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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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a child s understanding of their hospitalization
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
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
critical to remember
! 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
Stages of Separation
  • Protest
  • Despair
  • Detachment
stressors by developmental age
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 age1
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
stressors by developmental age2
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 age3
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
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
Advantages of play to the hospitalized child
  • Therapeutic
  • Emotional outlet
  • Teaches
  • Enhances


hospital admission
Hospital Admission
  • Taking the history
  • Physical Exam
    • Initial inspection
    • Baseline data
  • Family dynamics
environmental consideration in a healthcare setting
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
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
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
CSHCN, cont.
  • About 13% of the children
  • Account for 65-80% of all pediatric healthcare expenditures
  • Goals: accessing the resources available!
cshcn cont1
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
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
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
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
Specialists that assist the hospitalized pediatric client
  • Child Life specialist
  • Occupational therapist
  • Physical therapist
managing pain in the hospitalized
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
Consequences of unrelieved pain
  • Respiratory changes
  • Neurologic changes
  • Metabolic changes
  • Immune system changes
  • GI changes
pain scales
Pain scales
pharmologic vs nonpharmologic treatment for pain
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
Pain control, cont.
  • As nurses, we must remember:
    • Pain is what the child says it is! All pain is significant to document and treat