Seminar On Hospitalized Child
Seminar On Hospitalized Child
Seminar On Hospitalized Child
HOSPITALIZED CHILD
SUBMITTED TO SUBMITTED BY
Mrs.Bhima Uma Maheshwari Mr.Jinesh T Mathew
HOD of Child Health Nursing M.Sc Nursing I Year
Bangalore Bangalore
MASTER PLAN
UNIT THREE
PREPARATION,EFFECTS,STRESSOS
DATE 27-06-11
2. INTRODUCTION
CONTENT
1.MEANING OF ILLNESS HOSPITILIZATION
OF CHILD
• INFANT
• TODDLER
• PRESCHOOLER
• SCHOOLER
• ADOLESCENT
2. PREPARING THE ILL CHILD AND FAMILY
FOR HOSPITALIZATION
• PREPARING THE INFANT
• PREPARING THE TODDLER AND PRE-
SCHOOLER
• PREPARING SCHOOL AGE AND
ADOLESCENT
• PREPARING THE CHILD OF A
DIFFERENT CULTURAL
BACKGROUND
• PREPARING DISABLED AND
CHRONICALLY ILL CHILD
• PREPARING FAMILY CARE GIVERS
3. EFFECT OF HOSPITALIZATION ON CHILD
• INDIVIDUAL RISK FACTORS
• BENEFICIAL EFFECTS OF
HOSPITALIZATION
4. STRESSORS AND REACTION
• REACTION OF NEONATES
• REACTION OF INFANTS
• REACTION OF TODDLER
• REACTION OF PRE-SCHOOL CHILD
• REACTION OF SCHOOL AGED
• REACTION OF ADOLESCENT
5. EFFECTS OF HOSPITALIZATION IN
TERMINOLOGIES
Hospitilization ; To admit sumbody to a hospital
HOSPITALIZED CHILD
1. INTRODUCTION
Often illness and hospitalization are the first crises children must face.
Children during the early years are particularly vulnerable to the crises of illness &
hospitalization because stress represents a change from usual state of health and
environmental routine and children have a limited number of coping mechanisms
to resolve stressors, children’s reaction to these crises are influenced by their
developmental age, previous experience with illness, separation or hospitalization,
innate and acquired coping skills, the seriousness of the diagnosis and the support
system available.
•MEANING OF ILLNESS AND HOSPITALIZATION TO CHILD
Infant
Toddler
Preschool
•Causation same as toddler, often considers own role in causation ie, illness as
a punishment for wrong doing.
School Age
Adolescent
•This objects provide care giver should spend a great deal of time with an
infant.
•Three chief fears of the toddler and pre-schooler are fear of unknown, fear of
abandonment and separation and fear of mutilation.
•These children need preparation clearly aimed at alleviating these fears.
•Both school age and adolescents need factual explanations of what will happen
during hospitalization.
•Interact the child with another child who had undergone through the same
condition.
•Make the assurance that proper care will be provided to the child without any
differentiation.
•Help children to maintain a contact with their families and school friends
during a long hospitalization period, as they are staying in hospitals for long
term care through phone calls, letters & open visiting.
PREPARING FAMILY CARE GIVERS
•As a part of preparation parents should ask questions about the hospitalization
so that they become familiar with the situations. It will help to reduce anxiety.
•A number of risk factors make certain children more vulnerable than others to
the stress of hospitalization.
•It has also been noted that rural children exhibit significantly greater degree of
psychological upset than urban children, because urban children are familiar
with hospitals.
•Supportive practices such as family centered care, and frequent family visiting,
may lessen the detrimental effect of such admissions.
•What the hospital means to pediatric patient depend upon their stage of
maturity and depend upon how accustomed they are to being left with friends.
•If they regard the separation as a punishment of wrongdoing, they will be less
able to cope with it than if they know the real reason for hospitalization.
•Not only they are separated from parents but also they will have sensory
deprivation. If the nursing personal do not take the time to provide care.
•If the child doesn’t have close physical contact with another human being may
result in emotional trauma.
Reactions of neonates
•Inability of parents to love & care for the baby and inability of baby to respond
to parents and family members.
Reactions of infants
•Older infants have limited tolerance due to separation anxiety which is found
as fear of strangers, excessive cry, clinging & over dependence on mother.
Reaction to toddler
•Attention, urgent desire to find mother, showing signs of distrust with anger
and fears.
•In despair, toddler become hopeless, looks sad, cry continuously and use of
comfort measures like thumb sucking, fingering lip, and tightly clutching toy.
Reactions of school-aged
•School aged children are concerned with fear, worry, mutilation, fantasies,
modesty & privacy.
Reaction of adolescent
•They react with anxiety related to loss of control & insecurity in strange
environment.
a) Separation anxiety
•The major stress from middle infancy throughout the pre-school years,
especially for children ages 16 to 30 months is separation anxiety, also called
anaclitic depression.
•During the phase of protest children react aggressively to the separation from
the parent. They cry & scream for their parents and in-consolable by others.
•During the phase of despair the crying stops and depression evident, less
active, un-interested in play
•Third stage is detachment also called denial, the child is finally adjusted to the
loss, becomes interested with the surroundings and forms new relationships.
