care of the hospitalized child

7/30/2019 Care of the Hospitalized Child

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Binal Joshi


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INTRODUCTION

Hospitalization is aninterruption of the childs activecycle of growth anddevelopment and his or herfamily's life cycle also. The childis removed from the dailyroutines of home life andcontact with siblings, relativesand peers are limited.

He or she may be required toexperience strange and painfulevents and to communicatewith strangers.


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YOUR WORK IS

VERY HARD

BECAUSE YOUWANT ME TO

GET WELL

SOON.

YOU CARE FOR

ME AND MY

FAMILY.

I CAN BE VERY

DIFFICULT ATTIMES

IAM AFRAID

Nursing care needs

to be based on the

most common

psychosocial andphysiologic

alterations that

applies the

principles of

growth and

development, and

respect and

appreciation of

the parents andfamily as partners

in the care of their

children.


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EFFECTS OF ILLNESS AND HOSPITALIZATION ON

CHILDREN AND FAMILIES

Childrens understanding of health and illness.

Young child is likely to think that misbehavior

toward his or her mother caused on illness to occur

if the two events occur close in time. Older child sometimes feel responsible or guilty

about an illness.

Adolescents often feel invulnerable and may

believe that they will never become ill or have an

accident.


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Infant ( by about 6 months of age ). Infants have developed an awareness of

themselves as separate from their mothers

and fathers.

Infants are able to identify primary

caretakers and to feel anxious when in

contact w/ strangers.

Hospitalization can be traumatic time for the

infants.


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STAGES OF SEPARATION ANXIETY

PROTEST

Screaming, crying

Clinging to parents

Withdrawal from other adults

DESPAIR

Sadness, depression

Withdrawal or compliant behavior

Crying when parents appear


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STAGES OF SEPARATION ANXIETY

DENIAL

Lack of protest when parents leave

Appearance of being happy and content

with everyone.

Close relationships not established Developmental delay possible


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EFFECTS OF ILLNESSAND HOSPITALIZATION

ON CHILDREN ANDFAMILIES


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TODDLERS AND PRESCHOOLER

Toddlers and preschooler are beginning tounderstand illness but not its cause.

Toddlers consider the sun, an animal, bad

behavior, or even magic to be the cause of

their illness.

Separation from parents remains the major

stressor for the child.


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SCHOOL-AGE CHILD

Older children have a more realisticunderstanding of the reasons for illness.

Older children understand the functioning of

their body parts.

The child may worry about pain, stitches and

bandages, and wonder if his or her body will

return to normal.


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ADOLESCENT

Adolescent become increasingly aware of physiologic

and behavioral causes of illness and injury. Privacy and modesty are major concerns of

adolescents because their physical characteristics are

rapidly changing.

Separation from peers, home and school are sited as

major stressor of hospitalization by adolescents.


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THE HOSPITALIZED CHILD

Separation Anxiety!

Early Childhood

Protest

Despair

Detachment

Later Childhood

Loneliness Boredom

Isolation

Attitude is everything!


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The Effects of Hospitalization on the Child

and the Family

Parents

Disrupt usual routine

Fears/ anxiety

Coping abilities (made more difficult if lack of

financial, community or family support)

Siblings

Fears

Behavioral Disruption


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Adaptation to Hospitalization

Parents

Tailor nursing care to familys needs and

preferences

Maintain positive communication with family

Ask for parents participation in care

Explain all aspects of treatment, keep family in

the loop Provide information to family (ie teaching

materials etc.)


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Nurses can assist the parents inpreparing 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 aspossibleBe honest


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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.


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Siblings

Inform 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.


