The Child’s Experience of Hospitalization

The Child’s Experience of Hospitalization
Chapter 21 The Child’s Experience of Hospitalization

Objectives Identify various health care delivery settings.
Describe three phases of separation anxiety. List two ways in which the nurse can lessen the stress of hospitalization for the child’s parents. Discuss the management of pain in infants and children. Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

Objectives (cont.) Describe two milestones in the psychosocial development of the preschool child that contribute either positively or negatively to the adjustment to hospitalization. Contrast the problems of the preschool child and the school-age child facing hospitalization. Identify two problems confronting the siblings of the hospitalized child. Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

Objectives (cont.) List three strengths of the adolescent that the nurse might use when formulating nursing care plans. Organize a nursing care plan for a hospitalized child. Recognize the steps in discharge planning for infants, children, and adolescents. Interpret a clinical pathway for a hospitalized child. Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

Health Care Delivery Settings
Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

Outpatient Clinic Eliminates the need to separate the child from the family so that the treatment and the emotional impact of the illness are reduced Types Private office or hospital-affiliated Satellite Pediatric research centers Outpatient surgery centers Give an example of the types of patient populations that could be seen in each type of clinic. Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

Outpatient Clinic (cont.)
Promoting a positive experience Attitude of personnel child comes in contact with is of the utmost importance For many children, the only exposure to health care is through brief clinic appointments Discuss positive and negative attitudes and how they can affect a child’s experience. Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

Preparing the Child for a Treatment or Procedure
Infants Involve parents Include familiar objects Soothe, distract, and hug afterward Stress the importance of knowing the developmental stage of the child as it will guide the type of preparation needed. How would you involve the parents? Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

Preparing the Child for a Treatment or Procedure (cont.)
Toddlers and preschoolers Involve parents Offer simple explanations Give permission to express discomfort Offer one direction at a time Allow for choices, if possible Use distraction Hug after treatment or procedure Discuss simple terms in which to explain procedures to the toddler. Give an example of a preprocedure situation and how the nurse can effectively communicate with the toddler. Give an example of a situation in which a choice is offered to the toddler. What are some methods of distraction? Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

School-age child All of the previous preparations, plus Let them examine equipment Encourage child to verbalize fears Offer small reward after treatment or procedure, a sticker, for example 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? Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

Adolescent Provide privacy Involve teen in treatment or procedure Explain treatment or procedure and equipment Suggest coping techniques 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? Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

Home Not only a matter of supplying appliances and nursing care
Includes assessment of the total needs of children and their families Hospice care can also be provided in the home Changes in health care delivery affect the role and responsibilities of the nurse The various home and support groups that are available have the potential for improving life for the child and family and help reduce the cost of medical care Give an example of a situation in which a child might need varied home health care and discuss the impact on the family and child. What is the home health care nurse’s role in coordinating these services? Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

Children’s Hospital Unit
Designed to meet the needs of the child and parents Special treatment room for child to be examined or receive some form of treatment Playrooms for the children are also available Daily routine emphasizes parent rooming-in Provision of consistent caregivers Flexible schedules to meet the needs of the growing child How can the nurse assist the child and parents in maintaining their normal routine? Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

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 Discuss the varied reactions to hospitalization of an infant, toddler, preschooler, school-age child, and an 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. Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

The Child’s Reaction to Hospitalization (cont.)
The major causes of stress for children of all ages are Separation Pain Fear of body intrusion This is influenced by Developmental age Maturity of parents Cultural and economics Religious background Past experiences Family size State of health on admission Other factors 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? Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

Cultural Considerations
Familiar rituals and routines must be incorporated into the plan of care for a hospitalized child Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

Separation Anxiety Occurs in infants age 6 months and older
More pronounced in toddlers Three stages Protest Despair Denial or detachment Discuss nursing interventions which can assist the child through these stages. Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

Pain Pain is whatever the person says it is
May be verbally or nonverbally expressed 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 Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

