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Growth and Development of Maggie Bravo By: Jasmin Umana
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Table of Contents
Introduction
Maggie’s Family Physical appearance
Growth and Development
Fine and Gross Motor Skills
Developmental Theories
Erikson Piaget Kohlberg
Nutrition
Orem’s Self-Care Requisites
+ Introduction: Maggie’s Family •
Maggie Bravo is a seven-year-old child who is part of a single-parent family. Her father, Valentin Bravo, has been her primary caregiver since her mother abandoned her when she was 10-months-old. Her father, a Mexican citizen, initially attempted to locate Maggie’s mother, a US citizen, in California. After failing to locate Maggie’s mother, Valentin decided to stay in California and raise his daughter there because he feared that border patrol would take Maggie away from him. In general, many single-parent families face difficulties such as lack of emotional support, assistance with childrearing, and face financial strains (Ball, Binder, & Cowen, 2015) . To provide for his child, Valentin began working as a stuntman in the movie industry. With limited job opportunities as an undocumented man in the US, Valentin felt that taking this job, which paid an average of $10,000 per day, was the only way he could properly support Maggie.
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For the past six years, Valentin has given Maggie a happy, fun, and carefree home. His parenting style may be considered as permissive. Permissive parents usually show a great deal of warmth but set few controls or restraints on their child’s behavior (Ball et al, 2015). Although Valentin provides unconditional love to Maggie, it impedes him from performing some important functions. For instance, discipline is inconsistent and he is easily convinced to do whatever Maggie wants to do. However, when a parent does not impose any controls, the child may end up controlling the parent (Ball et al, 2015). Still, Valentin will do whatever it takes to make Maggie happy. This includes making up unrealistic stories to help his daughter feel better. For instance, instead of telling Maggie that her mother abandoned her, he secretly writes letters to Maggie and says they are from her mother. In the letters, the “mother” usually tells Maggie about her adventures with characters, such as Batman, and her role in saving the world from evil.
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According to Duvall’s (1977) eight stages of the family cycle, the Bravo family, a family with a school-aged child, would fall within the 4 th stage of the family life-cycle stage.
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Maggie’s social networks include school and the crew members from her father’s movie sets. Although her religion is not specified, faith-based therapies are performed by Maggie and her father. She believes that an amulet she owns has the power to heal her father when he gets hurt from dangerous stunts. Maggie and her father also identify as Mexican, and always speak Spanish due to Valentin’s refusal to learn the American language.
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Introduction: Physical Appearance Maggie Bravo
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Maggie Bravo is a seven-yearold Caucasian girl, with an engaging smile and bright blue eyes. She appears wellnourished and of her stated age. She has no visible deformities and her height and weight are that of an average child her age. Although she appears healthy, Maggie requires cardiac medication since being diagnosed with a heart defect at the age of 3 years. Although her condition has a poor prognosis, she is unaware about her condition and sometimes tires easily after physical activity.
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Growth & Development: Maggie: The school-aged child
School-aged children are expected to become leaner as their fat gives way to muscle. On average, the child grows 1.5-2.5 inches and gains 3-5 pounds within a year. Their jaw proportions also begin to change as their permanent teeth begin to erupt. Body organs and their immune systems also mature and result in fewer illnesses. At this stage, physical skills improve as the child engages in play sports. Fine motor skills are also well developed through school activities such as craft projects. Their sensory abilities improve and they are able to read and concentrate for longer periods on activities. At this stage, children have a mature use of language and can converse and discuss topics for greater lengths of time. More hours may be spent with friends in sports or other activities.
(Ball et al, 2015)
As a school-aged child, Maggie is growing and losing some of the baby fat she once had as a younger child. She has gained about 1 ½ pounds within the past year and also grew about 2 inches. She is lean and petite, but growing at an appropriate growth rate. She has already lost some of her baby teeth and her permanent teeth are begin to show. Maggie is very creative and enjoys playing in her home full of a never-ending toy supply. She also enjoys playing soccer with other children but tires easily after physical activity.
