Beata Antoszewska

Silence and remaining silent when facing a child with cancer – necessity, naturalness or failure?

Silence and remaining silent occupy a significant position in human life. We need silence to think over many matters, and sometimes it is necessary to re-think them, especially considering modern civilization overwhelmed with noise, chaos, haste and overuse of words lacking meaning. We need silence to express our respect for human dignity by remaining silent. This article will first present a general understanding of silence and remaining silent. Then we will refer these notions to situations when a space of silence and remaining silent emerges around a child with cancer. The sources of such specific space will be indicated. Silence and remaining silent do not concern only the child itself, but also the child’s relatives – parents and siblings, as well as all those individuals who come into contact with such a child. Silence and remaining silent when facing a child with cancer will be analyzed from various perspectives and dimensions, including diagnosis and treatment. For us, the most significant and at the same time the most unique situation is the one when silence and remaining silent embrace a child who cannot be cured and inevitably approaches death.In this paper we will attempt to answer a few key questions: Are silence and remaining silent a necessity or perhaps a natural reaction to the surrounding reality? Or, perhaps, their appearance is definitely unjustified. Maybe they should not accompany a child with cancer. Is it better or would it be better to speak or remain silent? And finally – where can the sources of such silence and remaining silent be found?

Paternalism as a source of dilemmas in the area of special education – the chosen aspects

The paper presents some reflections on a paternalistic approach to people with disabilities that may put the functioning of such individuals at risk. Paternalism, as an authoritarian approach of the physician to the patient, emerged in medicine and is most often analyzed with reference to the medical domain. It should be noted, however, that some activities performed by teachers, therapists and parents limit the autonomy of a child or disabled person. Although such actions undoubtedly aim at important rehabilitative outcomes, they overlook/limit possibilities, desires, and sometimes actually well-being of a person with disability. In this article paternalism is analyzed in three aspects: aim, therapy/rehabilitation and parental approach.

Artykuł w pierwszej części zawiera teoretyczne wprowadzenie do zagadnienia inkluzji i pracy nauczycieli w szkołach przyszpitalnych. Druga część prezentuje wyniki badań otrzymane w efekcie badań jakościowych osadzonych w paradygmacie interpretatywnym. Wybór wskazanego paradygmatu powiązany był z potrzebą uzyskania „głębszego” rozumienia zjawiska inkluzji. Cel badań dotyczył poznania i opisania pracy nauczycieli szkół przyszpitalnych przez pryzmat inkluzji ucznia ze specjalnymi potrzebami edukacyjnymi. Uzyskane dane i jakościowa ich analiza pozwoliły wyłonić sześć wspólnych obszarów procesu inkluzji: perspektywiczny, ciągłości, niepewności, teraźniejszości, teoretyzacji zadań i uprzedmiotowienia. Każdy z nich opisuje działania podejmowane przez nauczycieli szkól przyszpitalnych wobec ucznia przebywającego w szkole przyszpitalnej. Badania wskazują, iż nauczyciele koncentrują się przede wszystkim na realizacji zadań związanych z edukacyjna funkcją szkoły.

The work of a hospital school teacher in a view of the process of inclusion of a student with special educational needsobtained from the experience of the hospital school teachers in Warmian-Masurian Voivodeship

The paper starts with a theoretical introduction into the issue of inclusion and work of teachers in hospital schools. Its second part presents research results collected in the qualitative study set in the interpretative paradigm. The choice of the paradigm is related to the need to gain a “deeper” insight into the phenomenon of inclusion. The aim of the study was to get to know and describe work of teachers of hospital schools from the perspective of inclusion of a student with special educational needs. The obtained data and its qualitative analysis led to specifying six common areas of the inclusion process: the perspective, consistency, insecurity, presence, sentence theorizing and objectification. Each of them describes actions taken by the teachers, who work in the hospital school, towards pupils, who study at the same school. The investigations show, that teachers concentrate mostly on the completion of tasks, that are associated with the educational function of the school.

Artykuł prezentuje wyniki badań związane z opiniami rodziców na temat relacji nawiązywanych przez lekarzy prowadzących z pacjentami chorymi na nowotwory. Materiał badawczy zebrano przy wykorzystaniu metody sondażu diagnostycznego. Jako narzędzia użyto kwestionariusza skonstruowanego na wzór narzędzia opracowanego przez Aleksandrę Barczak i Sylwię Kołtan. Miejscem badań były trzy kliniki onkohematologii dziecięcej w Polsce należące do Polskiej Pediatrycznej Grupy ds. Leczenia Białaczek i Chłoniaków. Analiza zgromadzonego materiału badawczego wskazuje, iż relacja lekarz - dziecko chore na nowotwór została przez rodziców oceniona pozytywnie. Obserwacja w trakcie prowadzonych wcześniej badań oraz rozmowy z rodzicami pacjentów onkologicznych wskazują na przyjazny, a w niektórych przypadkach nawet rodzinny klimat oddziałów onkohematologii dziecięcej.

Physician - child relationship as perceived by parents of children treated at Departments of Paediatric Oncology and Haematology
This paper presents the results of research devoted to parents' opinions concerning the relationship established between attending physicians and patients treated due to cancer. The analyzed research material was collected with the use of a diagnostic survey. The survey was carried out using a questionnaire modelled on the tool designed by Aleksandra Barczak and Sylwia Kołtan. The study was conducted in three Clinics of Paediatric Oncology and Haematology in Poland that are supervised by the Polish Paediatric Leukaemia and Lymphoma Study Group. The analysis of the collected research material indicates that parents assess the physician - cancer patient relationship positively. Observations made during earlier studies and interviews with parents of oncology patients point to a friendly, and in some cases even familial setting of Departments of Paediatric Oncology and Haematology.

Keywords: cancer, physician - patient relationship, communication

„To leave the white uniform behind” – a child as a subject of the physician-patient relationship: theoretical aspects (part I)

The physician-patient relationship is very specific because of its subject. In literature, it is termed the triangle agreement because it involves three individuals as subjects of the relationship: physician, child and (depending on the child’s age) parents. They pass information to each other, observe and are observed. Parents’ involvement in the physician-child relationship is multifaceted and depends on a variety of factors, the most important ones include: the child’s age and/or level of intellectual development, experiences, personality, etc. It can be expected that the physician-child relationship proceeds differently depending on the environment in which it occurs (e.g., a visit at the pediatrician’s office, dentist’s office, at the department of pediatrics, a hospital admission room or an emergency department). The manner in which the physician initiates and sustains the relationship with the patient (not only a child) affects the patient’s feelings and behavior. Moreover, it conditions the patient’s satisfaction and compliance. This paper focuses on the relationship that emerges between the physician – the child – parents at the department of pediatrics in a hospital.