ch 38: family centered care & hospitalization

Question 1

when children are stressed in a hospital, what tends to develop with the child to the parents?

Answer 1

separation anxiety

Question 2

what are the separation anxiety phases?

Answer 2

1. protest phase
2. despair phase
3. detachment phase
   Please Don’t Die

Question 3

what happens in the protest phase?

Answer 3

crying, screaming, & clinging to the parent

Question 4

what happens in the despair phase?

Answer 4

stops crying, shuts down to prevent stress, & evidence of depression

Question 5

what happens in the detachment phase?

Answer 5

• denial
• accepts situation, not content
• wants to be alone

Question 6

how do we avoid separation anxiety?

Answer 6

assigning the same nurses to the same patients

Question 7

what happens in early childhood when we avoid separation anxiety?

Answer 7

they can withstand many other stressors

Question 8

in late childhood and adolescence, who do they feel more separated from?

Answer 8

their peers, not their family
- the only exception is the first time in the hospital

Question 9

when infants feel a loss of control, what should we do?

Answer 9

• trust! they are going through trust vs mistrust
• care for the baby when crying
• console them: pacifier, takling, etc
• consistent caregivers
• having a daily routine

Question 10

what happens to infants when you let them “cry it out”?

Answer 10

it can slow down their development & develop mistrust

Question 11

when toddlers feel a loss of control, what should we do?

Answer 11

• given them autonomy: the choice in medications is HOW they want to take their medication, not not taking it
• daily routine & rituals

Question 12

if toddlers feel a sense of control loss, what would that lead to?

Answer 12

• regression
• negativity
• temper tantrums

Question 13

what is regression? (in terms of toddlers)

Answer 13

losing skills they recently gained (sleeping through the night, potty training) –> going back to an earlier stage of development

Question 14

what should we do when a toddler has temper tantrums? what is the most important thing?

Answer 14

safety is the most important thing
- wait it out because they will calm down
- some grow out of it, some don’t

Question 15

what are needs of preschoolers when they lose control?

Answer 15

• they have egocentric & magical thinking –> let them be involved & have choices
• might view illness/hospitalization as punishment –> let them be more comfy with frequent visit
• they have preoperational thought

Question 16

what are kids of school age needs if they lose control?

Answer 16

• independence & productivity
• they always want to do something, or else they will be bored

Question 17

in the school age, what do they usually fear?

Answer 17

• death
• abandonment
• permanent injury

Question 18

what might adolescents do if they feel they are losing control?

Answer 18

• feeling like they are struggling for independence & freedom (it amplifies in the hospital)
• feel separated from the peer group
• might respond with anger/frustration
• needs information about the illness

Question 19

if adolescents feel separated from their peer group, what might they do?

Answer 19

pick nurses that are younger to relate
- especially with male patients that pick someone attractive

Question 20

what are some individual risk factors that increase their risk of going to the hospital?

Answer 20

• difficult temperament: every child is diff & have diff types of consoling
• lack of fit between child & parent: especially with the same sex
• age 6 mo - 5 yo: more likely to get injured
• male gender
• below avg. intelligence
• multiple & continuing stresses

Question 21

what are some changes in the pediatric population that we can identify?

Answer 21

• more serious & complex problems
• fragility of newborns
• severe injuries
• increased survival w/technology
• more invasive & traumatic procedures
• increase length of hospital stay
• increase of non accidental traumas

Question 22

with an increase of severe injuries in the pediatric, what do we as nurses have to do now?

Answer 22

CPR on younger

Question 23

what is the most common cause of severe injuries in children?

Answer 23

1st: gunshots
2nd: motor vehicle accidents

Question 24

what are the benefits of hospitalization?

Answer 24

• safe haven
• recovery
• competence in coping
• mastery of stress
• new social experience

Question 25

when kids who have been in the hospital for awhile, what happens?

Answer 25

they have a different maturity level
- normal to strangers
- competent of their health

Question 26

how might parents react to their children having illness & being in the hospital?

Answer 26

• sense of helplessness
• lack of confidence in skills in the staff
• hard accepting that reality
• fear
• have uncertainty
• seeks reassurance

Question 27

how might siblings react to their siblings having illness & being in the hospital?

Answer 27

• may be too young to understand
• cared by non relatives or outside of home
• gets little information about sibling
• thinks their parents will treat their siblings differently

Question 28

how should we prepare kids for hospitization?

Answer 28

• prevent separation
• prevent parents absence
• minimize loss of control –> freedom of movement, child routines, independence
• prevent fear

Question 29

what is the role of child life specialist?

Answer 29

provides developmental activities
- diversional & expressive activities
- toys

Question 30

what does the nurse need to do in order to care for the family?

Answer 30

• support family
• provide info
• encourage parents to participate
• prepare for discharge & home care

Question 31

what can ambulatory or outpatients settings help families?

Answer 31

• minimizes stress from hospital
• reduces risk of infection
• increases cost savings
• more for surgical or diagnostic procedure

Question 32

what are some examples of ambulatory or outpatient settings?

Answer 32

• VA treatment for children
• transitional care unit: long term, rehab, complex, vented & trach
• nursing homes for children

Question 33

how can isolation affect children?

Answer 33

• stressor of hospital
• children limited understanding
• fear
• sensory deprivation
• environmental changes

Question 34

what is the most traumatic hospitalization?

Answer 34

emergency admission

Question 35

what do parents need when their children are in the ICU?

Answer 35

• emotional needs to be met
• more information