Download decreases the child`s exposure to stressful

What is, “Atraumatic Care”
• Therapeutic care that minimizes or eliminates the psychological and
physical distress experienced by children and their families in the
health care system
• Provide nursing care that decreases the child’s exposure to stressful
situations and prevents or minimizes pain and bodily injury.
• Guiding children and their families through the health care
experience using a family-centered approach by:
• promoting family roles
• fostering family support of the child
• providing appropriate information.
• Pediatric nurses must be vigilant for situations that cause
distress and therefore must be able to identify potential
stressors
What is, “Atraumatic Care”
•Therapeutic communication
•Goal directed
•Focused and purposeful
•Therapeutic play
•Provides emotional outlet or coping devices
•Child education
•Helps child understand the reason for the
hospitalization/procedures
Preventing/Minimizing Physical Stressors
• Utilize a child life specialist.
• Specially trained individual who provides programs to prepare
children for hospitalization and painful procedures
• Nonmedical prep for tests or procedures
• Therapeutic play
• Support during procedures
• Activities that support normal growth and development
• Advocates
• Grief and bereavement support
• ER interventions
• Hospital pre-admission tours and orientation
Common Procedures
•Intravenous lines
• Dehydration
• Fluid maintenance or replacement
• Before diagnostic testing
• Blood product placement
• Medication administration
• Preoperatively
• Types
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Peripheral line
Normal saline locks
Central venous access devices
Peripherally inserted central catheter line (PICC)
Vascular access port (Infus-A-Port)
• Monitor for signs and symptoms of infection: change in
temperature, erythema, edema, pain at IV site, tenderness on
palpation
Common Procedures (cont’d)
• Measuring intake and output
• Vomiting, diarrhea, fever, NG suctioning, draining wounds, burns, presurgical patients and
children with cardiac, renal or respiratory illness
• Calculation of daily maintenance fluid requirements
Weight
0–10 kg
11–20 kg
> 20 kg
Fluid Requirement
100 mL/kg of body weight
1,000 mL + 50 mL/kg for each kg > 10
1,500 mL + 20 ml/kg for each kg > 20
• Output is 1 to 2 mL/kg per hour
• X-ray exams
• Diagnostic purposes
• Checking tube placement
• Specimen collection
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Urine sample collection
Stool sample collection
Blood sample collection
Throat culture collection
Cerebrospinal fluid collection
Common Procedures (cont’d)
• Enteral tube feedings
• Orogastric feeding tubes
• Nasogastric feeding tubes
• Gastrostomy feeding tubes
• Ostomies
Common Procedures (cont’d)
• Restraining the child
• May be necessary to ensure safety during procedure or to prevent injury
to operative site
• Inform parents and child why restraint is necessary
• Extremity is checked every 15 minutes for first hour after initial application
• Child must be checked and skin condition documented every 1–2 hours
• Physical restraint
• Elbow restraint
• Papoose restraint
• Pharmacological restraint
• Chloral hydrate (Aquachloral)
Preparing Children for Procedures
• Explaining procedures
• Preparing an infant, toddler, preschooler, school-age child,
and adolescent for procedure
• Distraction
• Environment
• Preparing the parent
• Use developmentally appropriate words
Informed Consent
• Provides patient with necessary knowledge to make
decision regarding health care
• Implies that person understands benefits and risks of
treatment or refusal of treatment
• Legal age is required
• Required before diagnostic procedures, medical
treatments or surgical procedures, immunizations, or
any treatment with inherent risks
Preventing/Minimizing Physical Stressors
•Minimize physical distress during procedures.
•Use positions that are comfortable to the
child.
•Therapeutic hugging
•Use distraction methods
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Have the child point toes inward and wiggle them.
Ask the child to squeeze your hand.
Encourage the child to count aloud.
Sing a song and have the child sing along.
Point out the pictures on the ceiling.
Have the child blow bubbles.
Play music appealing to the child
Before the Procedure
• Decrease anxiety (to whom???)
• Promote child’s cooperation
• Support family
• Improve coping skills
• Improve recovery
• Increase trust
During the Procedure
• Use a firm, confident, and positive approach gives
family a sense of security
• Allow child to express anxiety and feelings (almost all
behavior is acceptable)
• Toddlers and Preschoolers will resist despite the best
prep –
• BEING HELD DOWN OR RESTRAINED IS
TRAUMATIZING TO THE VERY YOUNG
• Older-distraction might help
After the Procedure
• Hold and comfort child
• Cuddle and soothe baby
• Distract with toy or puppet – get the kid to play!
• Provide older child to express feelings and be
comforted if they want
• REMEMBER: praise child regardless of response!
General guidelines for preparing a child for a
procedure, before, during, and after the
procedure.
• Any invasive
procedures should
be performed in a
treatment room, not
the child's room,
which should remain
a safe and secure
area.
