Nursing care of the child who is hospitalized

  • Nursing care of the child who is hospitalized
    • Preparation for hospitalization
      • Preparing child for admission
        • Nursing admission history according to functional health patterns
          • Health Perception/Health Management Pattern
            • Why has your child been admitted?
            • How has your child’s general health been?
            • What does your child know about this hospitalization?
              • Ask the child why he or she came to the hospital.
              • If the answer is “For an operation or for tests,” ask the child to tell you about what will happen before, during, and after the operation or tests.
            • Has your child ever been in the hospital before?
              • How was that hospital experience?
              • What things were important to you and your child during that hospitalization? How can we be most helpful now?
            • What medications does your child take at home?
              • Why are they given?
              • When are they given?
              • How are they given (if a liquid, with a spoon; if a tablet, swallowed with water; or other)?
              • Does your child have any trouble taking medication? If so, what helps?
              • Is your child allergic to any medications?
            • What, if any, forms of complementary medicine practices are being used?
          • Nutrition/Metabolic Pattern
            • What is the family’s usual mealtime?
            • Do family members eat together or at separate times?
            • What are your child’s favorite foods, beverages, and snacks?
              • Average amounts consumed or usual size of portions
              • Special cultural practices, such as family eats only ethnic food
            • What foods and beverages does your child dislike?
            • What are your child’s feeding habits (bottle, cup, spoon, eats by self, needs assistance, any special devices)?
            • How does your child like the food served (warmed, cold, one item at a time)?
            • How would you describe your child’s usual appetite (hearty eater, picky eater)?
              • Has being sick affected your child’s appetite? In what ways?
            • Are there any known or suspected food allergies?
            • Is your child on a special diet?
            • Are there any feeding problems (excessive fussiness, spitting up, colic); any dental or gum problems that affect feeding?
              • What do you do for these problems?
          • Elimination Pattern
            • What are your child’s toileting habits (diaper, toilet trained—day only or day and night, use of word to communicate urination or defecation, potty chair, regular toilet, other routines)?
            • What is your child’s usual pattern of elimination (bowel movements)?
            • Do you have any concerns about elimination (bed-wetting, constipation, diarrhea)?
              • What do you do for these problems?
            • Have you ever noticed that your child sweats a lot?
          • Sleep/Rest Pattern
            • What is your child’s usual hour of sleep and awakening?
            • What is your child’s schedule for naps; length of naps?
            • Is there a special routine before sleeping (bottle, drink of water, bedtime story, night light, favorite blanket or toy, prayers)?
            • Is there a special routine during sleep time, such as waking to go to the bathroom?
            • What type of bed does your child sleep in?
            • Does your child have a separate room or share a room; if shares, with whom?
            • Does your child sleep with someone or alone (e.g., sibling, parent, other person)?
            • What is your child’s favorite sleeping position?
            • Are there any sleeping problems (falling asleep, waking during night, nightmares, sleep walking)?
            • Are there any problems in awakening and getting ready in the morning?
              • What do you do for these problems?
          • Activity/Exercise Pattern
            • What is your child’s schedule during the day (preschool, daycare center, regular school, extracurricular activities)?
            • What are your child’s favorite activities or toys (both active and quiet interests)?
            • What is your child’s usual television-viewing schedule at home?
            • What are your child’s favorite programs?
            • Are there any television restrictions?
            • Does your child have any illness or disabilities that limit activity? If so, how?
            • What are your child’s usual habits and schedule for bathing (bath in tub or shower, sponge bath, shampoo)?
            • What are your child’s dental habits (brushing, flossing, fluoride supplements or rinses, favorite toothpaste); schedule of daily dental care?
            • Does your child need help with dressing or grooming, such as hair combing?
            • Are there any problems with these patterns (dislike of or refusal to bathe, shampoo hair, or brush teeth)?
              • What do you do for these problems?
            • Are there special devices that your child requires help in managing (eyeglasses, contact lenses, hearing aid, orthodontic appliances, artificial elimination appliances, orthopedic devices)?
              • Note: Use the following code to assess functional self-care level for feeding, bathing and hygiene, dressing and grooming, toileting:
                • 0: Full self-care
                • I: Requires use of equipment or device
                • II: Requires assistance or supervision from another person
                • III: Requires assistance or supervision from another person and equipment or device
                • IV: Is totally dependent and does not participate
          • Cognitive/Perceptual Pattern
            • Does your child have any hearing difficulty?
              • Does the child use a hearing aid?
              • Have “tubes” been placed in your child’s ears?
            • Does your child have any vision problems?
              • Does the child wear glasses or contact lenses?
