A CLIENT / FAMILY CENTERED CARE STUDY

ON

NOCTURNAL ENURESIS

WRITTEN BY

AGYEIWAA- TUFFUOH DIANA

1319180117

A FINAL YEAR STUDENT OF COMMUNITY HEALTH NURSES’ TRAINING

SCHOOL AKIM-ODA

JUNE, 2021
 A CLIENT / FAMILY CENTERED CARE STUDY

ON

NOCTURNAL ENURESIS

WRITTEN BY

AGYEIWAA- TUFFUOH DIANA

1319180117

A FINAL YEAR STUDENT OF COMMUNITY HEALTH NURSES’ TRAINING

SCHOOL AKIM-ODA

SUBMITTED TO THE NURSING AND MIDWIFERY COUNCIL OF GHANA IN

PARTIAL FULFILMENT OF THE REQUIREMENT FOR THE AWARD OF

DIPLOMA CERTIFICATE IN COMMUNITY HEALTH NURSING

JUNE, 2021
 PREFACE

Nursing process is an organized, comprehensive and systematic approach used by

nurses to meet the health needs of clients/families. Its goal is to define a client health status,

actual or potential health problem to establish plans to meet the identified problems and to

solve problems using specific interventions to address those problems. Nursing process is

cyclical, that is its components follow logical sequence that nurses assess, diagnose,

implement, intervene and evaluate.

A client/family centered care study is based on rendering quality health care to client and his/

her family using the nursing process. It is an expanded view of how to care for a client and

family in their own home. The care is based on thorough understanding that, the client is a

unique individual with her own problems which needs to be solved to avoid complications. In

order to achieve this, attention should be given to the physical, spiritual, social and

psychological needs of the client in relation to the family and the community in which client

lives.

Client/family centered care study is a tool that enables the student nurse to put into practice

the knowledge and skills he/she acquired in the course of his/her training to serve the society.

Care study is client and family centered project work undertaken by final year student nurses.

Upon completion of their academic course, it is part of the three-year course organized by the

Nursing and Midwifery Counsel of Ghana before diploma certificate is awarded.

 ACKNOWLEDGEMENT

My sincere gratitude goes to the client and family for accepting me to care for

them and their cooperation during the course of the work. My next thanks go to the

Authors of book I used for references. I also like to thank Mr. Jones Abeka- Baah

the Principal of the noble institution of Community Health Nurses’ Training

College, Akim Oda and all tutorial and non-tutorial staff. I am also grateful to my

supervisor, Mrs. Ellen Adjei for her kind supervision and direction in the work. I

will also thank my research tutor who impacted the knowledge that has made this

work a success.

My appreciation also goes to my family and friends for their support and

encouragement and to all my loved ones. God bless you all.

TABLE OF CONTENT
TABLE OF CONTENT

PREFACE

ACKNOWLEDGEMENT

LIST OF TABLES

CHAPTER ONE

INTRODUCTION

ASSESSMENT OF CLIENT AND FAMILY

ASSESMENT OF CLIENT AND FAMILY

MOTHER’S PARTICULARS

CLIENT’S FAMILY MEDICAL, SOCIAL AND ECONOMIC HISTORY

CLIENT’S PAST MEDICAL/SURGICAL HISTORY

CLIENT’S DEVELOPMENTAL HISTORY

CLIENT’S PRESENT MEDICAL/SURGICAL HISTORY

CLIENT’S OBSTETRICAL HISTORY

PROBLEMS IDENTIFIED

SWOT ANALYSIS

MAIN OBJECTIVE

SPECIFIC OBJECTIVES

CHAPTER TWO

BED WETTING [ENURESIS]

CHAPTER THREE

HOME VISITS AND CARE PLANS.

TYPES OF HOME VISIT

HOME SITUATION 27

HANDING OVER AND CONTINUITY OF CARE

SUMMARY

CONCLUSION

RECOMMENDATIONS

REFERENCES

SIGNATORIES

LIST OF TABLES

TABLE 1: COMPARISON OF TEXTBOOK CAUSES 21

TABLE 2: COMPARISON OF TEXTBOOK SIGNS AND SYMPTOMS 22

TABLE 3: FIRST NURSING CARE PLAN FOR FIRST HOME VISIT 28

TABLE 4: SECOND NURSING CARE PLAN FOR FIRST HOME VISIT 29

TABLE 5: NURSING CARE PLAN FOR SECOND HOME VISIT 32

TABLE 6: NURSING CARE PLAN FOR THIRD HOME VISIT 35

TABLE 7: NURSING CARE PLAN FOR FOURTH HOME VISIT 38

TABLE 8: NURSING CARE PLAN FOR SIXTH HOME VISIT 42

TABLE 9: NURSING CARE PLAN FOR SEVENTH HOME VISIT 44

TABLE 10: NURSING CARE PLAN FOR EIGHTH HOME VISIT 47

TABLE 11: NURSING CARE PLAN FOR NINTH HOME VISIT 50

 CHAPTER ONE

INTRODUCTION

Bedwetting also called nighttime incontinence or nocturnal enuresis is an involuntary

urination while asleep after the age at which staying dry at night can be reasonably expected.

There are two types of bedwetting, namely; primary bedwetting and secondary bedwetting.

Primary enuresis occurs in children who have never had bladder control at night and has

always wet the bed. It becomes a disorder when it persists after the age at which bladder

control usually occurs 4-7years and is either resulting in an average of at least two wet night

in a week with no long periods of dryness. The most common form of enuresis is the Primary

enuresis. Secondary enuresis describes those who have had bladder control at night for a

period of at least 6 months, but lost that control and now wets the bed again. Some causes

include bladder or kidney disease, genetics, stress, etc. Prevention include, discouraging your

child from drinking too much water at night and before going to bed.

I came into contact with the client on Monday 25 th February, 2021 in his home setting during

a special visit at Old Town, Akim Oda after a psychiatric nurse introduced him to me. I

knocked and entered the house upon response. I greeted, introduced myself and made my

mission known to them that I am a final year student of Community Health Nurses’ Training

School, Akim Oda and I am in their house to enquire about their health. I began my

interaction with them, asked questions and also observed their home environment with the

idea of assessing the needs of the client and family. Madam N.A (client’s mother) confirmed

that her son is a bedwetter and she has tried several means to help her son put a stop to it but

has proved futile.

1
This aroused my interest and planned to select client and family for my client/family centered

care study and she agreed upon detailed explanation pertaining what the study entails. I then

added that I will render care to them for a duration of 10weeks after which I will hand them

over to another community health nurse for continuity of care.

I chose this client in order to help build his self-esteem because nocturnal enuresis

have proven to be prevalent in some young adults and have emotional, psychological and

physical impact on the victim.

I scheduled date for my next visit with client and family on 27 th February, 2021 and bade

them Goodbye.

For confidentiality sake client’s name would be represented by Master A.E, his mother as

Madam N.A.

