Prepared by

Hoda Ragab Mohamed

Out line
 Objectives
 Introduction
 Definition
 Principles of normalization
 Guidelines of promoting normalization
 Nurses' role to facilitate normalization
 Application of normalization for a family with
mentally retarded child
 Objectives
By the end of this seminar each student should be able
to:

 Define the concept of normalization

 Mention the principles of normalization
 Determine guidelines of promoting normalization
 Explain nurses' role to facilitate normalization
 Apply normalization for a family with mentally retarded
child
Introduction
 Normalization involves an acceptance of people
with disabilities, with their disabilities, offering
them the same conditions as are offered to
other citizens. It involves the normal conditions
of life – housing, schooling, employment,
exercise, recreation and freedom of choice.
Definition of The concept of
normalization
 The concept of normalization describes
the process where by families of
children with chronic illness over time
begin to perceive the child and their
family life as normal.
 Normalization refers to establishing a
normal pattern of living
 Normalization: Also involves viewing the
social effects of having a child with a
chronic condition as minimal and
ongoing in behaviors that show other
that this is a normal family.
 Principles of normalization

1. Those involved in the care of the child,

including the child, are prepared for the
effects of the condition and treatment.
2. The child is involved is self care and
decisions mode about care.
3. The child is not treated differently from
others in the family.
4. The child's condition is not kept secret
but shared with others when appropriate.
5. The parent's role in managing care is
recognized.
Guidelines of promoting normalization

Preparation Control

Participation Expectation

Sharing Positive attitude

 Preparation

Prepare child in advance for changes that

may occur form the illness or disability
For example, the child is told in advance of
the possible side effects of drug therapy.
 Participation

Include child in as many decisions as

possible, especially those relating to his
or her care regimen
For example, the child is responsible for
taking medications or scheduling home
treatments.
 Sharing

Allow both family members and child's peers to

be a part of the care regimen whenever
possible.
For example, the child is given his or her
medication when the other siblings receive their
vitamins, family and if the child is invited to an
other's home, the parent advices the family of
the children's dietary restrictions.
 Control
Identify areas where child can be in control
so that feelings of uncertainty, passivity,
and helplessness are decreased.
For example, the child identifies activities
that are appropriate to his or her energy
level and chooses to rest when fatigued.
Expectation

Apply the same family rules to the child

with a chronic illness or disability as to the
well siblings or peers.
For example, the child is disciplined,
expected to fulfill household
responsibilities, and attends school in
accordance with abilities.
Positive attitude

Focus, and help the child to focus on

areas of ability and competence to build
self – esteem.
 Common tasks in adapting of parents of
chronically ill or disabled children

1. Accept the child's condition.

2. Manage the child's condition on a day-to-
day basis.
3. Meet the child's normal developmental
needs.
4. Meet the developmental needs of other
family members.
5. Cope with ongoing stress and periodic
crises.
6. Assist family members to manage their
feelings.
7-Educate others about the child's condition.
8 Establish a support system.
 Nurses' role to facilitate normalization
 Nurses can facilitate the normalization
process for families of children with special
needs by acknowledging their normalcy,
strengths, and weakness. Being supportive of
the child's illness and treatment and actively
including the family in all aspects of the care
will improve their self- esteem and promote
further development.
 One of the most important interventions to
promote coping is alleviating the child's feeling
of being different and normalization his or her
life as much as possible.
 The nurse can help parents to assess the child's
daily routine for indications of normalizing practices.
for example, the child who remains in bed room all
day needs restructured daily routine to provide
activities in different parts of the house , such as
eating in the kitchen with the family , and the
inclusion of social , recreational and academic
activities in the plan of care .
 Any thing that might improve
attractiveness and contribute to a positive
self – image is encouraged, such as
makeup for a teenager with a scar,
clothing that disguises a prosthesis, or a
hair style or wig to cover a deformity or
lost hair.
 the nurse may assist parents in facilitating
positive adaptation in their children.
Normalization is important because it
focuses on the child, not the condition.
 Nurses can demonstrate the process of
normalization to the child's family by being
supportive and open about the child's
condition and treatment, and by actively
including the family in all an aspects of
care. If the child's family adopts a
normalized view of management of the
chronic illness, the child may be more
confident in the home as well as in social
and community situations.
 Nurses also can assist parents by
identifying and building on family
strengths, promoting family and child
competence, and fostering the
development of a nurturing environment
that addresses the needs of siblings and
parents, as well as of the child with special
needs.
Application of normalization for a
family with mentally retarded child
1. Inform the parents with the problem when
the diagnosis is definitely established.
2. Parents required to invest in their
handicapped child as alone object and to
provide care for him.
3. Encourage the parents to ask questions
had help them to express about their feeling.
4. Parents and teachers should ton use
pressure in an attempt to force a retarded child
to learn, to prevent frustration which leads to
further emotional problem.
5. Provide the some kind of lower, security
and help that a normal child needs, but the
needs then longer because his dependence
extends beyond the usual age.
 6. Engaging the child in foster home care,
day care for management of emotional
problems.
7. Regular school which having special
programs for mentally retarded child should help
the children to be thought to care for
themselves.
 8. Helping the parents to accept the
diagnosis to gain confidence and emotional
support by joining a group of parents whose
children have the same problem as theirs.
9. Adequate explanation should be given to
the siblings of a retarded child and free
communication established so that
misconceptions can be eliminated and anxiety
reduced.
10. The nurse can assist each child to reach his
maximum potential if he is viewed objectively
and as a whole individual.
11.Using Denver developmental screening
test to evaluate the growing child.
The Denver Developmental Screening
Test (DDST) is a widely used assessment
for examining children 0-6 years of age as
to their developmental progress.
12.Reinforcement: through operant conditioning,
behavior therapy and behavior modification
which mean reward given for desirable behavior
to repeated, it can be used in toilet training,
feeding, dressing and reduction of destruction
behavior among others.
13.Teaching self help skills according to level of
mental ability at that time.
14.In training habit formation help the child to relax
then to proceed through the routine, repeating it
sufficiently to be able to do it himself.
15. Using the routine schedule of diminution and
bowel movement and put the child on toilet
every 2 hr according to this schedule.
16. If punishment is necessary it should follow
the misdeed immediately so that the two events
are connected in the child's mind.

17. Provide environmental stimulation to achieve

child potential as he needs such as objects to
look at, sounds to heart items to handled and
manipulated.
18. When the child is hospitalized the nurse obtain
schedule for routine care from mother to be a
guide in cares of child at hospital.

19. Helping the parents to select toys according to

child's mental not chronological age.

20. Provide constructive play activity to focus the

attention of child with liability to self injury on
acceptable behaviors.