Hospitalized child/communication

Spirituality

- Children have rich spiritual lives Although they don't use the same vocabulary as adults to describe them -Spiritual care is a vital coping resource for many children -To provide holistic care to children it is important to assess the child's believes and Faith -Supporting children's existing faith and spiritual practices is recommended -Children can be assisted in maintaining the rituals whether they are bedtime prayers songs are blessings at meals -Nurses can provide spiritual care in ways that offer help and encouragement and comfort and respect -Your resources to pursue in mini hospital or healthcare settings is the pastoral care or chaplains department

Evaluation of play

- Nurse looks at the outcome criteria to determine whether play has facilitated the achievement of goals

Care provider

- Nurse provided patient centered care to women infants and children's and their families in times of childbearing, illness, injury, recovery, wellness -Nursing of children is especially based on my understanding of the child's developmental stage and is aimed at meeting the child's physical and emotional needs at that level -Developing a therapeutic relationship with in providing support to patients and their families are essential components of nursing care -Maternity and pediatric nurses practice family centered care embracing diversity in family structures and cultural backgrounds -These nurses drive to empower families encouraging them to participate in self-care in the care of their child -Nurses who practice women's healthcare and we need to coordinate care with pediatric nurses in Family's headed by grandparents rather than parents of the child

Availability and openness to questions

-A nurse who doesn't take the time to see how a child or family are doing such as when the nurse leaves their room immediately after a treatment or administration of the medication will not encourage or invite families to ask questions -Families want and need and rushed and on interrupted time with the nurse -Sometimes this time can be made available only by purposely scheduling it into the day -Encouraging Family to write down the questions will enable them to take for vantage of the time with the nurse

Loss of control

-According to Ericsson the major task of the toddler is to develop autonomy -Controls a major issue with this age group -The toddler experience is the environment through all the senses and loves to explore the environment -At the same time toddlers need sameness rituals and routines -Because of changes and growth and development taking place in the toddler familiar rituals teams ride reassurance and stability -Hospitalization can severely disrupt the toddlers life -The child may be confined to the crib in the crib may have a cover over it -Because of safety issues the child is not allowed to run in the halls -Your parents are an able to be with the child the weather child is put to bed or Bathed may be unfamiliar -Information from parents about routines can assist the nurse in maintaining usual routines -When children can't do things themselves their sense of control and autonomy is weakened -They are frustrated and may have temper tantrum's -The tile sense of lack of control is often exhibited in behaviors related to feeding toileting playing and bedtime -The nurse should remember that each of these activities may have associated rituals and routines of the child may also shows some regression in these areas

Stressors associated with illness and hospitalization

-Age, cognitive development, preparation, coping skills, culture influence, previous experience with the healthcare system, the parents reaction to the illness affect the child reaction to illness -Hospitalization can create threats or fears for children including bodily injury and pain, separation from parents, fear of the unknown, uncertainty about limits and expected behaviors, loss of control and autonomy -Educating parents about what to expect when their child is hospitalized and supporting their participation in the childcare decrease his parental stress and enables them to better facilitate the child's adjustment *Children's response to illness Fear of the unknown separation anxiety fear of pain or mutilation loss of control anger guilt regression -This is help decrease stress for patients and their families who is stress can impair their ability to care for the child -Hire parental stress levels were identified for unexpected hospitalizations, observing a painful procedure and the altered behavior of the child -Decrease parental distress will result in improved ability to provide emotional support and care for their child -Although preschoolers in young school-age children experience separation anxiety it's most significant in infants and toddlers especially those aged 6 to 30 months -Children quickly learn to associate health care activities and professionals with pain and injury and the fear is usually focused on injections -Specific fears are related to the child's age, hospitalization puts our children at high risk for fears related to their unfamiliar Arity with the people, surroundings, events -The child has not developed trust in the healthcare provider and that does not know what to expect -Medical fears or prevailant in Ogden increase with age children, leave your needles which can increase perceived pain

Manager of care

-Because he's in acute care facilities are short nurses often or an able to provide total direct patient care - Instead they delegate concrete tasks as giving a bath or taking vital signs -As a result nurses spend more time in supervising unlicensed assistant personnel, planning including care, collaborating with other professionals and agencies -Nurses are expected to understand the financial effects of cost containment strategies in to contribute to their institutions economic viability -At the same time they must continue to act as a patient advocate and to maintain a standard of care

Emotional outlet play

-Called dramatic play -The child acts out or dramatizes real life stressors -They include emotional stressors such as abuse or neglect or painful physical stressor such as a bone marrow aspiration - The child who has been sexually abuse might not be able to communicate experience verbally but may be able to use a anatomically correct doll to show what happen -Terminally L children have been reported to use play to tell her stories into express thoughts and feelings an important part of the emotional healing process for children and parents -Many commercially crafted toys are available for dramatic play -Anatomically correct dolls And puppets -Injection and play is good for the child who has to go frequent blood work injections IV therapy -The needle is used for this type of activity safety is of the upmost importance and the nurse should assess the child's growth and development level before using this type of directed play -An adult is always present if any rose used the child can give a Don injection in there by work through anger and anxiety

