SEMINAR ON

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

SUBJECT PEDIATRIC NURSING

UNIT THREE

TOPIC HOSPILIZED CHILD,MEANING,

PREPARATION,EFFECTS,STRESSOS

AND REACTION,PLAY ACTIVITIES,

AND NURSING CARE

DATE 27-06-11

NAME OF THE STUDENT MR. JINESH T MATHEW

NAME OF THE SUPERVISOR MRS. BHIMA UMA MAHESHWARI

SL NO

CONTENT PAGE NO

1. TERMINOLOGIES

2. INTRODUCTION

CONTENT1.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 GIVERS3. EFFECT OF HOSPITALIZATION ON CHILD

INDIVIDUAL RISK FACTORS BENEFICIAL EFFECTS OF

HOSPITALIZATION4. 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 CHILDREN AND FAMILY A) STRESSOR’S OF HOSPITALIZATION AND CHILDREN’S REACTION

SEPARATION ANXIETY LOSS OF CONTROL BODILY INJURY AND PAIN

6. PLAY ACTIVITIES FOR ILL HOSPITILIZED CHILD FUNCTIONS OF PLAY IN THE HOSPITAL

PLAY IN INFANCY PLAY IN 2ND YEAR PLAY IN 3RD YEAR PLAY IN PRE-SCHOOL PLAY IN SCHOOL

7. NURSING CARE OF HOSPITISED CHILD AND

FAMILY (PRINCIPLES AND PRACTICE)

PREVENTING OR MINIMIZING

SEPARATION

MINIMIZING LOSS OF CONTROL

PREVENTING OR MINIMIZING FEAR OF

BODILY INJURY

8. STRATEGIES FOR COPING & NORMAL DEVELOPMENT

CHILD LIFE PROGRAMS

ROOMING-IN

THERAPEUTIC PLAY

(RESCHOOLER,SCHOOL AGE CHILD, CHILD

DEAL WITH STRESS)

THERAPEUTIC RECREATION

TERMINOLOGIES

Hospitilization ; To admit sumbody to a hospital

Rooming in ; The practice of having a parent stay in the child’s room

Depression ; A mental state characterized by excessive sadness

Temper tantrum ; Childish behaviour of bad temper

Hostility ; Intence anger

Anaclitic depression ; Charactized by strong emotional depentence on a mother

HOSPITALIZED CHILD

1. INTRODUCTION

Based on the theory that hospitalization can be an unnecessary stress to children, only those who cannot successfully be managed on an ambulatory basis are now admitted to the hospital. This was not always true. For example most children with head injuries automatically stayed overnight for observation. Currently unless a child is unconscious or shows other signs of neurologic injury he or she is sent to home to be observed by parents for signs of increased ICP. This policy requires that time be spent in teaching parent skills such as how to take a pulse or evaluate consciousness. Teaching them requires patience because parents under stress can have difficulty comprehending instructions however because psychological trauma as well as excessive health care costs are prevented by allowing a child to return home it is important teaching.

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

Charge in familiar routine and surroundings response with global reaction.

Separation from love object.

Toddler

Fear of separation, desertion, separation anxiety highest in this age group.

Relates illness to a concrete condition, circumstances or behavior

Preschool

Fear of bodily harm or mutilation, castration, intrusive procedures.

Separation anxiety less intense than toddlers but strong.

Causation same as toddler, often considers own role in causation ie, illness as a punishment for wrong doing.

School Age

Fears physical nature of illness

Concern regarding separation from age mates and ability to maintain position in peer group.

Perceives an external cause for illness, although located in body.

Adolescent

Anxious regarding loss independence. Control, identity concern about privacy.

Perceives malfunctioning organ or process as cause of illness. Able to explain illness.

B. PREPARING THE ILL CHILD AND FAMILY FOR HOSPITALIZATION

Many childhood illness, such as febrile convulsions, appendicitis and asthma attacks strike suddenly making advance preparation for hospital admission impossible. However, when hospitalization is planned ahead of time, for orthopedic second stage surgeries, preparation is possible. As a rule, parents eagerly seek guidance from nurses or what and how much to tell their children about an anticipated admission. The preparation a parent makes for a child obviously varies according to the child’s age and individual experience. No matter what the child’s age however, parents should be encouraged to above all convey a

positive attitude. The nurse can provide further health teachings and clear up all misunderstandings.

