International Classification Of Functioning, Disability And Health (ICF) Framework And The F-Words Concept

The purpose of the subsequent case study is to apply the International Classification of Functioning, Disability and Health (ICF) framework and the F-words concept to a previous experience to gain a more profound and holistic understanding of the patient’s capability to fully engage in their life.

The F-words act as a simple way to implement the ideas of the ICF, a universal classification system that includes all aspects of health. Implementing neutral language, the ICF views a person’s ability as a social construction between the person and their community and proposes that both environmental and personal factors affect the individual’s health. This case study will also use a family-centered services (FCS) approach recognizing that each family is unique, they are a constant in the child’s life, and the expert on the child. Within this approach, all family members receive consideration and support; thus, the case study will also explore the parents’ and siblings’ experiences.

Review of Case Study

Winston, six-months-old, was diagnosed with level 3 severe hypoxic-ischemic encephalopathy (HIE) at birth, which will likely develop into spastic quadriplegia, inhibiting the use of his legs, arms, and body. Winston also has a tracheotomy and surgical jejunostomy tube. At approximately one-month-old, clinicians informed Winston’s parents that he was going to die. Winston shocked his family and their medical team when he kept fighting, despite being taken off of life support.After 157 days of hospitalization, spending time in both the neonatal intensive care unit and the complex-care ward, while his family lived at the Ronald McDonald House (RMH), Winston was discharged. Approximately one-month post-discharge, Winston was readmitted for aspiration pneumonia and intussusception. While this was a shorter admission, due to the fragile nature of his health, his family is aware that readmission will occur frequently.

Application of Concepts

The biomedical model attempts to ‘fix’ a health problem; however, this is not a realistic solution to most childhood disabilities, including spastic quadriplegia. Instead of focusing on a cure, it is constructive to focus on Winston’s goals and strengths, as well as the external factors that influence his participation.

Function: The ICF framework and the F-words concept encourages healthcare teams to be openminded to alternative approaches and to focus on capabilities instead of ‘limitations’. Winston’s skills and achievements, regardless of how they appear, must be appreciated and respected. While admitted, Winston practiced following voices with his eyes and focusing on objects. Although Winston cannot support his head or turn his neck to look at objects, we would help his practice by moving to different sides of his crib and calling his name, which allowed Winston to track us with his eyes. He also practiced focusing on mobiles that hung above his bed and play aquariums that provide a visual simulation. Rather than ‘fixing’ Winston’s inability to support and move his head, we found another way for him to focus on humans and objects, and thus, he completed his goal.

Family: The family is a central contextual factor to the patient, and due to their importance and involvement, they also need resources and supports. Winston’s family lives over 70 kilometers away from the hospital. His mother, who experienced medical complications during labour, was unable to drive immediately afterward and felt torn between caring for her infant and spending time with her other two children. Eventually, Winston’s family came to stay at RMH, allowing them to be more involved in his care, but also enabling them to receive the support and resources they needed in a safe and welcoming environment. Additionally, Winston’s extended family played a role in his treatment; his parents, grandmothers, and sister were trained to use his tracheostomy equipment. Siblings and grandparents are both considered environmental support, and grandparents specifically can provide social, emotional, and material resources for both the patient and their parents.

By applying the F-words lens, I have recognized the importance of keeping families close for both the patient and their family and acknowledged the significance of a grandparents’ influence. Fitness: The ICF model views activity limitations as a result of the person and the environment, not a result of limited body function or the health condition. Additionally, and according to the FCS approach, the family can play an important role to promote activity as children function best when surrounded by a supportive family. While admitted, Winston’s family created a goal to bring him for outdoor walks. They began working towards this goal by walking around his ward, which evolved to walking around the floor, and finally, to outdoor walks. Although Winston’s walks may not be considered ‘normal’ (a nurse accompanied him and he used assistive devices), ‘normal’ was never the goal, only achievement.

Friends: Social development is an essential aspect of personhood; social interactions and fostering quality relationships should be encouraged between the patient and his peers. Winston’s family met other families of critically ill children, who became friends with Winston and the family’s support network. Winston’s sister especially benefited from befriending other siblings at RMH as it normalized her experience. The support network Winston’s family created has helped them through the challenges of extended hospital admission, and they have continued these relationships post-discharge.Fun: Participating in fun is meaningful to all children, including Winston, and builds a child’s confidence, competence, sense of achievement and capacity. Despite hospitalization, Winston’s family included him in meaningful life situations. As his health stabilized, and his parents passed their tracheostomy training, he was able to leave the hospital for temporary periods of time to join his family at RMH to celebrate his siblings’ birthdays. Winston’s inclusion in these important milestones was meaningful to both him and his family.

Future

It is critical to consider Winston’s future in a positive manner. While admitted, Winston’s sister proposed a family trip to Disney World, and a staff member explained that she thought this would be difficult given Winston’s limitations. Instead of deciding what she thought was impossible, she should have let his family express their expectations and dreams for the future. Then they can focus on Winston’s capabilities and work towards achievement rather than normalization. While they cannot ignore their present reality, both his family and service providers need to focus on his future potential. Currently, the family is also considering Winston’s education and his mother returning to work.

Conclusions

It is imperative to acknowledge that while these six F-words are portrayed separately within this paper, they are non-hierarchal, and interconnected. By reviewing Winston’s case with the F-words, the ICF framework, and the FCS approach, one can broaden their focus to include his entire environment, his interactions within it, and its role in his functioning (Rosenbaum & Stewart, 2004). We can move away from trying to ‘fix’ Winston’s health problems, and focus on his strengths, thus allowing us to personalize his interventions. When properly applied, these concepts benefit Winston, his family, and his clinicians.