Chapter 21: The Child's Experience of Hospitalization PDF

Chapter 21 The Child’s Experience of Hospitalization Copyright © 2019, Elsevier Inc. All rights reserved.  Lesson 21.1 Objectives 1. Define each key word listed. 2. Identify various health care delivery settings. 3. Describe three phases of separation anx...

Chapter 21 The Child’s Experience of Hospitalization Copyright © 2019, Elsevier Inc. All rights reserved.  Lesson 21.1 Objectives 1. Define each key word listed. 2. Identify various health care delivery settings. 3. Describe three phases of separation anxiety. 4. List two ways in which the nurse can lessen the stress of hospitalization for the child’s parents. 5. Describe two milestones in the psychosocial development of the preschool child that contribute either positively or negatively to the adjustment to hospitalization. Copyright © 2019, Elsevier Inc. All rights reserved.  Health Care Delivery Settings  Types  Acute care hospital  Extended or long-term care facility  Urgent care center  Outpatient clinic or office  Pediatric research center  Outpatient surgery center  Home Copyright © 2019, Elsevier Inc. All rights reserved.  Preparing the Child for a Treatment or Procedure  Infants  Toddlers and preschoolers  School-aged children  Adolescents Copyright © 2019, Elsevier Inc. All rights reserved.  Separation Anxiety  Occurs in infants age 6 months and older  More pronounced in toddlers  Three stages  Protest  Despair  Denial or detachment Copyright © 2019, Elsevier Inc. All rights reserved.  The Child’s Reaction to Hospitalization  Depends on  Age  Amount of preparation given  Security of home life  Previous hospitalizations  Support of family and medical personnel  Child’s emotional health  Stressors for children of all ages  Separation  Pain  Fear of body intrusion Copyright © 2019, Elsevier Inc. All rights reserved.  Fear  Intrusive procedures are fear provoking  Disrupts child’s trust level  Threatens self-esteem and self-control  May require restriction of activity Copyright © 2019, Elsevier Inc. All rights reserved.  Regression  The loss of an achieved level of functioning to a past level of behavior that was successful during earlier stages of development  Can be minimized by an accurate nursing assessment of the child’s abilities and the planning of care to support and maintain growth and development  When the child is free from the stress that caused the regression, praise will motivate the achievement of appropriate behavior. Copyright © 2019, Elsevier Inc. All rights reserved.  Lesson 21.2 Objectives 6. Discuss the management of pain in infants and children. 7. Discuss the importance of using a language interpreter in the delivery of healthcare. 8. Identify two problems confronting the siblings of the hospitalized child. 9. Interpret a clinical pathway for a hospitalized child. Copyright © 2019, Elsevier Inc. All rights reserved.  Pain  Children sometimes refrain from reporting pain for fear they will receive an injection.  Infants should be assessed according to a behavior scale.  In toddlers, crying may be caused by anxiety and fear rather than pain.  All factors related to pain should be considered. Copyright © 2019, Elsevier Inc. All rights reserved.  Managing Pain  Nonpharmacologic techniques  Drawing  Distraction  Imagery  Relaxation  Cognitive (thinking) strategies  Backrub or hand massage Copyright © 2019, Elsevier Inc. All rights reserved.  Response to Drugs  Elimination of the drug may be prolonged because of an immature liver enzyme system.  Dosages are influenced by weight and differences in expected absorption, metabolism, and clearance. Copyright © 2019, Elsevier Inc. All rights reserved.  Drugs Used for Pain Relief  Providing adequate pain relief enables patients to focus on their surroundings and other activities.  Inadequate pain relief causes the patient to focus on the pain and when more medications will be given to stop the pain.  More effective pain relief at lower dosages of the analgesic around the clock, referred to as preventive pain control. Copyright © 2019, Elsevier Inc. All rights reserved.  Conscious Sedation  The administration of IV drugs to a patient to impair consciousness but retain protective reflexes, the ability to maintain a patent airway, and the ability to respond to physical and verbal stimuli.  A 1:1 nurse–patient ratio is continued until there are stable vital signs, age-appropriate motor and verbal abilities, adequate hydration, and a presedation level of responsiveness and orientation. Copyright © 2019, Elsevier Inc. All rights reserved.  