The Child’s Experience of Hospitalization Chapter 21 The Child’s Experience of Hospitalization Note: Italic words throughout are key terms. Copyright © 2019, Elsevier Inc. All rights reserved.

Health Care Delivery Settings Types Acute care hospital Extended or long-term care facility Urgent care center Outpatient clinic or office Pediatric research center Outpatient surgery center Home Give examples of situations in which a child may need health care services provided in the various settings and discuss the impact on the family and child. What is the nurse’s role in coordinating these services? Copyright © 2019, Elsevier Inc. All rights reserved.

Preparing the Child for a Treatment or Procedure Infants Toddlers and preschoolers School-aged children Adolescents Infants Stress the importance of knowing the developmental stage of the child because it will guide the type of preparation needed. How would you involve the parents? Toddlers and Preschoolers Discuss simple terms in which to explain procedures to a toddler. Give an example of a preprocedure situation and how the nurse can effectively communicate with a toddler. Give an example of a situation in which a choice is offered to a toddler. What are some methods of distraction? School-Aged Child Give an example of a situation in which the nurse allows the child to examine or play with a piece of equipment prior to using it. What are other rewards a child might enjoy? Adolescent Discuss how the nurse can provide privacy to a teen and involve him or her in the treatment or procedure. What are some coping techniques that are appropriate for a teen? Copyright © 2019, Elsevier Inc. All rights reserved.

Copyright © 2019, Elsevier Inc. All rights reserved. Separation Anxiety Occurs in infants age 6 months and older More pronounced in toddlers Three stages Protest Despair Denial or detachment Discuss nursing interventions that can assist the child through these stages. Copyright © 2019, Elsevier Inc. All rights reserved.

The Child’s Reaction to Hospitalization Depends on Age Amount of preparation given Security of home life Previous hospitalizations Support of family and medical personnel Child’s emotional health Stressors for children of all ages Separation Pain Fear of body intrusion Discuss the varied reactions to hospitalization of an infant, toddler, preschooler, school-age child, and adolescent. How can the nurse prepare the child for hospitalization? Discuss the issue of previous hospitalizations and how they will affect the child during this hospitalization. Discuss the nurse’s role in attempts to decrease the child’s stress. How can the nurse involve the parents in decreasing the amount of stress the child is experiencing? Copyright © 2019, Elsevier Inc. All rights reserved.

Copyright © 2019, Elsevier Inc. All rights reserved. Fear Intrusive procedures are fear provoking Disrupts child’s trust level Threatens self-esteem and self-control May require restriction of activity Copyright © 2019, Elsevier Inc. All rights reserved.

Copyright © 2019, Elsevier Inc. All rights reserved. Regression The loss of an achieved level of functioning to a past level of behavior that was successful during earlier stages of development Can be minimized by an accurate nursing assessment of the child’s abilities and the planning of care to support and maintain growth and development When the child is free from the stress that caused the regression, praise will motivate the achievement of appropriate behavior. Give examples of regressive behavior. Copyright © 2019, Elsevier Inc. All rights reserved.

Copyright © 2019, Elsevier Inc. All rights reserved. Pain Children sometimes refrain from reporting pain for fear they will receive an injection. Infants should be assessed according to a behavior scale. In toddlers, crying may be caused by anxiety and fear rather than pain. All factors related to pain should be considered. Pain is whatever the person says it is. May be verbally or nonverbally expressed. Pain is the fifth vital sign and is assessed and recorded with routine documentation. Patients in pain secrete higher levels of cortisol, have compromised immune systems, experience more infections, and show delayed wound healing. Copyright © 2019, Elsevier Inc. All rights reserved.

Copyright © 2019, Elsevier Inc. All rights reserved. Pain Factors that can have a positive or negative effect on pain perception: Age and developmental stage Chronic or acute disease Prior experiences with pain Personality and family dynamics Culture Copyright © 2019, Elsevier Inc. All rights reserved.

Copyright © 2019, Elsevier Inc. All rights reserved. Pain intensity Data collection includes observation and self-report for children older than 4 years FLACC scale for children younger than 4 years Include the parent or caregiver in rating the child’s pain Determine the location, severity, and quality of pain Copyright © 2019, Elsevier Inc. All rights reserved.

Patient-centered care Recheck child’s pain level frequently Use pharm and non-pharm approaches to treating pain Ask the parent/caregiver their satisfaction of the pain management Monitor the child for adverse reactions to pain medications Copyright © 2019, Elsevier Inc. All rights reserved.

Copyright © 2019, Elsevier Inc. All rights reserved. Managing Pain Nonpharmacologic techniques Drawing Distraction Imagery Relaxation Cognitive (thinking) strategies Backrub or hand massage What are examples of distraction, imagery, and relaxation techniques? Copyright © 2019, Elsevier Inc. All rights reserved.

Copyright © 2019, Elsevier Inc. All rights reserved. Response to Drugs Elimination of the drug may be prolonged because of an immature liver enzyme system. Dosages are influenced by weight and differences in expected absorption, metabolism, and clearance. Copyright © 2019, Elsevier Inc. All rights reserved.

Drugs Used for Pain Relief Providing adequate pain relief enables patients to focus on their surroundings and other activities. Inadequate pain relief causes the patient to focus on the pain and when more medications will be given to stop the pain. More effective pain relief at lower dosages of the analgesic around the clock, referred to as preventive pain control. Discuss the nurse’s role in monitoring and relieving pain. Copyright © 2019, Elsevier Inc. All rights reserved.

