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Nursing Care of the Hospitalized Child

Nursing Care of the Hospitalized Child. 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

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Nursing Care of the Hospitalized Child

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  1. Nursing Care of the Hospitalized Child

  2. 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

  3. Developmental milestones and approach to communication

  4. Stages of Separation • Protest • Despair • Detachment

  5. Family Responses to hospitalization • Their perception • Support mechanisms available • Coping mechanisms

  6. Support and coping mechanisms that determine family’s responses • Communication strategies • Finances, friends • Separation from other children: who helps out? • Their ability to “disengage” from other responsibilities • Coping is developed from past experiences • **Most common reaction to child’s illness may be disbelief

  7. Nursing measures to assist the family • Teaching (relieves fear of unknown) • Orientation to the hospital routine • Communication regarding how they may help

  8. 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

  9. Types of facilities • Hospital • Medical/surgical units • ICU • Rehab • Outpatient/day facilities • 24 hr observation units • School-based clinics • Community clinics • Home Care

  10. Hospital Admission • Taking the history • Physical Exam • Initial inspection • Baseline data • Family dynamics

  11. 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

  12. ! 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

  13. **separation anxiety Nurses experience protest and despair in this group Fear of injury and pain Loss of control Need contact with mother Infants/Toddlers Stressors by developmental age

  14. 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

  15. School age Separation: may have already experienced when starting to school Fear of injury and pain Loss of control Stressors by developmental age

  16. Stressors by developmental age • Adolescence • Separation from friends rather than family more imp • Fear of injury and pain • Loss of Control

  17. 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

  18. CSHCN, cont. • About 13% of the children • Account for 65-80% of all pediatric healthcare expenditures • Goals: accessing the resources available!

  19. 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

  20. 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

  21. Advantages of play to the hospitalized child • Therapeutic • Emotional outlet • Teaches • Enhances cooperation

  22. 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

  23. 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

  24. Managing pain in the hospitalized child • According to age which technique is best • Types of techniques: • Behavioral distraction • Assorted visuals • Breathing techniques • Comfort measure • Diversional talk

  25. Management of pain, cont. • Understand type of assessment findings in each age group • PAIN IS WHAT THEY SAY IT IS! • All pain should be investigated

  26. Nursing interventions to assist the child in pain • Understand the misconceptions about pain • Assess: hx, culture, developmental response, scales (FACES, FLACC, CRIES)) • Always evaluate effects of medications administered • Sedation used for procedures

  27. Non-pharmacologic measures to relieve pain • Elevation of the affected part or extremity • Ice or heat when indicated • Reposition the client/injured part for comfort • Diversional therapy when indicated (board games, video games, cards, etc.)

  28. The End!

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