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hospitalised child

  4. 4. 12-06-2013 CRISIS AND NURSING INTERVENTION DEFINITIONS Crisis is an acute time limited phenomenon experienced as an over whelming emotional reaction to a stressful event or the perception of that event. It is the struggle for equilibrium and adjustment when problems are perceived as insolvable. Crisis intervention is a short term focuses on the solving of the immediate problem, aims to establish the former coping pattern and problem solving ability. It is usually limited to 4 – 6 week period after which resolution will be attained.
  5. 5. TYPES OF CRISIS 11-06-2013 CRISIS AND NURSING INTERVENTION 1 2 3 Maturational -each development stage can be referred to as the same. Situational -arises from an external rather than an internal source. Adventitious –it is not a part of every day life, is accidental and unplanned
  6. 6. CRISIS THEORY Erich Lindermann - 1940s conducted study of the grief reactions of close relatives of victims in a club fire. This study formed the foundation of crisis theory and clinical intervention. She showed that preventive intervention in crisis situations could eliminate or decrease serious personality disorganisation and other psychological consequences from the sustained effects of severe anxiety. Gerald Caplan -1960s defined crisis theory and outlined crisis intervention. Caplan identified four distinct phases of crisis. 12-06-2013 CRISIS AND NURSING INTERVENTION
  7. 7. 1206-2013
  8. 8. FOUR PHASES OF CRISIS PROCESS 1st phase - A person confronted by a conflict or problem that threatens the self concept responds with increased feelings of anxiety. The increase in anxiety stimulates the use of problem solving techniques in an effort to solve the problem and lower anxiety. 2nd phase - If the usual defence response fails, and if the threat persists, anxiety continues to rise and produce feelings of extreme discomfort. Individual functioning becomes disorganised. 12-06-2013 CRISIS AND NURSING INTERVENTION
  9. 9. 3rd phase - If the recovering attempts fail, anxiety can escalate to severe and panic levels, and the person mobilises automatic relief behaviour, such as withdrawal and flight. (compromising needs or solutions should be made) 4th phase - If the problem is not solved, anxiety can over whelm the person and leads to serious personality disorganisations. This maladaptive response can take the form of confusion, suicidal behaviour, yelling and running aimlessly. 12-06-2013 CRISIS AND NURSING INTERVENTION
  10. 10. Appraising Crisis Systematically: Systematic process deals with recurrent actual or potential crisises and the impact of these events. The nurse establishes goals in collaboration with the child,family and the interdisciplinary team members.  The plans to care are then implemented through direct intervention. Systemic evaluation facilitates the child’s progress towards his or her maximal level of function, especially as it changes during the various stages of development. CRISIS AND NURSING INTERVENTION
  12. 12. HOSPITALISED CHILD Preventive Best ------ Promotive Hospitalisation Curative
  13. 13. HOSPITALISED CHILD Functions Of Hospitalisation Provides diversion and relaxation minimise Feel more secure threat Lesser the stress separation to Develop positive attitude to others the Accomplish therapeutic goals child’s Care for sick and injured development Prevention of health Promotion of health Rehabilitation 12-06-2013 CRISIS AND NURSING INTERVENTION
  14. 14. PRINCIPLES OF HOSPITALISATION 1.Nurse should begin to build a working relationship with the patients and the child from the first contact with them. 2.Nurse should be aware that all behaviour is meaningful. 3.Nurse should accept the parents and the child exactly as they are. 4.Nurse should have empathy for parents and children. 5.Nurse should let them know that their problems are of importance, the nurse is there to aid their solutions.
  15. 15. PRINCIPLES contd… 6.Nurse must be willing to acknowledge the parents rights to their own decisions concerning their children. 7.Nurse permits the parents and the child to express even negative emotions. 8.Nurse should ask questions limited to a single idea or reference. 9.Nurse should speak the language understandable to parents and the child 10.Health team members should help the parents to feel that there is unity among them.
