Child's Experience of Hospitalization - Chapter 21

Chapter 21: The Child's Experience of Hospitalization

• The chapter focuses on the child's experience during hospitalization.
• Key objectives include defining key terms, identifying various healthcare settings, describing stages of separation anxiety, strategies to lessen parental stress, understanding psychosocial milestones impacting adjustment to hospitalization, managing pain, and discharge planning.
• Healthcare delivery settings include acute care hospitals, extended care facilities, urgent care centers, outpatient clinics, pediatric research centers, outpatient surgery centers, and home healthcare.
• Types of children requiring preparation for treatment or procedures include infants, toddlers and preschoolers, school-aged children, and adolescents.
• Separation anxiety is a common response to hospitalization, occurring in infants 6 months and older with the most pronounced symptoms in toddlers. This response progresses through protest, despair, and denial/detachment stages.

Lesson 21.1 Objectives

• Define key words related to child hospitalization.
• Identify health care settings.
• Describe the three phases of separation anxiety in children.
• Discuss two parental stress reduction methods in hospitalization.
• Discuss how preschool developmental milestones affect hospitalization adjustment.

Health Care Delivery Settings

• Acute care hospital
• Extended care facility
• Urgent care center
• Outpatient clinic
• Pediatric research center
• Outpatient surgery center
• Home healthcare

Preparing the Child for a Treatment or Procedure

• Infants
• Toddlers and preschoolers
• School-aged children
• Adolescents

Separation Anxiety

• Occurs in infants 6 months and older.
• More pronounced in toddlers.
• Three stages: protest, despair, denial/detachment

The Child's Reaction to Hospitalization

• Factors influencing reaction: age, amount of preparation given, security of home life, previous hospitalizations, support of family and medical personnel, child's emotional health.
• Stressors: separation, pain, fear of body intrusions

Fear

• Intrusive procedures are fear-provoking.
• Disrupts the child's trust level.
• Threatens self-esteem and self-control.
• May require activity restrictions.

Regression

• Loss of achieved functioning to earlier developmental stages.
• Minimized by accurate nursing assessments and care planning to support growth.
• Praise motivates appropriate behavior after stress is removed.

Lesson 21.2 Objectives

• Discuss pain management in infants and children.
• Discuss the importance of language interpreters in healthcare.
• Identify problems facing siblings of hospitalized children.
• Interpret clinical pathways for hospitalized children.

Pain

• Children may refrain from reporting pain due to fear of injections.
• Infants assessed using behavior scales.
• Toddlers' crying may stem from anxiety/fear, not solely pain.
• All pain factors must be considered.

Managing Pain

• Non-pharmacological techniques: drawing, distraction, imagery, relaxation, cognitive strategies, backrubs/hand massage.

Response to Drugs

• Drug elimination may be prolonged due to immature liver enzyme systems.
• Dosages influenced by weight and differences in absorption, metabolism, and clearance.

Drugs Used for Pain Relief

• Adequate pain relief allows patients to focus on their surroundings.
• Inadequate pain relief may focus the child solely on pain.
• More effective pain relief at lower doses given around the clock (preventive pain control).

Conscious Sedation

• IV drugs impair consciousness while maintaining airway reflexes and physical/verbal responsiveness.
• 1:1 nurse-patient ratio until stable vital signs, appropriate motor/verbal skills, adequate hydration, and pre-sedation level of responsiveness/orientation are reached.

Language Interpreters

• Improves communication between parents and healthcare team members.
• Family members should not be used.
• Healthcare settings legally required to provide language interpreters at no charge.

Cultural Response

• Cultural sensitivity decreases anxiety.
• Effective utilization & compliance enhanced when nurse's approach is compatible with cultural needs & beliefs.
• Nonverbal cues & body language important in intercultural communication.

Intercultural Communication and Responses to Hospitalization

• Consideration of personal space for various cultures is necessary.
• Understanding of acceptable smiling, eye contact, and touch within different cultural contexts.
• Nurses must take time to familiarize themselves with culturally acceptable behaviors.

The Parents' Reactions to the Child's Hospitalization

• Parents may express feelings though anger, crying, or body language.
• Parents' behaviors affected by early childhood experiences.
• Understanding parent's issues critical for successful care of pediatric patients.
• Poor communication can cause unnecessary fear.

The Nurse's Role in Hospital Admission

• Must be prepared to meet emotional needs of the child and parents.
• Parents should provide matter-of-fact approach to the experience.
• Avoid excessive detail about procedures to minimize anxiety.

Lesson 21.3 Objectives

• Contrast problems of preschool and school-age children with hospitalization.
• Identify strengths of adolescents that nurses should consider in developing care plans.
• Recognize discharge planning steps for infants, children, and adolescents.

Meeting the Needs of the Hospitalized Child

• Hospitalization can be frustrating.
• May miss continuous parental affection.
• Daily routines disrupted.
• Assisting parent-child attachment and promoting sensory activities is critical.
• Liberal visitation & caregiver consistency are important.

Adjustment to Illness

• Adolescents can understand disease implications and participate in care decisions.
• Nurses encouraging participation promote adolescent confidence.

Roommate Selection

• Adolescents usually benefit from single or shared rooms.
• Avoid placing senile or infant patients with adolescents.
• Room location is important.

Confidentiality and Legality

• Define clear confidentiality parameters during initial meetings.
• Emancipated minors no longer under parental authority.
• Understanding of state laws regarding confidentiality critical when dealing with adolescents.

Discharge Planning

• Starts at admission.
• Provide written instructions for home treatments.
• Prepare parents for potential behavioral issues after discharge.

Guidance for Parents

• Anticipate clinging and regression behaviors.
• Support child's participation in family life.
• Focus on the child, not the illness.
• Be kind, firm, and consistent with bad behaviors.
• Build trust through truthfulness.
• Allow time for play.

Legal and Ethical Considerations

• Discharge charting should include who accompanied the child, time of discharge, condition, method of transport, vital signs, weight, medications, and instructions to parents.

Home Care

• Acute or chronic conditions treated are often cared for at home.
• Family support by community health care agencies needed in such cases.
• Respite care available for primary caregivers.