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Child Health

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

2006 Pearson Education, Inc.


Pearson Prentice Hall
Upper Saddle River, NJ 07458

Childrens 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

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

Stressors of Hospitalization for


Children at Various Developmental
Stages
Refer to Table 17-2

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

The Effects of Hospitalization


on the Child and Family
Childrens 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 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

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.

Jasmines 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 childs age and culture. Why do you think that having the
parents read this material is valuable?
FIGURE 173

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 childs and familys coping
strategies to deal w/ hospitalization
Promoting optimal development and
safety
Minimizing disruption of the childs usual
routine

Safety Measures for the


Hospitalized Child
Refer to Box 17-3

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

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

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 (cont)
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 familys ability to manage
the childs 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

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