Nursing Care of the Nursing Care of the Hospitalized ChildHospitalized Child

A child’s understanding of A child’s understanding of their hospitalizationtheir hospitalization

Based on:Based on: Their cognitive ability at different Their cognitive ability at different

developmental stagedevelopmental stage Previous experiences with healthcare Previous experiences with healthcare

professionalsprofessionals

Importance of Effective Importance of Effective Communication with ChildrenCommunication with Children

More than wordsMore than words TouchTouch Physical proximity and environmentPhysical proximity and environment Listening with impartialityListening with impartiality Visual communicationVisual communication Tone of voiceTone of voice Body languageBody language TimingTiming Establishing rapport with the familyEstablishing rapport with the family Being open to questions/resolving conflictBeing open to questions/resolving conflict

Developmental milestones and Developmental milestones and approach to communicationapproach to communication

InfantsInfants (0-12 (0-12 mo)mo)

ToddlersToddlers(1-2 yr)(1-2 yr)

PreschoolePreschoolersrs(3-5 yrs)(3-5 yrs)

School-ageSchool-age(6-11)(6-11)

AdolescentAdolescentss(12 and (12 and older)older)

Use of calm Use of calm voice; voice; respond to respond to cries, mimic cries, mimic baby baby sounds, talk sounds, talk and read and read regularly, regularly, use a slow use a slow approach approach and allow and allow time to get time to get to know youto know you

Learn the Learn the toddler’s toddler’s words for words for common common items, items, picture picture books, books, respond to respond to their their receptivenereceptiveness, ss, preparation preparation should occur should occur immediately immediately before eventbefore event

Seek Seek opportunitieopportunities to offer s to offer choices, use choices, use play for play for explanationexplanations, simple s, simple sentences, sentences, picture picture books, books, puppets, be puppets, be concise; concise; limit length limit length of of explanationexplanationss

Photos, Photos, books, books, videos; est. videos; est. limits, use limits, use play, play, introduce introduce preparatory preparatory materials 1-materials 1-5 days in 5 days in advance of advance of the eventthe event

Engage in Engage in conversatioconversations about ns about their their interests, interests, use of use of videos to videos to explain, explain, foster foster independenceindependence, , preparatory preparatory materials up materials up to 1 wk in to 1 wk in advance, advance, respect respect privacy privacy needsneeds

! Critical to remember !! Critical to remember ! Child’s response to IllnessChild’s response to Illness

Fear of the unknownFear of the unknown Separation anxietySeparation anxiety Fear of pain or mutilationFear of pain or mutilation Loss of controlLoss of control AngerAnger GuiltGuilt RegressionRegression

Stages of SeparationStages of Separation ProtestProtest

DespairDespair

DetachmentDetachment

Stressors by developmental Stressors by developmental ageage

Infants/toddlersInfants/toddlers **Separation anxiety**Separation anxiety Nurses experience Nurses experience

protest and despair protest and despair in this groupin this group

Fear of injury and Fear of injury and pain pain

Loss of controlLoss of control

Stressors by developmental Stressors by developmental ageage

PreschoolerPreschooler Separation anxiety Separation anxiety

generally less than the generally less than the toddlertoddler

Less direct with Less direct with protests; cries quietlyprotests; cries quietly

May be uncooperativeMay be uncooperative Fear of injuryFear of injury Loss of controlLoss of control Guilt and shameGuilt and shame

Stressors by developmental Stressors by developmental ageage

School ageSchool age Separation: may Separation: may

have already have already experienced when experienced when starting to schoolstarting to school

Fear of injury and Fear of injury and painpain

Loss of controlLoss of control

Stressors by developmental Stressors by developmental ageage

AdolescenceAdolescence Separation from Separation from

friendsfriends rather than rather than family more impfamily more imp

Fear of injury and Fear of injury and painpain

Loss of ControlLoss of Control

Factors Affecting a Child’s Factors Affecting a Child’s Response to Illness and Response to Illness and

HospitalizationHospitalization Age/cognitionAge/cognition Parental responseParental response Coping skills of Coping skills of

family/childfamily/child Preparation of Preparation of

child/familychild/family Hospitalization can Hospitalization can

be a positive factorbe a positive factor

Advantages of play to the Advantages of play to the hospitalized childhospitalized child

TherapeuticTherapeutic Emotional outletEmotional outlet TeachesTeaches Enhances Enhances cooperationcooperation

Hospital AdmissionHospital Admission Taking the historyTaking the history Physical ExamPhysical Exam

