Nursing Care of the Hospitalized Child

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

Importance of Effective Communication with Children More than words More than words Touch Touch Physical proximity and environment Physical proximity and environment Listening with impartiality Listening with impartiality Visual communication Visual communication Tone of voice Tone of voice Body language Body language Timing Timing Establishing rapport with the family Establishing rapport with the family Being open to questions/resolving conflict Being open to questions/resolving conflict

Developmental milestones and approach to communication Infants (0-12 mo) (0-12 mo)Toddlers (1-2 yr) Preschoolers (3-5 yrs) School-age(6-11)Adolescents (12 and older) 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 Learn the toddler’s words for common items, picture books, respond to their receptiveness, preparation should occur immediately before event Seek opportunities to offer choices, use play for explanations, simple sentences, picture books, puppets, be concise; limit length of explanations Photos, books, videos; est. limits, use play, introduce preparatory materials 1-5 days in advance of the event Engage in conversations about their interests, use of videos to explain, foster independence, preparatory materials up to 1 wk in advance, respect privacy needs

! Critical to remember ! Child’s response to Illness Child’s response to Illness Fear of the unknown Fear of the unknown Separation anxiety Separation anxiety Fear of pain or mutilation Fear of pain or mutilation Loss of control Loss of control Anger Anger Guilt Guilt Regression Regression

Stages of Separation Protest Protest Despair Despair Detachment Detachment

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

Stressors by developmental age Preschooler Preschooler Separation anxiety generally less than the toddler Separation anxiety generally less than the toddler Less direct with protests; cries quietly Less direct with protests; cries quietly May be uncooperative May be uncooperative Fear of injury Fear of injury Loss of control Loss of control Guilt and shame Guilt and shame

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

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

Factors Affecting a Child’s Response to Illness and Hospitalization Age/cognition Age/cognition Parental response Parental response Coping skills of family/child Coping skills of family/child Preparation of child/family Preparation of child/family Hospitalization can be a positive factor Hospitalization can be a positive factor

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

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

Environmental consideration in a healthcare setting Safe place Safe place Playroom Playroom Patient’s room Patient’s room Treatment Room/end of crib Treatment Room/end of crib Senses: lighting, sound, temperature, smells Senses: lighting, sound, temperature, smells Dynamics: designate one person to direct/encourage Dynamics: designate one person to direct/encourage Medical play Medical play

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

Creating Partnerships with Families of Children with Special Healthcare Needs CSHCN: Children with Special Health Care Needs CSHCN: Children with Special Health Care Needs Defined as those with elevated risk for chronic physical, developmental, behavioral or emotional conditions Defined as those with elevated risk for chronic physical, developmental, behavioral or emotional conditions

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

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

CSHCN, cont. “ending on a happy note” Share the joys of focusing on the child’s growth and development Share the joys of focusing on the child’s growth and development Support and encourage the parents Support and encourage the parents Empower families to regain control of their lives Empower families to regain control of their lives Engage in authentic communication Engage in authentic communication Support strengths of families Support strengths of families

Dealing with Difficult Families Remember that the child, and the family bring “baggage” Remember that the child, and the family bring “baggage” Child: fear, expectations and ?? Child: fear, expectations and ?? Parent: preexisting dynamics and communication styles, finances, coping styles Parent: preexisting dynamics and communication styles, finances, coping styles

How to deal with the “baggage” Claiming potential baggage Claiming potential baggage Bring the “good baggage”: competency, calmness, caring, tolerance, openness Bring the “good baggage”: competency, calmness, caring, tolerance, openness Flexibility by all members of the team Flexibility by all members of the team Avoiding the negative baggage Avoiding the negative baggage COPE COPE

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

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

Consequences of unrelieved pain Respiratory changes Respiratory changes Neurologic changes Neurologic changes Metabolic changes Metabolic changes Immune system changes Immune system changes GI changes GI changes

Pain scales FACES FACES FLACC FLACC CRIES CRIES

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

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