care of the hospitalized child
TRANSCRIPT
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Binal Joshi
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INTRODUCTION
Hospitalization is aninterruption of the childs activecycle of growth anddevelopment and his or herfamily's life cycle also. The childis removed from the dailyroutines of home life andcontact with siblings, relativesand peers are limited.
He or she may be required toexperience strange and painfulevents and to communicatewith strangers.
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YOUR WORK IS
VERY HARD
BECAUSE YOUWANT ME TO
GET WELL
SOON.
YOU CARE FOR
ME AND MY
FAMILY.
I CAN BE VERY
DIFFICULT ATTIMES
IAM AFRAID
Nursing care needs
to be based on the
most common
psychosocial andphysiologic
alterations that
applies the
principles of
growth and
development, and
respect and
appreciation of
the parents andfamily as partners
in the care of their
children.
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EFFECTS OF ILLNESS AND HOSPITALIZATION ON
CHILDREN AND FAMILIES
Childrens understanding of health and illness.
Young child is likely to think that misbehavior
toward his or her mother caused on illness to occur
if the two events occur close in time. Older child sometimes feel responsible or guilty
about an illness.
Adolescents often feel invulnerable and may
believe that they will never become ill or have an
accident.
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Infant ( by about 6 months of age ). Infants have developed an awareness of
themselves as separate from their mothers
and fathers.
Infants are able to identify primary
caretakers and to feel anxious when in
contact w/ strangers.
Hospitalization can be traumatic time for the
infants.
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STAGES OF SEPARATION ANXIETY
PROTEST
Screaming, crying
Clinging to parents
Withdrawal from other adults
DESPAIR
Sadness, depression
Withdrawal or compliant behavior
Crying when parents appear
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STAGES OF SEPARATION ANXIETY
DENIAL
Lack of protest when parents leave
Appearance of being happy and content
with everyone.
Close relationships not established Developmental delay possible
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EFFECTS OF ILLNESSAND HOSPITALIZATION
ON CHILDREN ANDFAMILIES
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TODDLERS AND PRESCHOOLER
Toddlers and preschooler are beginning tounderstand illness but not its cause.
Toddlers consider the sun, an animal, bad
behavior, or even magic to be the cause of
their illness.
Separation from parents remains the major
stressor for the child.
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SCHOOL-AGE CHILD
Older children have a more realisticunderstanding of the reasons for illness.
Older children understand the functioning of
their body parts.
The child may worry about pain, stitches and
bandages, and wonder if his or her body will
return to normal.
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ADOLESCENT
Adolescent become increasingly aware of physiologic
and behavioral causes of illness and injury. Privacy and modesty are major concerns of
adolescents because their physical characteristics are
rapidly changing.
Separation from peers, home and school are sited as
major stressor of hospitalization by adolescents.
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THE HOSPITALIZED CHILD
Separation Anxiety!
Early Childhood
Protest
Despair
Detachment
Later Childhood
Loneliness Boredom
Isolation
Attitude is everything!
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The Effects of Hospitalization on the Child
and the Family
Parents
Disrupt usual routine
Fears/ anxiety
Coping abilities (made more difficult if lack of
financial, community or family support)
Siblings
Fears
Behavioral Disruption
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Adaptation to Hospitalization
Parents
Tailor nursing care to familys needs and
preferences
Maintain positive communication with family
Ask for parents participation in care
Explain all aspects of treatment, keep family in
the loop Provide information to family (ie teaching
materials etc.)
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Nurses can assist the parents inpreparing the child for hospitalization
byRead stories about the experienceTalk about going to the hospitalEncourage child to ask questions/ draw
picturesVisit hospital beforehandPlan hospital stay/routine as much aspossibleBe honest
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FIGURE 172 The childs anxiety and fear often will be reduced if the nurse explains what is going to
happen and demonstrates how the procedure will be done by using a doll. Based on your experience,
can you list five actions you can take to prepare a school-age child for hospitalization?
Jane W. Ball and Ruth C. BindlerChild Health Nursing: Partnering with Children & Families
2006 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458All rights reserved.
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Siblings
Inform siblings about their brother/ sisters
condition (using age-appropriate language
and concepts at their developmental level)
Encourage siblings to visit (as appropriate)
Discuss what to expect before the visit w/
the child, then f/u on how they are feeling
after.
