Transcript Nursing Care of the Hospitalized Child

Nursing Care of the
Hospitalized Child
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
(0-12 mo) (1-2 yr)
Preschoolers School-age
(3-5 yrs)
(6-11)
Adolescents
Use of calm
voice;
respond to
cries, mimic
baby sounds,
talk and read
regularly, use
a slow
approach and
allow time to
get to know
you
Seek
opportunities
to offer
choices, use
play for
explanations,
simple
sentences,
picture books,
puppets, be
concise; limit
length of
explanations
Engage in
conversations
about their
interests, use
of videos to
explain, foster
independence,
preparatory
materials up
to 1 wk in
advance,
respect
privacy needs
Learn the
toddler’s
words for
common
items, picture
books,
respond to
their
receptiveness,
preparation
should occur
immediately
before event
Photos,
books, videos;
est. limits, use
play,
introduce
preparatory
materials 1-5
days in
advance of
the event
(12 and older)
Stages of Separation

Protest

Despair

Detachment
Family Responses to
hospitalization



Their perception
Support mechanisms available
Coping mechanisms
Support and coping mechanisms
that determine family’s responses






Communication strategies
Finances, friends
Separation from other children: who helps out?
Their ability to “disengage” from other
responsibilities
Coping is developed from past experiences
**Most common reaction to child’s illness may
be disbelief
Nursing measures to assist the
family



Teaching (relieves fear of unknown)
Orientation to the hospital routine
Communication regarding how they may
help
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
Types of facilities

Hospital








Medical/surgical units
ICU
Rehab
Outpatient/day facilities
24 hr observation units
School-based clinics
Community clinics
Home Care
Hospital Admission


Taking the history
Physical Exam



Initial inspection
Baseline data
Family dynamics
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
! 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
Stressors by developmental age





**separation anxiety
Nurses experience
protest and despair in
this group
Fear of injury and
pain
Loss of control
Need contact with
mother

Infants/Toddlers
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
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:




Requires more info about the family
Family does most of the care
Involves many systems and people
Balance condition r/t needs with general wellbeing of the child
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
Advantages of play to the
hospitalized child




Therapeutic
Emotional outlet
Teaches
Enhances
cooperation
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
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
Management of pain, cont.



Understand type of assessment findings in
each age group
PAIN IS WHAT THEY SAY IT IS!
All pain should be investigated
Nursing interventions to assist
the child in pain




Understand the misconceptions about pain
Assess: hx, culture, developmental
response, scales (FACES, FLACC, CRIES))
Always evaluate effects of medications
administered
Sedation used for procedures
Non-pharmacologic measures to
relieve pain




Elevation of the affected part or extremity
Ice or heat when indicated
Reposition the client/injured part for
comfort
Diversional therapy when indicated (board
games, video games, cards, etc.)
The End!