Nursing Care of the Hospitalized Child Christina Hernandez RN, MSN A Child’s Understanding of their hospitalization Based on: Their cognitive ability at different developmental stages Previous experiences with healthcare professionals Preparation & Coping Skills Culture Parents reaction to illness Siblings reaction to illness Importance of Effective Communication with Children More than words Touch Physical proximity and environment Listening with impartiality Visual communication Tone of voice Body language Timing Establishing rapport with the family Being open to questions/resolving conflict Developmental milestones and approach to communication Infants Toddlers Preschoolers School-age Adolescents (3-5 yrs) (6-11) (12 and older) (0-12 mo) (1-2 yr) Use of calm Learn the Seek Photos, Engage in voice; toddler’s opportunities books, videos; conversations respond to words for to offer est. limits, use about their cries, mimic common choices, use play, interests, use baby sounds, items, picture play for introduce of videos to talk and read books, explanations, preparatory explain, foster regularly, use respond to simple materials 1-5 independence, a slow their sentences, days in preparatory approach and receptiveness, picture books, advance of materials up allow time to preparation puppets, be the event to 1 wk in get to know should occur concise; limit advance, you immediately length of respect before event explanations privacy needs ! Critical to remember ! Child’s response to Illness Fear of the unknown Separation anxiety Fear of pain or mutilation Loss of control Anger Guilt Regression Stages of Separation Protest Despair Detachment Stressors by developmental age Infants / Toddlers **separation anxiety Nurses experience protest and despair in this group Fear of injury and pain Loss of control Need contact with mother Stressors by developmental age Preschooler Separation anxiety generally less than the toddler Less direct with protests; cries quietly May be uncooperative Fear of injury Loss of control Guilt and shame Stressors by developmental age School age Separation: may have already experienced when starting to school Fear of injury and pain Loss of control Stressors by developmental age Adolescence Separation from friends rather than family more imp Fear of injury and pain Loss of Control Fear of unknown Factors Affecting a Child’s Response to Illness and Hospitalization Age/cognition Parental response Coping skills of family/child Preparation of child/family Hospitalization can be a positive factor Regression Pre-school: typically regress in comfort measures and toilet training, ‘temper tantrums’ and toddler-like behaviors School age: may be more fearful of strangers and require more emotional support (crying or ‘baby talk’) Developmental Approaches to the Hospitalized Child *Page 891 BOX 35-2 Factors Affecting a Parents response to illness & hospitalization Perception Support system Coping Mechanism Factors Affecting a Parents response to illness & hospitalization Parents may become anxious Financial stressors Additional obligations Guilt Nursing Interventions for the family of a hospitalized child Augment coping mechanisms (what specific factors influencing client teaching?) Reinforce information and encourage questions (who would have difficulty with asking questions?) Anticipate discharge needs (when should this begin) Preparation for Hospitalization Tour the hospital or surgical area Photographs or a videotape of medical setting and procedures Health fairs Contact with peers who had similar experiences Types of facilities Hospital Medical/surgical units ICU Rehab Outpatient/day facilities 24 hr observation units School-based clinics Community clinics Home Care Environmental consideration in a healthcare setting Safe place Playroom Patient’s room Treatment Room/end of crib Senses: lighting, sound, temperature, smells Dynamics: designate one person to direct/encourage Medical play Safe place to just “be a child” Specialists that assist the hospitalized pediatric client Child Life Specialist Occupational therapist Physical therapist Play in the Hospital Setting Advantages of play to the hospitalized child Therapeutic Emotional outlet Instructional Improve physiological abilities Enhances cooperation Rewards the child. Payment for a job well done! Pet therapy- play… Dealing with Difficult Families Remember that the child, and the family bring “baggage” Child: fear, expectations and ?? Parent: preexisting dynamics and communication styles, finances, coping styles How to deal with the “baggage” Claiming potential baggage Bring the “good baggage”: competency, calmness, caring, tolerance, openness Flexibility by all members of the team Avoiding the negative baggage COPE Creating Partnerships with Families of Children with Special Healthcare Needs CSHCN: Children with Special Health Care Needs Defined as those with elevated risk for chronic physical, developmental, behavioral or emotional conditions CSHCN, cont. About 13% of the children Account for 65-80% of all pediatric healthcare expenditures Goals: accessing the resources available! CSHCN, cont Care differs from other children: May require special equipment – visually or hearing impaired, wheelchairs Specialized care – feeding tubes, trachs/vents Assess who is the primary caregiver? Involve additional members of the healthcare team CSHCN, cont. “ending on a happy note” Share the joys of focusing on the child’s growth and development Support and encourage the parents Empower families to regain control of their lives Engage in authentic communication Support strengths of families Managing pain in the hospitalized child According to age which technique is best Types of techniques: Behavioral distraction Assorted visuals Breathing techniques Comfort measure Diversional talk Pain Assessment Infant: grimacing, poor feeding, restlessness, crying Toddler: clinging to parent, crying, pulling or rubbing area of pain, anorexia, vomiting, restlessness Pain assessment in the Neonate Pain Assessment Preschool: verbalize pain, guard injured extremity, anorexia, vomiting, sleeplessness Adolescent: verbalize pain, may not understand ‘type’ of pain. Possible reluctant to call for help. Consequences of unrelieved pain Respiratory changes Neurologic changes Metabolic changes Immune system changes GI changes Pain scales FLACC: face, legs, activity, cry, and consolability (p. 1215-1216) FACES: smile to worst hurt (tears) Oucher Scale After determining that the child has an understanding of number concepts, teach the child to use the scale. Point to each photo, explain that the bottom picture is a “no hurt,” the second picture is a “little hurt,” the third picture is “a little more hurt,” the fourth picture is “even more hurt” the fifth picture is “a lot of hurt” and the sixth picture is the “biggest or most hurt you could ever have.” The numbers beside the photos can be used to score the amount of pain the child reports. Pharmologic vs. Non-pharmologic treatment for pain Pharmacologic Non-pharmacologic methods Opiods Distraction Nonsteroidals Cutaneous stimulation Nonnarcotic analgesics Sucrose solution Electroanalgesia (TENS units) Application of heat/cold Relaxation, hypnosis, guided imagery Pain Management The presence of the parent is an important part of pain management. Children often feel more secure telling their parents about their pain and anxiety The End!
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