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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 -