            • Does your child have any learning difficulties?
            • What is the child’s grade in school?
          • Self-Perception/Self-Concept Pattern
            • How would you describe your child (e.g., takes time to adjust, settles in easily, shy, friendly, quiet, talkative, serious, playful, stubborn, easygoing)?
            • What makes your child angry, annoyed, anxious, or sad? What helps?
            • How does your child act when annoyed or upset?
            • What have been your child’s experiences with and reactions to temporary separation from you (parent)?
            • Does your child have any fears (places, objects, animals, people, situations)?
              • How do you handle them?
            • Do you think your child’s illness has changed the way he or she thinks about himself or herself (e.g., more shy, embarrassed about appearance, less competitive with friends, stays at home more)?
          • Role/Relationship Pattern
            • Does your child have a favorite nickname?
            • What are the names of other family members or others who live in the home (relatives, friends, pets)?
            • Who usually takes care of your child during the day and night (especially if other than parent, such as babysitter, relative)?
            • What are the parents’ occupations and work schedules?
            • Are there any special family considerations (adoption, foster child, stepparent, divorce, single parent)?
            • Have any major changes in the family occurred lately (death, divorce, separation, birth of a sibling, loss of a job, financial strain, mother beginning a career, other)? Describe child’s reaction.
            • Who are your child’s play companions or social groups (peers, younger or older children, adults, or prefers to be alone)?
            • Do things generally go well for your child in school or with friends?
            • Does your child have “security” objects at home (pacifier, bottle, blanket, stuffed animal or doll)? Did you bring any of these to the hospital?
            • How do you handle discipline problems at home? Are these methods always effective?
            • Does your child have any condition that interferes with communication? If so, what are your suggestions for communicating with your child?
            • Will your child’s hospitalization affect the family’s financial support or care of other family members (e.g., other children)?
            • What concerns do you have about your child’s illness and hospitalization?
            • Who will be staying with your child while hospitalized?
            • How can we contact you or another close family member outside of the hospital?
          • Sexuality/Reproductive Pattern
            • (Answer questions that apply to your child’s age group.)
            • Has your child begun puberty (developing physical sexual characteristics, menstruation)? Have you or your child had any concerns?
            • Does your daughter know how to do breast self-examination?
            • Does your son know how to do testicular self-examination?
            • How have you approached topics of sexuality with your child?
            • Do you think you might need some help with some topics?
            • Has your child’s illness affected the way he or she feels about being a boy or a girl? If so, how?
            • Do you have any concerns with behaviors in your child, such as masturbation, asking many questions or talking about sex, not respecting others’ privacy, or wanting too much privacy?
            • Initiate a conversation about an adolescent’s sexual concerns with open-ended to more direct questions and using the terms “friends” or “partners” rather than “girlfriend” or “boyfriend”:
              • Tell me about your social life.
              • Who are your closest friends? (If one friend is identified, could ask more about that relationship, such as how much time they spend together, how serious they are about each other, if the relationship is going the way the teenager hoped.)
              • Might ask about dating and sexual issues, such as the teenager’s views on sexuality education, “going steady,” “living together,” or premarital sex.
              • Which friends would you like to have visit in the hospital?
          • Coping/Stress Tolerance Pattern
            • (Answer questions that apply to your child’s age group.)
            • What does your child do when tired or upset?
              • If upset, does your child want a special person or object?
              • If so, explain.
                • If your child has temper tantrums, what causes them, and how do you handle them?
            • Whom does your child talk to when worried about something?
            • How does your child usually handle problems or disappointments?
            • Have there been any big changes or problems in your family recently? If so, how have you handled them?
            • Has your child ever had a problem with drugs or alcohol or tried to commit suicide?
            • Do you think your child is “accident prone”? If so, explain.
          • Value/Belief Pattern
            • What is your religion?
            • How is religion or faith important in your child’s life?
            • What religious practices would you like continued in the hospital (e.g., prayers before meals or bedtime; visit by minister, priest, or rabbi; prayer group)?
          • Complementary medicine practices and examples
            • Nutrition, diet, and lifestyle or behavioral health changes:
              • Macrobiotics, megavitamins, diets, lifestyle modification, health risk reduction and health education, wellness
            • Mind-body control therapies: 
              • Biofeedback, relaxation, prayer therapy, guided imagery, hypnotherapy, music or sound therapy, massage, aromatherapy, education therapy
            • Traditional and ethnomedicine therapies: 
              • Acupuncture, ayurvedic medicine, herbal medicine, homeopathic medicine, American Indian medicine, natural products, traditional Asian medicine

