1. Nursing Care of the Hospitalized Child

2. 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

3. 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

4. Stages of Separation Protest Protest Despair Despair Detachment Detachment

5. Family Responses to hospitalization Their perception Their perception Support mechanisms available Support mechanisms available Coping mechanisms Coping mechanisms

6. Support and coping mechanisms that determine family’s responses Communication strategies Communication strategies Finances, friends Finances, friends Separation from other children: who helps out? Separation from other children: who helps out? Their ability to “disengage” from other responsibilities Their ability to “disengage” from other responsibilities Coping is developed from past experiences Coping is developed from past experiences **Most common reaction to child’s illness may be disbelief **Most common reaction to child’s illness may be disbelief

7. Nursing measures to assist the family Teaching (relieves fear of unknown) Teaching (relieves fear of unknown) Orientation to the hospital routine Orientation to the hospital routine Communication regarding how they may help Communication regarding how they may help

8. 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

9. 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

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

11. 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

12. ! 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

13. Stressors by developmental age **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 Need contact with mother Need contact with mother Infants/Toddlers Infants/Toddlers

14. 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

15. 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

16. 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

17. 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

18. 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!

19. 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

20. 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

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

22. 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

23. 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

24. Managing pain in the hospitalized child 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

25. Management of pain, cont. Understand type of assessment findings in each age group Understand type of assessment findings in each age group PAIN IS WHAT THEY SAY IT IS! PAIN IS WHAT THEY SAY IT IS! All pain should be investigated All pain should be investigated

26. Nursing interventions to assist the child in pain Understand the misconceptions about pain Understand the misconceptions about pain Assess: hx, culture, developmental response, scales (FACES, FLACC, CRIES)) Assess: hx, culture, developmental response, scales (FACES, FLACC, CRIES)) Always evaluate effects of medications administered Always evaluate effects of medications administered Sedation used for procedures Sedation used for procedures

27. Non-pharmacologic measures to relieve pain Elevation of the affected part or extremity Elevation of the affected part or extremity Ice or heat when indicated Ice or heat when indicated Reposition the client/injured part for comfort Reposition the client/injured part for comfort Diversional therapy when indicated (board games, video games, cards, etc.) Diversional therapy when indicated (board games, video games, cards, etc.)

31. The End!