Child HealthNursingPartnering withChildren & FamiliesChapter 17

Nursing Care of the Hospitalized ChildJane W. BallRuth C. BindlerChild Health Nursing: Partnering with Children & FamiliesBy Jane W. Ball and Ruth C. Bindler 2006 Pearson Education, Inc.Pearson Prentice HallUpper Saddle River, NJ 07458

Childrens Understanding of Health and IllnessDevelopmental ConsiderationsInfantSeparation (highest age risk)Stranger Anxiety (6-18 mos)

Refer to Table 17-3: Stages of Separation Anxiety

Childrens Understanding of Health and IllnessDevelopmental ConsiderationsToddlerSeparation anxietyLoss of self-control

Childrens Understanding of Health and IllnessDevelopmental ConsiderationsPreschoolerRegression (highest age risk)Separation anxiety and fear of abandonmentInability to distinguish fact/ fiction Unable to understand reason for hospitalization

Childrens Understanding of Health and IllnessDevelopmental AspectsSchool ageLoss of control/ privacyAdolescentAware of the physiologic, psychologic and behavioral causes of illnessConcerned with appearanceSeparation from peer group

Stressors of Hospitalization for Children at Various Developmental Stages

Refer to Table 17-2

Childrens Understanding of Health And IllnessPsychological AspectsInfantIssues with attachmentToddlerDisruption of routine/ separation from parentsPreschoolerLoss of self-control Fear of dark Injury

Childrens Understanding of Health and IllnessPsychological AspectsSchool-aged childrenPain Bodily Injury DeathAdolescentsLoss of control/ privacyFear of altered body image

The Effects of Hospitalization on the Child and FamilyChildrens understanding of health and illness is primarily based on their cognitive ability at their developmental levelPrevious experiences with healthcare professionals

The Effects of Hospitalizaiton on the Child and theFamilyParentsDisrupt usual routineFears/ anxietyCoping abilities (made more difficult if lack of financial, community or family support)SiblingsFearsBehavioral Disruption

Adaptation to HospitalizationParentsTailor nursing care to familys needs and preferencesMaintain positive communication with familyAsk for parents participation in careExplain all aspects of treatment, keep family in the loopProvide information to family (ie teaching materials etc.)

Adaptation to HospitalizationSiblingsInform siblings about their brother/ sisters condition (using age-appropriate language and concepts at their developmental level)Encourage siblings to visit (as appropriate)Discuss what to expect before the visit w/ the child, then f/u on how they are feeling after.

Adaptation to HospitalizationScheduled AdmissionChild/ parentPreparationToursPlayWritten visual materialChild LifeTalking with peers with similar experience (adolescents)

Adaptation to HospitalizationRefer to Box 17-4 (p 537): Nursing Considerations in Preparing Parents and Child for Planned Short-Stay Admission

Adaptations to HospitalizationNurses can assist the parents in preparing the child for hospitalization byRead stories about the experienceTalk about going to the hospitalEncourage child to ask questions/ draw picturesVisit hospital beforehandPlan hospital stay/routine as much as possibleBe honest

FIGURE 172 The childs anxiety and fear often will be reduced if the nurse explains what is going to happen and demonstrates how the procedure will be done by using a doll. Based on your experience, can you list five actions you can take to prepare a school-age child for hospitalization? Jane W. Ball and Ruth C. BindlerChild Health Nursing: Partnering with Children & Families 2006 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458All rights reserved.

FIGURE 173 Jasmines parents are taking the time to prepare her for hospitalization by reading a book recommended by the nurse. Such material should be appropriate to the childs age and culture. Why do you think that having the parents read this material is valuable? Jane W. Ball and Ruth C. BindlerChild Health Nursing: Partnering with Children & Families 2006 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458All rights reserved.

Adaptation to HospitalizationUnanticipated admissionOrientation to unit/environmentExplain all of the proceduresOpportunities for parents/ child to express fearsStress-reduction methods

Adaptation to HospitalizationSpecial units and types of care:Short-stay unitOutpatient unitAmbulatory surgical unitGeneral pediatric unitEmergency DepartmentsNICU/ PICUAcute care or long-term rehabilitative unit

Adaptation to HospitalizationNursing care focuses on providing family-centered carePromoting the childs and familys coping strategies to deal w/ hospitalizationPromoting optimal development and safetyMinimizing disruption of the childs usual routine

Safety Measures for the Hospitalized ChildRefer to Box 17-3

Nursing strategies to Improve the Illness/ HospitalizationExperience of Parents/ ChildrenVarious Practice SettingsEmergency DepartmentPsychological considerationsSame day surgeryThorough discharge teaching instructions

Preoperative checklistRefer to Box 17-7

FIGURE 176 This child has just undergone surgery and is in the post anesthesia care unit (PACU). Although the childs physical care is immediate and important, remember that both the child and the family have strong psychosocial needs that must be addressed concurrently. It is important to reunite the family as soon as possible after surgery.Jane W. Ball and Ruth C. BindlerChild Health Nursing: Partnering with Children & Families 2006 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458All rights reserved.

Nursing strategies to Improve the Illness/ HospitalizationExperience of Parents/ ChildrenPractice SettingsICUPsychological considerationsParental decision making/ involvement in careHospital Care Mediation administrationDevelopmental considerations

Variations in Med AdministrationRefer to Table 17-6:OralRectalOphthalmic and oticTopicalIntramuscularIntravenous

Nursing strategies to Improve the Illness/ HospitalizationExperience of Parents/ ChildrenHospital (cont)Educational needsIndividual education plan (IEP)TeachingPartnering w/ parents

Adaptation to HospitalizationPreparation for ProceduresPsychological preparationUsing language the child understandsPhysical preparationSigned consent, pre-medicatePerforming the procedureTreatment room

Assisting Children through proceduresRefer to Table 17-7:Infant ToddlerPreschool childSchool-age childAdolescent

Strategies to Promote Coping and Normal Development of the Hospitalized ChildThese strategies help to meet the psychosocial needs of the hospitalized childRooming inChild Life ProgramsChild life specialistTherapeutic Play

Assessing the child and family in preparation for dischargeAssess the familys ability to manage the childs care ? Any special adaptation to home environment/ or other facilityCollaborate w/ parents to teach them treatment procedures and proper equipment useHave family member demonstrate proper care of equipment, and any procedures necessary

Professional Practice Standards for Pediatric Nursing PracticeCollecting health dataAnalyzing the assessment data in determining diagnosesIdentifying expected outcomes individualized to the child and familyDeveloping a plan of care that prescribes interventions to attain expected outcomesImplementing the interventions identified in the plan of care