Nursing Considerations for Hospitalized Child

Chapter 40

Effects of illness and hospitalization on children and families

Children’s 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.

Effects of illness and hospitalization on children and families

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.

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

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

Effects of illness and hospitalization on children and families

TODDLERS AND PRESCHOOLER Toddlers and preschooler are beginning to understand 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.

Effects of illness and hospitalization on children and families

SCHOOL-AGE CHILD Older children have a more realistic understanding 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.

Effects of illness and hospitalization on children and families

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.

Adaptation to hospitalization

SPECIAL UNITS AND TYPES OF CARE Emergency care Intensive care Preoperative and post operative areas Short stay units Isolations Rehabilitation

Strategies to promote coping and normal development

Child life program Roaming-in Therapeutic play

Strategies to promote coping and normal development

Therapeutic playInfant and toddlers Play is important for toddlers Through play they explore environment and learn to identify with significant

people in their lives.

Preschooler The nurse can intervene to reduce the stress produced by

preschooler’s fears through the use of some kind of play. Playing with safe hospital equipment may help preschoolers

to work through feeling such as aggression.

Strategies to promote coping and normal development

Therapeutic PlaySchool-age child School-age children often regress developmentally during

hospitalization demonstrating behaviors characteristic of an early states as separation anxiety and fear of body injury.

Strategies to promote coping and normal development

Therapeutic RecreationAdolescents do need a planned recreation program to help them meet developmental needs during hospitalization.

Physical activities that provide an outlet for stress are recommended.

Give teenagers choices to assist them in regaining control.

Strategies to meet educational needs

Parents, teachers, school nurse and other care providers may need to plan together to meet child’s educational needs and to establish an individualized education plan.

The social aspects of school and peers should be considered. Maintain the child’s and family’s privacy by discussing with

them the information needed by others and obtaining written permission before disclosing any information.

Preparation for procedures

Special techniques can help child to understand and cope with feelings about procedures.

Preparation for surgery

A child’s surgical experience can be elective, planned in advance, or a result of an emergency or trauma.

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.

Postoperative care

Postoperative care of the child includes both physical and psychologic care.

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 center that can

provide care for an extended period

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.

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).

Preparing the family for home care

Family may need to learn physical and rehabilitative procedures for the child’s care.

Preparing parents to act as case managers

Case manager – coordinate healthcare and to prevent gaps and overlaps.

Saint Bernadette College of Health and Sciences

*SLIM*