Patient-centered care Use a private treatment room for painful procedures and avoid such procedures in “safe” places (play room, child’s bed) Offer choices to the child, when possible Allow the parent/caregiver to stay with the child during painful procedures Use play therapy to explain procedures, allowing the child to perform the procedure on a doll or toy Copyright © 2019, Elsevier Inc. All rights reserved.

Copyright © 2019, Elsevier Inc. All rights reserved. Conscious Sedation The administration of IV drugs to a patient to impair consciousness but retain protective reflexes, the ability to maintain a patent airway, and the ability to respond to physical and verbal stimuli. A 1:1 nurse–patient ratio is continued until there are stable vital signs, age-appropriate motor and verbal abilities, adequate hydration, and a presedation level of responsiveness and orientation. Copyright © 2019, Elsevier Inc. All rights reserved.

Language Interpreters Improves communication between parents and health care team members Should not use family members because of information “being lost in translation” Health care delivery sites and providers are required, by federal law, to provide language interpreters at no charge to the patient or family. Copyright © 2019, Elsevier Inc. All rights reserved.

Copyright © 2019, Elsevier Inc. All rights reserved. Cultural Response Showing cultural sensitivity decreases anxiety. Effective utilization of health care service and compliance with treatment plans are enhanced when the nurse’s approach is compatible with cultural needs and beliefs. Nonverbal cues and body language are important in intercultural communication. How might the nurse adjust his or her approach when caring for the cultural needs of a child? Discuss positive and negative body language cues. Copyright © 2019, Elsevier Inc. All rights reserved.

Intercultural Communication: Responses to Hospitalization Approaches to various cultures involve knowing what is and is not acceptable as it relates to Personal space Smiling Eye contact Touch Focus It is important for the nurse to take the time to become familiar with culturally acceptable behaviors. Copyright © 2019, Elsevier Inc. All rights reserved.

The Parents’ Reactions to the Child’s Hospitalization Parents may ventilate their feelings and stresses through anger, crying, or body language. Behavior often involves attitudes resulting from early childhood experiences. An understanding and acceptance of people and their problems is essential for the successful pediatric nurse. Poor communication can result in unnecessary fear. Discuss communication techniques that can be used by the nurse to manage parents who exhibit anger or avoidance. Copyright © 2019, Elsevier Inc. All rights reserved.

The Nurse’s Role in Hospital Admission Must be prepared to meet the emotional needs of those involved Parents should try to be as matter-of-fact as possible about this new experience for their child. It is not necessary to go into great detail with the child about what is going to happen because it may increase the child’s anxiety. Give an example of a scenario in which a parent is providing too much and too detailed information to a child and how the nurse can manage this situation. Copyright © 2019, Elsevier Inc. All rights reserved.

Meeting the Needs of the Hospitalized Child Can be frustrating May miss continuous affection of their parents Daily schedules are disrupted Major goal is to assist parent–child attachment process and promote sensorimotor activities Liberal visiting hours are essential Consistency in caregivers Discuss nursing interventions in which the nurse assists the parents and infant in sensorimotor activities. Discuss the importance and rationale for liberal visiting hours. What is the rationale for consistency of caregivers for this population? Copyright © 2019, Elsevier Inc. All rights reserved.

Copyright © 2019, Elsevier Inc. All rights reserved. Adjustment to Illness Can understand the implications of disease Are capable of participating in decisions related to treatment and care A nurse who recognizes these skills and encourages their practice helps the adolescent gain confidence. Copyright © 2019, Elsevier Inc. All rights reserved.

Copyright © 2019, Elsevier Inc. All rights reserved. Roommate Selection Adolescents usually do better with one or more roommates. It is not a good choice to have a senile patient or infant as a roommate for an adolescent patient. Location of adolescent’s room is important. Discuss a situation in which an adolescent is in a room with a toddler and the issues this could cause. Copyright © 2019, Elsevier Inc. All rights reserved.

Confidentiality and Legality Many problems can be avoided if the confidentiality of the relationship is clearly defined during initial meetings. An emancipated minor is no longer under the parents’ authority. Be familiar with state law as it applies to adolescent patients. How might the nurse approach an adolescent and obtain his or her confidence? Discuss laws in your region regarding parental authority that might affect this population. Copyright © 2019, Elsevier Inc. All rights reserved.

Copyright © 2019, Elsevier Inc. All rights reserved. Discharge Planning Ideally begins at the moment of admission to hospital Written instructions should be given for any home treatments. Parents also must be prepared for behavioral problems that may arise after hospitalization. Copyright © 2019, Elsevier Inc. All rights reserved.

Copyright © 2019, Elsevier Inc. All rights reserved. Guidance for Parents Anticipate behaviors such as clinging or regression. Allow the child to become a participating family member as soon as possible. Take the focus off the illness. Be kind, firm, and consistent with misbehavior. Build trust by being truthful. Allow time for free play. Copyright © 2019, Elsevier Inc. All rights reserved.

Legal and Ethical Considerations Discharge charting should include who accompanied the child (and identification given), time of discharge, behavior and condition of the child, method of transportation, vital signs and weight, medications, and instructions given to the parents or caregiver. Discuss the rationale for documenting this information. Copyright © 2019, Elsevier Inc. All rights reserved.

Copyright © 2019, Elsevier Inc. All rights reserved. Home Care Children with acute or chronic conditions are cared for in the home. Home health care and other community agencies work with the family to provide holistic care. Respite care can be provided for the primary caregivers. Copyright © 2019, Elsevier Inc. All rights reserved.