  16. 16. MODERN CONCEPTS OF HOSPITALISATION Parent Support Self Care groups Visiting Care By Parent Unit CONCEPTS OF HOSPITALISATION
  17. 17. VISITING 2 – 8 pm visiting- early morning to bedtime Flexible unlimited visiting any time Visiting is determined by child’s need to see parents. If parents are unable to visit frequently, grandparents, uncles or aunts may visit instead. Siblings of 2 – 12 years are permitted in some hospitals for certain hours and older siblings fro any time. Siblings should be accompanied by parent and who have been exposed to infections is not permitted. Tape recording could be made and played.
  18. 18. ROOMING- IN Should not prohibit parents to stay at child’s bedside if they desire. Some hospitals provide a waiting rooms for parents. Sometimes they can have food with children. If there is no dietary restriction, food should be brought from home. Parents of seriously ill children could stay whole night if they desire.
  19. 19. CARE BY PARENT UNIT Parents live with child, to involve whole family in care of sick. Child gets attention from familiar person. Main fear about separation is eliminated. When parents are nearby, children can continue to learn and grow throughout hospital experience. Nurses’ responsibility is to meet needs of child, prepare parent for this, interpret medical procedures, diagnostic tests, health teachings etc. Nurse can observe parent’s skills, attitudes, techniques and any problem in parent child relation.
  20. 20. PARENT SUPPORT GROUPS Parents with common concern should emotionally support and comfort. This may be conducted by nurses, play therapists or by child life program staff, who act as facilitators or develop a support system among parents. Parents may feel comfortable enough to move away from hospital routine and ventilate their feelings and concerns to relieve anxiety and stress.
  21. 21. SELF CARE Assess abilities of child Help to learn self-care skills. Time and method depends on child’s cognitive abilities, emotional state and readiness to learn.
  22. 22. GROWTH AND DEVELOPMENT OF HOSPITALISED CHILD Professional team work is important All members needed to foster in every area of growth and development. Hospitals may have school teacher or a recreational specialist to create pleasant situation. Psychologists and psychiatrists help with serious emotional problems. Dietitian, physiotherapist work together focusing different facet of growth, toward full development
  23. 23. PLAY IN ILLNESS 3 year old Christie was due to receive a course of radio therapy. A play program was designed to prepare her for the experience, which involved Christie lying on a large sheet of paper on which her outline was drawn. The purpose of this was to explain the importance of lying still during the radio therapy session. To emphasis this, a water spray was used to show that when she moved it was difficult to spray the correct part of her body.
  24. 24. FUNCTIONS OF PLAY IN ILLNESS Diversional activities Social development Emotional expression Development of moral value Creative expression
  25. 25. TYPES OF PLAY Dramatic play Energy release Creative play PLAY
  26. 26. Drawings TECHNIQUES OF THERAPEUTIC PLAY INCLUDE: Stories Music Puppets Pets
  28. 28. INFANT • -Baby likes to pat and hug. • -Toys should be soft to hug and provide comfort. • -Brightly coloured, washable toys. • -Large enough that cannot be aspirated. • -Have smooth edges. • -Soft stuffed animals, soft balls, bath toys, • -Rattles, pots and pans.
  29. 29. TODDLER They may have favourite toys Enjoys exploring drawers Likes to place things in containers and dump them out. Dolls Engages in parallel play. Nest of blocks. Push-pull toys Telephone Rocking horse or chair
  30. 30. PRESCHOOLER It is the beginning stage of cooperative play. They exchange ideas with others.  Engages in imitative play Creative play, and dramatic play. Crayons, simple puzzles Paint with brush, finger paints Dolls, dishes Drums, horns Video tapes.
  31. 31. SCHOOLER Attention span increases, play is more organised, more competitive. Collection of things will be his hobby. Doll house, dolls, puppets and music. Skipping rope, dress up materials, table games, bicycle.
  32. 32. ADOLESCENT Play will not acquire great energy expenditure. They pay attention to special interest. Ball on string Telephone, easy puzzles, radio, hand puppets, and cut outs.
