Child Health Nursing Partnering with Children & Families Jane W. Ball Ruth C. Bindler Chapter 17 Nursing Care of the Hospitalized Child © 2006 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ 07458 Child Health Nursing: Partnering with Children & Families By Jane W. Ball and Ruth C. Bindler

Children’s Understanding of Health and Illness Developmental Considerations Infant Separation (highest age risk) Stranger Anxiety (6-18 mos) Refer to Table 17-3: Stages of Separation Anxiety

Children’s Understanding of Health and Illness Developmental Considerations Toddler Separation anxiety Loss of self-control

Children’s Understanding of Health and Illness Developmental Considerations Preschooler Regression (highest age risk) Separation anxiety and fear of abandonment Inability to distinguish fact/ fiction Unable to understand reason for hospitalization

Children’s Understanding of Health and Illness Developmental Aspects School age Loss of control/ privacy Adolescent Aware of the physiologic, psychologic and behavioral causes of illness Concerned with appearance Separation from peer group

Stressors of Hospitalization for Children at Various Developmental Stages Refer to Table 17-2

Children’s Understanding of Health And Illness Psychological Aspects Infant Issues with attachment Toddler Disruption of routine/ separation from parents Preschooler Loss of self-control Fear of dark Injury

Children’s Understanding of Health and Illness Psychological Aspects School-aged children Pain Bodily Injury Death Adolescents Loss of control/ privacy Fear of altered body image

The Effects of Hospitalization on the Child and Family Children’s understanding of health and illness is primarily based on their cognitive ability at their developmental level Previous experiences with healthcare professionals

The Effects of Hospitalizaiton on the Child and theFamily Parents Disrupt usual routine Fears/ anxiety Coping abilities (made more difficult if lack of financial, community or family support) Siblings Fears Behavioral Disruption

Adaptation to Hospitalization Parents Tailor nursing care to family’s 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.)

Adaptation to Hospitalization Siblings Inform siblings about their brother/ sister’s 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.

Adaptation to Hospitalization Scheduled Admission Child/ parent Preparation Tours Play Written visual material Child Life Talking with peers with similar experience (adolescents)

Adaptation to Hospitalization Refer to Box 17-4 (p 537): Nursing Considerations in Preparing Parents and Child for Planned Short-Stay Admission

Adaptations to Hospitalization Nurses can assist the parents in preparing the child for hospitalization by… Read stories about the experience Talk about going to the hospital Encourage child to ask questions/ draw pictures Visit hospital beforehand Plan hospital stay/routine as much as possible Be honest

FIGURE 17–2 The child’s 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. Bindler Child Health Nursing: Partnering with Children & Families © 2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

FIGURE 17–3 Jasmine’s parents are taking the time to prepare her for hospitalization by reading a book recommended by the nurse. Such material should be appropriate to the child’s age and culture. Why do you think that having the parents read this material is valuable? Jane W. Ball and Ruth C. Bindler Child Health Nursing: Partnering with Children & Families © 2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

Adaptation to Hospitalization Unanticipated admission Orientation to unit/environment Explain all of the procedures Opportunities for parents/ child to express fears Stress-reduction methods

Adaptation to Hospitalization Special units and types of care: Short-stay unit Outpatient unit Ambulatory surgical unit General pediatric unit Emergency Departments NICU/ PICU Acute care or long-term rehabilitative unit

Adaptation to Hospitalization Nursing care focuses on providing family-centered care Promoting the child’s and family’s coping strategies to deal w/ hospitalization Promoting optimal development and safety Minimizing disruption of the child’s usual routine

Safety Measures for the Hospitalized Child Refer to Box 17-3

Various Practice Settings Nursing strategies to Improve the Illness/ Hospitalization Experience of Parents/ Children Various Practice Settings Emergency Department Psychological considerations Same day surgery Thorough discharge teaching instructions

Preoperative checklist Refer to Box 17-7

FIGURE 17–6 This child has just undergone surgery and is in the post anesthesia care unit (PACU). Although the child’s physical care is immediate and important, remember that both the child and the family have strong psychosocial needs that must be addressed concurrently. It is important to reunite the family as soon as possible after surgery. Jane W. Ball and Ruth C. Bindler Child Health Nursing: Partnering with Children & Families © 2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

Nursing strategies to Improve the Illness/ Hospitalization Experience of Parents/ Children Practice Settings ICU Psychological considerations Parental decision making/ involvement in care Hospital Care Mediation administration Developmental considerations

Variations in Med Administration Refer to Table 17-6: Oral Rectal Ophthalmic and otic Topical Intramuscular Intravenous

Nursing strategies to Improve the Illness/ Hospitalization Experience of Parents/ Children Hospital (con’t) Educational needs Individual education plan (IEP) Teaching Partnering w/ parents

Adaptation to Hospitalization Preparation for Procedures Psychological preparation Using language the child understands Physical preparation Signed consent, pre-medicate Performing the procedure Treatment room

Assisting Children through procedures Refer to Table 17-7: Infant Toddler Preschool child School-age child Adolescent

Strategies to Promote Coping and Normal Development of the Hospitalized Child These strategies help to meet the psychosocial needs of the hospitalized child Rooming in Child Life Programs Child life specialist Therapeutic Play

Assessing the child and family in preparation for discharge Assess the family’s ability to manage the child’s care ? Any special adaptation to home environment/ or other facility Collaborate w/ parents to teach them treatment procedures and proper equipment use Have family member demonstrate proper care of equipment, and any procedures necessary

Professional Practice Standards for Pediatric Nursing Practice Collecting health data Analyzing the assessment data in determining diagnoses Identifying expected outcomes individualized to 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