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Hospitalized Child. Presented by Marlene Meador RN, MSN, CNE. Child’s Reactions to Illness or Hospitalization. Influencing factors Internal Age (cognitive development) Preparation & coping skills Culture Previous experience with healthcare system.

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hospitalized child

Hospitalized Child

Presented by

Marlene Meador RN, MSN, CNE

child s reactions to illness or hospitalization
Child’s Reactions to Illness or Hospitalization
  • Influencing factors Internal
    • Age (cognitive development)
    • Preparation & coping skills
    • Culture
    • Previous experience with healthcare system
child s reactions to illness or hospitalization1
Child’s Reactions to Illness or Hospitalization
  • Influencing factors External
    • Parent’s reaction to illness
    • Sibling’s reaction to current illness/hospitalization
what age is most effected by separation anxiety
What age is most effected by separation anxiety?
  • 0-8 months
  • 9-36 months
  • Preschool
  • School aged
  • Adolescent
stages of separation
Stages of Separation
  • Protest
  • Despair
  • Detachment
effects of illness hospitalization on the infant toddler
Effects of Illness/hospitalization on the:Infant/Toddler
  • Separation anxiety
  • Fear of injury
  • Loss of control
effects of illness hospitalization on the preschooler
Effects of Illness/hospitalization on the:Preschooler
  • Separation anxiety
  • Fear of injury
  • Loss of control
  • Guilt and shame
effects of illness hospitalization on the school age child
Effects of Illness/hospitalization on the: School-age Child
  • Separation anxiety
  • Fear of injury/pain
  • Loss of control
effects of illness hospitalization on the adolescent
Effects of Illness/hospitalization on the:Adolescent
  • Separation anxiety
  • Fear of injury
  • Loss of control
  • Fear of the unknown
  • Preschool-typically regress in comfort measures and toilet training, “temper tantrums” and toddler-like behaviors
  • School age- may become more fearful of strangers and require more emotional support (crying or “baby talk”)
clinical judgment
Clinical Judgment
  • What are some psychological benefits of hospitalization for a child and family?
clinical judgment1
Clinical Judgment:

How would a nurse best respond to a parent who is overly concerned about the child’s regression?

How does toileting pattern and pacifier/bottle response differ from other regression?

family s response to hospitalization
Family’s Response to Hospitalization
  • Perception
  • Support system
  • Coping mechanism
families response to illness hospitalization
Families’ Response to Illness/Hospitalization
  • Parents may become anxious
  • Financial stressors
  • Additional obligations
  • Guilt
nursing interventions how does the nurse meet the needs of the hospitalized child in each age group
Nursing Interventions:How does the nurse meet the needs of the hospitalized child in each age group?
  • Infant
  • Toddler-Preschool
  • School- aged
  • Adolescent
  • P891 BOX 35-2
what is the best method for communicating with the family of a hospitalized child
What is the best method for communicating with the family of a hospitalized child?
  • What factors influence the family’s ability to interact with the hospital staff?
  • What nursing interventions should receive highest priority when communicating with these families?
nursing interventions for the family of a hospitalized child
Nursing Interventions for the family of a hospitalized child:
  • Augment coping mechanisms- (what specific factors influence client teaching?)
  • Reinforce information and encourage questions (who would have difficulty with asking questions?)
  • Anticipate discharge needs (when should this begin?)
  • Why is this an effective tool for assisting the child and the family?
  • How would the nurse assist the child and family to arrive at the PPEN?
  • Is this a static assessment?
preparation for hospitalization
Preparation for Hospitalization
  • What nursing interventions prepare a child for hospitalization?
  • Are the interventions the same for all children?
  • Who should the nurse include in these preparations?
  • Tour of the Hospital or surgical area
  • Photographs or a videotape of medical setting and procedures
  • Health Fairs
  • Contact with peers who had similar experience
promoting coping and normal development
Promoting Coping and Normal Development
  • Child life specialists: assist with preparing child for procedures, and to adjust to illness and hospitalization.
  • Therapeutic play: emotional outlet, teaching strategy, assessment tool
  • Anticipate child/family’s needs
difficult families
Difficult Families
  • What is the nurse’s best response to a family identified as “difficult”?
  • What additional information does the nurse require?
  • What is COPE, and how is it helpful with families in crisis?
cope convey genuine caring concern and interest in the child s wellbeing
COPE: Convey genuine caring, concern and interest in the child’s wellbeing.
  • C- collaboration
  • O- objective
  • P- proactive
  • E- evaluate

