NURSING CARE OF HOSPITALISED CHILD AND FAMILY PRICIPLES AND PRACTICE.

1. NURSING CARE OF HOSPITALISED
CHILD AND FAMILY PRICIPLES AND
PRACTICE.

2. CONTENT
1. Meaning of illness hospitalization of child.
2. Nursing care of hospitalised child and family (principles and
practice)
 Preventing or minimizing separation
 Minimizing loss of control
 Preventing or minimizing fear of bodily injury
3. Strategies for coping & normal development
• Child life programs
• Rooming-in
• Therapeutic play (preschooler,school age child, child deal with
stress)
• Therapeutic recreation.

3. MEANING OF ILLNESS AND HOSPITALIZATION
TO CHILD
INFANT
• Change 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.

4. Contd….
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.

5. NURSING CARE OF
HOSPITALISED CHILD
AND FAMILY PRICIPLES
AND PRACTICE.

6. A. 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, nurse
provide support through physical presence.

7. Contd….
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.

8. B. 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.

9. Contd…
• 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 activities are encouraged in hospitals other approaches
include jointly planning care, time structuring, making choices in
food selection & bedtime etc.
• Promoting understanding- Informing children about their rights
foster greater understanding any may relieve the feelings of
powerlessness.

10. C. 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.
 Use pain reduction techniques.

11. 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.

12. 1. 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.

13. 2. Rooming-In:
It 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 between nurse & parent is important so
that the parent’s desire for involvement is supported.

14. 3. 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.

15. Contd…
 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.

16. Contd….
 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

17. Toddler
 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.

18. Toddler…..
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.

19. Pre-schooler:
• The nurse can intervene to reduce the stress produced by pre-
schooler 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.

20. 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

21. 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.
 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.

22. 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.

23. Contd…
• 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

24. Contd……
• 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 programme.

25. Contd….
• 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.

26. Contd…
• Nurse should have an opportunity to participate
with children play activities.
• Story telling-telling stories with themes.
• Water play during bath

27. SUMMARY

28. 1. Meaning of illness hospitalization of child.
2. Nursing care of hospitalised child and family
(principles and practice)
 Preventing or minimizing separation
 Minimizing loss of control
 Preventing or minimizing fear of bodily injury
3. Strategies for coping & normal development
• Child life programs
• Rooming-in
• Therapeutic play (preschooler, school age child,
child deal with stress)
• Therapeutic recreation.

29. CONCLUSION

30. THANK YOU !