Four Pain Assessment Tools for Children
Discuss Figure 21-2, page 474. Audience Response Question #1 A 7-year-old is in the hospital following an appendectomy. The nurse assesses him for pain using the face scale. He points to the 0 face indicating no hurt, but the nurse notices he is grimacing and guarding the operative site. What would be the best action for the nurse to take? 1. Note that the child is pain free. 2. Reposition the child. 3. Attempt assessment using another tool. 4. Medicate immediately for pain as ordered. Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

Two Additional Pain Assessment Scales
PICIC (Pain Indicator for Communicatively Impaired Children) Crying with or without tears Screaming or groaning Distressed facial expression Tense body Irritability to touch FLACC Face: grimace Legs: restless to kicking Activity: quiet to arched Crying: moan to scream Consolability: touch to inconsolable Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

Pain (cont.) 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 Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

Managing Pain Nonpharmacological techniques Drawing Distraction
Imagery Relaxation Cognitive (thinking) strategies Backrub or hand massage What are examples of distraction, imagery, and relaxation techniques? Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

Drug Physiology 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 Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

Drugs Used for Pain Relief
Acetaminophen—mild to moderate pain Can lead to liver failure if not dosed correctly Nonsteroidal antiinflammatory drugs (NSAIDs)—mild to moderate pain Opioids—moderate to severe pain Used for long periods of time Tolerance and respiratory depression can occur Discuss the importance of proper dosage calculations for the pediatric patient. Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

Drugs Used for Pain Relief (cont.)
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. Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

Drugs Used for Pain Relief (cont.)
Fentanyl Naloxone (Narcan)—used in case of opioid overdose Local anesthetics (e.g., EMLA cream) Patient-controlled analgesia (PCA) Child must be 7 years of age or older Discuss the proper administration method for naloxone. How is EMLA cream used? Discuss the use of PCAs and signs/symptoms to monitor in the child. Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

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 Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

Fear Intrusive procedures are fear-provoking
Disrupts child’s trust level Threatens self-esteem and self-control May require restriction of activity Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

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. Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

Cultural Needs 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 the child? Discuss positive and negative body language cues. Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

Cultural Needs (cont.) Crying may be interpreted by some cultures as a signal of an organic upset of illness One cultural group may prize autonomy and initiative while others may tolerate only complete obedience Respecting cultural and religious beliefs will enhance compliance Assess family through the eyes of its culture to avoid labeling a family who is “different” as dysfunctional Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

Fostering Intercultural Communication
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 Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

The Parents’ Reactions to the Child’s Hospitalization
May believe they are to blame for their child’s illness Immunizations may have been neglected Guilt, helplessness, and anxiety Parents are seldom the direct cause for hospital admission The nurse listens carefully to parental concerns and acknowledges the legitimacy of their feelings Encourages and supports parents and other family members, stresses their importance to the child’s recovery Encourages their participation in the care of the child In what ways can a nurse support the family and involve them in the care of the hospitalized child? Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

The Parents’ Reactions to the Child’s Hospitalization (cont.)
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. Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

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 as 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. Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

Developmental History
Family relationships and support systems Cultural needs that may affect care and hospital routine Nicknames, rituals, routines Developmental level and abilities Communication skills Personality, adaptability, coping skills Past experiences, divorces, new siblings, extended family Previous separation experiences Impact of current health problem on growth and development Preparation given to the child Previous contact with health care personnel Discuss the nurse’s role and rationale for obtaining this information. Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

Developing a Pediatric Nursing Care Plan
Result of nursing process States specifically what is to be done for each child Keeps the focus on the child and not on the condition or therapy Involves growth and development process; evaluation of the primary caregiver, who has a direct role in the safety and maintenance of the child’s health Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

Clinical Pathways Interdisciplinary plan of care
Displays progress of entire treatment plan Nursing care plan focuses on the nurse’s role Clinical pathway focuses on the team’s approach to outcomes of care Discuss which disciplines can be involved in the clinical pathway. Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

Developmental Nursing Tips
Play is an important part of a nursing care plan for children The achievement of developmental tasks should be part of the plan of care for the hospitalized child Give an example of a nursing intervention involving play. Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

Needs of the Hospitalized Child
Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

