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Nursing Care of the Hospitalized Child

Nursing Care of the Hospitalized Child. A child’s understanding of their hospitalization. Based on: Their cognitive ability at different developmental stage Previous experiences with healthcare professionals. Importance of Effective Communication with Children. More than words Touch

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Nursing Care of the Hospitalized Child

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  1. Nursing Care of the Hospitalized Child

  2. A child’s understanding of their hospitalization • Based on: • Their cognitive ability at different developmental stage • Previous experiences with healthcare professionals

  3. 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

  4. Developmental milestones and approach to communication

  5. ! 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

  6. Stages of Separation • Protest • Despair • Detachment

  7. Stressors by developmental age • Infants/toddlers • **Separation anxiety • Nurses experience protest and despair in this group • Fear of injury and pain • Loss of control

  8. 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

  9. School age Separation: may have already experienced when starting to school Fear of injury and pain Loss of control Stressors by developmental age

  10. Stressors by developmental age • Adolescence • Separation from friends rather than family more imp • Fear of injury and pain • Loss of Control

  11. 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

  12. Advantages of play to the hospitalized child • Therapeutic • Emotional outlet • Teaches • Enhances cooperation

  13. Hospital Admission • Taking the history • Physical Exam • Initial inspection • Baseline data • Family dynamics

  14. 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

  15. Types of facilities • Hospital • Medical/surgical units • ICU • Rehab • Outpatient/day facilities • 24 hr observation units • School-based clinics • Community clinics • Home Care

  16. 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

  17. CSHCN, cont. • About 13% of the children • Account for 65-80% of all pediatric healthcare expenditures • Goals: accessing the resources available!

  18. CSHCN, cont • Care differs from other children: • Requires more info about the family • Family does most of the care • Involves many systems and people • Balance condition r/t needs with general well-being of the child

  19. 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

  20. 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

  21. 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

  22. Specialists that assist the hospitalized pediatric client • Child Life specialist • Occupational therapist • Physical therapist

  23. Managing pain in the hospitalized • According to age which technique is best • Types of techniques: • Behavioral distraction • Assorted visuals • Breathing techniques • Comfort measure • Diversional talk

  24. Consequences of unrelieved pain • Respiratory changes • Neurologic changes • Metabolic changes • Immune system changes • GI changes

  25. Pain scales • FACES • FLACC • CRIES

  26. Pharmologic treatments Opiods Nonsteroidals Nonnarcotic analgesics Nonpharmalogic methods Distraction Cutaneous stimulation Sucrose solution Electroanalgesia (TENS units) Application of heat/cold Relaxation, hypnosis, guided imagery Pharmologic vs. Nonpharmologic treatment for pain

  27. Pain control, cont. • As nurses, we must remember: • Pain is what the child says it is! All pain is significant to document and treat

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