Nursing care of the hospitalized child
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Nursing Care of the Hospitalized Child. A child’s understanding of their hospitalization. Based on: Their cognitive ability at different developmental stage Previous experiences with healthcare professionals. Importance of Effective Communication with Children. More than words Touch

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Nursing Care of the Hospitalized Child

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Nursing Care of the Hospitalized Child

A child’s understanding of their hospitalization

  • Based on:

    • Their cognitive ability at different developmental stage

    • Previous experiences with healthcare professionals

Importance of Effective Communication with Children

  • More than words

    • Touch

    • Physical proximity and environment

    • Listening with impartiality

    • Visual communication

    • Tone of voice

    • Body language

    • Timing

    • Establishing rapport with the family

    • Being open to questions/resolving conflict

Developmental milestones and approach to communication

! Critical to remember !

  • Child’s response to Illness

    • Fear of the unknown

    • Separation anxiety

    • Fear of pain or mutilation

    • Loss of control

    • Anger

    • Guilt

    • Regression

Stages of Separation

  • Protest

  • Despair

  • Detachment

Stressors by developmental age

  • Infants/toddlers

  • **Separation anxiety

  • Nurses experience protest and despair in this group

  • Fear of injury and pain

  • Loss of control

Stressors by developmental age

  • Preschooler

  • Separation anxiety generally less than the toddler

  • Less direct with protests; cries quietly

  • May be uncooperative

  • Fear of injury

  • Loss of control

  • Guilt and shame

School age

Separation: may have already experienced when starting to school

Fear of injury and pain

Loss of control

Stressors by developmental age

Stressors by developmental age

  • Adolescence

  • Separation from friends rather than family more imp

  • Fear of injury and pain

  • Loss of Control

Factors Affecting a Child’s Response to Illness and Hospitalization

  • Age/cognition

  • Parental response

  • Coping skills of family/child

  • Preparation of child/family

  • Hospitalization can be a positive factor

Advantages of play to the hospitalized child

  • Therapeutic

  • Emotional outlet

  • Teaches

  • Enhances


Hospital Admission

  • Taking the history

  • Physical Exam

    • Initial inspection

    • Baseline data

  • Family dynamics

Environmental consideration in a healthcare setting

  • Safe place

    • Playroom

    • Patient’s room

  • Treatment Room/end of crib

  • Senses: lighting, sound, temperature, smells

  • Dynamics: designate one person to direct/encourage

  • Medical play

Types of facilities

  • Hospital

    • Medical/surgical units

    • ICU

    • Rehab

    • Outpatient/day facilities

    • 24 hr observation units

  • School-based clinics

  • Community clinics

  • Home Care

Creating Partnerships with Families of Children with Special Healthcare Needs

  • CSHCN: Children with Special Health Care Needs

  • Defined as those with elevated risk for chronic physical, developmental, behavioral or emotional conditions

CSHCN, cont.

  • About 13% of the children

  • Account for 65-80% of all pediatric healthcare expenditures

  • Goals: accessing the resources available!

CSHCN, cont

  • Care differs from other children:

    • Requires more info about the family

    • Family does most of the care

    • Involves many systems and people

    • Balance condition r/t needs with general well-being of the child

CSHCN, cont. “ending on a happy note”

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

  • Support and encourage the parents

  • Empower families to regain control of their lives

  • Engage in authentic communication

  • Support strengths of families

Dealing with Difficult Families

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

  • Child: fear, expectations and ??

  • Parent: preexisting dynamics and communication styles, finances, coping styles

How to deal with the “baggage”

  • Claiming potential baggage

  • Bring the “good baggage”: competency, calmness, caring, tolerance, openness

  • Flexibility by all members of the team

  • Avoiding the negative baggage

  • COPE

Specialists that assist the hospitalized pediatric client

  • Child Life specialist

  • Occupational therapist

  • Physical therapist

Managing pain in the hospitalized

  • According to age which technique is best

  • Types of techniques:

    • Behavioral distraction

    • Assorted visuals

    • Breathing techniques

    • Comfort measure

    • Diversional talk

Consequences of unrelieved pain

  • Respiratory changes

  • Neurologic changes

  • Metabolic changes

  • Immune system changes

  • GI changes

Pain scales




Pharmologic treatments



Nonnarcotic analgesics

Nonpharmalogic methods


Cutaneous stimulation

Sucrose solution

Electroanalgesia (TENS units)

Application of heat/cold

Relaxation, hypnosis, guided imagery

Pharmologic vs. Nonpharmologic treatment for pain

Pain control, cont.

  • As nurses, we must remember:

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

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