In school, Maggie enjoys participating in small projects and is enthusiastic when sharing stories about her long-lost mother. Although she receives good grades in school, she sometimes misses school more than once a week. When she is at school, her peers sometimes bully her due to the highly imaginative family stories that she shares in school. For the most part, Maggie spends her time with her father in comparison to time spent with friends.
Maggie likes to read with her father and has strong communication skills that allow her to serve as his interpreter since she is fluent in English and Spanish.
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Fine & Gross Motor Skills Expected Fine & Gross Motor Skills
Observed Fine Motor Skills Maggie is very creative and always working on small craft projects that will decorate her room. She is a good fisherman and can cast a line with ease. Maggie dresses all by herself and wears whatever she likes. Maggie frequently writes letters to her long-lost mother
Observed Gross Motor Skills Maggie enjoys running and playing soccer with other children outside the school setting Maggie enjoys rock climbing with her father She has an indoor rock-climbing wall in her home and climbs frequently with her father’s assistance
Fine
Motor Skills Enjoy craft projects Plays card board and board games
(Ball et al, 2015)
Gross
Motor Skills Rides 2-wheeler Jump ropes, roller skates, or ice skates Gross motor development is fostered by ball sports
(Ball et al, 2015)
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Developmental Theories Erikson: Industry vs. Inferiority
In this stage, children develop new interests and are involved in more activities. School-aged children are now engaged in cooperative play- a type of play that requires cooperation with others in order to contribute to a unified whole. For them, play is an extremely important way of learning and living and a sense of industry is achieved through the child’s accomplishments in school, home, and community. If the child cannot accomplish what is expected, a sense of inferiority is achieved.
(Ball et al, 2015)
Although Maggie is always optimistic and full of energy, she has developed a sense of inferiority within the past few weeks. Unlike most of her peers, Maggie does not have a mother figure and to compensate, she has enthusiastically shared stories about her mother’s adventures. However, these stories derive from letters Maggie has received from her “mother” within the past few years. Secretly, her father has been sending these letters to his daughter but these stories usually involve her mother partaking in heroic adventures, often aided by fictional characters such as Batman and Superman. An innocent child, Maggie has completely believed these stories and her peers laugh at her when she shares her stories. In the schoolyard, Maggie has become isolated from her peers and is not invited to play. She does not have close friendships in school, which may later contribute to feelings of purposelessness and sadness.
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Developmental Theories Piaget: Concrete Operations
In this stage, Maggie may consider alternative solutions to solve problems but still rely on concrete experiences and materials to form their thoughts. The concept of conservation is learned at this stage and the child learns that matter does not change when its form is altered. This is important because it is helpful when thinking logically about a sequence of events and understand others’ perspective as egocentric thought diminishes.
(Ball et al, 2015)
Maggie is transitioning from perceptual to conceptual thinking. Her stage of transition is notable because she still demonstrated magical thinking. Magical thinking, the belief that events occur because of thought or wishes, is a characteristic found primarily in the intuitive stage of Piaget’s theory of cognitive development (Ball et al, 2015). In a few instance, Maggie’s father, Valentin, has been injured, to the point of unconsciousness, during his dangerous stunts. However, Maggie believes she can “revive” her father by saying a special chant while waving her amulet around his head. It is a somewhat spiritual chant but her father recognizes that it is a game he made up in order to help Maggie feel like she has control and that nothing is wrong with him. Nonetheless, Maggie’s growing maturity and ability to solve problems demonstrate that she is transitioning into the concrete operations stage.
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Developmental Theories Kohlberg: Conventional Stage
At this stage, children develop a conscience, or internal set of standard. Rules are very important to please other people, and to be considered as a “good child”, children believe they must follow rules (Ball et al, 2015). In Maggie’s case, following rules has not been as important because her father is so permissive. Therefore, she can sometimes get away with behaviors that are usually unacceptable. On one occasion, she hit one of her peers and was not ashamed of her actions even though she knew what she had done was wrong.