2
 ASSESSMENT OF CLIENT AND FAMILY

Assessment is the systematic and comprehensive method of collecting, organizing and

documenting client’s data gathered from the client, relatives, friends, client’s folder and

significant others in order to determine client’s health status and identify any actual or

potential health problems. It includes physical, cognitive, social, emotional and

environmental status of the client. This information helps to identify client and family’s

specific needs and strengths for the formulation of appropriate nursing diagnosis which

includes both potential and actual needs identified therefore planning the necessary care to

solve client’s problems.

3
 ASSESMENT OF CLIENT AND FAMILY

CLIENT’S PARTICULARS

Name: Master A.E

Date of birth: 8th February, 2005.

Age: 16

Sex: Male

Weight: 38kg

Height: 139cm

Religion: Christian

Educational level: Junior High

Language Spoken: Twi and English

Home town: Akim Oda

Nationality: Ghanaian

Clinical Diagnosis: Nocturnal Enuresis

Current place of residence: Old Town

House number: A512/2

4
 MOTHER’S PARTICULARS

Name: Madam N.A

Age: 48

Religion: Christian

Educational Background: Form 4

Occupation: Trader

Address: A512/2 Old Town

Marital status: Married

Ethnicity: Akan

5
 CLIENT’S FAMILY MEDICAL, SOCIAL AND ECONOMIC HISTORY

Client’s family alleged that, illness occurs as a result of alteration in any of the body

systems rather than evil spirits. However, they usually seek for medical treatment at the

hospital whenever illness occurs. Client’s mother revealed that, they do not have any chronic

diseases such as diabetes, mental illness, etc. but have a history of bedwetting in the family.

Client’s mother is a trader and the father is a farmer. Client’s family further disclosed that the

family depend on their individual income they make for livelihood. The mother also

disclosed that the family interacts with each other very well and both parents are willing to

help and support their children emotionally and financially when the need arises.

6
 CLIENT’S PAST MEDICAL/SURGICAL HISTORY

Client’s mother revealed that Master A.E was admitted at the Government hospital,

Akim Oda in 2019 on account of severe malaria for which he was treated without any further

complications. Madam N.A said that client does not have any known allergies to food or

drugs. He also has not undergone any surgical procedure before.

7
 CLIENT’S DEVELOPMENTAL HISTORY

According to client’s mother, client was born in 2005 through a spontaneous vaginal

delivery at the Oda Government hospital in the Eastern region. He passed through the normal

developmental stages without any abnormality and he received all his childhood

immunization as required as evidenced in his Child Welfare Clinic book. He started his

primary school at Akim Oda Anglican School and presently in Junior High School three

(J.H.S 3). According to Erik Erickson theory of developmental stages, client is in the

IDENTITY VS. ROLE CONFUSION stage. This occurs during adolescence.

At this stage (12-18years), the adolescent develops a sense of self and personal identity

through an intense exploration of personal values, beliefs and goals. This is a major stage of

development where the child has to learn the roles he will occupy as an adult. It is during this

stage that the adolescent will re-examine his or her identity a try to find out exactly who he or

she is. According to Erikson, success in this stage will lead to a virtue of”fidelity”.

However, client has been able to identify himself well and has spelled his ambitions and roles

for the future. Master A.E falls under Identity.

8
 CLIENT’S PRESENT MEDICAL/SURGICAL HISTORY

Madam N.A revealed that presently, his son often wets bed, which has affected his

personal hygiene (body odour). Client has no present surgical history.

9
 CLIENT’S OBSTETRICAL HISTORY

Client is a male hence has no obstetric history.

10
 PROBLEMS IDENTIFIED

1. Client and family had an untidy environment.

2. Client had rashes on the buttocks.

3. Client and family had inadequate knowledge on bedwetting

4. Client family were anxious about client condition (bedwetting).

5. Client had low self-esteem.

6. Client complained of constipation.

7. Client’s mother complained of insomnia.

8. Client and family lack of knowledge about behavioural treatment for bedwetting.

9. Client had mild cough.

11
 SWOT ANALYSIS

STRENGTHS

1. Client is able to perform activities of daily living such as bathing, brushing of teeth

and dressing up.

2. Client is cooperative and open to receive treatment assistance.

3. Client is willing to quit the bedwetting.

4. Client has a valid National Health Insurance.

WEAKNESS

1. Client sometimes feels shy and isolated due to his condition (bed wetting).

2. Client’s family has inadequate knowledge on bed wetting.

OPPORTUNITIES

1. Client’s family members are willing to support him financially and psychologically.

2. Client is willing to put a stop to the bed wetting.

3. Master A.E is young and can make maximum use of his time.

THREAT

1. Client’s family has a history of bed wetting.

2. Client drinks too much water during night and before going to bed.

12
 MAIN OBJECTIVE

By the end of client or family care study, family will help client build positive esteem

through adequate knowledge and training on the subject of bedwetting.

SPECIFIC OBJECTIVES

1) Assess the home situation and familiarize myself with client and family.

2) Educate client and family on bedwetting.

3) Encourage client’s family to provide psychological and emotional support to client.

4) Enlighten client and family on growth and development.

5) Client and family will be assisted to the hospital for a check-up.

6) Educate client and family on life style modification.

7) Enlighten client and family on how client can build his self-esteem.

8) Educate client and family on behavioural therapy in relation to bedwetting.

9) Prepare client and family psychologically towards the impending handling over for

continuity care.

13
 CHAPTER TWO

BED WETTING [ENURESIS]

Definition

Nocturnal Enuresis, also called bed wetting is involuntary urination whiles asleep

after the age at which bladder control usually begins (Reynosa, 2010).

Types of Bed Wetting

Primary bed Wetting.

Primary bed wetting is the most common form of bed wetting. Bed wetting becomes a

disorder when it persists after the age at which bladder control usually occurs at 4-7 years and

is either resulting in an average of at least two night-wets in a week with no long period of

dryness.

Secondary bed wetting

Secondary bed wetting occurs after a patient goes through an extended period of dryness at

night and then reverts to night-time bed wetting. Secondary bed wetting can be caused by

emotional stress or medical conditions such as bladder infection.

14
 PATHOPHYSIOLOGY OF BED WETTING

Bedwetting or nocturnal enuresis refers to unintentional passage of urine during sleep

as defined by carol .et al (2007). Enuresis is the medical term for wetting whether in the

clothing during the day or in bed at night. Another name for enuresis is urinary incontinence.

Bedwetting is an issue that millions of families face every night. It is extremely common

among young kid but can last into the teen years by (Carol et al.2007)

Doctors don’t know what causes bedwetting .But it is a natural part of development, and kids

usually grow out of it. Most of the time, bedwetting is not a sign of any deeper medical or

emotional issues. Meanwhile, bedwetting can be very stressful for families. Kids can feel

embarrassed or guilty about wetting their bed and anxious about spending the night at a

friend’s house or at camps. Parent often feels helpless to stop it .Cojer J et al. (1992).

