Binal Joshi

INTRODUCTION
Hospitalization is an interruption of the childs active cycle of growth and development and his or her family's life cycle also. The child is removed from the daily routines of home life and contact with siblings, relatives and peers are limited. He or she may be required to experience strange and painful events and to communicate with strangers.

YOUR WORK IS VERY HARD BECAUSE YOU WANT ME TO GET WELL SOON. YOU CARE FOR ME AND MY FAMILY.
I CAN BE VERY DIFFICULT AT TIMES IAM AFRAID

Nursing care needs to be based on the most common psychosocial and physiologic alterations that applies the principles of growth and development, and respect and appreciation of the parents and family as partners in the care of their children.

EFFECTS OF ILLNESS AND HOSPITALIZATION ON CHILDREN AND FAMILIES

Childrens 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.

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.

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.

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.

THE HOSPITALIZED CHILD

Separation Anxiety!
Early Childhood
Protest Despair Detachment

Later Childhood
Loneliness Boredom Isolation

Attitude is everything!

The Effects of Hospitalization on the Child and the Family

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 Hospitalization
Parents
Tailor nursing care to familys 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.)

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

The childs anxiety and fear often will be reduced if the nurse 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 take to prepare a school-age child for hospitalization?
FIGURE 172

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

2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

 Siblings
Inform siblings about their brother/ sisters 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.

ROLE OF NURSE
Provide family centered care In neonates Provide continual contact between baby and parents with active involvement by rooming in and sensory motor stimulation as appropriate.

IN INFANTS
CONTROLON SEPARATION ATTENTION AND APPROPRIATE HANDLING TOYS

ROOMING IN AND PLAY MAINTAIN HOME ENVIRONMENT AND ROUTINE PROVIDE LOVE AND TOUCH TRUSTING RELATIONSHIP AND SECURITY

IN TODDLERS

PRESCHOOL CHILDREN
PARENTRAL PRESENCE AND PARTICIPATION IN CARE PRIVACY AND CO OPERATION EXPLANATION ACCORDING TO LEVEL OF UNDERSTANDING PROVIDE OPPORTUNITY TO VERBALIZE FEELINGS DO NOT IMPOSE NEGATIVE FEELINGS

SCH0OL AGE CHILDREN

ELECTIVE HOSPITALIZATION PRIVACY EXPLAIN THE PROCEDURE ENCOURAGE THE CHILD TO MAINTAIN SELF CARE ASSIST THE CHILD TO COPE WITH HOSPITALIZATION PARENTRAL PARTICIPATION

ADOLESCENTS
PLANNED HOSPITAL ADMISSION ORIENTATION TO HOSPITAL ROUTINE THOROUGH NURSING HISTORY MAINTAIN PRIVACY PROVIDE OPPORTUNITIES FOR RECREATION, PEER RELATIONSHIP, INTERACTION WITH OTHER ADOLESCENT PATIENT AND EXPRESSION OF FEELINGS

Adaptation to Hospitalization
Preparation for Procedures
Psychological preparation
Using language the child understands

Physical preparation
Signed consent, pre-medicate

Performing the procedure

Treatment room

Strategies to Promote Coping and Normal Development of the Hospitalized Child

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

Therapeutic Play

Professional Practice Standards for Pediatric 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

Adaptation :Nursing strategies

Welcome to family and child during each nursing intervention Call by name and touch gently Explain the procedure Ask for co operation and its benefit Encourage to express the feelings, allow to verbalize and answer the question

 Demonstrate the interest and empathy to the child and family members Explain and reason out unpleasant experience Discuss about cultural and religious pattern Allow parents to participate in care Maintain privacy, minimize exposure, and gentle handling of the child Physical comfort during each procedure Take opinion of parents in decision making Maintain eye contact during conversation

 Use diversional activities during therapy Use retrains Skilful and confident approach. patience, tenderness and emotional strength Protect from physical injuries and infection Assure the confidentiality of the information Never give negative statements Praise the child for co operation Establishment of rapport and friendly approach

PREPARATION FOR SURGERY

A childs 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 childs care.

CONCLUSION
So do children, but their level of psychosocial development may make some aspects of the hospital experience particularly difficult for them. For one thing, children are less able than adults to influence and understand what is happening to them. The experience of being hospitalized is distressing for children of all ages, but the reasons for their distress tend to change as they get older . Nursing sick children is quite challenging.

THANK YOU FOR LISTENING