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NURSING CARE OF HOSPITALIZED CHILD AND FAMILY -PRINCIPLES AND PRACTICES

BY:MARIA POLY FIRST YEAR M.SC NURSING

FAMILY-CENTERED CARE

BENEFITS FOR PARENTS AND CHILD Care and teaching are in keeping with specific

family needs and strengths. Family roles and close family interactions during

time of stress are enhanced. Minimizes separation anxiety. Decreases reactions of protest, denial, and despair. Increases sense of security for the child. Family needs to care for their child physically and

emotionally are fulfilled.

Parents feel useful and important, rather than dependent and peripheral.

Decreases parental guilt feelings. Increases parents' competence and confidence

in caring for the sick child. Families of children with special needs share

comfort and support from one another. Greater absorption of staff teaching by the

family. Diminishes post hospitalization reactions.

IMPLEMENTATION STRATEGIES

Taking a family history and listening for specific family/cultural needs and preferences.

Allowing rooming-in for parents of young children. Having parents participate in the child's physical

care. Acknowledging that parents are not visitors;

having flexible visiting regulations for family members, including siblings.

Having pictures of family members available at the hospital.

Encouraging telephone contact. Using family tape recordings. Encouraging the child and family members to

participate in health care provider or team rounds when appropriate. Having patient and parental input during the development of the daily medical plan can be beneficial.

Acknowledging that there are varying types of family units. Ensure that the child's usual caregiver (who may not always be a parent) or legal guardian is included in the decision-making process as appropriate.

ROLE OF THE NURSE

To create an environment conducive to maintaining family strength, integrity, and unity.

To assist parents with decision making about when to stay with their child and when to be away

To develop trusting, goal-directed relationships with families.

To observe the parent-child relationship To teach parents knowledge,

understanding, and skills necessary to function effectively with the hospitalized child.

To help parents adapt to the situation and to develop their own feeling of value by coping with the child's illness and deriving meaning through the difficult experiences they are facing.

To assist families, as appropriate, in dealing with normative family developmental tasks.

EMOTIONAL SUPPORT TO CHILD

If possible, familiarize the child with the setting or unit before admission.

Provide immediate physical care that communicates competence, caring, and strength and facilitates trust.

Be alert to behavioral changes that may indicate physical distress.

Facilitate parent-child interaction; facilitate frequent family visits.

Ask the parents about the child's own way of responding to emotional stress. Use particular comforts that are most soothing to the child.

Support parents so they will be best able to support their child. Ask a social worker to visit the family to ensure the parents have a plan regarding transportation, daycare for siblings, and sleeping arrangements if they have come to the facility from out of town.

Foster rest and prolonged periods of sleep. Time activities to reduce interruptions; dim lights to allow for adequate sleep; whenever possible, cluster caregiving activities.

Do everything possible to reduce the amount of pain the child must endure; anticipate and prevent anxiety and pain; provide comfort measures and therapeutic distractions as appropriate. Administer anxiety-reducing or pain-reducing medications as ordered, and determine effectiveness. Request topical anesthetics (eg, lidocaine 2.5% and prilocaine 2.5%) prior to venipuncture and injections when appropriate. Consider conscious sedation, and assist according to standards and procedures.

Provide age-appropriate stimulation when indicated by the child's condition (TV, games, books, and toys). Encourage child life therapy whenever appropriate.

Provide opportunities for the child to express his fears and concerns.

If possible, avoid exposing an alert child to the death or resuscitation of another child. If the child is exposed, provide adequate and developmentally appropriate explanation. Help the child express his own feelings and work through the experience.

Prepare the child and his family for transfer from the ICU by implementing a nursing care plan similar to one that the child will experience on a regular unit (eg, decrease frequency of monitoring of vital signs, encourage independence). Give a thorough report to the receiving nurse during transfer.

EMOTIONAL SUPPORT TO THE FAMILY

Orient parents to the unit and its waiting areas. Clarify visiting policies and hospital expectations.

Encourage liberal visiting hours and unlimited phone calls from the parents to the ICU.

Assure the parents that everything possible is being done for their child. Whenever possible, allow them to see the child receiving treatment.

Make certain that the parents are informed of important changes in the child's clinical status. If the parents are leaving the unit, exchange telephone numbers to ensure contact if needed. Reinforce medical interpretations.

Explain special equipment and changes in nursing management.

Provide opportunities for the parents to ask questions and have them answered.

Encourage the parents to keep a journal of their hospital experience. It is a very real way for parents to confront their feelings, especially if they are not expressing them to the hospital team. Urge them to include information such as medical updates they receive from staff members. This allows them to have a written summary of the medical plan.

Encourage the parents to interact verbally and physically with their child. Support them in this endeavor.

Facilitate expression of parental grief. Provide opportunities for the parents to talk

to a person with whom they can share their concerns and fears (ie, chaplain, social worker, psychiatrist). Be sure this person can see them as often as they require

Provide opportunities for parents to meet together to share experiences and offer mutual support. Encourage parents not to compare progress of other patients to their child. It can set them up to be quickly disappointed. Focus on each child and situation as unique.

Be sensitive to the parents' additional commitments to family as well as to their need to remain with their child. Whenever possible, allow visiting at mutually convenient time.

Help the parents provide anticipatory guidance for siblings and extended family members.

Refer the parents to appropriate community resources for help for financial, environmental, or psychological problems.

Offer follow-up contact to the parents if appropriate.

Guide families in the use of the Internet, and help connect them with support groups for information and peer support.

Ask the parents to discuss any medical information they find on the Internet to ensure accuracy.

NURSING CARE OF HOSPITALIZED CHILD AND FAMILY

PREVENTING OR MINIMIZING SEPARATION

MINIMIZING LOSS OF CONTROL PREVENTING OR MINIMIZING FEAR

OF BODILY INJURY PROVIDING DEVELOPMENTALLY

APPROPRIATE ACTIVITIES PROVIDING OPPORTUNITY FOR PLAY

AND EXPRESSIVE ACTIVITIES

MAXIMIZING POTENTIAL BENEFIT OF HOSPITALIZATION

Fostering parent child relationship Providing educational opportunities Promoting self mastery Providing socialization

NURSING CARE OF THE FAMILY Supporting family members Providing information Encouraging patient participation

BIBLIOGRAPHY

Dutta P, Pediatric Nursing, First Edition, New Delhi India,Jaypee Brothers,2007

Pillitteri A, Care Of The Child And Family,Child Health Nursing, Lippincott

Pottis N. L,Barbara, Pediatric Nursing, Caring Of Children And Family, 2nd Edition

Behrman, Kliegman, Jenson Nelson,Text Book Of Pediatrics, Vol 1,18th Edition.

Marlow D.R,Barbara, Text Book Of Pediatrics Nursing, 6th Edition, Philadelphia, Sounders Company, 2005

Whailey, Wong. Essentials of pediatric nursing. 8th ed. Elsevier publishers. USA; 2008 

THANK YOU