UNIT 1 PRINCIPLES OF ATRAUMATIC CARE

Question 1

What is the #1 question in a child’s mind when in the hospital?

Answer 1

“Is this going to hurt?”

Question 2

What is atraumatic care?

Answer 2

Is the provision of therapeutic care in settings, by personnel, and through the use of interventions that eliminate or minimize the psychological and physical distress experienced by children and their families in the health care system.

Question 3

What are physical stressors?

Answer 3

1.Pain and discomfort
2.Immobility
3.Sleep deprivation
4. Inability to eat or drink
5. Changes in elimination habits
6. Other- temperature, noises, bright lights or darkness.

Question 4

What are some examples pain and discomfort physical stressors?

Answer 4

1. injections
2. venipunctures
3. intubation
4. suctioning
5. dressing changes

Question 5

What are some examples of immobility (physical stressors)

Answer 5

1. restraints
2. bedrest
3. Inability to get up without assistance

Question 6

What are some psychological stressors?

Answer 6

1. Separation from child or parents
2. Lack of privacy
3. Inability to communicate
   
   • intubated
   • speaks different languages
4. Inadequate knowledge & understanding of the situation
5. Severity of illness
6. Parental behavior “the look”
   
   • expression of concern
7. Child behavior
   
   • looking very ill

Question 7

What are environmental stressors

Answer 7

1. Unfamiliar surroundings
2. Unfamiliar sounds
3. Unfamiliar people
4. Unfamiliar and unpleasant smells
   
   • alcohol, adhesive remover, body fluids
5. constant lights
6. Activity related to other patients
   
   • talking, crying, coughing, or moaning
7. sense of urgency or lack of urgency/concern among staff
   
   • unkind comments

Question 8

What are some social structures?

Answer 8

1. Disrupted relationships (especially w/ family/friends)
2. Concern with missing school or work
3. Play deprivation

Question 9

What are the principles of atraumatic care?

Answer 9

1. Prevent or minimize physical stressors
2. prevent or minimize parent/child separation
3. promote a sense of control

Question 10

How can we prevent or minimize physical stressors?

Answer 10

1. Avoid or reduce intrusive and painful procedures
2. Avoid or reduce other kinds of physical distress or bodily injury
3. Control pain

Question 11

What are some examples of avoiding or reducing intrusive and painful procedures?

Answer 11

1. rectal temps—> tympanic, axillary or temporal temps
2. ABG’s—>pulse ox
3. Circumcision—> topical anesthetic or block
4. foley—> use 2% xylocaine jelly
5. serum bilirubin–>transcutaneous bilirubin sensor
6. Multiple venipunctures–> two try policy
7. Using lidocaine in IM injections of Rocephin
8. Painful injections–> smallest gauge needles and topical anesthetics
9. Painful infusions –> slow infusions, warm packs to the IV site

Question 12

What are some examples of avoiding or reducing other kinds of physical distress (or bodily injury)?

Answer 12

1. Restraints—> comfort positions (therapeutic hugging vs. papoose board)
2. Shivering—> cover them with warm blankets
3. Sleeplessness —> organize care to allow for 1-2 hour nap
4. Smells—> uncover tray away from the patient
5. Thirst—> allow breast bottle, or clear liquids longer before NPO
6. Skin Trauma–> avoid tape

Question 13

What are way we can prevent or minimize parent/child seperation?

Answer 13

1. Promote family-centered care
2. Use core primary nursing
3. Consider research finding on parents’ and children’s preferences
4. Numerous research studies have supported that the majority of the time, parents and children want to be together

Question 14

What are some examples of times we can minimize parent/child seperation?

Answer 14

1. At time of anesthesia induction & PACU
2. In the emergency department
3. During CPR- they felt their adjustment to death was easier & that their presence was beneficial to the dying child.

Question 15

Preventing or minimizing parent/child separation…. to be or not to be together…

Answer 15

1. offer child & parents an informed choice
2. Prepare them ahead of time for any unfamiliar treatment or procedure
   
   • child (based on their developmental level)
   • parent

Question 16

When minimizing parent/child separation what are some things we can do to help?

Answer 16

1. allow the child to assume a position of control
2. encourage the child to take a familiar object with them (provides comfort)
3. Help parents support the child during the procedure

Question 17

For procedures that require immobilization of an extremity how can we minimize parent/child seperation?

Answer 17

1. Allow for close physical contact with the parent
2. Support the child with a secure, comforting hold or tug
3. Promote the child’s self-control by allowing the child to assume a sitting position when possible

Question 18

How can we promote a sense of control?

Answer 18

1. Respect and elicit family’s knowledge about child and health condition .
2. Reduce fear of unknown.
3. Provide opportunities for control

Question 19

How can we reduce the fear of the unknown?

Answer 19

1. Educate about environment and routines
2. Make environment less threatening–> preparing medications prior to entering the room.
3. “Animism”– assigning lifelike qualities to an inanimate object

Question 20

How can we provide opportunities for control?

Answer 20

1. Do procedures with child in parents lap
2. Allow child to have a familiar object
3. Provide choices- select food choices
4. Allow privacy
5. Provide play activities
6. Time structuring
7. Respect cultural differences