Evidence-based Practice

Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care

www.qsen.org

1

Who is Betty Neuman’s “Client”?

An individual, a family, a group or a community.

Continuous exchanges between the client system and the environment

The model is Wholistic—looks at all aspects of the client’s five key variables and how each impacts and is impacted by the other.

2

The Client System According to Neuman

Physiological Developmental

Spiritual

Socio-culturalPsychological

Stressor

Resource

3

How can we apply NSM to family?

Family as core What are family strengths?

(FLD) Individual systems as

Stressors Resources

4

What makes a family healthy?

5

What are risk factors to a family’s health?

6

Potential ND for families

Decisional conflict Compromised family coping Disabled family coping Ineffective family Therapeutic

regimen management Interrupted Family processes Readiness for enhanced Family

Coping

7

Stressors of Hospitalization

Fear Separation – family & peers Feelings of loss of control Regression common

8

Infant & Toddlers

Separation anxiety (6-30 months)3 phases

Protest:

Despair:

Detachment:

9F

Toddlers

React to any intrusive procedure the same

Developing autonomy Rituals and routines

10

Preschool

Less obvious separation anxiety

Fears mutilation Literal interpretation of words Like familiar routines & rituals Magical thinking

11

School-Age

Some separation anxiety Fears:

Body disability & death Dependence /loss of control

Ask relevant questions Understand cause and effect

12

Adolescent

Separation Body & body image Control important

13

Playroom

A safe area NO Intrusive procedures Not for administering

medications. Therapeutic Play

14

Risk for Falls

Who’s at risk? “Humpty Dumpty”

®assessment tool Individualized plan of care

4 siderails up not a restraint, it’s safety.

Communicate Educate

15

Risk for Impaired Skin Integrity Who’s at risk? (i.e. “risk factors”) Braden Q Scale

Mobility Activity Sensory Perception Moisture Friction-Shear Nutrition Tissue perfusion and oxygenation

16

Pain

Subjective and personal “an unpleasant sensory and emotional

experience… Associated with actual or potential

tissue damage” QSEN competencies on patient-

centered care: “Demonstrate comprehensive understanding of the concepts of pain and suffering, including physiologic models of pain & comfort.” (www.qsen.org)

17

Myths about Pain

Neonates do not experience pain.* Children have no memory of pain.* Correct amount of pain for a specific

injury or procedure* Parent’s exaggerate. Children tell you about pain. Children become addicted to

narcotics easier.* Narcotics cause respiratory

depression easier in children.*18

Influences on Pain Assessment

Previous experience with pain Developmental level

Ex: language ability Young infants: generalized

response – not able to localize. Type of pain – acute or chronic Parental response to child's pain

19

Behavioral Indicators

Restless, agitated

Difficult to distract

Irritability Facial grimacing Posturing

Drawing up knees

Anorexia Lethargy Sleep

disturbances

20

SpiritualitySpiritus

Meaning Value Transcendence Connecting Becoming

21

Spiritual Assessment

Religion: system of practices Culture – strong influence on

spirituality

Professional responsibility Collaborative

22

Spiritual Assessment of Children

Infant: sense of trust Toddler: rituals & routines Pre-school: concept of God concrete

family’s beliefs & customs important

School-age: good vs evil; help receiving love, hope, forgiveness

Adolescents: need for meaning & purpose in life.

Listen

23

Nursing Dx

Spiritual Distress Risk for Spiritual Distress Readiness for enhanced

Spiritual well-being

24

Chronic Illness

McKinney : a chronic illness or condition is one that is: long term Does not resolve spontaneously Usually without complete cure frequently has residual

characteristics that limit ADL &/or require adaptation or special assistance.

25

Needs of Family /Caregiver

Illness a family experience Reduce physical & emotional

burdens Provide knowledge & skill Resources for support Promote healthy coping Help prepare for impending

death 26

Caregiver role strain

Stages of caregiving http://www.alsa.org

Caregiver and care recipient at risk when caregiver overloaded.

27

Perception of Death: Infants & Toddlers

Lack understanding of concept

Greatest fear is separation No sense of time Reaction to loss of caregiver

28

Perception of Death: preschoolers

Death temporary & reversible Magical thinking Behaviors: Questions

29

Perception of Death: School-age

Death irreversible By age 10, universality Behaviors:

30

Perception of Death: Adolescent

Death irreversible, universal, inevitable

Personal, but distant Better understanding illness &

death Behaviors:

31

Nursing Care

Be available Personal beliefs & expectations Time & attention to the dying

child. Recognize need to talk Pain control, oral care, privacy Information Allow family members time

32

Children with Special Needs

Visual Impairment

Hearing Impairment

Language Aphonic

Neurologic impairment

Chronic illness Congenital

disability Developmental

delay or disability

33

Etiology

Hereditary- 5% Early embryonic alterations Early Intrauterine /neonatal

conditions Acquired childhood Environmental problems Unknown

34

35

Congenital Hypothyroidism

A deficiency of thyroid hormone present at birth.

Screening: 2-6 days after birth Untreated: severe mental

retardation. Primary prevention (of negative

outcome): lifelong thyroid supplements

36

F

Down Syndrome

Small square head Upward slant to eyes Flat nasal bridge Protruding tongue Hyperflexibility, muscle weakness Wide space between big & 2nd toes

37

Down Syndrome-higher incidence of:

Congenital heart malformations Frequent respiratory tract infections Thyroid disorders incidence of leukemia Atlantoaxial instability

38

Nursing Care

Early detection Developmental level Strengths vs. disabilities Support parents Encourage socialization Appropriate therapy

39

Nursing Care

Promote optimal growth & development

Behavior modification program Anticipatory guidance

40

Safety Concerns

Poor short-term memory Learn at a slower rate Physical problems w/mobility

41