1) Preparing the infant

As because the infant cannot understand explanations, preparation has to be minimal.

Special items such as favorite toy, blanket, should be packed.

This objects provide care giver should spend a great deal of time with an infant.

2) Preparing the toddler and pre-schooler

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.

Bringing a favorite toy can be a help.

Child could be encouraged to play hospital with dolls

3) Preparing school age and adolescent

Both school age and adolescents need factual explanations of what will happen during hospitalization.

A hospital orientation program in which facts of hospitalization are discussed

Interact the child with another child who had undergone through the same condition.

4) Preparing the child of a different cultural background

Make the assurance that proper care will be provided to the child without any differentiation.

5) Preparing disabled and chronically ill child

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

Planning for hospitalization begins as soon as parents know that hospitalization will be necessary.

Easing parental anxiety regarding illness and hospitalization is important because infants and children can keenly sense a parent’s stress.

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.

Advise parents to ask about the diagnostic procedures required length of hospital stay, etc.

EFFECT OF HOSPITALIZATION ON CHILD

Children may react to the stress of hospitalization before admission, during hospitalization and after discharge. A child’s conception of illness is even more important than age and intellectual maturity in predicting level of anxiety before hospitalization. This may or may not be affected by the duration of condition or prior hospitalization. Therefore nurses should avoid over estimating the illness concept of children with prior medical experience.

Individual risk factors

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.

Because separation is such an important issue of hospitalization for young children nurses should be alert to children who passively accept all changes, these, children need more support and care.

The stressors of hospitalization may cause young children to experience short and long term negative out comes.

Adverse outcome may be related to the length & number of admissions, multiple invasive procedures and the anxiety of the parents.

Common response includes regression, separation anxiety, apathy, fears, sleeping disturbances, especially children younger than 7 years of age.

Supportive practices such as family centered care, and frequent family visiting, may lessen the detrimental effect of such admissions.

A child’s pain experience indicates how the overall hospitalization is experienced.

Increasing length of hospitalization because of complex medical and nursing care, elusive diagnosis, and complicated psychosocial issues.

Without special attention, to meet child’s psychosocial developmental needs in hospital environment the detrimental consequences of prolonged hospitalization may be severe.

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.

Infants may be emotionally disturbed by 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.

Beneficial effects of hospitalization

The most obvious effect is the recovery from illness.

Hospitalization provides an opportunity for the children to master stress and feel competent in their coping abilities.

Hospital environment can provide new socialization experience.

Child can broaden their inter personnel relationships.

Psychological status of child also maximized.

CHILDS REACTION TO HOSPITALIZATION AND PROLONGED ILLNESS

Illness threatens both physiological and psychological development of children.

Sickness causes pain, restraint of movement, long sleep less periods, restrictions of feeds. Separation from parent home environment, which may result emotional trauma.

Hospitalization and prolonged illness related growth and development and cause adverse reaction in the child based on stage of development.

Reactions of neonates

Interrupts the early stages of development of a mother child relationship and family integration.

Impairment of bonding and trusting relationship.

Inability of parents to love & care for the baby and inability of baby to respond to parents and family members.

Reactions of infants

Infant’s reactions are mainly separation anxiety and disturbances in development of basic trust.

Emotional withdrawal and depression are found in the infants of 4 to 8 months of age.

Interference of growth and delayed development is also found.

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

Toddler reactions are found as protest, despair, denial and regression.

Toddle protest by frequent crying, shaking crib, rejecting nurses.

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.

In denial, the child reacts by accepting care without protest.

Toddlers react by regression in an attempt to control stress

Found to stop using newly acquired skills & may return to the behavior of an infant during illness.

Reactions of pre-school child

Pre-school child adopts various defense mechanisms to adjust with stress.