Bedwetting may last for a while, but providing emotional support and reassurance can help

your child feel better until it stops.

Dryness at night usually follows achievement of continence by day, during the second

year of life; children start to develop the ability to relax the external urethral sphincter

voluntarily and to initiate voiding, even in the absence desire to void. By approximately age

four, all children with normal bladder function should have acquired this ability.

Bedwetting or nocturnal enuresis refers to unintentional passage of urine during sleep as

defined by carol, et al (2007). Enuresis is the medical term for wetting whether in the clothing

during the day or in bed at night. Another name for enuresis is urinary incontinence.

Bedwetting is an issue that millions of families face every night. It is extremely common

among young kid but can last into the teen years by (Carol et al.2007)

15
Doctors don’t know what causes bedwetting .But it is a natural part of development, and kids

usually grow out of it. Most of the time, bedwetting is not a sign of any deeper medical or

emotional issues.

Meanwhile, bedwetting can be very stressful for families. Kids can feel embarrassed

or guilty about wetting their bed and anxious about spending the night at a friend’s house or

at camps. Parent often feels helpless to stop it .Cojer J et al. (1992). Bedwetting may last for a

while, but providing emotional support and reassurance can help your child feel better until it

stops.

Causes of Bed-wetting

Wetting the bed is caused by a mix of three things:

1. The body making a large amount of urine during the night;

2. A bladder that can only store a small amount of urine at night

3. And not being able to wake up from sleep to empty the bladder.

A worldwide research (2017) indicates some other causes of bedwetting. Such as:

1. Bed wetting can run in some families.

2. Some bladder can’t hold very much urine through the day and this can course problem

at night.

3. Some bladder does not fully empty on the toilet, which means urine stays in the

bladder.

4. Taking in a lot of salt or calcium from foods and drinks can change kidney function.

16
Things that can make it difficult to control bedwetting.

1. Infections in the kidney or bladder, these means that since the kidney is not

functioning well its ability to hold urine for long time becomes problem hence making

bedwetting possible.

2. Drinking enough water, drinking enough water before going to bed can promote

bedwetting since the body may contain excess water kidney producing urine as well.

3. Drinking too much caffeine and alcoholic beverages, this means excessive alcohol

intake can promote bedwetting since the person may be unconscious.

4. Allergies or enlarged adenoids and tonsils which block the nose or upper airways at

night.

Signs and symptoms of bedwetting

1. Most people (80%) who wet their beds wet only at night. They tend to have no other

symptoms other than wetting their bed.

2. Other symptoms however suggest psychological courses problem with the nervous system

or kidney. These are signs that bed wetting is more than a passing phenomenon.

3. Wetting during the day.

4. Frequency, urgency or burning in urination.

5. Straining, dribbling or other usual symptoms with urination.

17
 Diagnosis of bed wetting

Urinalysis is done when investigating on bedwetting. A urine sample taken to text and observe for

the presence of an infection or other condition of the urinary tract.

Management of bedwetting

Treatment will not only depend on the outcome of the text or observation, but could be:

1. Treatment of constipation and bladder infection: drugs or sprays to boost how much your

bladder can hold or to cut down how much urine is made through the night.

2. Training to control how well the bladder stores and empties urine.

3. Use of an alarm that goes off when the bed becomes wet. This can be useful for young

adults as well as children but may not be the first thing tried

4. A mix of some of the above treatment; and use of continence products to protect bedding

and skin, reduce odour and increase comfort while treatment is underway.

Treatment available for enuresis is Desmopressin acetate (the preferred medication for treating

children with enuresis). Olinergic agents such as oxybutynin chloride and tolterodine (especially

patient with over active bladder dysfunctional voiding, neurogenic bladder). The combination of

decompressing acetate and oxybutynin chloride may be efficacious in children with over active

bladder or dysfunctional voiding who show day time response to ant cholinergic therapy.

18
 Complication of Bed-wetting

Although frustrating, bed-wetting without a physical cause does not pose any health risks.

However, bet-wetting can create some issues for your child, including

1. Guilt and embarrassment, which can lead to low self esteem

2. Loss of opportunities for social activities, such as sleepovers and camps.

3. Rashes on the child buttocks and genital area especially, if your child sleeps in wet

underwear.

Prevention of Bed-Wetting

1. Discourage drinking fluids in the evening following dinner. Limiting your child’s

fluid intake to 2mls or less in the 2 hours before bedtime will decrease the amount of

urine he produces at night. Offer gentle reminders about excessive fluids intake, but

don’t worry about a few extra swallows of water.

2. Teach your child bladder-stretching exercises. Some children have a small bladder

capacity, and such exercises may be helpful. Have your child practice holding her

urine as long possible during the day, when she has easy access to a toilet. When she

feels the urge to urinate, encourage her to wait an additional few minutes.

3. Protect the bed from urine. Children over 4 years of age should not wear diapers and

plastic pants, but they can wear extra-thick underwear to bed in addition to pyjamas or

can sleep on a waterproof pad to keep sheets dry. Placing a plastic mattress cover on

the mattress will keep urine from soaking through.

4. Develop a routine that is not embarrassing for your child in handling wet clothes and

sheets. Keep clean pyjamas and towels on a chair near your child’s bed to make it

easier for him to change out of wet clothes at night. Have your child shower regularly

in the morning to ensure that you do not smell of urine during the day. Agree on a

19
 plan for how your child will take care of wet items (e.g. rinsing them out, putting

them in the washing machine or another designated place) to decrease morning

frustrations.

5. Respond positively to dry nights and gently to wet nights. Additional to praising your

child for dry night, compliments her for any efforts made to go to the bathroom at

night, even if she is wet in the morning. Do not allow siblings to tease your child.

6. Consider using a bed-wetting alarm device. If your child is 7 years old or older and

still having difficultly waking up to go to the bathroom at night, a small bed-wetting

alarm that buzzes when it senses a few drops of urine may be useful in helping your

child wake up at night.

7. There are medications available that may temporarily help your child stay dry at

night. If you would like to learn more about the possible risks and benefits of these

medications, consult your primary care health professional.

Client’s Family Teaching

1. Assist client’s family to give psychological and emotional support to client.

2. Educate clients on nocturnal enuresis or bed-wetting.

3. To support clients quit bed-wetting.

4. To advice clients on method he must adopt to quit bedwetting.

20
Table 1: comprising of data on the causes of nocturnal Enuresis (bed-wetting) with clients’.

Textbook Clients (Master A.E)

Bed wetting can run in some families Bedwetting can run in some families is

present

Drinking enough water, drinking enough Drinking enough water, drinking enough

water before going to bed can promote water before going to bed can promote

bedwetting since the body may contain excess bedwetting since the body may contain

water and kidney producing urine as well. excess water and kidney producing urine as

well is present.

