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373 Pediatrics > Children and Maltreatment > Flashcards

Children and Maltreatment Flashcards

1
Q

What is family?

A

“A group of people who want to be involved in each other’s lives and are therefore bound together by emotional ties and a sense of belonging.”

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2
Q

What is every family?

A
  • is a small social system
  • has its own cultural values and rules
  • has a structure and basic functions
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3
Q

Why is Family-Centered Care (FCC) so important in pediatrics?

A
  • Importance to always listen to families/parents – they know when something is going on with their children
  • Parents cope better if they are able to see what is going on, especially should the child not make it – harder to cope with finality if aren’t present
  • FCC is part of best practice
  • Recognizes the centrality of families to the well-being of hospitalized children
  • Acknowledges that hospitalization of a child affects the whole family
  • Promotes partnership: between family, child, health care providers
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4
Q

What are the 8 Key elements of FCC?

A

1) Family is the constant in a child’s life
2) Family and health care provider collaboration
3) Complete & unbiased information is provided in a supportive manner at all times
4) Honour cultural diversity, strengths and individuality within and across families
5) Recognize and respect different methods of coping and remain non-judgmental
6) Encourage/facilitate family to family support
7) Provide flexible, accessible and comprehensive care in response to family-identified needs
8) Appreciate families as families and children as children

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5
Q

What are some of the benefits of FCC?

A
  • Decreased stress for children and families
  • Increased adherence to plans of care
  • Improved child and family sleep & nutrition
  • Decreased disruption of family routines
  • Increased child and family satisfaction with care

Two outcomes = enabling & empowerment

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6
Q

What considerations are key when communicating to parents?

A
  • Encouraging parents to talk
  • Directing the focus
  • Listening and cultural awareness
  • Providing anticipatory guidance
  • Avoiding blocks to communication
  • Communicating through an interpreter
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7
Q

What are some of the standards for FCC?

A

Standard I: Supporting and Partnering with the child and their family

Paediatric Nurses partner with the child and their family to achieve their optimal level of health and well‐being leading to resilient families and healthy communities

Standard IV: Creating a child and family friendly environment

Paediatric nurses play an essential role in creating a child and family friendly environment that welcomes families and promotes hope and healing. It is understood that the environment changes as the child grows and is influenced by multiple factors including but not exclusive to psychological, spiritual, and social.

Standard III: Delivering developmentally appropriate care

Paediatric Nurses perform assessment based on growth and development and deliver paediatric‐specific care.

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8
Q

How can you support and partner with the child and family?

A
  • Establishes an intentional therapeutic relationship with the child and family
  • Respects the child and family in goal setting and decision making
  • Collects and uses information from the child and family context to inform care
  • Communicates with both child and family as partners in care
  • Advocates for optimal use of resources to support the child and family
  • Recognizes and fosters the parenting role to support child well-being
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9
Q

How can you create a child and family-friendly environment?

A
  • Completes a child and family assessment
  • Demonstrates cultural competency and humility in all child and family interactions
  • Engages with child and family in all care decisions and plan of care in a respectful non-judgmental, culturally safe manner
  • Shares information relevant to plan of care and collaborates with and amongst circle of care providers
  • Recognizes and fosters family strengths and supports
  • Uses strategies to support and foster resiliency
  • Demonstrates caring and compassion to both child and family
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10
Q

What are some ways you can detect signs of maltreatment?

A
  • Stimulating and looking at kids – inspect, some times bruising, feel fontanels, kid looks unwell – look at general appearance, work of breathing, colour and what it looks like at the skin level
  • Fontanels bulging – intracranial pressure, baby with multiple fractures – when assume abuse, do a skeletal survey – look at all bones (206 bones) – can see the healing of different times
  • Red flags – if a kid isn’t reacting/crying as they would at their developmental stage, need to pause and think about what is going on
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11
Q

What is child neglect?

A
  • Child neglect is the most common form of maltreatment
  • Defined as failure to provide for child’s basic needs and an adequate level of care
  • can be physical or emotional
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12
Q

How can you detect neglect?

A

History and Interview
- Is child in a safe environment? Does caregiver have skills and resources to care for child?
Physical Assessment
- Child’s height, weight, nutritional status, hygiene, age appropriate interactions

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13
Q

What is physical abuse?

A

Defined as violence, mistreatment, or neglect of child while in care of someone they trust and depend on

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14
Q

How can you detect physical abuse?

A
  • Make proper assessments – if see bruising, lash marks, might measure belly for distention
  • History and Interview
    Watch for inconsistencies in child or caregiver history of events compared with physical findings
  • Physical Assessment
    Goal is to identify all injuries… systematic head to toe approach…location and detailed description documented (measurements, diagrams, photos)
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15
Q

What is sexual abuse?

A

Definitions cover a range of acts, includes incest, molestation, exhibitionism, child pornography, child prostitution, pedophilia

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16
Q

How can you detect sexual abuse?

