Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Chapter 22 Caring for the Family Across Care Settings

Across Care Settings Family-centered care across all settings, from community to acute care, is the underpinning for contemporary nursing and parallels today’s trend for the child and family to obtain health care in diverse familiar settings in which they live, grow, play, work, or go to school.

Across Care Settings  Benefits of a medical home  A child regularly sees the same primary care physician and staff.  There is coordination of care for the child.  There is an open exchange of information in an honest and respectful manner.  There is support for finding resources and information related to all stages of growth and development and medical conditions.  The family is connected to information and family support organizations.  The medical home partnership promotes health and quality of life as the child grows and develops.

Primary Health Care Provider or Clinic Setting  A private medical office or clinic  Health information is provided  Discussions about how to take care of the child at home  Comprehensive and safe nursing care  Education about child’s condition  Additional community resources can be recommended  Advantages include a reasonable cost of care and continuity of care (child remains in the care of the family)

Teaching Tips for Families The nurse can tell the family to  Bring a list of questions or concerns to discuss when visiting the primary care physician’s office.  Bring a list of any allergies that the child has, along with medications the child is currently taking.  Be ready to share information as to how the child is growing and changing. Keep track of the child’s developmental progress.  Inquire about resources including community organizations that may provide assistance.  Ask about how to receive care after normal business hours or emergency care.  Request to meet the health team members who will be working with the child.

The Hospitalized Child  Hospitalization is required when the child becomes ill.  It may be a new experience where both the child and family are exposed to an unfamiliar medical environment.  Children are more vulnerable to the stress of hospitalization because they do not have a full range of coping mechanisms.  The child and family are also introduced to an entirely new group of people.

The Hospitalized Child  The pediatric nurse  Provides skilled, safe, and competent care  Understands that the family is the primary caregiver  Provides education about the child’s condition, diagnostic testing, and procedures  Provides discharge and teaching instructions  Provides emotional support  Communicates effectively and therapeutically  Commits to nurturing the child’s development  Uses evidence-based theory

The Hospitalized Child  A child who is hospitalized exhibits three stages of separation  Protest phase (child realizes parents are leaving and could cry, cling, and act aggressively)  Despair phase (child seems to withdraw and becomes apathetic)  Detachment phase (child represses pain at the sense of loss and shows disinterest on parent’s return)

Ways to Decrease the Stress of Hospitalization  Rooming-in  Encourage child  To bring something from home  To draw a picture that can be hung up  To watch a movie or select a game  Therapeutic play  Guided imagery  Role modeling

Effects of Hospitalized Child on Parents  Feel incapable  Loss of control  Inability to protect child  Behaviors: anxiety, denial and withdrawal, guilt and fear

Assist Parents in Adapting to the Child’s Hospitalization  Begin with the admission process  Include parental involvement  Assess home routines, preferences, and developmental and special needs  Allow parents to tell their story  Promote trust  Give prompt attention to child’s needs  Allow parents to participate in care  Give positive reinforcement  Conduct ongoing evaluation

Twenty-Four Hour Observation Unit  Short-stay hospitalization experience  Sudden illness, most likely recover quickly  Nurse provides acute nursing care  Quickly begins to prepare the child and family for discharge

Ambulatory Surgery Center  Provides minimal surgical treatment  Child recovers from the procedure and is then discharged home soon after the surgery  Minimizes separation between child and family (emotionally less stressful)  Be sure to teach the family about the surgery and ways to care for the child at home

Critical Care Unit  The child is admitted to the critical care unit through the emergency department or operating room, or is transferred from a medical- surgical floor  After delivery, a newborn who requires intensive care is transferred to a neonatal intensive care unit  Other types of critical care units include cardiac, surgical, or psychiatric critical care units  In any of these units, the child is extremely ill and receives specialized care, medication, intravenous fluid, or respiratory or ventilator support

Emergency Department  Quick treatment for children who have become suddenly ill or experienced a severe injury  Open 24 hours/day and 7 days/week  Rapid screening or triage assessment  Several areas of treatment  “Fast Track”  May be admitted to the hospital

Community Settings  Today children are apt to receive the majority of their health care in a community setting  Community settings are on the front line of prevention and early detection  These settings may be located in neighborhood clinics, schools, shopping malls, or health care centers

Caring for Children in the Community: Where They Live, Play, and Go to School  Community centers  Preventative medicine center  Home health care  Medical home  Mobile health care units  Primary physician’s office  Rehabilitation services  School setting  State health program  The Department of Health and Human Services

Community Settings  Clinics  Specialty camps  Recreational, educational, and supportive resource  Churches, synagogues, mosques

Community Settings Community settings often provide primary care along with health screening and surveillance.  Health screening means to test or examine children for the presence of a disease, illness, chronic condition, developmental delay, or mental health issue.  Health surveillance is the continuous observation related to tracking health conditions and risk behaviors.

Care in School Settings: The Nurse  Helps to prevent illness  Helps children with special needs  Assists in early identification  Promotes optimal health and learning  Helps children maintain good health practices, along with academic success  Facilitates normal development  Promotes health and safety  Intervenes with actual and potential health problems  Provides case management services  Collaborates with other professionals  Instills self-management skills  Works with children who do not have access to primary care, are uninsured, or are homeless  Advocates for children  Encourages parents to immunize  Keeps track of immunizations