Professional Documents
Culture Documents
Nursing
Partnering with
Children & Families
Jane W. Ball
Ruth C. Bindler
Chapter 17
Nursing Care of the
Hospitalized Child
Child Health Nursing: Partnering with Children & Families
By Jane W. Ball and Ruth C. Bindler
Childrens Understanding of
Health and Illness
Developmental Considerations
Infant
Separation (highest age risk)
Stranger Anxiety (6-18 mos)
Childrens Understanding of
Health and Illness
Developmental Considerations
Toddler
Separation anxiety
Loss of self-control
Childrens 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
Childrens 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
Childrens 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
Childrens Understanding of
Health and Illness
Psychological Aspects
School-aged children
Pain
Bodily Injury
Death
Adolescents
Loss of control/ privacy
Fear of altered body image
Siblings
Fears
Behavioral Disruption
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.)
Adaptation to
Hospitalization
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.
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
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?
FIGURE 172
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 childs and familys coping
strategies to deal w/ hospitalization
Promoting optimal development and
safety
Minimizing disruption of the childs usual
routine
Preoperative checklist
Refer to Box 17-7
This child has just undergone surgery and is in the post anesthesia
care unit (PACU). Although the childs 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.
FIGURE 176
Hospital Care
Mediation administration
Developmental considerations
Variations in Med
Administration
Refer to Table 17-6:
Oral
Rectal
Ophthalmic and otic
Topical
Intramuscular
Intravenous
Teaching
Partnering w/ parents
Adaptation to
Hospitalization
Preparation for Procedures
Psychological preparation
Using language the child understands
Physical preparation
Signed consent, pre-medicate
Therapeutic Play