Infection in the kidney or bladder. Infection in the kidney or bladder is not

present.

21
Tables 2: Comparison of Data on the Signs and Symptoms of Nocturnal Enuresis (Bed-

Wetting) with Clients’.

TEXTBOOK CLIENTS (MASTER A.E)

Wetting during the day Not present

Frequency, urgency, or burning on Not present

urination.

Straining, dribbling, or other unusual Not present

symptoms with urination.

80 per cent of people who wet their beds Presents

wet only at night. They tend to have no

other symptoms other than wetting the bed.

22
 CHAPTER THREE

HOME VISITS AND CARE PLANS.

Home visit is the act of making health visits in the homes of clients and families to educate them on

healthy living and promoting their confidence in caring for clients at home. It is the core of

preventive nursing and it is carried out by the public health nurse and the community health nurse,

as well as, other health personnel with varying objectives. The purpose of home visiting is to assess

the home situation and identify resources available in the home and to understand their limitations

and weakness. It also aims at giving direct nursing care to individuals and to counsel, advice and

educate family members on general care like prevention of home accidents, clothing and the

importance of family planning and others.

TYPES OF HOME VISIT

1. Special home visit

2. Routine home visit

SPECIAL HOME VISIT: This is the type of home visit where the nurse has already identified

problem and special client and family in mind.

ROUTINE HOME VISIT: This is the type of home visit where the Community Health Nurse

moves from house to render health services to client and families without any special client in

mind.

23
 ADVANTAGES OF HOME VISIT

1. It affords the health worker the opportunity clients in their homes

2. It also helps in tracing defaulters of health services

3. It also helps ensuring continuity of care

4. Home visiting also help health workers to identify positive and negative causes that

operate on client for effective counselling

5. Finally, some clients are reluctant to discuss their individual problems in the home in the

presence of other relatives

DISADVANTAGES OF HOME VISIT

1. It is time consuming.

2. There might be unfavourable weather conditions.

3. Risk of injuries from snake bites, dog and fall.

4. There are distractions in the home which may make teaching difficult.

24
 FIRST HOME VISIT ON 27TH FEBUARY, 2021.

Objectives;

By the end of my visit, I will be able to;

1. Assess the home situation and familiarize myself with client and family.

I paid my first visit to Master A.E and family on the 27 th day of February, 2021. I

gave a prior notice via phone call before my arrival at exactly 4:30pm as scheduled by client,

family and I. I knocked and entered the house upon response. Client and family were very

excited to see me; I was warmly welcomed and offered a seat. Enquiry made about their

health status and client’s mother responded that everyone was doing well. I had an interaction

with client and family. Quick assessment was done on the home environment. Upon

observation, the house was unkempt. Rubbish scattered all over the compound and flies

hovering around the waste bin. I then encouraged client and family to always tidy up their

home environment and empty their waste bin regularly in order to prevent diseases associated

with poor environment hygiene practices.

The idea of my visit was communicated to them. The client and family were assured of

confidentiality and their attention and cooperation throughout my visit were sought as well.

I asked client and family if they have any issue that they would like me to address and

Master A.E said he has started developing itchy rashes on the buttocks. I enquired from client

and mother if they knew the cost of the rashes, client’s mother replied she was not too sure

but thinks it was due to the son sleeping with wet cloth through the night a result of

bedwetting. She further added that she had applying some powder to the rashes before she

realize that it is spreading to the other part of the buttocks. I examined the rashes and notice

they are tiny white bumps filled with fluid on the surface of the skin and some developing

25
into wounds. Client and family were reassured that rashes and wounds will subside with

treatment so they should keep calm.

I quickly set my tray and dressed the wounds, after which I applied calamine antihistamine

cream on them to keep it dry and prevent itching. After that, I gave the family health

education on the need to keep wounds clean and dressed it aseptically as failure to do so will

lead to more infection and worsen situation or delay healing process. I also went further to

teach client mother how to dress wounds aseptically and apply calamine cream on the rash

which is for external use only client was advised to report the condition to the hospital for

further treatment.

Again, I advised family to include more vegetables and fruits in their diet because

they are vital in providing essential nutrients to help boost the immune system to fight against

my micro bacterial infections in the body’s system. Client should wear cotton cloths when

sleeping to help soak moisture when he bed wets.

After interactions, client and family were very grateful for our encounter that day and I also

expressed my gratitude to them for their cooperation and attention. My next visit with the

family was on the 5th of March, 2021 and bade them goodbye.

Problems Identified;

1. Client and family had an untidy environment.

2. Client had rashes on the buttocks.

26
 HOME SITUATION

Master A.E lives with his parents in two-bedroom building. There are four members

living in the house. The house is located at Old Town opposite the main information centre,

Akim - Oda. The house is built with cement blocks, roofed with aluminium sheet and painted

with yellow colour. The rooms are three, spacious and have trap doors which prevent

mosquitoes from entering the room when the main gate is opened. Each of the room have two

windows which serve as good source of ventilation. They use a stand pipe in the community

near their house as their sources of water. Their source of power is electricity. They dispose

their liquid waste in a nearby bush and have a small covered waste bin at a corner of the

house in which they collect wastes and dispose-off in a community refuse dump on daily

basis. They have no kitchen so they cook outside on the corridor and their toilet facility and

bathroom is outside the house, their toilet facility is a KVIP type.

27
28
 TABLE 3: NURSING CARE PLAN FOR FIRST HOME VISIT ON 27TH FEBRUARY, 2021.

DATE NURSING/ OBJECTIVE/ NURSING ORDERS NURSING INTERVENTION EVALUATION

& DIAGNOSIS OUTCOME
TIME CRITERIA

27/02/2021 High risk of Client and 1. Educate client and family to 1. Client and family educated to 27/02/2021
At infections family will practice good personal and practice good personal and At
5:00 pm related to be free from environmental hygiene. environmental hygiene to prevent infection. 4:30pm
untidy infection within 2. Educate client and family on 2. Client and family educated on the Goal fully met
environment 2hrs as the need to sweep the environment need to sweep the environment regularly Client and family had
evidenced by regularly. to prevent the spread of microorganisms. Maintained a clean
client’s family 3. Educate client and family on 3. Client and family educated on home environment
keeping their diseases associated with poor diseases associated with poor environmental(by tidying up)
compound environmental hygiene. hygiene such as cholera, malaria, etc. and freed from
clean. infection
4. Advise client and family to get 4. Client and family advised to get a
a waste bin with a befitting lid. waste bin with a befitting lid in order to
temporarily keep their waste and then discard
appropriately to prevent flies hovering
around it.

