Family-Centered Care of the Child During Illness and Hospitalization

Question 1

Separation anxiety

Answer 1

-Major stress from middle infancy throughout preschool
-More common in ages 6 - 30 months
-AKA anaclitic depression

Question 2

Protest phase

Answer 2

-Crying and screaming
-Clinging to parent
-Attempts to physically force parent to stay
-Behaviors may last from hours to day
-Behaviors such as crying may only cease from physical exhaustion
-Approach of stranger may initiate protest

Question 3

Despair phase

Answer 3

-Crying stops
-Evidence of depression, lacks interest in the environment
-Regresses to earlier behaviors (bedwetting, thumb sucking)
-Behaviors may last for variable length of time
-Child’s physical condition may deteriorate from refusal to eat, drink, or move
-Signs of aggression
-Child’s physical condition may deteriorate from refusal to eat, drink,or move

Question 4

Detachment (denial phase)

Answer 4

-Forms new but superficial relationships
-Appears happy
-May seriously affect attachment to the parent after separation
-Detachment usually occurs after prolonged separation from parent; rarely seen in hospitalized children
-Behaviors represent a superficial adjustment to loss
-Usually occurs after prolonged separation from parent; rarely seen in hospitalized children
-When they become more interested in surroundings and nearby people, it is a result of resignation and not contentment

Question 5

Patient and family-centered care

Answer 5

-Family is child’s primary source of length and support
-Hospitalization alters parental role
-Nurses are role models and mentors for engaging parents in hospital routines and daily care that benefits the child

Question 6

Loss of control: infant’s needs

Answer 6

-Trust
-Consistent loving caregivers
-Daily routines
-Failure for this occur will lead to mistrust and infant will have loss of control

Question 7

Loss of control: toddler’s needs

Answer 7

-Autonomy: is the capacity to make an informed, uncoerced decision
-Daily routine and rituals
-Loss of control may contribute to (regression of behavior, negativity, temper tantrums)

Question 8

Loss of controls: preschoolers

Answer 8

-Egocentric and magical thinking is typical of this age
-May view illness or hospitalization as punishment or misdeeds
-Preoperational thought (egocentric and intuitive and not yet logical or capable of performing mental tasks)

Question 9

Loss of control: school-age children

Answer 9

-Striving for independence and productivity
-Used to structure and routine and being around friends
-Fears of death, abandonment, permanent injury
-Boredom (zoom school, activities, means of communications w/ friends)

Question 10

Loss of control: adolescents

Answer 10

-Struggle for independence and liberation
-Separation from the peer group
-May respond w/ anger or frustration
-Need for more info abt condition

Question 11

Fears of bodily injury and pain

Answer 11

-Common fears among children
-Beyond early infancy, all children fear bodily injury from mutilation, bodily intrusion, body image change, disability, or death
-Preparation of painful procedures decreases fears and increases cooperation
-Modifying procedural techniques for children in each age group also minimizes fear of bodily injury (ex: axillary in place of rectal temp q4 hours in ED, rectal temps must be ordered)
-Children may fear bodily injury from a great variety of sources (present info at their cognitive level)
-Large band aid = more importance to wound
-Watching dressing become smaller comforts them
-Prematurely removing dressing is a concern
-Use phrase “all fixed, no more fixing to do”

Question 12

Effects of hospitalization post discharge: young children

Answer 12

-Show aloofness toward parents (may last few min which is more common, to a few days)
-Tendency to cling to parents
-Demands for parents’ attention
-Vigorous opposition to any separation
-Regression in newly learned skills (self-toileting)F21.

Question 13

Effects of hospitalization post discharge: older children

Answer 13

-Emotional coldness followed by intense, demanding dependence on parents
-Anger toward parents
-Jealousy toward others (ex: siblings)

Question 14

Effects of hospitalization post discharge: adolescents

Answer 14

-Loneliness and isolation
-Fears of tx, losing self-determination and choices
-Anger
-Sadness
-Stress and regression
-Cooperation
-Sleep disturbances

Question 15

Effects of hospitalization on families: parents

Answer 15

-Overall sense of helplessness
-Questioning the skills of staff
-Accepting the reality of hospitalization
-Needing to have information explained in simple language
-Dealing w/ fear
-Coping w/ uncertainty
-Seeking reassurance from caregivers
-Make sure to openly share info and keeping them well informed

