CHANGES TRENDS IN

HOSPITAL CAREMs. Lingampelli Soundarya

M.Sc.Nursing(Pediatrics)

1)VISITING 2)ROOMING-IN

3)CARE BY PARENT UNITS4)PARENT SUPPORT GROUPS

5)SELF-CARE

Types approaches

@private care

@Ambulatory care

6) NEIGHBOURHOOD HEALTH CENTER OR CLINIC7) EMERGENCY FACILITIES8) HOSPITAL BASED AND FREE STANDING

FACILITIES FOR MINOR SURGICAL CARE

9)PEDIATRIC UNIT10) PEDIATRIC NEWBORN AND PICU11) INTERMEDIATE CARE UNIT

12) OUT PATIENT DEPARTMENT’S OF HOSPITAL13) THE PEDIATRIC RESEARCH CENTER

HOSPITAL ENVIRONMENT

FOR SICK CHILD

1) IMPACT OF HOSPITALIZATION ON CHILD AND FAMILY

1. IMPACT ON PARENTS OR PARENTAL REACTION *child feel inadequacy *feel anxiety, anger, fear, *disappointment and *possibly guilt.

Anxious Parents can be recognized by;Trembling, coarse, or wavery

voice, Restless, irritability, withdrawal, Erratic body movements, Aggressive behavior towards

those caring of the child may be evident.

Causes of parental anxiety • Fear of the strange environment in the hospital• Fear of separation from the child• Fear of unknown and of what will happen to the

child immediately and in the future.• Fear that the child will suffer.• Fear that the condition is infectious and may

spread to other members of the family.• Fear of unbearable financial expenditure.• Fear that society will look upon the illness as

result of something wrong with the parents.

2) IMPACT OF HOSPITALIZATION ON CHILDREN

A)REACTION OF NEONATES: It is interrupt in the early stages of development of a healthy mother child relationship and family integration.Impairment bonding and trusting relationship

Inability of the parents love and care for the babyInability of the baby to respond to parents and family members are common reactions of neonates.

B) IMPACTS OF INFANTS infants reactions are mainly separation anxiety and disturbance of development of basic trust.When the infant separates from the mother;Meeting the needs of infantEmotional withdrawal Depression found (4-8 months of age)

Interference of growth and delayed developments are also found.Older infants(8-12 months)may have limited tolerance due to separation anxiety which is found as fear of strangers, excessive crying, and over dependence on mother.

3) REACTIONS OF TODDLERS• Protest, despair, denial,regression.• Toddler protest by crying, shaking crib,

rejecting nurses attention, urgent desire to find mother and showing signs of distrust with anger and tears, especially when with mothers.

• In despair; toddler becomes helpless, apathetic, anorectic, looks sad, cry continuously or intermittently and use comfort measures like-thumb sucking, fingering lip and tightly clutching a toys.

• They stop to find newly acquired skills and may return to the behavior of an infant during illness and hospitalization.

4) REACTIONS OF PRE-SCHOOL CHILDRENThese children adopt various mental mechanisms to adjust with the stress full experience of hospitalization and prolonged illness.They react by exhibiting regression, repression, projection, displacement, identification, aggression, denial, withdrawal and fantasy.They may show similar behavior of the toddler i.e. protest, despair, denial.

5) REACTIONS OF SCHOOL AGE CHILDRENThese children are concerned with fear, worry, fantasies, modesty and privacy.Reactions; regression, separation anxiety, negativism, depression, phobia unrealistic fear, suppression or denial of symptoms.

6) REACTIONS OF ADOLOSCENTSThey are concerned with problem of privacy, separation from peers or family and school, interference with body image or independence or self concept and sexuality.They show anxiety and insecurity in strange environment and anger and un-co-operative behavior towards parents and staff.They may adopt rejection of treatment, depression, denial, or withdrawal.

ROLE OF CHILD HEALTH NURSE IN CARING FOR A HOSPITALIZED CHILD

A) FAMILY: provide family centered care, with different approach to specific age group

B) IN NEONATES: Provide continual contact between baby and parents with active involvement by rooming in.

A) IN INFANTS: encourage the mother to balance her responsibilities and minimize separation with confidence and competence.

Basic needs can be fulfilled with attention, and appropriate handling.

Mother can be allowed during procedure. Tension and loneliness can be relieved by toys.

4) IN TODDLERS: provide rooming in and unlimited visiting hours to express child’s feeding.

No punishment to the childHome routine can be continued like sleeping, eating,

bathing etc.Provided the familiar toys to play and choice

whenever possible.Parents should provide love and understanding to

help the child, restore trusting relationship.

5) FOR PRE-SCHOOL:

Minimize stress of separation by providing parental presence and participation in care.Help the child to accept the stressful situation by love and concern.Careful preparation for all procedures by privacy and explanation according to level of understanding. Encourage the to participate in self care and hygiene as appropriate.Discourage parents negative feelings

6)SCHOOL CHILDREN:Help the parents to prepare the child for elective hospitalizationHelp the child’s need for privacy during examination.Help the child to identify problems and to ask questions.Use treatment room whenever possible to perform painful and invasive procedures.Encourage in self-care, play (condition)Encourage the parents participation in child care

7) IN ADOLESCENT:• Help the parents to prepare the adolescent

for planned hospital admission.• Hospital staff, routines and facilities available

in the hospital unit should be explained soon after admission. Provide opportunities for recreation, peer relationship, interaction with other adolescent patients and expression of feelings.

• Nurse guide the hospitalized child in health promotion and restoration activities.

THANK YOU