•The child detaches from the parent in an effort to escape the emotional pain of
desiring the parent’s presence and copes by forming shallow relationship with
others being increasingly self centered, and attaching primary importance to
material objects.
•Health team member understand the meaning of each stage of behavior and
should label as positive or negative.
•Eg. The loud crying of the protest phase as a bad behavior during quite
withdrawn phase of behavior, health team member may think that child is
settling in.
Early childhood
•Pre-schoolers are more secure interpersonally than toddlers, they can tolerate
brief period of separation from their parents and are more inclined to develop
trust in other significant adults.
•The stress of illness usually renders pre-schooler less able to cope with
separation.
•In school age child being away from family higher than any other fear
associated with hospitalization.
•Middle and late school age children may react more due to separation from
usual activities and peer groups than to the absent of their parents.
b) Loss of control
•In hospital setting, routines may be established to meet hospital staffs need
instead of infant needs.
•Inconsistent care and deviation from infant’s routine may lead to mistrust and
decreased sense of control.
Toddlers
•Toddlers are striving for autonomy, and this goal is evident in most of their
behaviors.
•When their ego-centric pleasures meet with obstacles toddlers react with
negativism, especially temper tantrums.
Preschoolers
•Pre schoolers also suffer from loss of control caused by physical restriction,
altered routines, and enforced dependency.
•Their specific cognitive abilities which make them feel omnipotent and all
powerful; also make them feel out of control.
•When physical or enforced limitation curtails their usual abilities to care for
themselves, school age children generally respond with depression, hostility and
frustration.
Adolescents
•In caring for children nurses must have an appreciation of a child’s concerns
about bodily harm and reactions to pain at different developmental periods.
Infants
•Infants may express pain by squirming, writhing, jerking and failing some
infants may cry loudly, where as others are easily calmed by gentle hug.
•Toddlers reaction to pain are similar to those seen during infancy. They will
react with intense emotional upset and physical resistance to any actual or
perceived experience. Behaviors indicating pain include grimacing clenching
teeth or lips, opening their eyes wide, rocking, rubbing & acting aggressively.
Pre-schoolers
•Instead of showing total body resistance, preschoolers may push the offending
person away, try to secure the equipment and lock them
•safely
•pre-schools can locate pain & can use appropriate pain scales.
School age
•By 9-10 years of age they show less fright or over resistance and aggression
are less likely at this age unless the adolescent is totally up prepared for a
procedure.
•They are able to describe pain experience & can use any of the pain
assessment tools.
•Helps to lessen the stress of separation & the feeling of home sickness.
•Places child in active role & provides opportunity to make choices & be in
control.
Play in infancy
• When helping parents with the fears of separation, nurses should suggest the
way of leaving and returning.
• If the parents can’t room-in they can leave a favorite article from home the
children gain comfort and re-assurance from them.
MINIMIZING LOSS OF CONTROL
•Feelings of loss of control results from separation, physical restriction,
changed routine, enforced dependency and magical thinking.
•Maintaining child’s routine: One technique that can minimize the disruption in
child’s routine is time structuring.
•It include scheduling the child’s day to include all those activities that are
important to the child and nurse such as treatment procedures, school work,
exercise, television etc. together nurse, parent and the child then plan a daily
schedule with times and activities written down.
•For children, who is fear of mutilation of body parts, the nurse repeatedly
stress the reason for a procedure and evaluate child’s understanding.
•Employ pain reduction techniques.
•These strategies include child life programs, rooming in, therapeutic play, and
therapeutic recreation.
•Professional child life specialists, para professionals, & volunteers staff these
departments.
•A child life specialist plan activities to provide age appropriate play time for
children either in playroom or child’s room.
•Child specialist & nurses formulate plan together to assist children with
particular needs.
b) Rooming-In
is the practice of having a parent stay in the child’s hospital room & care for
the hospitalized child.
•Some hospitals provide cots, others have special built-in beds & in some
institutions parent stays in a separate room on the unit.
•Parent who is rooming in may want to perform all of the child’s basic care or
help with some of the medical care.
•Communication below nurse & parent is important so that the parent’s desire
for involvement is supported.
Therapeutic play
•Not only is normal development facilitated by play, but play sessions can
provide a means for the child to learn about health care, to express anxieties to
work through feelings & to achieve a sense of mastery over control over
frightening or little understood situations.
•Play presents an opportunity to deal with the fears & concerns of health
experiences are called therapeutic play.
•Through therapeutic play the nurse may assess the child’s knowledge of his or
her illness.
•A common technique involves using body line drawing or stories & asking the
child to draw or talk about illness or injury means to him/her.
•Child may be asked to draw a picture or make a story enabling the nurse to
assess fears & other emotions.
•The good enough-draw-A-Person test help the nurse assess the congnitive
level of children below 3& 13 years of age.
•The gillert index is another tool that help the nurse assess child’s knowledge of
the body.
•The same techniques may be used in a slightly different way to teach the child
about surgery or plan activities that allow child to express fears & gain mastery
over the situation.
