Psychosocial and Physical Aspect of the

Care of the Child in Critical Care

"[i]nterruption of the unique parent-child relationship is more stressful to parents than the physical aspects of the PICU environment"

Martha Curley (nurse

researcher)

Psychosocial Care 3 sets of care practices that influence

survival, growth and development of children:

- Social - Emotional - cognitive interactions between caregivers and

children

Psychosocial Environment

1.Provide a nonthreatening environment2.Determine support people and

resources available to the child3.Assess responses of the support

people4.Be supportive of child’s effective

coping behaviors

Psychosocial Skills (of the nurse)

A.Communication skills and behavioral assessment techniques-Establish trust with the child and family-Demonstrate sensitive interaction with the child-Recognize the different parameters of the behavioral cues of children

HEALTHY CHILD CRITICALLY ILL CHILD

POSTURE moves, flexes Loose, flaccid

GESTURES Turns to familiar voices Responds slowly to familiar voices

MOVEMENT moves purposefully moves toward new, pleasurable items moves away from threatening items, people

Minimal movementLethargy, unresponsive

REACTIONS/COPING STYLE responds to parents coming, leaving Responds to environment, equipment Cries and fights invasive procedures

Responds minimallyDisplays minimal defensive responses

FACIAL EXPRESSIONS looks at faces, make eye contact Changes facial expression in response to interactions Blinks in response to stimuli Widens eye with fears

May not track faces, objectsAvoids eye contact, minimal response to interactionsDrools, has loose mouth musculature

Contrasting Affective Nonverbal Behavior Cues of the Healthy and Critically ill Child

2. Family-centered Care

- involve parents in assessing the child’s level of comfort or in scheduling daily activities for the child

- Family is the “constant” in the child’s life

PICU must provide multidisciplinary definitive

care for a wide range of complex, progressive, and rapidly changing medical,

surgical, and traumatic disorders occurring in

pediatric patients of all ages, excluding premature

newborns.

Physical Environment

1.Planning a designated area

-A specific area in the ICU should be designated and designed for the care of the child and family.-Separate pedia and adult patients

2. Family support areas-Should be in close proximity to the pedia unit

3. Pediatric supply cart- Facilitate bedside equipment for easy access

Physical Assessment Skills:

1.Interpreting vital signs based on age-appropriate norms (HR, RR, BP)

-Baseline parameters are the most useful and are obtained at rest or during sleep

-It is important to compare the child’s vital signs not only to the age-appropriate norms but also to the present clinical condition.

2.Modifying assessment techniques on the anatomic and physiologic differences and similarities of the child

- Pediatric assessment: airway/breathing, circulatory, neurologic, gastrointestinal, renal, endocrine, immunologic, pain and agitation

3. Recognizing the decompensating child using a quick examination

approach (Wong-Baker faces)

THANK YOU!

- LOURDES DIZON -