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ROLE OF NURSE


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IN INFANTS

CONTROLON SEPARATION

ATTENTION AND APPROPRIATE HANDLING

TOYS

ROOMING IN AND PLAY

MAINTAIN HOME ENVIRONMENT AND

ROUTINE PROVIDE LOVE AND TOUCH

TRUSTING RELATIONSHIP AND SECURITY

IN TODDLERS


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PRESCHOOL CHILDREN

PARENTRAL PRESENCE AND PARTICIPATION IN

CARE

PRIVACY AND CO OPERATION

EXPLANATION ACCORDING TO LEVEL OF

UNDERSTANDING

PROVIDE OPPORTUNITY TO VERBALIZE

FEELINGS

DO NOT IMPOSE NEGATIVE FEELINGS


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SCH0OL AGE CHILDREN

ELECTIVE HOSPITALIZATION

PRIVACY

EXPLAIN THE PROCEDURE ENCOURAGE THE CHILD TO MAINTAIN SELF

CARE

ASSIST THE CHILD TO COPE WITHHOSPITALIZATION

PARENTRAL PARTICIPATION


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ADOLESCENTS

PLANNED HOSPITAL ADMISSION

ORIENTATION TO HOSPITAL ROUTINE

THOROUGH NURSING HISTORY MAINTAIN PRIVACY

PROVIDE OPPORTUNITIES FOR RECREATION,

PEER RELATIONSHIP, INTERACTION WITHOTHER ADOLESCENT PATIENT AND

EXPRESSION OF FEELINGS


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Adaptation to Hospitalization

Preparation for Procedures

Psychological preparation

Using language the child understands

Physical preparation

Signed consent, pre-medicate

Performing the procedure Treatment room

St t i t P t C i d


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Strategies to Promote Coping and

Normal Development of the

Hospitalized Child

These strategies help to meet the

psychosocial needs of the

hospitalized childRooming in

Child Life Programs

Child life specialist

Therapeutic Play


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Professional Practice Standards for

Pediatric Nursing Practice

Collecting health data

Analyzing the assessment data indetermining diagnoses

Identifying expected outcomes individualizedto the child and family

Developing a plan of care that prescribes

interventions to attain expected outcomes Implementing the interventions identified in

the plan of care


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Adaptation :Nursing strategies

Welcome to family and child during each

nursing intervention

Call by name and touch gently

Explain the procedure

Ask for co operation and its benefit

Encourage to express the feelings, allow toverbalize and answer the question


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Demonstrate the interest and empathy to the

child and family members

Explain and reason out unpleasant experience

Discuss about cultural and religious pattern

Allow parents to participate in care Maintain privacy, minimize exposure, and

gentle handling of the child

Physical comfort during each procedure Take opinion of parents in decision making

Maintain eye contact during conversation


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Use diversional activities during therapy

Use retrains

Skilful and confident approach. patience,

tenderness and emotional strength

Protect from physical injuries and infection

Assure the confidentiality of the information

Never give negative statements

Praise the child for co operation

Establishment of rapport and friendly

approach


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PREPARATION FOR SURGERY

A childs surgical experience can be

elective, planned in advance, or a

result of an emergency or trauma.


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PREOPERATIVE CARE

Psychosocial Preparation The goal of preoperative teaching is to reduce the

fear associated with the unknown and decrease

stress and anxiety associated with surgery.

Physical Preparation Preoperative procedures and guidelines vary among

hospitals and outpatient surgical centers.


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POSTOPERATIVE CARE

Postoperative care of the child

includes both physical andpsychologic care.


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PREPARATION FOR LONG-TERM CARE

Home care with support services

such as visiting nurses and physical

therapists A long-term care facility

A specialized rehabilitation centerthat can provide care for an

extended period


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PREPARATION FOR HOME CARE

The nurse works with the social service

department, home agencies, and family to

plan for equipment, procedures and other

home care needs.


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ASSESSING THE CHILD IN PREPARATION FOR

DISCHARGE

When a child is to be discharged home,

the school district should be contacted

and plans for education made.

This involves an assessment of the child

by the school district and formulation of

an individualized education plan (IEP).


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PREPARING THE FAMILY FOR

HOME CARE

Family may

need to learn

physical and

rehabilitative

procedures forthe childs care.


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CONCLUSION

So do children, but their level of psychosocialdevelopment may make some aspects of thehospital experience particularly difficult forthem. For one thing, children are less able

than adults to influence and understand whatis happening to them.

The experience of being hospitalized isdistressing for children of all ages, but thereasons for their distress tend to change asthey get older .

Nursing sick children is quite challenging.


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THANK YOU FOR LISTENING

care of the hospitalized child

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