They react by exhibiting regression, projection, displacement identification, aggression, denial & fantasy.

They simply shows similar behavior of toddlers.

Reactions of school-aged

School aged children are concerned with fear, worry, mutilation, fantasies, modesty & privacy.

They react with defense mechanism like regression, negativism, depression, phobia, un-realistic fear or denial symptoms and conscious symptoms and conscious attempts of mature behavior.

Reaction of adolescent

Adolescents are concerned with lack of privacy, separation from peers or family & school interference with body image or independence or self concept & sexuality.

They react with anxiety related to loss of control & insecurity in strange environment.

They may show anger and demanding or un co-operative behavior

They may adopt mental mechanisms like intellectualization about disease, rejection of treatment, depression, denial/withdrawal.

D. EFFECTS OF HOSPITALIZATION IN CHILDREN AND FAMILY

1) Stressor’s of hospitalization and children’s reaction

Major stressors of hospitalization includes, separation, loss of control, bodily injury, and pain children’s reactions to these crisis are influenced by their developmental age, their previous experience with illness, separation or hospitalization their innate and acquired coping skills, the seriousness of the diagnosis and the support system available.

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.

This behavior is a sign of resignation and i9s not a sign of contentment

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.

Detachment behavior as a proof of adjustment & child is considered as ideal patient.

Early childhood

Separation anxiety is the greatest stress imposed by hospitalization during early childhood.

Children in the toddler stage demonstrate more goal oriented behaviors.

They may demonstrate displeasure on parent’s return or departure by temper tantrums or regression to primitive levels of development.

Temper tantrums, bed wetting or other behaviors are expression of anger or response to stress.

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.

They may show separation anxiety by refusing to eat, experiencing difficulty in sleeping, crying quietly for their parents withdrawing from others.

They will express indirectly by breaking toys, hitting other children.

Later childhood and adolescence.

In school age child being away from family higher than any other fear associated with hospitalization.

Hospitalization increase their need of parental security and guidance.

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.

Feelings of loneliness, boredom, isolation and depression are common.

School age children have irritability and aggression towards parents withdrawal from hospital personnel, inability to relate to peers, rejection of siblings, subsequent behavioral problems in school.

b) Loss of control

The major areas of loss of control in terms of physical restriction, altered routine or rituals, and dependency.

Infants

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.

Loss of control results from altered routines and rituals.

It can cause regression to toddlers.

Enforced dependency is a chief characteristic of toddler during sick role most toddlers react negatively and aggressively to this.

Prolonged loss of autonomy may result in passively to this.

Prolonged loss of autonomy may result in passive withdrawal from interpersonal relationships. And regression in all areas of development.

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.

This loss of control is a critical influencing factor in their perception of and reaction to separation, pain, illness hospitalization.

School age

Because of their striving for independence and productivity school age children are particularly vulnerable to events that may lessen their feeling of control and power.

Altered family roles, physical disability, fears of death, abandonment, or permanent injury, loss of peer acceptance, lack of productivity and inability ot cope with stress according to perceived cultural expectation may result in loss of control.

One of the most significant problems of this age is boredom.

When physical or enforced limitation curtails their usual abilities to care for themselves, school age children generally respond with depression, hostility and frustration.

Adolescents

Adolescents struggle for independence, self assertion, and liberation centers on the quest for personal identity. Anything that interferes with this poses a threat to their sense of identity and result in loss of control.

BODILY INJURY AND PAIN:

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.

Older infants react intensely with physical resistance and un-co-

cooperativeness. They may refuse to lie still or try to escape with motor

activity they have achieved.

Toddlers

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.

Young children become restless and overly active is a consequence of pain.

They usually able to localize the specific painful area.

Pre-schoolers

Reactions to pain tend to be similar to those seen in toddler hood

Physical and verbal aggressions are more specific.

Instead of showing total body resistance, preschoolers may push the offending person away, try to secure the equipment and lock them

safely

some times they may verbally abuse the nurse

pre-schools can locate pain & can use appropriate pain scales.

School age

They will have a fear of illness itself, disability & death.