A
  • History and Interview
    Skillful questioning, documentation includes verbatim statements made by child
  • Physical Assessment
    Physical signs vary and may not be obvious
    Goal is to document genital findings, might include forensic evidence
17
Q

What can influence children’s reactions to being hospitalized?

A
  • Developmental age
  • Previous experience
  • Innate and acquired coping skills
  • Seriousness of their diagnosis
  • Support systems available
18
Q

What are some stressors of hospitalization?

A 
1) Separation Anxiety
Protest                   
Despair                                      
Detachment / denial
2) Loss of Control
3) Fear of Bodily Injury & Pain
19
Q

What are some nursing goals for the hospitalized child?

A
  • Prevent or minimize separation anxiety, try to get the family involved as much as possible
  • Minimize loss of control by promoting freedom of movement, maintaining the child’s routine, encouraging independence, promote understanding and providing privacy
  • Prevent or minimize fear of bodily injury by preparing child for procedure and modifying techniques to be age appropriate, and manage pain
  • Maximize potential benefits of hospitalization (provide socialization, promote self-mastery, provide educational opportunities)
  • Provide developmentally appropriate activities - Play! minimize threats
20
Q

What are the functions of play in general?

A

1) Sensorimotor Development
2) Intellectual Development
3) Socialization
4) Creativity
5) Self-Awareness
6) Therapeutic Value
7) Moral Value

21
Q

What are the functions of play in the hospital?

A

1) Distraction and relaxation
2) Helps the child feel more secure in an unfamiliar environment
3) Decreases separation anxiety
4) Provides an outlet to express feelings
5) Encourages positive interactions with others
6) Provides an outlet for creative ideas/interests
7) Provides a means for accomplishing therapeutic goals
8) Allows the child to be in control

22
Q

What are the different types of therapeutic play?

A

Normative Play
Emotional Outlet Play
Instructional Play
Physiologically Enhancing Play

23
Q

Describe normative play

A

Activities that children spontaneously engage in and find pleasurable
Something that maybe they do naturally without you prompting
Ie/ 6 year old playing with dolls and talking to self
Teenage playing sodoku

24
Q

Describe emotional outlet play

A

Dramatic Play
Medical Play
Often do before procedure – helps them better understand
Have a bear, put iv on bear, helps them understand
Difficult for them to understand when you put an IV in – think there will be a hole in their hand for the rest of their life – can have magical thinking in a negatie way
Active Play
Art
This can be drawing
Books
Music

25
Q

Describe instructional play

A

They can be putting oxygen maks on the bear – letting them do it, let them touch equipment
Kids like to touch things
Preparatory play
Learning about their bodies, medical conditions and surgery
Use of puppets

26
Q

Describe physiologically enhancing play

A

Activities selected that are designed to treat a specific condition or problem
Sometimes put through play with PT – could have a stroke and can get them to play, but a way to strengthen muscles, move their arms

27
Q

How do you prepare a child before, during and after a procedure?

A

Before:

  • Parental presence and support
  • Provide an explanation in terms for their age
  • Establish trust and provide support to both child and family

During:

  • Expect success and involve the child
  • Provide distraction
  • Allow expression of feelings
  • Positive reinforcement (i.e. pizza or treasure box)

After:

  • Encourage expression of feelings
  • Provide positive reinforcement
28
Q

How do you communicate with children to prepare them for procedure?

A

Infants: sucrose, swaddling, holding (non-verbal)
Toddlers: focus on their perspective, be direct and concrete, do not give them choice
School-age: can give a bit of choice, - be direct and concreate, provide explanations and reasons, involve them in procedure
Adolescents: trust is very important for effective communication, can speak in abstract terms

29
Q

What are some tips in preparing a child for a procedure?

A

1) Match the affect of the child, if they take it seriously , speak seriously to the child
2) Eliminate distractions - take time and sit and explain
3) Negotiate the child’s responsibilities - emphasize the child’s role in the procedure
4) Negotiate the parent’s role - always give the parents the option to stay with child
5) Develop an individualized plan for procedures - assess and identify coping techniques
6) Use a designated space for procedure
7) Position the child for comfort (not supine)
8) Allow and encourage of feelings
9) Maintain a calm and positive atmosphere

30
Q

How can you deliver developmentally appropriate care?

A
  • Demonstrates knowledge of typical development and variation from typical
  • Demonstrates knowledge of safety risks relevant to developmental stage
  • Provides anticipatory guidance and coaching on typical development and safety related to the developmental stage – they don’t know, they haven’t done this before, want to help guide them thorugh
  • Performs safety assessments at point of care to minimize risk and harm
  • Incorporates developmentally appropriate play and/or recreational activities into care
  • Performs age and developmentally appropriate biopsychosocial assessment
  • Uses developmentally appropriate strategies when preparing for and performing interventions
  • Considers development that is influenced by ethnicity, spirituality and culture

373 Pediatrics (6 decks)

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