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Nursing Care of the Hospitalized Child Importance of Effective Communication with Children More than words Touch Physical proximity and environment Listening with impartiality Visual communication Tone of voice Body language Timing Establishing rapport with the family Being open to questions/resolving conflict Developmental milestones and approach to communication Infants Toddlers (0-12 mo) (1-2 yr) Preschoolers School-age (3-5 yrs) (6-11) Adolescents Use of calm voice; respond to cries, mimic baby sounds, talk and read regularly, use a slow approach and allow time to get to know you Seek opportunities to offer choices, use play for explanations, simple sentences, picture books, puppets, be concise; limit length of explanations Engage in conversations about their interests, use of videos to explain, foster independence, preparatory materials up to 1 wk in advance, respect privacy needs Learn the toddler’s words for common items, picture books, respond to their receptiveness, preparation should occur immediately before event Photos, books, videos; est. limits, use play, introduce preparatory materials 1-5 days in advance of the event (12 and older) Stages of Separation Protest Despair Detachment Family Responses to hospitalization Their perception Support mechanisms available Coping mechanisms Support and coping mechanisms that determine family’s responses Communication strategies Finances, friends Separation from other children: who helps out? Their ability to “disengage” from other responsibilities Coping is developed from past experiences **Most common reaction to child’s illness may be disbelief Nursing measures to assist the family Teaching (relieves fear of unknown) Orientation to the hospital routine Communication regarding how they may help Environmental consideration in a healthcare setting Safe place Playroom Patient’s room Treatment Room/end of crib Senses: lighting, sound, temperature, smells Dynamics: designate one person to direct/encourage Medical play Types of facilities Hospital Medical/surgical units ICU Rehab Outpatient/day facilities 24 hr observation units School-based clinics Community clinics Home Care Hospital Admission Taking the history Physical Exam Initial inspection Baseline data Family dynamics Factors Affecting a Child’s Response to Illness and Hospitalization Age/cognition Parental response Coping skills of family/child Preparation of child/family Hospitalization can be a positive factor ! Critical to remember ! Child’s response to Illness Fear of the unknown Separation anxiety Fear of pain or mutilation Loss of control Anger Guilt Regression Stressors by developmental age **separation anxiety Nurses experience protest and despair in this group Fear of injury and pain Loss of control Need contact with mother Infants/Toddlers Stressors by developmental age Preschooler Separation anxiety generally less than the toddler Less direct with protests; cries quietly May be uncooperative Fear of injury Loss of control Guilt and shame Stressors by developmental age School age Separation: may have already experienced when starting to school Fear of injury and pain Loss of control Stressors by developmental age Adolescence Separation from friends rather than family more imp Fear of injury and pain Loss of Control Creating Partnerships with Families of Children with Special Healthcare Needs CSHCN: Children with Special Health Care Needs Defined as those with elevated risk for chronic physical, developmental, behavioral or emotional conditions CSHCN, cont. About 13% of the children Account for 65-80% of all pediatric healthcare expenditures Goals: accessing the resources available! CSHCN, cont Care differs from other children: Requires more info about the family Family does most of the care Involves many systems and people Balance condition r/t needs with general wellbeing of the child CSHCN, cont. “ending on a happy note” Share the joys of focusing on the child’s growth and development Support and encourage the parents Empower families to regain control of their lives Engage in authentic communication Support strengths of families Advantages of play to the hospitalized child Therapeutic Emotional outlet Teaches Enhances cooperation Dealing with Difficult Families Remember that the child, and the family bring “baggage” Child: fear, expectations and ?? Parent: preexisting dynamics and communication styles, finances, coping styles How to deal with the “baggage” Claiming potential baggage Bring the “good baggage”: competency, calmness, caring, tolerance, openness Flexibility by all members of the team Avoiding the negative baggage COPE Managing pain in the hospitalized child According to age which technique is best Types of techniques: Behavioral distraction Assorted visuals Breathing techniques Comfort measure Diversional talk Management of pain, cont. Understand type of assessment findings in each age group PAIN IS WHAT THEY SAY IT IS! All pain should be investigated Nursing interventions to assist the child in pain Understand the misconceptions about pain Assess: hx, culture, developmental response, scales (FACES, FLACC, CRIES)) Always evaluate effects of medications administered Sedation used for procedures Non-pharmacologic measures to relieve pain Elevation of the affected part or extremity Ice or heat when indicated Reposition the client/injured part for comfort Diversional therapy when indicated (board games, video games, cards, etc.) The End!