Language Interpreters  Improves communication between parents and health care team members  Should not use family members because of information “being lost in translation”  Health care delivery sites and providers are required, by federal law, to provide language interpreters at no charge to the patient or family. Copyright © 2019, Elsevier Inc. All rights reserved.  Cultural Response  Showing cultural sensitivity decreases anxiety.  Effective utilization of health care service and compliance with treatment plans are enhanced when the nurse’s approach is compatible with cultural needs and beliefs.  Nonverbal cues and body language are important in intercultural communication. Copyright © 2019, Elsevier Inc. All rights reserved.  Intercultural Communication: Responses to Hospitalization  Approaches to various cultures involve knowing what is and is not acceptable as it relates to  Personal space  Smiling  Eye contact  Touch  Focus  It is important for the nurse to take the time to become familiar with culturally acceptable behaviors. Copyright © 2019, Elsevier Inc. All rights reserved. The Parents’ Reactions to the Child’s Hospitalization  Parents may ventilate their feelings and stresses through anger, crying, or body language.  Behavior often involves attitudes resulting from early childhood experiences.  An understanding and acceptance of people and their problems is essential for the successful pediatric nurse.  Poor communication can result in unnecessary fear. Copyright © 2019, Elsevier Inc. All rights reserved.  The Nurse’s Role in Hospital Admission  Must be prepared to meet the emotional needs of those involved  Parents should try to be as matter-of-fact as possible about this new experience for their child.  It is not necessary to go into great detail with the child about what is going to happen because it may increase the child’s anxiety. Copyright © 2019, Elsevier Inc. All rights reserved.  Lesson 21.3 Objectives 10.Contrast the problems of the preschool child and the school-age child facing hospitalization. 11.List three strengths of the adolescent that the nurse might use when formulating nursing care plans. 12.Recognize the steps in discharge planning for infants, children, and adolescents. Copyright © 2019, Elsevier Inc. All rights reserved.  Meeting the Needs of the Hospitalized Child  Can be frustrating  May miss continuous affection of their parents  Daily schedules are disrupted  Major goal is to assist parent–child attachment process and promote sensorimotor activities  Liberal visiting hours are essential  Consistency in caregivers Copyright © 2019, Elsevier Inc. All rights reserved.  Adjustment to Illness  Can understand the implications of disease  Are capable of participating in decisions related to treatment and care  A nurse who recognizes these skills and encourages their practice helps the adolescent gain confidence. Copyright © 2019, Elsevier Inc. All rights reserved.  Roommate Selection  Adolescents usually do better with one or more roommates.  It is not a good choice to have a senile patient or infant as a roommate for an adolescent patient.  Location of adolescent’s room is important. Copyright © 2019, Elsevier Inc. All rights reserved.  Confidentiality and Legality  Many problems can be avoided if the confidentiality of the relationship is clearly defined during initial meetings.  An emancipated minor is no longer under the parents’ authority.  Be familiar with state law as it applies to adolescent patients. Copyright © 2019, Elsevier Inc. All rights reserved.  Discharge Planning  Ideally begins at the moment of admission to hospital  Written instructions should be given for any home treatments.  Parents also must be prepared for behavioral problems that may arise after hospitalization. Copyright © 2019, Elsevier Inc. All rights reserved.  Guidance for Parents  Anticipate behaviors such as clinging or regression.  Allow the child to become a participating family member as soon as possible.  Take the focus off the illness.  Be kind, firm, and consistent with misbehavior.  Build trust by being truthful.  Allow time for free play. Copyright © 2019, Elsevier Inc. All rights reserved.  Legal and Ethical Considerations  Discharge charting should include who accompanied the child (and identification given), time of discharge, behavior and condition of the child, method of transportation, vital signs and weight, medications, and instructions given to the parents or caregiver. Copyright © 2019, Elsevier Inc. All rights reserved.  Home Care  Children with acute or chronic conditions are cared for in the home.  Home health care and other community agencies work with the family to provide holistic care.  Respite care can be provided for the primary caregivers. Copyright © 2019, Elsevier Inc. All rights reserved.