29
 TABLE 4: NURSING CARE PLAN FOR FIRST HOME VISIT ON 27TH FEBRUARY, 2021.

DATE NURSING/ OBJECTIVE/ NURSING NURSING EVALUATION

& DIAGNOSIS OUTCOME ORDERS INTERVENTION
TIME CRITERIA

27/02/2021 Impaired skin Client skin 1. Reassure client that skin rashes 1. Client reassured of rashes healing 3/03/2021
At integrity (minor integrity will be will heal. 2. Wound dressed and kept clean At
6:30 pm wounds) related restored within 2. Dress wound using aseptic 3. Family advised on infection prevention 7:02pm
to skin rashes 7days as technique. and how to keep wound clean Goal partially met
evidenced by 3. Advise family on infection 4. Client educated on fruit and vegetable as wound dress
client Prevention by keeping wound clean Intake. aseptically.
verbalizing that 4. educate client to wear cotton 5. Client educated to wear cotton
rashes and minor dresses when sleeping cloths when going to bed
wounds have 5. Educate client to take in fruits 6. Prescribed medication served
healed and vegetables.
6. Self prescribed education
(calamine cream)

30
 SECOND HOME VISIT ON 5TH MARCH, 2021.

OBJECTIVE;

By the end of the visit I will be able to;

1. Educate client and family on bedwetting.

On 5th March, 2021 at exactly 5:30pm I made my second home visit to Master A.E and

his family as was scheduled. The main purpose was to educate client and family on

bedwetting. On arrival, quick assessment was made on the home environment. Upon

observation, the house was well swept and things were arranged in order. Client and his

mother were sitting in front of their house, they were greeted and enquired about their health

and they replied they are fine; after which I was offered a seat to made myself comfortable.

Client and family were congratulated for their compliance and then encouraged them to

always keep their home environment tidy to avoid any related infections.

Client’s mother was asked if she had any knowledge on bedwetting but she replied

no. I educated client and mother that Nocturnal Enuresis, also known as bedwetting is an

involuntary urination whiles asleep after the age at which bladder control usually begins.

There are two types of bedwetting namely; primary and secondary bedwetting but the

primary type is the most common form of bedwetting. Primary bedwetting is a disorder that

persists after the age at which the bladder control usually occurs 4-7 years and is either

resulting in an average of at least two wet nights a week with no long periods of dryness and

Secondary bedwetting also occurs when a person goes through an extended periods of

dryness at night and then reverts to night-time wetting. I enquired from client’s mother if she

had idea on the causes of bedwetting and she replied that some include laziness. I

congratulated her and I further mentioned some of the causes of bedwetting such as infections

31
of the bladder and psychological problems. In the course of the discussion, I assessed client

knowledge on the effects of bedwetting and he mentioned low self-esteem. I thanked her and

further explained to her that bedwetting can bring about embarrassment or low self-esteem,

loss of opportunities for social activities, as sleepovers and cramp, rashes on the child

buttocks and genital area, especially if the child sleeps in wet underwear. Lastly, I mentioned

some of the measures we can adopts to manage bedwetting which are; discouraging the child

from taking plenty water at night, teach the child bladder control, etc. After our discussion

answers were given to client’s questions, I thanked client and family for their cooperation and

time and I scheduled my next visit with them on 19th March, 2021.

Problems Identified;

1. Client and family had inadequate knowledge on bedwetting.

32
 Table 5: NURSING CARE PLAN FOR SECOND HOME VISIT ON 5TH MARCH, 2021.

DATE NURSING OBJECTIVE/ NURSING ORDERS NURSING EVALUATION

AND DIAGNOSIS OUTCOME
INTERVENTION
TIME CRITERIA

5/3/2021 Deficient Client and 1. Reassure client and family. 1. Client and family reassured that with their cooperation and 5/3/2021.
knowledge family will 2. Assess the knowledge level attention they would have a good understanding on bedwetting.
At
related to have adequate of client and family on 2. Client and family’s knowledge level assessed by asking At

5:45pm. inadequate knowledge on bedwetting. relevant questions pertaining to bedwetting.

information on bedwetting 3. Provide clear and 3. Client and family provided with a clear and understandable 6:20pm.

bedwetting. within 45 understandable explanations on explanations on the causes (such as inability to wake up at night
Goal fully met,
minutes as the causes and complications of to empty the bladder, too much intake of fluids just before
evidenced by bedwetting. bedtime, etc.) and complications such as guilt and client and
client and 4. Educate client and family on embarrassment, loss of opportunities for social activities, etc. family
family the preventive measures and 4. Client and family educated on the preventive measures such as
answered most
answering management of bedwetting. discouraging the intake of too much fluids just before bedtime,
most (80%) of 5. Encourage client and family considering the use of bedwetting alarm device, etc. and of the questions
the questions to ask questions. management such as treatment of any underlying medical asked correctly.
asked conditions like bladder infections.
correctly. 5. Client and family encouraged to ask questions pertaining to the
topic at hand to ensure learning had taken place.

33
 THIRD HOME VISIT ON THE 19TH MARCH, 2021.

Objectives;

By the end of the visit, I will be able to;

1. Encourage client’s family to provide psychological and emotional support to client.

My third home visit was scheduled on the 19 th March, 2021 around 4:00pm. On arrival, quick

assessment was done on their home environment. Upon observation, the house was well swept and

things were arranged in order. I met client and family at home. I greeted and asked them and

enquired about their health and they responded that everyone was doing well. Client was in the

bedroom. While waiting for him, the family was engaged in a conversation and client came out to

joined the discussion.

I began by asking client’s family the kind of support they provide for client and Madam N.A

responded that they sometimes punish client for wetting the bed. I explained to the family to refrain

from using punishment as a way to put fear in client. Rather, encouraged them to provide

psychological support in the form of love, motivation and care rather than disgracing and punishing

him whenever he wets the bed. Client’s family further revealed to me that; they are always anxious

about client’s condition as to whether it will stop. I encouraged them not to lose hope but rather

they should be supportive and exercise patience with client.

I encouraged the family to provide psychological, emotional and physiological support

which will help reduce anxiety related to this condition. I paused and allow them ask questions but

they responded that they have understood what have just been discussed. I thanked them for their

time and cooperation throughout the discussion; they also promise me that whatever we have

discussed today will be put into practice. I thanked them and schedule my next visit with them on

the 2nd April, 2021.

34
Problem Identified:

1. Client’s family were anxious about client’s condition (bedwetting).

35
36
 Table 6: NURSING CARE PLAN FOR THIRD HOME VISIT ON 19TH MARCH, 2021.

DATE NURSING OBJECTIVE/ NURSING ORDERS NURSING INTERVENTION EVALUATION

AND DIAGNOSIS
OUTCOME
TIME
CRITERIA

19/3/2021 Anxiety Client’s 1. Reassure client and 1. Client and family reassured that with their 19/3/2021.
related to anxiety will be family. compliance with management and lifestyle
At At
unknown allayed within modifications, client will be free from
4:22pm. outcome of 1hour as 2. Assess client and bedwetting. 5:30pm
disease evidenced by a family’s knowledge 2. Client and family’s knowledge level on the
Goal fully met,
(nocturnal nurse level on the possible complications of bedwetting assessed to build on
client’s anxiety
enuresis). observing a complications of their knowledge using simple and clear language.
was allayed and
cheerful facial bedwetting. 3. Client and family’s anxiety allayed to have hope
had a cheerful
expression and 3. Allay client and and be patient with client in order to alleviate
facial expression.
client family’s fear. fear.
verbalizing 4. Encourage client and 4. Client and family encouraged to provide
absence of fear family to provide psychological support in the form of love,
and anxiety. psychological support to motivation and care.
client.

