Nursing considerations for the

hospitalized child It is stressful for children of all ages and their families. 第 1 段第 2 行Hospitalized children are in an unknown environment, surrounded by strange people, equipment, and frightening sights and sounds. They are subjected to unfamiliar procedures, some of which are invasive, and may even have surgery. 第 4 行Nurses need to provide support (before, during, and after hospitalization) 第 2 段第 1 行

P164

影響兒童適應住院壓力的調節因子

Effects of illness and hospitalization on children and families

Children’s understanding of health and illness

Family responses to hospitalization P180

Preparation for hospitalization （ p180 ）

Adaptation to hospitalization

大綱

影響兒童適應住院壓力的調節因子 Child’s perceptions of the event

Availability of social support

Child’s coping skills

Individual risk factors

Effects of illness and hospitalization on children and families P164

Children’s understanding of health and illness – Their understanding is based primarily on their cognitive a

bility at various developmental stages and on previous experiences with health care professionals.

– Infancy、 Toddlerhood and Preschool age、 School age、 Adolescent

Family responses to hospitalization P165

身心發展– learning through sensorimotor exploration– developing attachment with primary care giv

er– acguiring a sense of trust

The concepts of illness– Separation anxiety： protest 、 despair 、 de

nial （ detachment ） Stressors to the child Nursing intervention

Infancy（ < 1 years）

Nursing intervention P164

--Protest is viewed as a healthy response 第 3 段倒數第 4 行--Parents should be encouraged to remain with and provide ca

re to the hospitalized infants. （ rooming-in ）--primary nurse

--self-comforting measure-pacifier

--human touch, talking, stroking, singing, eye contact

Toddlerhood and Preschool age（ 2-6 years） 身心發展

-- Preoperational --Autonomy v.s. shame and doubt (1-3y/o)Autonomy v.s. shame and doubt (1-3y/o) --Initiative versus guilt (3-6y/o)--Initiative versus guilt (3-6y/o)

The concepts of illness (1)  Understand illness but not its cause P164 此段第 1 行(2)  Two unrelated events may appear to have a cause-and-effect relationship (3)  May blame other people, event, or themselves for an illness 此段倒數第 2 行(4)  Limited to names and locations of some body parts 第 2 段第 1 行

Stressors to the child Nursing intervention

Nursing intervention--rooming-in

--reminders can be left with the child p165 第 2 段第 2行

--encourage the parents to be present as much as

possible for important rituals such as toileting,

carrying out bedtime routines and singing

favorite nursery rhymes. 倒數第 3 行 --explain the procedure 倒數第 3 行 -- 將孩童的貼身物品或喜歡的玩具帶來醫院

School age（ 7-10 years） 身心發展

--Concrete operation

--Industry v.s. inferiority--Industry v.s. inferiority

The concepts of illness (1)  More realistic understanding of the reasons for illness and are ab

le to Comprehend explanations. 此段第 1 行

(2)  The concept of body parts and function is maturing 第 2 行

(3) Concepts of time are well formed 第 3 行 Stressors to the child

Nursing intervention

Nursing intervention --Encourage parents to tell the child when they will retur

n. 此段第 3 行 --Telephone calls 第 4 行 --Stressful procedures can lead to regression or other be

havioral changes. The child relies on parents and others for support and understanding during these event. 第 5 行

-- 鼓勵孩童及家屬參與討論 -- 給於孩童自主權及選擇權 -- 鼓勵同儕來探視 -- 維持學校課程進度

Adolescent（ 11-15 years） 身心發展

– Formal operation

– Identity v.s. role confusion dentity v.s. role confusion

The concepts of illness– Aware of the physiologic, psychologic, and behavioral ca

uses of illness and injury. 第 1段第 1行 – Concerned with appearance. 第 2 行 – Privacy and modesty are major concerns 第 1段倒數第 2

行

Stressors to the child Nursing intervention

Nursing intervention--Allowing choices 第 1 段第 3 行--respect child’s feelings

--Adolescents can control over aspects of their care is important 第 2 段第 1 行

--peer group is major influences 第 2 行--having recreation and teen lounge 第 3 行

Family responses to hospitalization P165

Altered family roles– Other parent or siblings take on additional tasks

at home. 第 2 行

– May be anxious and fearful, especially when the outcome is unknown or potentially serious. 第 3 行

Parental reactions Sibling reactions

Parental reactions P166 第 2 段

(1) Disbelief

(2) Anger, guilt (3) Fear, anxiety, frustration

(4) Depression

Nursing care P166

Maintain positive communication 第 2 段第 2 行Ask for their participation and partnership in care 倒數

第 4 行Explain all aspects of treatment 倒數第 3 行parent need support to lessen their anxiety

Sibling reactions p166

(1)Receive little attention 第 3 段第 1 行 (2)Fantasize about the illness or the appearance of the

child 第 3 行(3)May fear that the child will be disabled or even die.

第 4 行最後(4) May feel guilty 倒數第 3 行最後

(5)May feel insecure and anxious 第 4 段第 1 行(6)Behavioral problems or school performance may d

eteriorate

(7)May jealous 第 2 行

Nursing care （ chapter 8 ）

Preparation for hospitalization （ P166）

•Provide information•Tours fig 5-1 5-2•Photographs or a videotape•Books or films

•Parents as be instrumental

Adolescent– Different approaches are useful for adolescent

Written materials, models, and videotapes.

Talking with peers who have had similar experiences

Provide an opportunity for asking questions without

parents present should be provided.

Adaptation to hospitalization P168

Special care units

Family assessment P170

Child and family teaching

Strategies to promote coping and normal

development

Strategies to meet educational needs P179

Preparation for procedures

Special care units

Emergency care Intensive care Preoperative and postoperative areas Short stay units Isolation Rehabilitation

Child and family teaching P170 – Teaching may be informal or structured. 第 1 段第 2 行

– Account their developmental level and cognitive abilities. P171 第 2 段第 1 行

– More than one sense. 第 2 段第 2 行 – Time: scheduling specific times. 第 3 段第 1 行

– Cognitive, psychomotor or affective domains 第 4 段第 1 行– Teaching plans P173-Families want to know

Strategies to promote coping and normal development P172

Not only on meeting physiologic, but also on meeting psychosocial and developmental needs. 此段第1 行

1.Child life programs—psychosocial needs p173

2.Room in—Parent may want to perform all of the child’s basic care or help with some of the medical care. P175 第 2 行

3.Therapeutic play and therapeutic recreation4.Minimizing loss of control5.Preventing or minimizing bodily injury6.Pain management

Strategies to meet educational needs

Assess the effects of hospitalization on the child’s education 第 1 段倒數第 1 行

Provided with schoolwork to do in the hospital or at home 第 2 段第 2 行

Provide pencils, paper, comfortable work areas, computers, and quiet work time. 第 2 段倒數第 3 行

Telephone calls or Internet connections with teachers 第 2 段倒數第 2 行

Peers can be encouraged to visit a hospital. 第 3 段第1 行最後

P179

Preparation for procedures P179

– Administration of medication can also be frustration. P181 Table 5-8

Assess the child’s feeling’s about the procedure. P180

Assisting children through procedures P182（ Table 5-9）

Assess the child’s feeling’s about the procedure P180, 181

Purpose? Experience? What happen? Painful? Control techniques Provide support?

Preparation for surgery P183

Preoperative care Psychosocial preparation P183 Physical preparation（ Table 5-10）

Postoperative care– Consciousness – Vital signs– Drainage– Dressing– Intake and output– Pain relief– Parents allow to visiting as soon.