Factors affecting parents’ reactions to their child’s illness

    • Parental reactions
      • Factors affecting parents’ reactions to their child’s illness
        • Seriousness of the threat to the child
        • Previous experience with illness or hospitalization
        • Medical procedures involved in diagnosis and treatment
        • Available support systems
        • Personal ego strengths
        • Previous coping abilities
        • Additional stresses on the family system
        • Cultural and religious beliefs
        • Communication patterns among family members
        • Overall sense of helplessness
        • Questioning the skills of staff
        • Accepting the reality of hospitalization
        • Dealing with fear
        • Coping with uncertainty
        • Seeking reassurance
    • Sibling reactions
      • Experiencing many changes and being too young to understand them
      • Being cared for by nonrelatives or outside of the home
      • Receiving little information about the ill brother or sister
      • Perceiving that parents will treat the sick child differently

Family-Centered Care of the Child During Illness and Hospitalization

Family-Centered Care of the Child During Illness and Hospitalization

  • Stressors of hospitalization and children’s reactions
    • Separation anxiety
      • Protest phase
        • Behaviors observed during later infancy include
          • Crying
          • Screaming
          • Searches for parent with eyes
          • Clinging to parent
        • Additional behaviors observed during toddlerhood
          • Verbally attacks strangers (e.g., “Go away”)
          • Physically attacks strangers (e.g., kicks, bites, hits, pinches)
          • Attempts to escape to find parent
          • Attempts to physically force parent to stay
        • Behaviors may last from hours to days.
        • Protest, such as crying, may be continuous, ceasing only with physical exhaustion.
        • Approach of stranger may precipitate increased protest.
      • Despair phase
        • Observed behaviors include
          • Is inactive
          • Withdraws from others
          • Is depressed, sad
          • Lacks interest in environment
          • Is uncommunicative
          • Regresses to earlier behavior (e.g., thumb sucking, bed-wetting, use of pacifier, use of bottle)
        • Behaviors may last for variable length of time.
        • Child’s physical condition may deteriorate from refusal to eat, drink, or move.
      • Detachment phase
        • Observed behaviors include
          • Shows increased interest in surroundings
          • Interacts with strangers or familiar caregivers
          • Forms new but superficial relationships
          • Appears happy
        • Detachment usually occurs after prolonged separation from parent; it is rarely seen in hospitalized children.
        • Behaviors represent a superficial adjustment to loss.
      • Effect of hospitalization on the child
        • Post-Hospital Behaviors in Children
          • Young Children
            • They show initial aloofness toward parents; this may last from a few minutes (most common) to a few days.
            • This is frequently followed by dependency behaviors:
              • Tendency to cling to parents
              • Demands for parents’ attention
              • Vigorous opposition to any separation (e.g., staying at preschool or with a babysitter)
            • Other negative behaviors include the following:
              • New fears (e.g., nightmares)
              • Resistance to going to bed, night waking
              • Withdrawal and shyness
              • Hyperactivity
              • Temper tantrums
              • Food peculiarities
              • Attachment to blanket or toy
              • Regression in newly learned skills (e.g., self-toileting)
          • Older Children
            • Negative behaviors include the following:
              • Emotional coldness followed by intense, demanding dependence on parents
              • Anger toward parents
              • Jealousy toward others (e.g., siblings)
        • Risk factors that increase children’s vulnerability to the stresses of hospitalization
          • “Difficult” temperament
          • Lack of fit between child and parent
          • Age (especially between 6 months and 5 years of age)
          • Male gender
          • Below-average intelligence
          • Multiple and continuing stresses (e.g., frequent hospitalizations)