The Child s Response to Illness Hospitalization Surgery Lecture 2 Review Concepts Developmental care Developmental versus chronological age want to make sure what that individual child needs Stages individual yet predictable Family centered care Stages of family development Family as client taking care of the entire family must meet their needs Siblings have a really hard time Atraumatic care looking at impact of hands on nursing care with the childs developmental level Cognizance of developmental impact Least traumatic care possible Deliver safe care Most preparation possible Family presence What Does Illness Hospitalization or Surgery meant to a child and family Acute versus chronic Acute child could be in ICU Chronic could be passed from the parents Age of onset is it the first born vs 3rd what is the age of child Cognitive level of child and parents Knowledge of condition Impact on abilities Duration Pain injury or changes in appearance Ability for parents and caregivers to meet child s needs Stressors coping Support systems Individualized Stress Response Major stressors Pain Bodily injury deformity involved Loss of control Separation of child from family or peer group Changes in behavior is child acting out Fear of unknown Patterns of coping how does the family cope How does illness hospitalization or surgery stress a child What affects their ability to cope put your mom shoes on then your nursing shoes Think beyond the child family Try to relate to your own family Family Stress Response Parents Fear Disbelief Guilt Anxiety Anger Depression very common response for family to go through Especially in mom age 25 35 Caregiver role strain beyond what they can handle stress wise Siblings are they jealous Guilty Wishing bad things to happen Altered family roles are the normal things no longer normal Suggested Nursing Interventions Provide information teaching health education give to families so that they have concrete information sit with them allow them to ask questions Encourage self family care and mastery Instill hope facilitate coping Encourage parent presence participation visitation rooming Set and encourage realistic goals Atraumatic care don t come at them with needles be careful to remember that kids fear the unknown Support and referral access resources Encourage independence Allow child to maintain some of routine Allow for freedom of movement More Nursing Interventions Provide developmentally appropriate play and activities Play as teaching tool teach child about what is going on around them Safe practice Manipulation of equipment Role play Play as diversion helps child get their mind off what is going on Play as an emotional outlet video games Play as a source of expression coloring drawing Play as a route for socialization play with other children Appropriate toys depending on age group what works best Preparing the Child For Hospitalization Tours of hospitals show where things are bathroom cafeteria play room Teaching to the senses what child will see hear feel smell and taste in the hospital Playroom bed safe places Taken to treatment room for blood lab work etc Using resources Child life specialists help pick dolls toys to use as teaching aids or therapeutic play helps child release and verbalize anxiety through play Preparing the Child for Surgery Informed consent parents make sure they understand all aspects of the surgery Psychological preparation Guidelines in Wong Cognitive preparation tool outlines resources Teaching to the senses Physical preparation atraumatic principles Decrease pain of an IV let them know what you are doing Family presence before and after surgery Sometimes child brings toy into surgery with them Care of the child having surgery Developmental Consideration Infants Period of trust vs mistrust they expect to see their mom if not you must be there for them Feeding Bonding Learn through sensorimotor experiences toys and diversion activities Dependency rapid change in physiological status tell mom what to look for Adjustment to parenthood learning baby care Pain restraint learn to recognize pain and how to restrain from injury Toddlers Autonomy vs shame and doubt Learn through sensorimotor experiences exploration and experimentation Independence milestones Mobility self care Separation anxiety they cant help but be scared of you Must do some care while they are sleeping Negative behavior Beginning of language cant quite communicate and we cant quite understand Pain immobility restraint they do not understand Preschoolers Initiative versus guilt Learn through preoperational thought magical thinking Body image sexual identity Master self care skills want to be able to do things for themselves yet it is limited Approval of authority unsure of nurse Peer relationships form some may be in isolation Discipline push the envelope Mutilation anxiety Pain and threats of bodily injury afraid of pain and any threat to body Explain give lots of info no lag time School Age Industry versus inferiority Learn through concrete operations Peers Schools Hobbies and collections Accomplishments Stage variations Puberty waiting and anticipating Fear of disability pain and death afraid that things wont work for them afraid of what lies ahead they do not understand that death is permanent Adolescent Identity versus role diffusion Learn through formal abstract thinking Personal sexual identity Independence Planning for future Peers peer pressure Self care contracting don t want you around Fear of pain body image changes injury and death based on perceptions of self Child With Special Needs Increasing abilities and decreasing the impact of disabilities Find out what they understand Supporting the family strength They are used to their family and normalization of their life Home care Normalization Mainstreaming Early intervention programs Critical thinking exercise child with chronic illness Parent Professional Partnerships Parents may be Silent in care want to know all the info but don t have much to say Recipients of care may not want to talk to you Monitors of care checking on you Managers of care want everything to be the way it is at home Know these phases early on they are silent and then they transition into managers as child has been sick for a while Key to family centered care Growth and Development Dynamic process that encompasses growth development maturation differentiation Interrelated dependent on a sequence of influences including endocrine genetic