being spiteful towards their adult carers (Alderson 2008). This was certainly the problem in the past when children’s accusations against their carers were not taken seriously enough, as in the notorious case of the Haut de la Garenne children’s home on the island of Jersey (Byers 2008). All too often children were simply not listened to or believed (Hallett & Prout 2003; Archard 2004; Leeson 2007).

Children of course can comment most reliably and creatively about many aspects of their lives and fortunately not only about the desperate or criminal aspects of some of their experiences. The Iowa Historical Society together with the University of Iowa have recently launched the Historic Iowa Children’s Diaries Project (HICD 2006), where they have made available to the public a digitalised collection of diaries written 150 years ago by children and youngsters in rural Iowa. This opportunity to look into the mindset of children of American pioneers is an excellent example of folk history being presented in such a way that it can enlighten and inform subsequent generations of children and adults. Children today are actively encouraged by their teachers and carers to have their say and to express themselves which today is more likely to be via the computer than in the form of diary entries; nonetheless, this gives them a platform to state what they are experiencing for all who have the inclination to hear them or read what they have to say. Professiona...

Table of contents

• Cover
• Contents
• Title page
• Copyright
• Notes on Contributors
• Forword
• Preface
• Acknowledgements
• Part I The Philosophical Foundations of Caring for Children and Young People
• Part II Ethical Aspects of the Continuum of Care
• Part III Ethical Issues in the Acute Care Setting
• Part IV Philosophical Considerations in Professional Practice
• Appendix I Summary of Possible Situations for Withdrawal and Withholding Treatment in Children According to the Royal College of Paediatrics and Child Health Guidelines
• Appendix II United Nations Convention on the Rights of the Child (Abridged)
• Appendix III Summary of the International Council of Nurses Ethical Code
• Appendix IV Summary of the Principles for the Ethical Conduct of Medical Research Involving Children
• Index