Fear of intrusive procedures in genital area.

School age children verbally communicate their pain in respect to location, intensity and description.

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.

They may be reluctant to disclose their pain.

PLAY ACTIVITIES FOR ILL HOSPITILIZED CHILD

FUNCTIONS OF PLAY IN THE HOSPITAL

Provides diversion & bring about relaxation.

Helps the child feel more secure in strange environment

Helps to lessen the stress of separation & the feeling of home sickness.

Provides a mean for release of tension & expression of feelings.

Encourages interaction & development of positive attitude towards others.

Provides an expressive outlet for creative ideas or interests.

Provides a mean for accomplishing therapeutic goals.

Places child in active role & provides opportunity to make choices & be in control.

Play in infancy

Pleasure by touch & manipulation.

5-6 months – infant repeat activities

9 months – repetitive games (pat-a-cake)

12 month - recognition & acknowledgement of other

Play in 2nd year

2 to 3 year – fascination with working part of toys talking on toy phone involve parents

Third year – child taught to share

Conflict below parents & child.

Pre-school – competition, mastery of tasks

Genders roles (House, Doctor)

School – Foot ball, basket ball.

NURSING CARE OF HOSPITISED CHILD AND FAMILY (PRINCIPLES AND

PRACTICE)

PREVENTING OR MINIMIZING SEPARATION

Primary goal is to prevent separation particularly in children younger than 5 years of age.

Welcome the presence of parents at all time throughout the child’s hospitalization.

Many hospitals developed a system of family centered care.

During the time of separation behavior, nu8rse provide support throught physical presence

If behaviors of detachment are evident, the nurse maintains the child’s contact with the parents by frequently talking about them, encouraging child to remember them etc.

When helping parents with the fears of separation, nurses should suggest the way of leaving and returning.

Parental visits should be frequent

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.

Promoting freedom of movement during procedures can be completed by placing child in parents lap.

Mechanical freedom can be provided by transporting child in wheel chairs, or beds with mechanical freedom.

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.

Encouraging independence; promoting children’s control involves maintaining independence and the concept of self-care can be most beneficial. Self care refers to the practice of activities that individuals personally initiates and perform on their own behalf individuals personally

initiates and perform on their own behalf in maintaining health and well being. Self care activities are encouraged in hospitals other approaches include jointly planning care, time structuring, making choices in food selection & bedtime etc.

Promoting understanding- Anticipatory preparation and providing information help greatly to lessen stress and prevent lack of understanding. Informing children about their rights foster greater understanding any may relieve the feelings of powerlessness.

PREVENTING OR MINIMIZING FEAR OF BODILY INJURY

Preparation of children for painful procedures decreases their fears.

Manipulating procedural techniques also minimizes fear

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.

STRATEGIES TO COPING & NORMAL DEVELOPMENT

During hospitalization care of the child focuses not only on meeting physiologic needs, but also on meeting psychosocial and developmental needs.

Several strategies may be used to help children adapt to the hospital environment, promote effective loping & provide developmentally appropriate activities.

These strategies include child life programs, rooming in, therapeutic play, and therapeutic recreation.

a) Child life programs

If focus on the psychosocial need of hospitalized children.

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.

Some of the activities are designed to assist children in working through feeling about illness.

Eg: Playing with medical equipment

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

Play is an important part of the childhood.

The stress of illness & hospitalization increase the value of 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 use of transitional objects, such as a familiar blanket or stuffed animal, can temporarily substitute for the security of parents.

The toddler who is restrained can be read familiar stories. Repetition of stories promotes a sense of stability in the unfamiliar hospital environment.

A doll is familiar toy that can be used to recreate a stressful environment, thereby providing an opportunity for the child to express & work through feelings.

Other developmentally appropriate toys for toddlers include familiar objects from home such as measuring cups or spoons, wooden puzzles, push & pull toys.

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.

School age child

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

Child deal with stress.

School age children often regress developmentally during hospitalization, demonstrating behaviors characteristics of an earlier state, such as separation anxiety & fear of bodily injury.

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.