  33. 33. A research study conducted by Uttara Chari, Uma Hirisave, and L. Appaji in 2012 reported the benefits of play therapy in paediatric oncology. The study was conducted with a 4 year old girl diagnosed with acute lymphoblastic leukaemia and outcome was examined using a combination of qualitative and quantative assessments. The play therapy manifested in better illness adjustment and general mental well being, enhanced coping and normalisation.
  34. 34. In this study the child initially inhibited, avoided medical toys and engaged in rudimentary play. Her affect was considered and the interaction with the researcher was limited. As sessions progressed, she became active and engaged in various types of play. Her initial avoidance of medical toys followed by repeated enactment of medical procedures carried out on her reflects the mechanism of play therapy in facilitating catharsis and mastery through re- enactment of stressful experiences. Thus as sessions progressed, child’s play become similar to those of healthy children indexing normalisation. This reflects enhanced coping and use of adaptive defences in play sessions.
  35. 35. SCHOOL Public school teacher is employed by local board of education in paediatric ward. Use of television, radio or computerised self instruction program enhances contact with school system. If child is too ill to return to school, continuing class is important as a link with outside world. Child will keep busy, feels useful and important. This help child to return to school after cure.
  36. 36. PREPARATION FOR HOSPITALISATION  Varied emotional changes  Unknown environment  Exposed to unfamiliar equipment  Witnessing frightening sights and sounds  Unfamiliar procedures. Company Logo
  37. 37. • For well children who do not need immediate hospitalisation • For children who are scheduled for hospitalisation • For all children of all age group • booklets, films and puppet shows. • pre admission parties should be conducted. • Familiarising the hospital before admission and pre hospital counselling
  38. 38. BASIC BELIEFS REGARDING CHILDREN • The family is the basic unit of society • Each child needs love and security to develop feelings of trust and self esteem. • Each child is an unique individual with different needs based on his or her family background, level of growth and development and degree of illness • Nurse seeks to promote, maintain and restore health in both children and their parents.
  39. 39. • Each ill child should be under the accountable care of one professional nurse. • The family and child should be included in planning for therapeutic and nursing interventions and for implementing and evaluating the plan of care. • Within a safe environment, the ill child needs expert physical care, emotional support, play that allows for expression of feelings to promote continued growth.
  40. 40. • Parents who have trusted relation with nurses feel welcome whenever they visit and participate in child care. • Family members and terminally ill child who are at great stress should be emotionally supported so that child can die with dignity and with feeling of being loved. Company Logo
  41. 41. GUIDELINES HOSPITAL ADMISSION • Assign a room based on child’s developmental age, seriousness of diagnosis, communicability of illness and length of stay. • Preparing the roommates for the new patient. • Prepare room for the child and family • Introduce primary nurse • Orient to the inpatient facility. • Facilities in the room • Unit ( play room, dining room, lab) • identification band. • hospital regulations and schedules • Perform nursing admission list • vital signs, anthropometric measurements • Obtain specimens • physical examination. PRE- ADMISSION ADMISSION
  42. 42. Emergency admission • Appropriate introduction • Use of child’s name • Determination of child’s age and some judgment made about developmental age • chief complaint from both parents and child. • general state of health, sensitivity to medication, previous hospitalisation. ICU admission • Prepare child and parents for elective ICU admission. • Guide the child’s appearance and behaviour. • Emotional support and answer questions. • Prepare sibling visit. • Encourage parents to stay with child.
