UNIT 1 PRINCIPLES OF ATRAUMATIC CARE Flashcards
What is the #1 question in a child’s mind when in the hospital?
“Is this going to hurt?”
What is atraumatic care?
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.
What are physical stressors?
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.
What are some examples pain and discomfort physical stressors?
- injections
- venipunctures
- intubation
- suctioning
- dressing changes
What are some examples of immobility (physical stressors)
- restraints
- bedrest
- Inability to get up without assistance
What are some psychological stressors?
- Separation from child or parents
- Lack of privacy
- Inability to communicate
- intubated
- speaks different languages
- Inadequate knowledge & understanding of the situation
- Severity of illness
- Parental behavior “the look”
- expression of concern
- Child behavior
- looking very ill
What are environmental stressors
- Unfamiliar surroundings
- Unfamiliar sounds
- Unfamiliar people
- Unfamiliar and unpleasant smells
- alcohol, adhesive remover, body fluids
- constant lights
- Activity related to other patients
- talking, crying, coughing, or moaning
- sense of urgency or lack of urgency/concern among staff
- unkind comments
What are some social structures?
- Disrupted relationships (especially w/ family/friends)
- Concern with missing school or work
- Play deprivation
What are the principles of atraumatic care?
- Prevent or minimize physical stressors
- prevent or minimize parent/child separation
- promote a sense of control
How can we prevent or minimize physical stressors?
- Avoid or reduce intrusive and painful procedures
- Avoid or reduce other kinds of physical distress or bodily injury
- Control pain
What are some examples of avoiding or reducing intrusive and painful procedures?
- rectal temps—> tympanic, axillary or temporal temps
- ABG’s—>pulse ox
- Circumcision—> topical anesthetic or block
- foley—> use 2% xylocaine jelly
- serum bilirubin–>transcutaneous bilirubin sensor
- Multiple venipunctures–> two try policy
- Using lidocaine in IM injections of Rocephin
- Painful injections–> smallest gauge needles and topical anesthetics
- Painful infusions –> slow infusions, warm packs to the IV site
What are some examples of avoiding or reducing other kinds of physical distress (or bodily injury)?
- Restraints—> comfort positions (therapeutic hugging vs. papoose board)
- Shivering—> cover them with warm blankets
- Sleeplessness —> organize care to allow for 1-2 hour nap
- Smells—> uncover tray away from the patient
- Thirst—> allow breast bottle, or clear liquids longer before NPO
- Skin Trauma–> avoid tape
What are way we can prevent or minimize parent/child seperation?
- Promote family-centered care
- Use core primary nursing
- Consider research finding on parents’ and children’s preferences
- Numerous research studies have supported that the majority of the time, parents and children want to be together
What are some examples of times we can minimize parent/child seperation?
- At time of anesthesia induction & PACU
- In the emergency department
- During CPR- they felt their adjustment to death was easier & that their presence was beneficial to the dying child.
Preventing or minimizing parent/child separation…. to be or not to be together…
- offer child & parents an informed choice
- Prepare them ahead of time for any unfamiliar treatment or procedure
- child (based on their developmental level)
- parent
When minimizing parent/child separation what are some things we can do to help?
- allow the child to assume a position of control
- encourage the child to take a familiar object with them (provides comfort)
- Help parents support the child during the procedure
For procedures that require immobilization of an extremity how can we minimize parent/child seperation?
- Allow for close physical contact with the parent
- Support the child with a secure, comforting hold or tug
- Promote the child’s self-control by allowing the child to assume a sitting position when possible
How can we promote a sense of control?
- Respect and elicit family’s knowledge about child and health condition .
- Reduce fear of unknown.
- Provide opportunities for control
How can we reduce the fear of the unknown?
- Educate about environment and routines
- Make environment less threatening–> preparing medications prior to entering the room.
- “Animism”– assigning lifelike qualities to an inanimate object
How can we provide opportunities for control?
- Do procedures with child in parents lap
- Allow child to have a familiar object
- Provide choices- select food choices
- Allow privacy
- Provide play activities
- Time structuring
- Respect cultural differences