Peers are important and the isolation of hospitalization can be difficult.

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.

The independence of adolescence is interrupted by illness. Nurses can provide choices for teenagers to assist them in regaining control.

Giving them options & letting them choose an evening recreational activity can promote their feelings of independence.

Passes to leave the hospital for special activity may be possible.

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.

Puppets are used to demonstrate procedures to children.

Such activities help children work out feelings about hospitalization.

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.

Much can be learned from watching children play in a relaxed environment. Their approaches to play & their relationship with peers, parents, adults should be observed and recorded.

Also to be noted are the degree of their activities attention span, ability to tolerate frustration, verbal abilities, concept formations.

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.

Nurse should have an opportunity to participate with children play activities.

Story telling-telling stories with themes.

Water play during bath.

Television-by instructing them about programs.

Needle play

Pre-post operative teaching

Art.

RESEARCH AND JOURNAL ABSTACT

[The multiple social roles of female lay caretakers of hospitalized children].[Article in Portuguese]

Wegner W, Pedro EN.

Source

Centro Universitário Metodista IPA, Porto Alegre, Rio Grande do Sul, Brasil. wiliamwegner@yahoo.com.br

Abstract

This is a qualitative, descriptive, exploratory, and interventionist research carried out with nine female lay caretakers of children undergoing oncologic treatment. The objectives were to present the multiple social roles performed by female lay caretakers of children with cancer and to discuss the caretaker's role in society. The study was carried out between March and April, 2007, at Hospital de Clinicas de Porto Alegre, Rio Grande do Sul, Brazil. The data collection was performed with the focal group technique. The results were examined through the analysis of thematic content, which evidenced the multiple social roles performed by women, the main group of caretakers in society, regardless of the context. Final considerations enhance a discussion in the educational, political and social levels about the redistribution of social roles, particularly family responsibility between men and women. The participation of the nursing staff can take place through the comprehension of those roles imposed by the context and facilitate family inclusion in the care relationship.

[Child hospitalization: how the nursing staff conceives the accompanying mother].[Article in Portuguese]

Quirino DD, Collet N, Neves AF.

Source

Programa de Pós-Graduação em Enfermagem da Universidade Federal da Paraíba (PPGEnf/UFPB), João Pessoa, Paraíba, Brasil. danydiasq@hotmail.com

Abstract

The presence of the family is fundamental in the care of hospitalized child, because, as a source of protection and security, it provides an environment less aggressive. The objective of this study was to understand how nursing staff conceives the accompanying mother This is an exploratory qualitative research, developed in a reference hospital of infant care in the Northeast of Brazil, carried out between April and May, 2007, through semi-structured interview. Data were subjected to thematic analysis and the ethical aspects respected. We observed that although the mother is recognized as an important person in the process of giving support to the child, she does not receive proper care from health professionals. Seen as agents in the process work, mothers do not participate in decision making yet they carry the responsibility of nursing care. So it is important that members of the nursing staff reorient their work with the objective of building links and a comprehensive care.

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

Till now we discussed about the Childs Hospitilization’s. We discussed

about the Meaning of illness, Preparation for hospitilization, Effects of hospitilization of

child, Hospitalization and prolonged illness related growth and development, effect of

hospitalization on the family of the child, Play activities for ill hospitilized child,

Nursing Care of hospitilized child and family-principles and practice, Strategies for

coping & normal development

BIBLIOGRAPHY

PARUL DUTTA, PEDIATRIC NURSING, FIRST EDITION, NEW DELHI

INDIA,JAYPEE BROTHERS,2007

ADELE PILLITTERI, CARE OF THE CHILD AND FAMILY,CHILD HEALTH

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JOURNAL ARTICLE

WEGNER W,PEDRO EN, THE MULTIPLE SOCIAL ROLES OF FEMALE LAY

CARETAKERS OF HOSPITALIZED CHILDREN, HOSPITALIZED CHILDREN,

WEBSITE

CHILD HOSPITILIZATION, PARAIBA BRAZIL, AVAILABLE FROM

http://www.ncbi.nlm.nih.gov/pubmed/