The Hospitalized Infant
Can be frustrating for the infant Used to getting what they want when they want it May miss continuous affection of their parents Daily schedules are disrupted Nurse must try to meet the needs of the infant while preventing excess frustration Major goal is to assist parent-infant attachment process and promote sensorimotor activities Liberal visiting hours are essential Consistency in caregivers is important at this stage of development 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? Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

The Hospitalized Toddler
Their world revolves around their parents, especially their primary caregiver Cannot understand why they are separated from their caregiver and become distressed Cohesive staff is essential to meet the needs of the children and their parents Give an example of the difference between how a toddler might perceive a hospitalization versus a school-age child. Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

Nursing Goals of the Hospitalized Toddler
Reassure parents, particularly the child’s primary caregiver Maintain the toddler’s sense of trust Incorporate home habits into care plans Allow the child to work through or master threatening experiences through soothing techniques and play Provide individualized, flexible nursing care plans in accordance with the child’s development and diagnosis How can the nurse obtain the toddler’s trust? Give an example of a soothing technique and play intervention for a toddler who has experienced a threatening situation. Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

Nursing Goals of the Hospitalized Toddler (cont.)
Children should be forewarned about any unpleasant or new experience that they may need to undergo Preparation and explanation are done immediately before the procedure Crying and protestations are healthy expressions and relieve tension When restraint is indicated (splints, IV therapy, large dressings), increased emotional support should be provided Discuss the rationale for preparing and explaining the procedure just prior to performing it. How can a toddler’s emotions be supported when restrained for a procedure? Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

The Hospitalized Preschooler
Fear of bodily harm Magical thinking and fantasy Concrete thinking, may be better able to understand what is happening Explanations must be realistic, clear, understandable, and truthful Children who ask questions should be complimented and listened to; any misinterpretations should be corrected Teach parents that upon discharge that the child may be demanding and irritable Discuss the preschooler’s ability to think concretely and give an example. Give an example of how a preschool child might misinterpret what a nurse or physician has told him or her. Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

The Hospitalized School-Age Child
Stage of industry and independence Forced dependency in the hospital can result in a feeling loss of control and security Can participate in own care and make simple choices to foster their feelings of independence Common for this age to be “brave” and to show little, if any, fear in situations that are actually quite upsetting Observe body language Give an example of behavior exhibiting industry and independence. Give an example of body language which exhibits fear while the child is attempting to be brave. Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

Safety Alert Observation of nonverbal clues such as facial grimaces, squirming, and finger tapping is important in determining the need for pain relief and support for the child Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

The Hospitalized Adolescent
Experience feelings of loss of control during hospitalization May cause adolescent to withdraw, be noncompliant, or display anger May be concerned with how the illness will affect their appearance Incorporating choice, privacy, and the opportunity for peer visitors is important Discuss how body image is very important to this population. Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

Adjustment to Illness Can understand the implications of their disease
Are capable of participating in decisions related to treatment and care The nurse who recognizes these skills and encourages their practice helps the adolescent gain confidence Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

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 the 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. Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

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 parent’s 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 which might affect this population. Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

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 Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

Guidance for Parents Anticipating behaviors such as clinging or regression Allowing the child to become a participating family member as soon as possible Taking the focus off the illness Being kind, firm, and consistent with misbehavior Building trust by being truthful Allowing time for free play Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

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. Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

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 Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

Home Care (cont.) The health care worker in the home should
Observe how the parents interact with the child Observe facial expressions and body language Listen to the parents and observe how they attend to the physical needs of the child Ask questions or discuss apprehensions the parents may have Be attuned to the needs of other children in the home Explore community facilities or support groups available Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

Review Objectives Key Terms Key Points Online Resources
Review Questions Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

The Child’s Experience of Hospitalization

Similar presentations

Presentation on theme: "The Child’s Experience of Hospitalization"— Presentation transcript:

Similar presentations

About project

Feedback

Log in

Auth with social network:

The Child’s Experience of Hospitalization

Similar presentations

Presentation on theme: "The Child’s Experience of Hospitalization"— Presentation transcript:

Similar presentations

About project

Feedback