37
 FOURTH HOMEVISIT ON 2ND APRIL, 2021.

Objectives;

By the end of the visit, I will be able to;

1. Enlighten client and family on growth and development.

I embarked on my fourth home visit on 2 nd April, 2021 at exactly 4:55pm. On arrival, I knocked

and entered the house upon response. I greeted and was offered a seat. Madam N.A revealed that

everyone was doing well when I enquired about their health. The mission behind my visit to client

and family that day was made known to them and started by asking client’s family the behavior

client normally exhibit in the home in relation his age. Client’s mother responded that client enjoys

playing with his peers but sometimes feels shy due to his condition. I explained to client and family

that growth and development is the milestone of physical and intellectual advancement that occurs

at every stage in one’s life.

I added that client is now in the Identity vs. Role confusion stage (12-19years) and informed

them that at this stage, the adolescent search for self and personal identity, through an intense

exploration of personal values, beliefs and goals whiles enjoying company from his or her peers

which will become a major source of the child’s self-esteem as he prepares to enter adulthood. I

also advised client’s family to encourage Master A.E to always feel free to play with his peers

without feeling shy and then encouraged Madam N.A to keep and maintain client’s personal

hygiene at optimal level in to boost his confidence. I asked client status of his condition and said he

was able to remain dry last night. I then congratulated him and encourage him to keep it up. I also

showed appreciation to the family for assisting client psychologically and also helping client to quit

bedwetting. I was informed by Madam N.A that she would take client to the hospital on 15 th April,

38
2021 for a check-up and I assured client and family of my availability to assist them on that day.

We then scheduled my next visit on 15th April, 2021.

Problem Identified;

1. Client had low self-esteem.

39
 TABLE 7: NURSING CARE PLAN FOR FOURTH HOME VISIT ON 2ND APRIL, 2021.

DATE/ NURSING OBJECTIVE/ NURSING NURSING EVALUATION

TIME DIAGNOSIS OUTCOME ORDERS INTERVENTION

CRITERIA

2/4/2021 Low self- Client’s will have 1. Reassure client and family. 1. Client and family reassured that with 4/4/2021.
their compliance, client will have an
At esteem an improved At
2. Encourage client’s family improved self-esteem.
5:30pm related self-esteem within to provide psychological support 2. Client’s family educated to provide 4:35pm
to client. psychological support to client in the form
bedwetting. 48hours as evidenced by Goal met.
of love, care and attention.
client exhibiting 3. Encourage client’s mother 3. Client’s mother encouraged to assist Client showed
to always assist client with client with his personal hygiene to boot his
an increased sense a sense of confidence
personal hygiene. confidence level.
and mingled with
of confidence and 4. Educate client’s family to 4. Client’s family educated to
encourage client to play with his encourage client to play with his peers in his peers
freely mingling
peers. order to boost his confidence level.
without feeling
with his peers .
shy.
without feeling shy.

40
 FIFTH HOME VISIT ON 15TH APRIL, 2021.

Objectives;

By the end of the visit,

1. Client and family will be assisted to the hospital for a check-up.

On the 15th April, 2021, I met client and Madam N.A at the Oda Government Hospital as

scheduled in my previous visit to assist and family for a check-up at the hospital. Upon meeting

with them, I asked of client and family’s health and they said they were doing well.

Madam N.A said they were going to the psychiatric unit for a review as planned. I lead and assisted

them to the unit. Upon arrival, we greeted the in-charge of the unit, he welcomed and offered us a

seat. I introduced myself to the unit in-charge and told him the care rendered to client and family so

far. Since Master A.E is a known client at the unit, the head of the unit began by asking about the

status of client’s condition and Madam disclosed that client had been able to go dry for about a

month and two weeks now. The unit in-charge applauded client and his mother for complying with

his directives in relation to the bedwetting and encouraged them to keep it up for the manifestation

of the expected outcome.

I then enquired from the unit in-charge whether there would be an additional therapy and he

replied no. He added that client would have to continue with the already existing therapy. He asked

if client and his mother had any problem or questions and they replied no. client’s mother then

expressed her gratitude and we sought permission to leave. On our way, we scheduled the next visit

on 30th April, 2021 and bade them goodbye.

Problems identified;

1. No problem identified

41
 SIXTH HOME VISIT ON 30TH APRIL, 2021.

Objectives;

By the end of this visit, I will be able to;

1. Educate client and family on lifestyle modification.

I embarked on my sixth home visit to client and family on 30 th April, 2021 around 4:15pm. I met

client with his family, I greeted and was offered a seat. I enquired about their health and they

responded that everyone was doing fine. Quick assessed was made on the home environment and

observed everything was arranged in order.

My mission for the visit that day was then made known to client and family; that is to educate them

on lifestyle modification. I began by enquiring from client’s family the kind of lifestyle client has

been living, pertaining to his diets, exercise, rest and sleep. Client’s mother responded that client

normally eats three times in a day; porridge with bread most of the time in the morning, rice or

ampesi with stew in the afternoon and banku, rice or yam as supper. She further revealed that client

was often engaged in play with his peers and sleeps at least 8hours each day. I commended Madam

N.A for her responses. I then explained to them that good nutrition is the key to good mental and

physical health.

The kind of food we eat affects the way one feels and how the body works. Having regular

meals including the four-star diet such as wholegrain, animal source, fruit and vegetables, fat and

oil boast your immunity. I further told them to eat food containing roughage to prevent constipation

and protein food to help the body repair cells and make new once especially Master A.E which

included beans, meat, egg, and fish. I also encouraged them to drink more water, take in fruits and

vegetables, and avoid fatty and sugary foods. Lastly, I advised them to exercise regularly, have

enough rest and sleep as they also promote optimal health. Enquiries were made from client and

42
mother and they answered all questions I asked them. I congratulated them for their corporation and

asked if they had any problem to lodge and client complained of passing hardened, inconsistent

stools (constipation). I therefore reassured and encouraged him to eat more roughage and fibre diet

as well as taking in enough water as we discussed earlier. My next visit was scheduled with them on

the 8th May, 2021 and bade them goodbye.

Problems Identified;

1. Client complained of constipation.

43
44
 TABLE 8: NURSING CARE PLAN FOR SIXTH HOME VISIT ON 30TH APRIL, 2021.