  43. 43. REACTIONS TO HOSPITALISATION Physiological reactions • Temperature elevations: as response to infections • Convulsions : resulted from rise in temperature • Immobilisation • Anorexia, vomiting and diarrhoea • Nutritional deficiencies • Fluid and electrolyte imbalance • Inconsistent weight loss • Lack of growth Psychological reactions • Separation anxiety • Stranger anxiety • Sleep deprivation • Loss of self control • Fear of darkness • Fear of death • Sensory overload
  44. 44. REACTIONS OF EACH AGE GROUP Neonates • Interruption in the early stages of development • Impairment of bonding and trusting relationship • Inability of the parents to love and care for the baby and inability of baby to respond to parents Company Logo
  45. 45. INFANT  Stressors  Separation anxiety  Stranger anxiety  Painful invasive procedure  Immobilization  Sleep deprivation  Sensory overload  Responses  Sleep awake cycle disrupted  Feeling routines disrupted  Displays excessive irritability  Rejection of feed  Crying  Nursing implications  Rooming-in  Homely routine  Topical aesthetics  Promote a quite environment
  46. 46. TODDLER Stressors  Separation anxiety  Reactions of toddlers are expressed as protest, despair, denial and regression.  Protest  Despair  Denial  Regression  Loss of autonomy and control  Fear of bodily restraint,injury Reactions  Frightened to sleep in supine position  Think as a punishment  Wonder why the parents are not rescuing Nursing implications  Encourage parental presence  Allow the parent to hold the child in her lap to do any procedure  Give choices  anaesthetics  Explain the procedure in sequence  Provide night light
  47. 47. PRESCHOOLER Stressors  Separation anxiety  Loss of self control  Bodily injury  Painful invasive procedure  Fear of dark Responses  Displace difficulty in separating  Fear of ghost  Fear of body part loss  Fear of pain  Aggression  Regression Nursing implications  Encourage parental presence  Give choices  anaesthetics  Explain the procedure in sequence  Provide night light
  48. 48. SCHOOLER  Stressors  Loss of self control  Separation from family and friends  Bodily injury  Painful invasive procedure  Fear of death  Loss of privacy  Loss of own control  Responses  Displays increased sensitivity to the environment  Demonstrates detailed cause for illness  Nursing implications  Encourage parental presence  Utilise topical anaesthetics  Explain all the procedure  Encourage peer interaction
  49. 49. ADOLESCENT Stressors  Lack of control  Lack of privacy  Fear of lack of body integrity  Fear of disfigurement  Fear of death / disability  Separation from peer group  Loss of privacy Responses  Anger  Regression  Withdrawal  Bargaining  Depression Nursing implications  Include the adolescent in plan of care  Encourage peer group interaction  Parental involvement  Explain each steps of procedures prior
  50. 50. EFFECTS OF HOSPITALISATION ON THE FAMILY OF CHILD PARENTS  Stressors  Strange environment in the hospital  Separation from the child  Unknown events and outcomes  The suffering of the child  Spread of infections to other members in family  Unbearable financial obligations Reactions  anxiety, anger, fear, disappointment,self blame,guilt  The anxiety interferes with the parent’s ability to care the child, support.  This anxiety could be recognised by the trembling,coarse voice, restlessness, irritability and withdrawal. Nursing implications  Recognise the need for support  Encourage to obtain help from other family members or friends  Maintain parent child relationship  Parent support group and care by parent unit  Psychological support  Counselling  Encourage to perform the tasks
  51. 51. SIBLINGS Stressors  Younger child  Experiencing the changes  Cared for outside by care providers  Received little information about their sibling Reactions  Anger  Resentment  Jealousy  Guilt Nursing implications  Explanation about the condition  Provision for sibling to remain home  Sibling visits
  52. 52. DISCHARGE FROM HOSPITAL • plan for discharge with the assistance of parents, child and other health team members. • A discharge preparation involves education for family • The preparation of discharge begins during the admission assessment. • Short and long term goals are established to meet the child’s physical and psychosocial needs. • For children with complex care needs, discharge planning focuses on obtaining appropriate equipment and health care personnel at home. • The teaching plan involves levels of learning, such as observing, participating with assistance and finally, acting without help. • All families need to receive detailed written instructions
  53. 53. OBJECTIVES OF PLANNING FOR DISCHARGE 1. To make certain that the care given in the hospital will be continued as necessary at home – the nurse can assist the parent and child to meet the objective by educating them concerning the illness and the essential requirements for care. 2. To share information with other appropriate community resources or agencies to enable them to assist the parents and the child to continue care at home.
  54. 54. LOGO