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ROLE OF NURSE
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IN INFANTS
CONTROLON SEPARATION
ATTENTION AND APPROPRIATE HANDLING
TOYS
ROOMING IN AND PLAY
MAINTAIN HOME ENVIRONMENT AND
ROUTINE PROVIDE LOVE AND TOUCH
TRUSTING RELATIONSHIP AND SECURITY
IN TODDLERS
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PRESCHOOL CHILDREN
PARENTRAL PRESENCE AND PARTICIPATION IN
CARE
PRIVACY AND CO OPERATION
EXPLANATION ACCORDING TO LEVEL OF
UNDERSTANDING
PROVIDE OPPORTUNITY TO VERBALIZE
FEELINGS
DO NOT IMPOSE NEGATIVE FEELINGS
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SCH0OL AGE CHILDREN
ELECTIVE HOSPITALIZATION
PRIVACY
EXPLAIN THE PROCEDURE ENCOURAGE THE CHILD TO MAINTAIN SELF
CARE
ASSIST THE CHILD TO COPE WITHHOSPITALIZATION
PARENTRAL PARTICIPATION
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ADOLESCENTS
PLANNED HOSPITAL ADMISSION
ORIENTATION TO HOSPITAL ROUTINE
THOROUGH NURSING HISTORY MAINTAIN PRIVACY
PROVIDE OPPORTUNITIES FOR RECREATION,
PEER RELATIONSHIP, INTERACTION WITHOTHER ADOLESCENT PATIENT AND
EXPRESSION OF FEELINGS
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Adaptation to Hospitalization
Preparation for Procedures
Psychological preparation
Using language the child understands
Physical preparation
Signed consent, pre-medicate
Performing the procedure Treatment room
St t i t P t C i d
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Strategies to Promote Coping and
Normal Development of the
Hospitalized Child
These strategies help to meet the
psychosocial needs of the
hospitalized childRooming in
Child Life Programs
Child life specialist
Therapeutic Play
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Professional Practice Standards for
Pediatric Nursing Practice
Collecting health data
Analyzing the assessment data indetermining diagnoses
Identifying expected outcomes individualizedto the child and family
Developing a plan of care that prescribes
interventions to attain expected outcomes Implementing the interventions identified in
the plan of care
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Adaptation :Nursing strategies
Welcome to family and child during each
nursing intervention
Call by name and touch gently
Explain the procedure
Ask for co operation and its benefit
Encourage to express the feelings, allow toverbalize and answer the question
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Demonstrate the interest and empathy to the
child and family members
Explain and reason out unpleasant experience
Discuss about cultural and religious pattern
Allow parents to participate in care Maintain privacy, minimize exposure, and
gentle handling of the child
Physical comfort during each procedure Take opinion of parents in decision making
Maintain eye contact during conversation
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Use diversional activities during therapy
Use retrains
Skilful and confident approach. patience,
tenderness and emotional strength
Protect from physical injuries and infection
Assure the confidentiality of the information
Never give negative statements
Praise the child for co operation
Establishment of rapport and friendly
approach
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PREPARATION FOR SURGERY
A childs surgical experience can be
elective, planned in advance, or a
result of an emergency or trauma.
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PREOPERATIVE CARE
Psychosocial Preparation The goal of preoperative teaching is to reduce the
fear associated with the unknown and decrease
stress and anxiety associated with surgery.
Physical Preparation Preoperative procedures and guidelines vary among
hospitals and outpatient surgical centers.
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POSTOPERATIVE CARE
Postoperative care of the child
includes both physical andpsychologic care.
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PREPARATION FOR LONG-TERM CARE
Home care with support services
such as visiting nurses and physical
therapists A long-term care facility
A specialized rehabilitation centerthat can provide care for an
extended period
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PREPARATION FOR HOME CARE
The nurse works with the social service
department, home agencies, and family to
plan for equipment, procedures and other
home care needs.
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ASSESSING THE CHILD IN PREPARATION FOR
DISCHARGE
When a child is to be discharged home,
the school district should be contacted
and plans for education made.
This involves an assessment of the child
by the school district and formulation of
an individualized education plan (IEP).
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PREPARING THE FAMILY FOR
HOME CARE
Family may
need to learn
physical and
rehabilitative
procedures forthe childs care.
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CONCLUSION
So do children, but their level of psychosocialdevelopment may make some aspects of thehospital experience particularly difficult forthem. For one thing, children are less able
than adults to influence and understand whatis happening to them.
The experience of being hospitalized isdistressing for children of all ages, but thereasons for their distress tend to change asthey get older .
Nursing sick children is quite challenging.
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THANK YOU FOR LISTENING