DATE/ NURSING OBJECTIVE/ NURSING NURSING EVALUATION

TIME DIAGNOSIS OUTCOME ORDERS INTERVENTION

CRITERIA

30/4/2021 Constipation Client will 1. Reassure client and family. 1. Client and family reassured that 2/5/2021.
he will be relieved from the constipation.
At related to be able to pass stool At
2. Educate client to take in fibre diets. 2. Client educated to take in fibre
4:45pm inadequate within 48hours as foods like maize, orange, etc. 5:30pm
3. Encourage client to take in
intake of evidenced by client Goal met.
enough water. 3. Client encouraged to
roughages and being able to take in enough water to help empty the Client had
4. Advise client to undertake bowel.
low intake of pass stool at least normal bowel
passive exercise. 4. Client advised to
water. once a day without undertake in passive exercises to aid in movement.
5. Encourage client to empty his bowel digestion.
straining.
whenever he feels the urge. 5. Client encouraged to
empty bowel whenever he
feels the urge to avoid constipation.

45
 SEVENTH HOME VISIT ON THE 8TH MAY, 2021.

OBJECTIVE;

By the end of the visit, I will be able to;

1. Enlighten client and family on how client can build his self-esteem.

I embarked on my seventh home visit on 8th May, 2021 at exactly 4:55pm. On arrival, I

knocked and entered the house upon response. I greeted and was offered a seat. Madam N.A

revealed that everyone was doing well when I enquired about their health. I probed further

and asked Master A.E whether he had a normal bowel movement and he replied yes and

thanked me for the care and education given to him during my previous visit. Client’s mother

disclosed that she couldn’t sleep the previous night as a result of noisy environment. I

encouraged her to sleep in a quite environment, take a warm bath before bed and put on loose

cotton gown to absorb moisture and aid better sleep.

The mission behind my visit to client and family that day was made known to them. I

introduced the objectives and started and asked Madam N.A about client’s relation with his peers

and he replied that client sometimes feels shy due to his condition. I explained that at this stage, the

child enjoys the company of his peers which will gain him greater significance and will become a

major source of the child’s self-esteem as he enters the adolescence stage therefore, the need to

provide psychological and emotional support to client. I added on that client’s family should

constantly encourage Master A.E to always feel free to play with his peers without feeling shy

whiles maintaining client’s personal hygiene in order to boost his confidence. I thanked them and

asked permission to leave and scheduled my next visit with them on 15th May, 2021.

Problem Identified;

1. Client’s mother complained of insomnia.

46
 TABLE 9: NURSING CARE PLAN FOR SEVENTH HOME VISIT ON 8TH MAY, 2021

DATE NURSING OBJECTIVES/ NURSING ORDERS NURSING INTERVENTIONS EVALULATION

DIAGNOSIS OUTCOME
&
CRITERIA
TIME

8/5/2021 1. Reassure client’s 1. Client’s mother reassured that she will be 9/5/2021
Sleep pattern Client’s mother
mother. relieved of insomnia and will be able to sleep
@ disturbance will have a good @
well.
related to noisy night sleep within 2. Encourage client’s
5:25pm 4:30pm
environment. 24 hours as mother to sleep in a quiet 2. Client’s mother encouraged to sleep in a
evidenced by environment. quiet environment to aid better sleep. Goal fully met as
Madam N.A Client’s mother
3. Encourage Madam 3. Madam N.A encouraged to put on loose
verbalising that has an improved
N.A to put on appropriate cotton gown to absorb moisture, ensure
she was able to sleep pattern.
clothing. comfort and aid sleep.
sleep well.

4. Encourage Madam 4. Madam N.A encouraged to take a warm

N.A to take a warm bath bath as it helps to induce sleep.
before bed.
5. Madam N.A encouraged to plan activities
5. Encourage Madam to prevent stress to aid good sleep.
N.A to plan activities to
avoid stress.

47
 EIGHTH HOME VISIT ON 15TH MAY, 2021.

Objectives;

By the end of my visit, I will be able to;

1. Educate client and family on behavioural therapy in relation to bedwetting.

I paid my eighth visit to client and family on 15 th May, 2021 at 4:15pm. I knocked, entered the

house upon response and was offered a seat. I enquired about the health of client and family and

they responded that everyone was doing well.

I introduced my objective for the visit which was to educate client and family on behavioural

therapy in relation to bedwetting. I asked them about their knowledge concerning the topic, but

unfortunately, I was told they had no idea. Client and family were reassured that by the end of the

discussion, they would gain insight about the topic at hand.

I went ahead and explained that, the behavioural therapy of bedwetting has motivational therapy as

an integral aspect it. It was also explained that, motivational therapy involves keeping a record of

progress with bigger rewards for longer period of dryness. The parent of the child should agree

about the reward in advance and might progress from sticker on a calendar for each dry night to a

favorite book or favorite place of visit for seven consecutive dry nights.

In addition, self-awakening was explained to them. It was explained to them as a therapy

aimed at teaching the child how to recognize when the bladder is full at day time and hope that he

or she can recognize this during the night. I asked them if they had questions but they replied no. I

thanked client and family for their time and corperation. The date for my next visit was scheduled

with them on 22nd May, 2021 and bade them goodbye.

48
Problems identified;

1. Lack of knowledge about the behavioural treatment for bedwetting

49
 Table 10: NURSING CARE PLAN FOR HOME VISIT ON 15TH MAY, 2021.

DATE NURSING OBJECTIVE/ NURSING ORDERS NURSING INTERVENTION EVALUATION

AND DIAGNOSIS
OUTCOME CRITERIA
TIME

15/5/2021 Knowledge Client and family will 1. Provide a calm and 1. Client and family were provided 15/5/2021.
deficit related have adequate peaceful environment without with peaceful environment during
At At
lack of knowledge on interruption. discussion
4:05pm. information behavioural therapy of 2. Client and family will be 2. Client and family were provided 4:37pm
on bedwetting within 30 provided with clear and with clear and understandable
Goal partially
behavioural minutes as evidenced understandable explanation explanation
met as
therapy of by client and family 3. Encouraged client and 3. Client and family were
evidence by
bedwetting answering question family to ask question encouraged to ask questions
client and
correctly on Incorporate rewards into Rewords were incorporated during
family given
behavioural therapy of learning process by clapping learning process by clapping of
feedback after
bedwetting hands
discussion

50
 NINTH HOME VISIT ON THE 22ND MAY, 2021.

Objective;

By the end of the visit, I will be able to;

1. Prepare client and family psychologically towards the impending handling over for

continuity care.

My ninth home visit was conducted on 22nd May, 2021 at 3:30pm. We exchanged greetings and

asked of their health and they replied that they are fine. They offered me seat and I informed them

of my objective for the visit, which was to prepare them for the impending handing over for another

community health nurse for continuity of care.