•A variety of technique may be used to promote therapeutic play. Specific
techniques are chosen to reflect the child’s developmental stage.
•Toddler, play is important for toddler. Through play the explore the
environment & learn to identify with significant people in their lives.
•Play is also an acceptable way for toddlers to release tensions caused by stress
or aggressive impulses.
•Toddlers should be approached slowly & the initial approach should be made
in their parent’s presence, if possible to decrease feelings of stranger anxiety.
•Playing a variation of peek-a-boo or hide & seek using the curtain surrounding
the toddlers crib or bed help to promote realization of that objects out of sight,
such as parents, do return.
•The toddler who is restrained can be read familiar stories. Repetition of stories
promotes a sense of stability in the unfamiliar hospital environment.
•Playing with safe hospital equipments (bandages, syringes without needles etc)
help toddlers to over come the anxiety associated with these items.
Pre-schooler
The nurse can intervene to reduce the stress produced by pre-schoolers fear
through the use of some kinds of play.
•A simple body outline or doll can be used to address the child’s fantasies &
fears of bodily harm. Playing with safe hospital equipment may help pre-
schoolers to work through feelings such as aggression.
•Pre schoolers like crayons & coloring books, puppets, felt & magnetic boards,
play dough, & recorded stories.
•Both pre-schooler & school age children may enjoy play with a toy hospital.
Although play begins to lose its importance in the school age years, the
nurse can still use some techniques of therapeutic play to help the hospitalized
•Body outlines & occasionally dolls can be sued to illustrate the cause and
treatment of the child’s illness.
•Terms for body parts that are suitable for older children should be used
drawings provide an out let for expression of fears & anger.
•School age children enjoy collecting, organizing objects & often ask to keep
disposable equipment that has been used in their care. They may use these items
later to relive the experience with their friends.
•Games, books, crafts, computers, provide an outlet for aggression & increase
self esteem in the school age child.
•The type of play used should promote a sense of mastery & achievement.
THERAPEUTIC RECREATION
•Many of the special play techniques used with younger children are not
suitable for adolescents.
•Adolescents do need a planned re-creation program to assist them in meeting
developmental needs during hospitalization.
•Telephone contact with other teenagers & visits from friends should be
encouraged.
•Interactions with other teenagers ate a pizza party or a video game or movie
night can help adolescents feel normal.
•Physical activities that provide an outlet for stress are recommended. Even
adolescents on bed rest or in wheelchairs can play a modified form of basket
ball.
•Giving them options & letting them choose an evening recreational activity
can promote their feelings of independence.
The nurse in corporate play activities into the daily life of each pediatric
patient because play is a part of child’s total needs.
•The nurse must consider, when planning activities for child, the age, interests
diagnosis & limitations imposed by illness.
•An acutely ill child who is unable to play actively with toys may enjoy
listening to stories.
•Telling a story rather than reading draws children into emotional involvement
with it.
•The story teller can ask questions pass comments & can make the child a part
of it.
•Other activities children can do are watching a plant grow, watching an anthill
or gold fish in a tank or watching supervised television programmes.
•In the play area, children who are permitted out of bed should be free to
develop mental, motor & social skills and to express themselves. In a variety of
art media such as finger painting or molding with clay.
•Domestic play re-assures them that their own homes are still there & that they
are missed.
•Children usually select toys such as doctor, syringes with which they can
imitate the activities seen around.
•Old cloth in such play can be used to restrain hands of a doll in case of
fractures to make bandages to promote healing.
•Children also enjoy play telephone because they can pretend that they are
calling home.
•They also can enjoy clay, paints, pounding boards on which they can express
their anger.
•They enjoy tricycles, wagons, through the use of which they develop or
exercise their large muscles.
•Children play areas cannot be kept clean & orderly as judged by adult
standars.
•It the nurses are too concerned about the physical appearance of play area
during play time the children feel that the unit personnel do not approve o f
their play.
•Children should be taught to take care of toys & a place must be provided to
store their toys.
•In addition, nurse is able to note their comments about home, hospitalization,
general attitudes & behavior.
•It will help the nurse to understand how well the child is coping with the
situations & crisis.
•If the child handle it well, the experience may be of help in mastering problem
situations.
•Needle play
•Art.
Source
Centro Universitário Metodista IPA, Porto Alegre, Rio Grande do Sul, Brasil.
wiliamwegner@yahoo.com.br
Abstract
Source
Abstract
Conclusion
Nurse is not only meant for providing care to the patient she should also
shoulder some of the responsibilities in respecting the patient need..The philosophy of the
nurse about the nature of caretaker-nurse-child relationships influences the quality of
child care..The role of nurse in maintaining the psychological wellbeing of children and
their caregivers and helping them grow during the crisis of illness is a critical and
complex contribution to recovery and health.
Summary
BIBLIOGRAPHY
PARUL DUTTA, PEDIATRIC NURSING, FIRST EDITION, NEW DELHI
INDIA,JAYPEE BROTHERS,2007
JOURNAL ARTICLE
WEBSITE
http://www.ncbi.nlm.nih.gov/pubmed/