Avoid placating or condescending phrases.

nursing care of the child with special needs
Nursing Care of the Child with Special Needs:
  • Special equipment- visually or hearing impaired, wheelchairs,
  • Specialized care- feeding tubes, trachs/vents
  • Assess family coping ability- who is primary caregiver
  • Assess support systems
  • Involve additional members of the healthcare team
advantages to play
Advantages to play:
  • Therapeutic play
    • Motional outlet
    • Instructional
    • Improve physiological abilities
  • Enhancing cooperation through play
  • Rewards the child’s payment for a job well done!
play as an assessment tool
Play as an assessment tool:
  • When might a nurse use play as an assessment tool?
  • Why is this and effective technique?
child life specialist
Child Life Specialist
  • A person who plans activities to provide age-appropriate playtime for children either in the child’s room or in a playroom.
  • Goal: Assist children to work through feelings about their illness
pain assessment
Pain Assessment
  • What happens when you ask a patient of any age “what is your pain level?”
  • How would you best assess a child’s pain?
pain assessment1
Pain Assessment
  • Infant- grimacing, poor feeding, restlessness, crying
  • Toddler- clinging to parent, crying, pulling or rubbing area of pain, anorexia, vomiting, restlessness.
pain assessment cont
Pain Assessment cont…
  • Preschool- verbalize pain, guard injured extremity, anorexia, vomiting, sleeplessness.
  • Adolescent- verbalize pain, may not understand “type” of pain. Possibly reluctant to call for help.
oucher scale
Oucher Scale
  • After determining that the child has an understanding of number concepts, teach the child to use the scale.
  • Point to each photo, explain that the bottom picture is a “no hurt,” the second picture is a “little hurt,” the third picture is “a little more hurt,” the fourth picture is “even more hurt” the fifth picture is “a lot of hurt” and the sixth picture is the “biggest or most hurt you could ever have.”
  • The numbers beside the photos can be used to score the amount of pain the child reports.
pain assessment tools
Pain Assessment Tools:
  • FLACC- face, legs, activity, cry and consolability (p. 1215-1216)
  • NIPS- neonatal pain during/after procedures- facial expression, cry quality, breathing patterns, arm & leg position, state of arousal
faces smile to worst hurt tears
FACES- smile to worst hurt (tears)

Remember to ask “where” they hurt.

To children, emotional feelings are a “hurt”.

physiological response to pain
Physiological response to pain:
  • What happens to VS?
  • How does the nurse assess anxiety in a hospitalized child?
  • How does sleeplessness impact healing?
nursing interventions pharmacologic
Nursing interventions: pharmacologic
  • PCA- what age can use this most effectively?
  • Ketoralac- why is this effective? What specific nursing interventions apply to this medication?
  • Why are NSAIDS used with children?
  • What lab values and contraindications are important for analgesic medications used with children?
nursing interventions nonpharmacologic
Nursing interventions: nonpharmacologic
  • What actions should the nurse include with each of the following?
    • Positioning for comfort (turning or elevation)
    • Thermal therapy (heat or cold)
    • Diversion therapy
  • What actions would work best with an infant?
pain management
Pain Management
  • The presence of the parent is an important part of pain management.
  • Children often feelmore secure telling their parents about their pain and anxiety
If you have any questions or concerns regarding this information please contact Marlene Meador via email

Or cell phone 512-422-8749