I then reminded them that as I informed them that the care was going to last for a specific period

from the beginning of our interaction, so I will hand over the care I rendered to a community health

nurse who will continue with the care I rendered. They became sad due to the change in care giver

but with adequate education and the reason for the handing over they agreed. I added that, they

should come out with any problem they have concerning their health, since she will plan, assess and

implement their health needs as well as evaluating their health to ensure promotion of their health. I

informed them that, I will come with the nurse on my next visit for them to meet her officially. I

pleaded with them to cooperate with her as they did to me. I asked client and family if they had any

complains to lodge and they said no.

Tactfully, I said to Master A.E, I saw him coughing during our interaction and he

said it was true, but not anything serious that was why he did not complain, but think it is as a result

of inhalation of dust particles while sweeping his room two days ago. I encouraged him to take in

more fluids and fruits to help fight against infections, he should avoid inhaling dust particles when

sweeping by wearing the nose mask and also advised him to cover his mouth with handkerchief

51
when coughing. Furthermore he should report to the hospital if cough persist. I thanked them and

asked permission to leave. My next visit with them was schedule on 14 th June, 2021. I bade them

farewell and left.

Problem Identified;

1. Client’s was having mild cough

52
 TABLE 11: NURSING CARE PLAN FOR NINTH VISIT ON 22ND MAY, 2021

DATE NURSING OBJECTIVES/ NURSING ORDERS NURSING EVALULATION

DIAGNOSIS OUTCOME INTERVENTIONS
&
CRITERIA
TIME

22/5/2021 1. Educate client to cover his 1. Client was educated to his 25/5/2021
Cough related Client will be
mouth with handkerchief when mouth with handkerchief when
At to inhalation of relived of cough At
coughing. coughing.
dust particles with in 72hours
3:30 pm 4:15pm
as evidenced by 2. Educate client to take in more 2. Client was educated to take
absence of cough fluid and fruits. in more fluid and fruits. Goal fully met. Client
had a relief from
3. Advice client to avoid in 3. client was advised to avoid
cough
halation of dust particles in halation of dust particles

4. served prescribed antitussives 4. Prescribed antitussives

e.g. simple linctus served.

53
 HANDING OVER AND CONTINUITY OF CARE

Client’s health care needs over time can rarely be met by a single health professional,

therefore multi-professional pathways of continuity exist to help achieve both quality of care

and effective health care. Client and family were made aware that my interaction with them

was for a short period of time. Client and family were made aware that my interaction with

them was for a short period of time and the aim was to help client build a positive self-esteem

pertaining to his condition and to provide the necessary nursing care to client/family.

On Thursday 3rd June, 2021, I went to Old Town Health Centre to look for a community

health nurse with the idea of handing client and family over to. I met the nurse in-charge of

the facility, introduced myself and made my mission known to her that I wanted a

community health nurse to hand over client and his family to and also added up by giving

details of client and family and all the care rendered to them so far. The nurse in-charge

agreed and assigned one of the nurses to me. I established rapport with the nurse assigned to

me as well as a brief detail about client and his condition; a 16year old boy who experiences

bedwetting and further disclosed that throughout my visits to him and his family, they had

been educated on bedwetting, its management, personal and environmental hygiene, etc. She

accepted my request and I communicated the date for the handing over to her and we

scheduled a time for the visit. I thanked her, the nurse in-charge and the nurses around and

bade them goodbye.

I visited the client and his family with the Community Health Nurse on 14th June, 2021. I

introduced the nurse to the family and informed them she was the one to take over the care of

them and for that, they should cooperate with her for effective and complete services to be

rendered to them. The Community Health Nurse took over by assuring client and family of

confidentiality and competent work. She advised client’s family not to use punishment as a

54
mean to stop client from wetting the bed, showing love to client as well as good personal

hygiene. The nurse scheduled the next visit with them and we asked permission to leave.

SUMMARY

55
The client and family centered care study is based on rendering quality health care to client and his/

her family using the nursing process. This client and family centered care study was conducted

using Master A.E, a 16year old male child and his family. Client was identified during a special

home visit on Monday 25th February, 2021 in his home setting after a psychiatric nurse introduced

him to me. The main objective was to enlighten client and family on bedwetting, its management,

personal and environmental hygiene and help client build a positive self-esteem pertaining to his

condition. Specific objectives set for the study were to; educate client on bedwetting, encourage

client’s family to provide psychological and emotional support to client, assist client and family to

the hospital for a check-up, educate client and family on lifestyle modification, etc.

The client and family gained enough knowledge on bedwetting through education and

counselling I gave to them and with their support and co-operation, all the objectives set for

this client/family centered care study were achieved. The following problems were identified

and intervened successfully during the visits; Client’s family were anxious about client’s

condition (bedwetting), client complained of constipation, client’s mother complained of

insomnia, client had headache, client had low self-esteem, etc. Finally, client and family were

handed over to a Community Health Nurses at Old Town Health Centre for continuity of

care.

56
 CONCLUSION

This study has granted me a great opportunity to provide an independent and a holistic

nursing care to a client/family by putting into practice the knowledge and skills I acquired

during my three-year training as a Community Health Nurse. I have gained more confidence

and experience working independently with a client/family and providing nursing care to

them. With this experience, I will be able to deal with and manage well any similar situations

in the community as a professional Community Health Nurse.

57
 RECOMMENDATIONS

I recommend to the Public Health department of the Birim Central Municipal Health

Directorate to intensify health education to community members in the form of health talk to

enlighten the public on causes, effects and preventions of bedwetting (nocturnal enuresis).

I kindly recommend that Community Health Nurses should also help intensify home visits to

help identify individuals with such condition (bedwetting) in the community and provide

education and the needed care to clients to attain optimal health.

58
 REFERENCES

Attitudes and Perfections, Hong Kong Journal of Pediatrics, (2008). Primary Nocturnal

Enuresis.

National Institute of Diabetes and Digestive and Kidney Disease, (2017). Facts for Bladder

Control Problems & Bedwetting in Children.

Helen Gavin, (2013). Criminology and Forensic Psychology.

Meds Cape, Wm Lane M. Robson (2018). Pathophysiology of bedwetting.

Reynosa, Parades, MD, Potenciano, (2010). Case-Based Pediatrics for Medical Students and

Residents, Symptoms of bedwetting.

Worldwide research, (2017). Reviews about the causes of bedwetting.

59
 SIGNATORIES

NAME OF STUDENT: AGYEIWAA- TUFFUOH DIANA

SIGNATURE: …………………………………………………………………………………

DATE: …………………………………………………………………………………………

NAME OF SUPERVISOR: MS. ELLEN ADJIE

SIGNATURE: …………………………………

DATE: …………………………………………

NAME OF DISTRICT PUBLIC HEALTH NURSE: MS. GRACE DANQUAH

SIGNATURE: …………………………………………

DATE: ………………………………………

NAME OF PRINCIPAL: MR JONES ABEKA- BAAH

SIGNATURE: …………….......…………………………

DATE: ……………….......………………………………

60