Focus of Family-Centered Care
(the American Academy of Pediatrics)
• Respect for the child and family
• Recognition of the effects of cultural, racial, ethnic, and
socioeconomic diversity on the family’s health care
experience
• Identification of and expansion of the family’s strengths
• Support of the family’s choices related to the child’s health
care
• Maintenance of flexibility
• Provision of honest, unbiased information in an affirming and useful
approach
• Assistance with the emotional and other support the child and family
require
• Collaboration with families
• Empowerment of families
Positive Outcomes of Family-Centered Care for
Children
•Anxiety is decreased.
•Children are calmer and pain management is
enhanced.
•Recovery times are shortened.
•Families’ confidence and problem-solving skills are
improved.
•Communication between the health care team and
the family is also improved.
•A decrease in health care costs is seen.
•Health care resources are used more effectively.
Providing a Sense of Control for the
Hospitalized Child
•Provide effective communication and teaching.
•Find a balance between neutral and affective
communication.
•Use verbal communication and nonverbal
communication.
•Use developmental techniques for
communicating with children.
•Assist family to obtain necessary information and
resources.
Communication and teaching
• Open-ended questions that don’t restrict
• Redirect the conversation to maintain focus
• Use reflection to clarify parent’s feelings
• Paraphrase
• Acknowledge emotions
• Demonstrate active listening, using the child’s own words
• Non-verbal
• Relax, allowing time
• Eye contact
• Demonstrate active listening
The Child’s Culture
•Understanding and respecting the child’s culture
helps foster good communication and improves child
and family education about health care.
•Assess each family's beliefs and practices by asking
questions and listening.
•List of examples of appropriate interview questions
for assessing a child's culture.
Working With an Interpreter
• Help the interpreter prepare and understand what needs to be done
ahead of time.
• The interpreter is the communication bridge, not the content expert;
the interpreter’s timing may not match that of others involved.
• Speak slowly and clearly; avoid jargon.
• Pause every few sentences so the interpreter can translate your
information.
• Talk directly to the family, not the interpreter.
• Give the family and the interpreter a break.
• Express the information in two or three different ways if needed.
• Use an interpreter to help ensure the family can read and understand
translated written materials.
• Avoid side conversations during sessions.
• Remember that just because someone speaks another language, it
doesn’t mean he or she will be a good interpreter.
• Do not use children as interpreters.
Goals of Child and Family Education
•Improve the child and family’s health literacy
•Encourage communication with physicians or nurse
practitioners
•Improve health outcomes and promote healthy
lifestyles
•Encourage involvement of child and family in care
and decision making about care
•Improve compliance with care and treatment plan
•Promote a sense of autonomy and control
Specific Learning Principles Related to
Parents
•Adults are self-directed.
•Adults are problem focused and task oriented.
•Adults want an immediate need satisfied.
•Adults value past experiences and beliefs.
Questions Appropriate to Ask When
Performing a Cultural Assessment
•Who is the person caring for the child at home?
•Who is the authority figure in the family?
•What is the social support structure?
•Are there any special dietary needs and concerns?
•Are any traditional health practices used?
•Are any special clothes or other items used to help
maintain health?
•What religious beliefs, ceremonies, and spiritual
practices are important?
Making Child and Parents Knowledgeable
•Families need to be knowledgeable about such
things as their child’s condition, the health care
management plan, and when and how to contact the
physician or nurse practitioner in order to participate
fully in making health care decisions
•To provide atraumatic care to children, pediatric
nurses must focus on teaching goals and begin
teaching at the earliest opportunity.
Components of
Learning Needs
Assessment
Red Flags Indicating Poor Literacy Skills
•Difficulty filling out forms
•Frequently missed appointments
•Noncompliance and lack of follow-up with treatment
regimens
•History of medication errors
•Responses such as “I forgot my glasses” or “I’ll read
this when I get home”
•Inability to answer questions about treatment or
medicines
•Avoiding asking questions for fear of looking stupid
Helping Poor Literacy Skills
•Use pictures
•Use videos
•Color-coded medications
•Record audiotape
•Repeat verbal instructions and have them
repeat it
•Return demonstration
•Utilize a “back-up” family member-not the kid!
Techniques to Improve Learning
•Slow down and repeat information often.
•Speak in conversational style using plain
language.
•“Chunk” information and teach in small bites.
•Prioritize information and teach “survival
skills” first.
•Use visuals.
•Teach using an interactive, “hands on”
approach.
Evaluating Learning
•The child or family demonstrates a skill.
•The child or family repeats back or
teaches back the information in own
words.
•The child or family answers open-ended
questions.
•The child or family responds to a pretend
scenario in their home.
Documentation of Child and Family
Teaching
• The learning needs assessment
• Information on the child’s medical condition and plan of
care
• Goals of child education; date goal is met
• Teaching method used and how received by child and
family
• Medications, including drug–drug and drug–food
interactions
• Modified diets and nutritional needs
• Safe use of medical equipment
• Follow-up care and community resources discussed