Family-Centered Care of the Child During Illness and Hospitalization Flashcards
Separation anxiety
-Major stress from middle infancy throughout preschool
-More common in ages 6 - 30 months
-AKA anaclitic depression
Protest phase
-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
Despair phase
-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
Detachment (denial phase)
-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
Patient and family-centered care
-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
Loss of control: infant’s needs
-Trust
-Consistent loving caregivers
-Daily routines
-Failure for this occur will lead to mistrust and infant will have loss of control
Loss of control: toddler’s needs
-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)
Loss of controls: preschoolers
-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)
Loss of control: school-age children
-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)
Loss of control: adolescents
-Struggle for independence and liberation
-Separation from the peer group
-May respond w/ anger or frustration
-Need for more info abt condition
Fears of bodily injury and pain
-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”
Effects of hospitalization post discharge: young children
-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.
Effects of hospitalization post discharge: older children
-Emotional coldness followed by intense, demanding dependence on parents
-Anger toward parents
-Jealousy toward others (ex: siblings)
Effects of hospitalization post discharge: adolescents
-Loneliness and isolation
-Fears of tx, losing self-determination and choices
-Anger
-Sadness
-Stress and regression
-Cooperation
-Sleep disturbances
Effects of hospitalization on families: parents
-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
Factors affecting parents’ rxns to their child’s illness
-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
Parental responses to stressors of hospitalization
-Disbelief, anger, guilt (especially if illness was sudden)
-Fear, anxiety (r/t child’s pain and severity of illness)
-Frustration
-Depression
Effects of hospitalization on families: siblings
-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
Sibling rxns
-Loneliness, fear, worry
-Anger, resentment, jealousy
-Guilt
Child life specialists
-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
Individual risk factors that increase vulnerability to stressors of hospitalization
-“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)
Altered family roles can occur with hospitalization
-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
Goal: minimizing loss of
-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)
Preparation for hospitalization
-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
Preventing or minimizing separation
-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
Normalizing hospital environment
-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)
Play and expressive activities
-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
Techniques for supporting siblings
-Dx education
-Family education
-Coping support
-Therapeutic play
-Peer support
-Community resources
Isolation
-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
ICU
-Increased stress
-Family’s emotional needs
-Parents’ need for information
-Perception of security resulting from constant monitoring and individualized care
