Slide 1Slide 2Settings for CareCommon Stressors and Children’s Response to Hospitalization/IllnessInfantToddlersStages of SeparationPreschoolerSchool Age ChildAdolescenceSlide 11Children’s Understanding of HospitalizationFamilies Response to HospitalizationNursing Care to Assist the Child with HospitalizationInfant – Trust vs. MistrustOlder Infant / Toddler Autonomy vs. Shame and DoubtPreschooler – Initiative vs. GuiltThis pre-schoolers parents are taking the time to prepare her for hospitalization by reading a book recommended by the nurse. Such material should be appropriate to the child’s age and culture. Why do you think that having the parents read this material is valuable?School Age – Industry vs.School Age Child Allowing the child to dress up as a doctor or a nurse helps prepare the child for the hospitalization experience. This helps the child adjust to treatment, care, and the recovery process.The child’s 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?Some hospitals offer a special classroom and teacher for children undergoing a lengthy hospital stay, enabling them to remain current with their school work. The child who falls behind other students might not fit in when he or she returns to school or might be required to repeat a grade.Adolescent – Identity vs Identity DiffusionSlide 24Advantages of play to the hospitalized childTherapeutic Play TechniquesSlide 27Pet TherapyChildren with Special NeedsSlide 30Nursing Measures to Tailoring CarePreparationPreparation StrategiesThings Parents can do to Prepare ChildNursing Care to Assist Families to CopeIt is important to allow the parents to be a part of the child’s care. Reunite the family as soon as possible after surgery. This child has just undergone surgery and is in the post anesthesia care unit (PACU). Although the child’s physical care is immediate and important, remember that both the child and the family have strong psychosocial needs that must be addressed concurrently. It is important to reunite the family as soon as possible after surgery.Preparation for ProceduresUsing RestraintsChild Life SpecialistSlide 40Myths About PainPain AssessmentOucher ScaleFaces Pain ScaleConsequences of PainPain ManagementNon-pharmacological Pain ManagementPharmacologic Interventions for PainAdministering Analgesics to ChildrenNursing InterventionsSettings for CareSettings for CareHospital24-hour observationEmergency hospitalizationOutpatient and day facilitiesRehabilitative careMedical-surgical unitIntensive care unitSchool-based clinicsCommunity clinicsHomeCommon Stressors and Children’s Common Stressors and Children’s Response to Hospitalization/IllnessResponse to Hospitalization/IllnessFear of the unknownSeparation anxietyFear of pain or mutilationLoss of controlAngerGuiltRegressionInfantInfantAt about 6 months of age are At about 6 months of age are acutely aware of the absence of acutely aware of the absence of parent and become fearful of parent and become fearful of unfamiliar persons. unfamiliar persons. They can sense the anxiety their They can sense the anxiety their parents are experiencingparents are experiencingAccustomed to having basic needs Accustomed to having basic needs of food and sleep met by parent of food and sleep met by parent and constraints of hospitalization and constraints of hospitalization results in loss of needs being met. results in loss of needs being met.ToddlersToddlers**Separation **Separation anxietyanxietyNurses experience Nurses experience protest and despair protest and despair in this groupin this groupFear of injury and Fear of injury and pain pain Regressive behaviorRegressive behaviorStages of SeparationStages of SeparationPro test Despair DetachmentScreaming, crying, inconsolable Clinging to parents, pleading for parents to stayAgitated, temper tantrums, refuse to comply with careResists caregiversChild becomes hopeless and becomes quiet, withdrawn, apatheticSadness, depressionWithdrawal or complaint behaviorCrying when parents appearLack of protest when parents leaveAppearance of being happy and content with caregivers and other children. Close relationships not establishedIf parents reappear, child may ignore.PreschoolerPreschoolerSeparation anxiety Separation anxiety generally less than the generally less than the toddlertoddlerLess direct with Less direct with protests; cries quietlyprotests; cries quietlyMay be uncooperativeMay be uncooperativeFear of injuryFear of injuryLoss of controlLoss of controlGuilt and shameGuilt and shameSchool Age ChildSchool Age ChildSeparation: may have Separation: may have already experienced already experienced when starting to schoolwhen starting to schoolFear of injury and painFear of injury and painWant to know reason Want to know reason for procedures andfor procedures andLike being involved and Like being involved and wants to make choiceswants to make choicesAdolescenceAdolescenceSeparation from Separation from friendsfriends rather than rather than family more importantfamily more importantFear of altered appearanceFear of altered appearanceWill act as though not afraid when Will act as though not afraid when they really are.they really are.Give them some control to avoid a Give them some control to avoid a power strugglepower struggleChildren’s Understanding of Children’s Understanding of HospitalizationHospitalizationA child or adolescent bases their understanding of hospitalization on:Cognitive ability at various developmental stagesPrevious experiences with health care professionalsFamilies Response to Families Response to HospitalizationHospitalizationHospitalization is disruptive to the family’s usual routinesMay lead to change in rolesFamily members are anxious and fearfulNursing Care to Assist the Nursing Care to Assist the Child with HospitalizationChild with HospitalizationRelated to AgeRelated to AgeInfant – Trust vs. MistrustInfant – Trust vs. MistrustEncourage parent to visit / rooming inEncourage parents to participate in care, Teach parents procedures they are capable of doingDiscuss arrangements for care of other family at