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Nutrition
According to the USDA (2015), a moderately active seven-year-old would require a daily intake of 14001600 calories. In addition, 45-65% of their intake should be from carbohydrates, 10-30% from proteins, and 25-35% from fat. On a daily basis, they should consume about about 1 ½ cups of fruit, 1 ½-2 cups of vegetables, 4-5 ounces of protein, 2 ½ -3 cups of dairy, 17-22 grams of oil, and 5 ounces of grains.
Maggie has a normal weight, with a BMI of 19.5. She appears well-nourished and meets the recommended nutrition guidelines. She drinks plenty of water and only drinks milk for her breakfast cereal. On occasion, she does eat out with her father and has more dessert than necessary.
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Orem’s Self-Care Requisites
Maggie and her father have a very strong and positive relationship. Her father is very affectionate and is very supportive. He comforts Maggie when she feels sad and she comforts him when he fears performing some of his dangerous stunts. They are each others support system. Both are respectful towards each other and they enjoy spending time together.
Maggie is able to take care of most of her self-care needs, with some prompting. At this age, her need for privacy has also increased and her father lets her dress in any way she likes, allowing her to be creative with her wardrobe.
Although Maggie is doing well in school, academically, she has been absent frequently . She misses about 1-2 days of school on a weekly basis simply because she does not want to go to school. Her father does not feel that there is anything wrong with spending a bit more quality time with his daughter.
Maggie does not have a good balance between solitude and social interaction. She does not have many friends and has been bullied by a group of girls. She plays alone in the school yard during her recess time.
Maggie does not have a good balance between activity and rest. Due to her heart condition, she tires easily after physical activity and will take 2-3 naps a day. On average, a school-aged child needs about 9 hours of sleep each night (Ball et al, 2015).
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QSEN Core Competencies
QSEN Core Competencies include:
Patient-centered Care
Teamwork and Collaboration
Evidence-Based Practice Quality Improvement Safety Informatics
Patient-Centered Care
Focus on providing care that is caring and compassionate, and culturally sensitive. It should address the patient’s physiological, sociological, spiritual, and cultural needs, preferences, and values (Assessment Technologies Institute (ATI), 2013).
Maggie’s designee, her father, is the source of control when deciding how care should be provided for his daughter. Healthcare providers must respect his decision to not tell Maggie about her worsening condition. Although treatment has been implemented, it has been unsuccessful. Maggie is dying and for this reason, Valentin wants to spend as much time possible. Physical and emotional support should be implemented to provide quality care for both father and daughter.
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Concerns to Address Physical Development
Nutrition
Although Maggie is wellnourished, she occasionally consumes food that are not nutrient dense. As a solution, Valentin should implement the following strategies for healthier eating practices: Avoid using food as a reward and emphasize physical activity (Ball et al, 2015). Model healthy behaviors and teach Maggie to make healthy food selections (Ball et al, 2015).
Maggie is currently losing her baby teeth and permanent teeth are emerging. She should be taught the importance of proper oral hygiene. Some points to highlight include: Brush your teeth at least twice each day, morning and night (Bright Futures, 2010). . Floss your teeth every day (Bright Futures, 2010).
When physically active, Maggie should maintain adequate hydration and rest, as needed, to prevent overexertion.
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Concerns to Address Safety
Development/Social Development
When dealing with bullies, we can teach Maggie the following practices: Tell kids who pick on you or try to hurt you to stop it. Then walk away (Bright Futures, 2010. Tell adults you trust about bullies (Bright Futures, 2010).
Maggie’s father can also talk to her teacher about bullies and Discuss rules and consequences with Maggie (Bright Futures, 2010).
Being honest is very important to school-aged children and Valentin should be encouraged to speak honestly with his daughter in order to build trust (Ball et al, 2015).
Maggie does not use her seatbelt consistently. To prevent motor-vehicle injuries, the following practices can be taught: Use an approved car restraint system until Maggie achieves a height of 4 feet, 9 inches (ATI, 2013). Teach Maggie appropriate seat belt use when no longer using a car restraint system or a booster seat (ATI, 2013). Reinforce safe pedestrian behaviors (ATI, 2013).
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