Chapter 22 Family-Centered Care of the Child During Illness and Hospitalization Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Learning Objectives: Identify factors that increase children's vulnerability to the stresses of hospitalization. List potential beneficial effects of hospitalization for the ill child and his or her family. Discuss strategies for supporting parents and hospitalized children in meeting psychosocial needs. Contrast strategies for educating adults and children. Discuss indications and safety considerations for use of the mummy restraint, jacket restraint, arm and leg restraints, and elbow restraints. Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 2

Factors that increase children's vulnerability to the stresses of hospitalization. Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 3

LOSS OF CONTROL Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.4

Minimizing Loss of Control  Promote freedom of movement  Preserve parent-child contact  Preventing or minimizing fear of bodily injury  Maintaining routine and independence  Anticipatory preparation  Provide information  Provide resources  Patient- and Family-Centered Nursing  Recognizing and promoting family strengths  Provision of school for prolonged hospitalizations Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.5

Coping with Hospitalization  Support family members during a child's hospitalization.  Minimize children's stress associated with special hospital situations  Minimize the hospitalized child's loss of control across each developmental stage. (upcoming) Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.6

Scenario Greg, age 2½ years, was admitted to the pediatric unit yesterday. His parents are making plans to visit as often as possible during his hospitalization. Greg’s parents complain to the nurse that the child “cries, screams, and throws himself” whenever they leave the hospital to eat. Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.7

The nurse should do which of the following? A. Explain that his behavior is a normal response to hospitalization. B. Explain that this behavior will diminish in a few days. C. Encourage the parents not to leave the child’s room. D. Encourage the parents to leave when the child is ​ asleep. Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.8

Effects of Hospitalization  Stress and separation anxiety  Developmental response  Infants and preschool:  Separation anxiety  Stage of protest  State of despair  Detachment or denial  Early Childhood  Separation anxiety is greatest  Reaction of protest  goal-directed behaviors Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.9

Reaction to Hospitalization  Later childhood and Adolescence  Feelings of loneliness and isolation  Fears of treatments, losing self-determination and choices  Anger  Sadness  Stress and regression  Cooperation  Sleep disturbances Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.10

Play and Expressive Activities  Essential to child’s mental, emotional, and social well-being  Allows child to act out fears and anxieties  Assists with coping, preparation, and education  Used for diversion and recreation  Creative expression  Drawings, music, dance Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.11

Patient- and Family-Centered Care (PFCC)  Family is the child’s primary source of strength and support  Hospitalization alters the parental role  Nurses are role models and mentors for engaging parents in hospital routines and daily care that benefits the child Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.12

Scenario You are caring for a 7 year old girl admitted for an asthma exacerbation. Her mother speaks Vietnamese primarily, but she is able to ask simple questions. The mother would like the results of the test (a viral swab) obtained when the girl was in the ED. You saw the results, which are negative (no key viruses noted), during shift handoff. What would you do? Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.13

PFCC strategies  Structured information-sharing dialogue  Patient-family participation in decision making and rounding  Recognize and respect cultural differences  Collaboration with team for discharge planning Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.14

List potential beneficial effects of hospitalization for the ill child and his or her family. Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.15

Beneficial Effects  Recovery from illness  Master stress and feel competent in coping  Provide new socialization experiences  Support to family Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.16

Review Factors affecting the parents’ reactions to their child’s illness include: Select all that apply. A.Seriousness of the threat to the child B.Previous experience with illness or hospitalization C.Available support systems D.Previous coping abilities E.The type of food served to the patient and family F.Communication patterns among family members Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.17

Effects of Hospitalization on Families  Parental Reactions  Sibling Reactions Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.18

Recognizing Family Strengths  Empowers families to cope with stressful events of hospitalization  Builds confidence  Increases understanding of hospitalization  Improves decision making  May help older children choose a career Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.19

Strategies for educating the adult and child Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.20

I am self-directed and take responsibility for decisions? A. Teenager B. Adult C. School Age Child D. Preschooler 21

Adult Learner  Learning should build on prior knowledge or experience.  Learning should adapt to an individuals need.  Literacy  Language  Learning preference (VARK) Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.22 dult learning programs should capitalize on the experience of participants. Adult learning programs should adapt to the aging limitations of the participants. Adults should be challenged to move to increasingly advanced stages of personal development. Adults should have as much choice as possible in the availability and organization of learning programs. dult learning programs should capitalize on the experience of participants. Adult learning programs should adapt to the aging limitations of the participants. Adults should be challenged to move to increasingly advanced stages of personal development. Adults should have as much choice as possible in the availability and organization of learning programs.

TEACH BACK Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.23

What Is Teach-back?  A way to make sure explained information clearly; it is not a test or quiz of patients.  Asking a patient (or family member) to explain—in their own words—what they need to know or do, in a caring way.  A way to check for understanding and, if needed, re-explain and check again.  A research-based health literacy intervention that promotes adherence, quality, and patient safety. American Medical Association and American Medical Association Foundation. (2016). Retrieved from 24

Educating the Child  Infant  Toddler  Preschooler  School Age  Adolescent Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.25

RESTRAINTS Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.26

Restraining Methods ​  Behavioral restraints ​  Physical restraints ​  Therapeutic hugging ​  Jacket restraints ​  Mummy or swaddle restraint ​  Limb restraints Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.27

A student can help hold a patient for a procedure? A. True B. False Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.28

It is appropriate to hold a patient down if they are kicking you? A. True B. False Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.29