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Child HealthChild HealthNursingNursing

Partnering withPartnering withChildren & FamiliesChildren & Families

Chapter 17Chapter 17

Nursing Care of the Nursing Care of the Hospitalized ChildHospitalized Child

Jane W. BallJane W. BallRuth C. BindlerRuth C. Bindler

Child Health Nursing: Partnering with Children & FamiliesBy Jane W. Ball and Ruth C. Bindler

© 2006 Pearson Education, Inc.Pearson Prentice HallUpper Saddle River, NJ 07458

Children’s Understanding of Children’s Understanding of Health and IllnessHealth and Illness

• Developmental Considerations– Infant

• Separation (highest age risk)• Stranger Anxiety (6-18 mos)

– Refer to Table 17-3: Stages of Separation Anxiety


• Developmental Considerations– Toddler

• Separation anxiety• Loss of self-control


• Developmental Considerations– Preschooler

• Regression (highest age risk)• Separation anxiety and fear of abandonment• Inability to distinguish fact/ fiction • Unable to understand reason for

hospitalization


• Developmental Aspects– School age

• Loss of control/ privacy

– Adolescent• Aware of the physiologic, psychologic and

behavioral causes of illness• Concerned with appearance• Separation from peer group

Stressors of Hospitalization for Stressors of Hospitalization for Children at Various Developmental Children at Various Developmental

StagesStages

• Refer to Table 17-2

Children’s Understanding of Children’s Understanding of Health And IllnessHealth And Illness

• Psychological Aspects– Infant

• Issues with attachment

– Toddler• Disruption of routine/ separation from parents

– Preschooler• Loss of self-control • Fear of dark • Injury


• Psychological Aspects– School-aged children

• Pain • Bodily Injury • Death

– Adolescents• Loss of control/ privacy• Fear of altered body image

The Effects of Hospitalization The Effects of Hospitalization on the Child and Familyon the Child and Family

• Children’s understanding of health and illness is primarily based on their cognitive ability at their developmental level

• Previous experiences with healthcare professionals

The Effects of Hospitalizaiton on The Effects of Hospitalizaiton on the Child and theFamilythe Child and theFamily

• Parents– Disrupt usual routine– Fears/ anxiety– Coping abilities (made more difficult if

lack of financial, community or family support)

• Siblings– Fears– Behavioral Disruption

Adaptation to Adaptation to HospitalizationHospitalization

• Parents– Tailor nursing care to family’s 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.)


• Siblings– Inform siblings about their brother/

sister’s 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.


• Scheduled Admission– Child/ parent

• Preparation– Tours– Play– Written visual material– Child Life– Talking with peers with similar experience

(adolescents)


• Refer to Box 17-4 (p 537): Nursing Considerations in Preparing Parents and Child for Planned Short-Stay Admission

Adaptations to Adaptations to HospitalizationHospitalization

• Nurses can assist the parents in preparing the child for hospitalization by…– Read stories about the experience– Talk about going to the hospital– Encourage child to ask questions/ draw

pictures– Visit hospital beforehand– Plan hospital stay/routine as much as

possible– Be honest

FIGURE 17–2FIGURE 17–2 The child’s anxiety and fear often will be reduced if the nurse The child’s anxiety and fear often will be reduced if the nurse explains what is going to happen and demonstrates how the procedure will be 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 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?take to prepare a school-age child for hospitalization?

Jane W. Ball and Ruth C. BindlerJane W. Ball and Ruth C. BindlerChild Health Nursing: Partnering with Children & FamiliesChild Health Nursing: Partnering with Children & Families

© 2006 by Pearson Education, Inc.© 2006 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458Upper Saddle River, New Jersey 07458

All rights reserved.All rights reserved.

FIGURE 17–3FIGURE 17–3 Jasmine’s parents are taking the time to prepare her for Jasmine’s parents are taking the time to prepare her for hospitalization by reading a book recommended by the nurse. Such material should hospitalization by reading a book recommended by the nurse. Such material should be appropriate to the child’s age and culture. Why do you think that having the be appropriate to the child’s age and culture. Why do you think that having the parents read this material is valuable?parents read this material is valuable?





• Unanticipated admission– Orientation to unit/environment

• Explain all of the procedures• Opportunities for parents/ child to express

fears• Stress-reduction methods


• Special units and types of care:– Short-stay unit– Outpatient unit– Ambulatory surgical unit– General pediatric unit– Emergency Departments– NICU/ PICU– Acute care or long-term rehabilitative

unit


• Nursing care focuses on providing family-centered care– Promoting the child’s and family’s

coping strategies to deal w/ hospitalization

– Promoting optimal development and safety

– Minimizing disruption of the child’s usual routine

Safety Measures for the Safety Measures for the Hospitalized ChildHospitalized Child

• Refer to Box 17-3

Nursing strategies to Improve the Nursing strategies to Improve the Illness/ HospitalizationIllness/ Hospitalization

Experience of Parents/ ChildrenExperience of Parents/ Children

• Various Practice Settings– Emergency Department

• Psychological considerations

– Same day surgery• Thorough discharge teaching instructions

Preoperative checklistPreoperative checklist

• Refer to Box 17-7

FIGURE 17–6FIGURE 17–6 This child has just undergone surgery and is in the post anesthesia This child has just undergone surgery and is in the post anesthesia care unit (PACU). Although the child’s physical care is immediate and important, care unit (PACU). Although the child’s physical care is immediate and important, remember that both the child and the family have strong psychosocial needs that remember that both the child and the family have strong psychosocial needs that must be addressed concurrently. It is important to reunite the family as soon as must be addressed concurrently. It is important to reunite the family as soon as possible after surgery.possible after surgery.






• Practice Settings– ICU

• Psychological considerations– Parental decision making/ involvement in care

– Hospital Care • Mediation administration

– Developmental considerations

Variations in Med Variations in Med AdministrationAdministration

• Refer to Table 17-6:– Oral– Rectal– Ophthalmic and otic– Topical– Intramuscular– Intravenous



• Hospital (con’t)– Educational needs

• Individual education plan (IEP)

– Teaching• Partnering w/ parents


• Preparation for Procedures– Psychological preparation

• Using language the child understands

– Physical preparation• Signed consent, pre-medicate

– Performing the procedure• Treatment room

Assisting Children through Assisting Children through proceduresprocedures

• Refer to Table 17-7:– Infant – Toddler– Preschool child– School-age child– Adolescent

Strategies to Promote Coping and Strategies to Promote Coping and Normal Development of the Normal Development of the

Hospitalized ChildHospitalized Child

• These strategies help to meet the psychosocial needs of the hospitalized child– Rooming in– Child Life Programs

• Child life specialist

– Therapeutic Play

Assessing the child and family Assessing the child and family in preparation for dischargein preparation for discharge

• Assess the family’s ability to manage the child’s care

• ? Any special adaptation to home environment/ or other facility

• Collaborate w/ parents to teach them treatment procedures and proper equipment use– Have family member demonstrate

proper care of equipment, and any procedures necessary

Professional Practice Standards for Professional Practice Standards for Pediatric Nursing PracticePediatric Nursing Practice

• Collecting health data• Analyzing the assessment data in

determining diagnoses• Identifying expected outcomes

individualized to 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