Initial inspectionInitial inspection Baseline dataBaseline data

Family dynamicsFamily dynamics

Environmental Environmental consideration in a consideration in a healthcare settinghealthcare setting

Safe placeSafe place PlayroomPlayroom Patient’s roomPatient’s room

Treatment Room/end of cribTreatment Room/end of crib Senses: lighting, sound, temperature, smellsSenses: lighting, sound, temperature, smells Dynamics: designate one person to Dynamics: designate one person to

direct/encouragedirect/encourage Medical playMedical play

Types of facilitiesTypes of facilities HospitalHospital

Medical/surgical unitsMedical/surgical units ICUICU RehabRehab Outpatient/day facilitiesOutpatient/day facilities 24 hr observation units24 hr observation units

School-based clinicsSchool-based clinics Community clinicsCommunity clinics Home CareHome Care

Creating Partnerships with Creating Partnerships with Families of Children with Special Families of Children with Special

Healthcare NeedsHealthcare Needs CSHCN: Children with Special Health CSHCN: Children with Special Health

Care NeedsCare Needs Defined as those with elevated risk Defined as those with elevated risk

for chronic physical, developmental, for chronic physical, developmental, behavioral or emotional conditionsbehavioral or emotional conditions

CSHCN, cont.CSHCN, cont. About 13% of the childrenAbout 13% of the children Account for 65-80% of all pediatric Account for 65-80% of all pediatric

healthcare expenditureshealthcare expenditures Goals: accessing the resources Goals: accessing the resources

available!available!

CSHCN, contCSHCN, cont Care differs from other children:Care differs from other children:

Requires more info about the familyRequires more info about the family Family does most of the careFamily does most of the care Involves many systems and peopleInvolves many systems and people Balance condition r/t needs with general Balance condition r/t needs with general

well-being of the childwell-being of the child

CSHCN, cont. “ending on a CSHCN, cont. “ending on a happy note”happy note”

Share the joys of focusing on the Share the joys of focusing on the child’s growth and developmentchild’s growth and development

Support and encourage the parentsSupport and encourage the parents Empower families to regain control of Empower families to regain control of

their livestheir lives Engage in authentic communicationEngage in authentic communication Support strengths of familiesSupport strengths of families

Dealing with Difficult Dealing with Difficult FamiliesFamilies

Remember that the child, and the Remember that the child, and the family bring “baggage”family bring “baggage”

Child: fear, expectations and ??Child: fear, expectations and ?? Parent: preexisting dynamics and Parent: preexisting dynamics and

communication styles, finances, communication styles, finances, coping stylescoping styles

How to deal with the How to deal with the “baggage”“baggage”

Claiming potential baggageClaiming potential baggage Bring the “good baggage”: Bring the “good baggage”:

competency, calmness, caring, competency, calmness, caring, tolerance, opennesstolerance, openness

Flexibility by all members of the teamFlexibility by all members of the team Avoiding the negative baggageAvoiding the negative baggage COPECOPE

Specialists that assist the Specialists that assist the hospitalized pediatric client hospitalized pediatric client

Child Life specialistChild Life specialist Occupational therapistOccupational therapist Physical therapistPhysical therapist

Managing pain in the Managing pain in the hospitalizedhospitalized

According to age which technique is According to age which technique is bestbest

Types of techniques:Types of techniques: Behavioral distraction Behavioral distraction Assorted visualsAssorted visuals Breathing techniquesBreathing techniques Comfort measureComfort measure Diversional talkDiversional talk

Consequences of unrelieved Consequences of unrelieved painpain

Respiratory changesRespiratory changes Neurologic changesNeurologic changes Metabolic changesMetabolic changes Immune system changesImmune system changes GI changesGI changes

Pain scalesPain scales FACESFACES FLACCFLACC CRIESCRIES

Pharmologic vs. Nonpharmologic Pharmologic vs. Nonpharmologic treatment for paintreatment for pain

Pharmologic Pharmologic treatmentstreatments

OpiodsOpiods NonsteroidalsNonsteroidals Nonnarcotic Nonnarcotic

analgesicsanalgesics

Nonpharmalogic Nonpharmalogic methodsmethods DistractionDistraction Cutaneous stimulationCutaneous stimulation Sucrose solutionSucrose solution Electroanalgesia (TENS Electroanalgesia (TENS

units)units) Application of heat/coldApplication of heat/cold Relaxation, hypnosis, Relaxation, hypnosis,

guided imageryguided imagery

Pain control, cont.Pain control, cont. As nurses, we must remember:As nurses, we must remember:

Pain is what the child says it is! All pain Pain is what the child says it is! All pain is significant to document and treatis significant to document and treat