Question 16

Factors affecting parents’ rxns to their child’s illness

Answer 16

-Seriousness of threat to child
-Previous experience w/ illness and hospitalization
-Medical procedures involved in dx and tx
-Available support systems
-Personal ego strengths
-Previous coping abilities
-Additional stresses on the family system
-Cultural and religious beliefs
-Communication patterns among family members
-Info and education provided to family thruout hospitalization
-Socioeconomic status

Question 17

Parental responses to stressors of hospitalization

Answer 17

-Disbelief, anger, guilt (especially if illness was sudden)
-Fear, anxiety (r/t child’s pain and severity of illness)
-Frustration
-Depression

Question 18

Effects of hospitalization on families: siblings

Answer 18

-Rxns to sibling’s illness differ little when a child becomes temporarily ill
-Experience loneliness, fear and worry, anger, resentment, jealousy, guilt
-Parents often unaware of # of effects that siblings experience during sick child’s hospitalization
-Would benefit from explicit explanation about illness and provisions for the siblings to remain at home

Question 19

Sibling rxns

Answer 19

-Loneliness, fear, worry
-Anger, resentment, jealousy
-Guilt

Question 20

Child life specialists

Answer 20

-Health care professionals with extensive knowledge of child growth and development and of special psychosocial needs of children
-Help prepare children for hospitalization, surgery, procedures, and offer coping strategies
-Primary program objectives are promoting of normal child development, minimizing anxiety of the hospitalization and health care related experiences, and alleviating stress and fear thru education and play

Question 21

Individual risk factors that increase vulnerability to stressors of hospitalization

Answer 21

-“Difficult temperament”
-Lack of fit between a child and a parent
-Age (especially age 6 months to 5 years)
-Male gender
-Below average intelligence
-Multiple and continuing stressors (frequent hospitalizations)

Question 22

Altered family roles can occur with hospitalization

Answer 22

-Anger and jealousy between siblings and the ill child
-Ill child is obligated to play the sick role
-Parents continue a pattern of overprotection and indulgent attention

Question 23

Goal: minimizing loss of

Answer 23

-Promote freedom of movement (limit restraining of child)
-Preserve parent-child contact (in infants and toddlers this typically decreases the need for restraints)
-Preventing or minimizing fear of bodily injury
-Maintaining routine and independence (altered schedules and loss of rituals are stressful for toddlers and preschoolers)
-Pt and family center nursing (recognizing and promoting family strengths, provision of school for prolonged hospitalizations, collaborative approach of a daily schedule)

Question 24

Preparation for hospitalization

Answer 24

-Prepare child
-Tours, books, videos
-If acute illness: orient pt and family to hospital routines
-Incorporate child life to reduce anxiety and pain
-Admission assessment

Question 25

Preventing or minimizing separation

Answer 25

-Primary nursing goal for children under 5
-Family centered care: family is considered to be partners in care of child
-Parents are not “visitors,” allowed 24/7
-Familiar items from home
-Nurse presence

Question 26

Normalizing hospital environment

Answer 26

-Maintain child’s routine
-Time structuring
-School work
-Friends and visitors
-Encourage independence in older children
-Promote understanding
-Prevent/minimize fear of bodily injury
-Provide developmentally appropriate activities (ex: painting to express feelings)

Question 27

Play and expressive activities

Answer 27

-Essential to child’s mental, emotional, and social well-being
-Allows child to act out fears and anxieties
-Assists w/ coping, preparation, education
-Used for diversion and recreation
-One of most effective tools for managing stress
-Play room
-Ask child to select or draw pics or symbols to represent daily or weekly fun activities (fav TV shows, family visits, playroom times)
-Draw clock face w/ hands depicting the time each event will occur
-Have the child compare the clock on the schedule w/ a clock or watch in the room
-When the 2 match, child knows it is time for a fav activity

Question 28

Techniques for supporting siblings

Answer 28

-Dx education
-Family education
-Coping support
-Therapeutic play
-Peer support
-Community resources

Question 29

Isolation

Answer 29

-Added stressor
-Child may have limited understanding
-Dealing w/ child’s fears
-Potential for sensory deprivation
-Decreased social interaction can have negative effect on developmental growth

Question 30

ICU

Answer 30

-Increased stress
-Family’s emotional needs
-Parents’ need for information
-Perception of security resulting from constant monitoring and individualized care