Stressors of hospitalization


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Stressors of Hospitalization

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  • Nurse is primary person in care of childIntroductionBuilding a trusting relationshipMaking decisionsProviding comfort & reassurance
  • If you can enjoy looking after children when at their worst, crying, in pain, missing home/parents, naughty. Yet still find yourself happy at the end of the day, then I think it's the perfect job for youProtest: loud, demanding cries, rejects comfort measuresDespair: lies on abdomen, flat facial expression, weight loss, insomnia, loss of developmental skillsDenial or Detachment: silent expressionless child, deterioration of developmental milestones, may have trouble forming close relationshipsChildren loose control over their: Routine, Body, Basic decisions, Loss of school, boredom, Ability to socialize, Bodily Injury.Procedures are uncomfortableDisease processes are painfulPostoperative pain can be very severeInfants: watch facial expression, FLACC Toddlers: grimace, clench teeth, restlessPreschoolers: can locate pain, use face scale, fear bodily injury & mutilation, literalSchool-aged: fear disability & death, pain is punishment, “magical quality” of germs, can use faces scaleAdolescents: use same pain scale as adults
  • Nurses serve as advocates and are obligated to provide the highest level of atraumatic care possible, especially for pediatric patients. Anticipatory guidancePsychological preparation of a pt for an event expected to be stressful, as in the preparation of a child for surgery by explaining what will happen and what will it fell like. It also used 2 prepare parents for normal growth and development of their kids.Wellness nursing diagnosesDescribes human responses to levels of wellness in an individual, family or community that have the potential for growth and/or the potential for enhancement to a higher state of well-being, must have an effective present status or functionFamily centered careIs a philosophy of care that recognizes the family as the constant in the child's life and holds that systems and personnel must support, respect, encourage, and enhance the strengths and competence of the family
  • I am new to peds nursing. I have my own kids and endeavor to treat every sick child like I would want my children to be treated. Ask the child to tell you about their fav movie or video game or book, and they will get involved in telling you and you can ask questions, and it builds trust. Learn to sing lullabies and silly songs (one of my favs is Raffi's song Brush your Teeth when I'm doing oral care). I am not the best singer but the kids like it and singing breaks down barriers of fear. Be honest with them, if it's going to hurt tell them. Use simple non-alarming words like use straw instead of IV. Use band-aid instead of dressing. If drawing blood off an IV tell them you are just looking at it to make sure it works, and try to get another person to distract them. I have started a pretend IV on a spare diaper to show an 11 year old how an IV works so she could feel the soft straw that would be in her arm, not a needle. My ability to relate to the kids and watch them and do what they do. I have learned a lot from my nannies on how to talk to and comfort kids. We give the kids meds and treatments, but the aides really interact with them during bath times, and I have seen them work magic.
  • Make sure the child has an understanding of number concepts and then teach the childto use the scale. Point to each face and use the words under the picture to describe the amount of pain the child feels. Then ask the child to select the face that comes closest to the amount of pain felt.After determining that the child has an understanding of number concepts, teach the child to use the scale. Pre-schooler age is first to do this. Point to each photo, explain that the bottom picture is a “no hurt,” the second picture is a “little hurt,” the third picture is “a little more hurt,” the fourth picture is “even more hurt” the fifth picture is “a lot of hurt” and the sixth picture is the “biggest or most hurt you could ever have.”The numbers beside the photos can be used to score the amount of pain the child reports.
  • After determining that the child has an understanding of number concepts, teach the child to use the scale.Point to each photo, explain that the bottom picture is a “no hurt,” the second picture is a “little hurt,” the third picture is “a little more hurt,” the fourth picture is “even more hurt” the fifth picture is “a lot of hurt” and the sixth picture is the “biggest or most hurt you could ever have.”The numbers beside the photos can be used to score the amount of pain the child reports.
  • ResponseLoud crying, screaming, kicking, biting, spitting, trying to grab equipment or push away stimulusVerbalizations: “Ow”, “Ouch”, “It hurts”. May also be verbally abusive and even curse.Toddlers may react to all procedures negatively whether painful or notToddlers can localize pain by pointing to it, but cannot describe itPreschoolers have a great fear of mutilation and of “insides leaking out”Preschoolers can localize pain and can describe severity by using Faces Pain ScaleBehavioral distraction Assorted visualsBreathing techniquesComfort measureRepositioning, holdingTouching, massagingWarm or cold compressesDiversional talkGuided imageryBiofeedbackProgressive muscle relaxation
  • I can't stress Family Centered Care enough. With children, you aren't taking care of just the child - you are taking care of the parents as well. Just remember, that child in the bed is their #1 priority, the thing they love most in the world. So they will be anxious, they will ask questions!! And definitely remember that that parent is your biggest ally, and the person that knows that child the best. It is THEIR child.Family centered care has been mentioned before already, I guess just remember sometimes it's more the parents you're reassuring/educating/assessing than the child. Welfare...Ward of the state...Failure to thrive cases anyone?Encourage positive communication with health care teamView care as a partnershipBe aware that the parents are the ones who knows the child bestProvide support to the parents, allow them to assist with the careRecognize influences of cultural background
  • Take the child to a treatment roomEncourage a parent or loved one to provide comfort and supportUse developmentally appropriate terminologyOffer the child choicesTell the child and family how they can help with the procedureDo not threaten punishment for lack of cooperationDo not force an unwilling parent to stay; encourage participationProvides diversion, brings about relaxation.Helps child feel more secure in strange environment.Helps lessen stress of separation.Means for release of tension & fears.Means for accomplishing therapeutic goals.Allows making choices & being in controlI think one is to know how to be playful, making normal procedures and actions a game, from peek-a-boo to turning an asthma spacer into a magic space mask. Testing development with children and interacting with them goes better when they're distracted and happy than crying and non-cooperative.Another is to know what children are into, from favourite games and cartoons of young children to the movies, console games and hobbies of teenagers, conversation is easier on familiar topics and great for building a patient nurse relationship.
  • Orient to hospitalAssess what parent/child know of illness and treatmentAssess teaching needs - keep updated on condition of childReinforce and encourage questionsDiscuss ways the parents can participate in the careAssess & discuss family support, make referrals
  • Stressors of hospitalization

    1. 1. Say AHA! Stressors of Hospitalization Atraumatic Care
    2. 2. Learning Outcomes At the end of this session, participants will be able to identify:  Stressors of Hospitalization  Interventions to Minimize Stressors  Pain Management Methods  Ways to use Play to Minimize Stress
    3. 3. Stressors of Hospitalization 1. Separation Anxiety 2. Loss of Control 3. Bodily Injury & Pain
    4. 4. Atraumatic Care Donna Wong’s Conceptual Model of Atraumatic care defines atraumatic care in healthcare settings as care that “eliminates or minimizes the psychological and physical distress experienced by children and families”. Within this framework, there are three principles: • Prevent child’s separation from family • Promoting a sense of control • Minimizing bodily injury and pain1
    5. 5. Preventing or Minimizing Separation Anxiety • Primary nursing goal • Especially for children <5 yrs • Family-centered care— parents are not “visitors” • Familiar items from home • Assign same primary nurse if possible • Continue school work • Allow friends to visit or call
    6. 6. Preventing or Minimizing Loss of Control • Maintain child’s routine, if possible • Schedule times for treatments and activities as close to home as possible • Self-care (age appropriate) or making some of own decisions • Decrease physical restriction if possible; allow street clothes if possible • Explain just before doing
    7. 7. Preventing or Minimizing Fear of Bodily Injury and Pain • • • • • • Prepare Child for Pain Give Choices if Possible Allow Child to Express Pain Reward Bravery Ask Child for Perception Proper Pain Management
    8. 8. Major stressor for adolescents • -Peer support and sharing • -Consistent approach among caregivers • -Truthful explanations • -Tolerate emotional outbursts • -Encourage family support • -Manage pain • -Cooperatively develop nursing plan of care
    9. 9. Principles of Pain Assessment in Children: QUESTT • Question the child • Use Pain Rating Scales • Evaluate Behavior & Physiologic Changes • Secure the Parents’ Involvement • Take into consideration: Cause of Pain • Take Action & Evaluate Results
    10. 10. Pediatric Pain Assessment “Pain is whatever the child experiencing it says it is”.
    11. 11. Oucher Scale • Pre-schooler Age • • • • • • “no hurt,” “little hurt,” “a little more hurt,” “even more hurt” “a lot of hurt” “biggest or most hurt you could ever have.”
    12. 12. Young Child’s Response to Pain • Loud crying, screaming, kicking • Verbalizations: “Ow”, “Ouch”, “It hurts” • May also be verbally abusive and even curse • Toddlers may react to all procedures negatively • Toddlers can localize • Preschoolers have a great fear of mutilation insides leaking out” • Preschoolers can localize pain and can describe severity by using Faces Pain Scale
    13. 13. Pain Management • The presence of the parent is an important part of pain management. • Children often feel more secure telling their parents about their pain and anxiety
    14. 14. Ways to use Play to Minimize Stress
    15. 15. Summary Thank you Atraumatic Care |
    16. 16. REFERENCES Furdon, S,A, Pfeil V,C, Snow K. (1998). Operationalizing Donna Wong's principle of atraumatic care: pain management protocol in the NICU. Pediatric Nursing, 24(4), 336-42.