Touch

-Can be positive, supportive that is effective from birth through adulthood -Touch can come by warmth, comfort, reassurance, security, trust, caring, support -In infancy, messages above, security, comfort are conveyed through holding, cuddling, gentle stroking, patting -Infants don't have a cognitive understanding of the word stay here but they sent the emotional support and they can feel, interpret, respond to a gentle, loving, supportive hands caring for them -Toddlers and preschoolers find it soothing and comforting to be held and rocked as well as gently stroked on the head, back, arms, legs -School-age children and adolescents appreciate giving and receiving hugs and getting a reassuring pat on the back or a gentle hand on the hand -Nurse needs to request permission for any contact beyond a casual touch with these children

Unstructured play

-Children control events ideas and relationships -Music therapy can be given and gives children choices to play instruments such as drums in bells or to join in while a music therapist lead songs and plays a guitar -Animal therapy is another popular type of play with a child can interact with animals and their trainers

Regression

-Children may regress and toileting her cry for a bottle although they have been weaned for several months -Might want more attention at bedtime or have temper tantrum's -The older child my react to separation by the cleaning or crying or have fears about shadows on the walls or noises in the halls -Parents may be overly concerned about regression -Parents should be told that the child might continue some regressive behavior is at home for a period of time following hospital discharge -Child might need more motional support while the parents slowly reintroduce is the child's normal routines -If the child has regressed in toileting the parents should wait until the child has returned with daily routine and then we can the toilet training again -Behavior that is appropriate for the child's age should be reinforced -The child soiling their pants is an expected reaction to the stress of being ill and in the hospital when he returns home and things return to normal for him he will likely resume his previous schedule it for using the toilet

Play rooms

-Children should see this area as a safe place where procedures and treatments don't take place -When their condition is stable children can be taken to the playroom in their beds and wheelchairs -A separate activity area should be provided when possible for adolescence to listen to music play video games or visit with their peers -If play rooms are not available is apply of developmentally appropriate toys games books are given

Tips to enhance listening and communication skills

-Children understand more clearly than they can speak -To develop conversations with children ask open ended questions rather than questions requiring yes or no responses -Comprehension is increased when the nurse uses different methods to present and share information -Use people first language such as Sally in for 28 has cystic fibrosis instead of the CF patient in 428 is Sally -Encourage the child to be an active participant through creating a respectful listening environment where children can express concerns ask questions and participate in the development of a plan of care -Encourage the child to be an active participant through creating a respectful listening environment which children can express concerns as questions and participate in the development of a plan of care

Enhancing cooperation through play

-Children with illness that require unpleasant or painful therapies often are uncooperative -Developing a plan that will stimulate and engage such a child in the activity is a challenge -Nurse should include age-appropriate growth and development activities -The school age child who loves competition in games is more likely to increase range of motion of an arm if points can be made each time a foam ball is thrown through a hoop -Blowing bubbles and whistle stimulate blowing out the nurses penlight can enhance the breathing exercises -Range of motion can be accomplished by throwing foam balls being bags or paper balls -The child who needs to increase intake can sometimes be motivated to drink more fluids if a graph shows the amount taken in and the child receives a Reward when I selected goal is reach -These in enhance motivation

Age in cognitive development

-Children's developmental levels affect their reactions to illness -Developmental differences should be considered during the planning of nursing care -Preparing a toddler for hospitalization or procedure difference from preparing a school-age child -The content the timeframe for setting the method of preparation or all based on the child growth and development -Pediatric nurses must have a clear understanding of the cognitive abilities of children in each age group

Physical proximity and environment

-Children's familiar hilarity in comfort with their physical surroundings affect communication -Children are most at ease in their home environments -Once the injury clinic emergency department for patient care unit they are in a unfamiliar environment and the experience increased anxiety -Hospital and clinic staff members have a tremendous advantage in knowing the clinic or unit is a familiar workplace -Nurses gain better picture of what a child is experiencing by trying to play some selves in the child's position and imagining the child's first impression of the tryouts desk, reception desk, admitting office, treatment room, hospital room -Child's perspective is probably very different from adults -Creating a supportive, inviting environment for children include the use of child size furniture, colorful banners and posters, develop toys and art displayed any child eye level -Individuals have different comfort zones for physical distance -The nurse should be aware of differences that should cautiously move when meeting family respecting each individual personal space -Example sending over the child and family from the intimidating instead the nurse to bring a chair and sit near Child and family fashions that's the nurse said I level, if the chair is not accessible the nurse my stoop or squat. The important part is to be at I level while remaining in a comfortable distance for the child and family -Do not overload the privacy or underestimates the importance -Your room should be available for conducting a private conversation away from roommate family members and visitors -Privacy is critical in working with adolescents who typically were not discussed sensitive topics with parents present -Nurse skill and ease With parents of our lessons will increase the adolscents trust in the nurse -Nurses need to avoid hallway conversations particularly outside a child's room because children and parents me over here only some words or phrases and miss interpret that meaning -Overhearing may lead to unnecessary stress and miss trust between the healthcare providers in the child or family

Development of family centered Child care

-Developed from the recognition that the emotional needs of hospitalwide children usually were unmet -Parents were not involved in the direct care of their children -Children are often unprepared for procedures and tests visiting was severely controlled and even discouraged -Based on a philosophy that recognizes and respects the pivotal role of the family in the lives of both well and I'll children -It's drives to support families and their natural caregiving rules and promotes healthy patterns of living at home and in the community -Parents and professionals for Vitas equals in a partnership committed to excellence in all levels of healthcare -Most healthcare settings have a family centered philosophy in which facilities are given choices provide input and are given information that is understandable by them -Family is respected and it's strenghths are recognized -Association for the care of children's health is a international and enter professional organization founded in 1965 to provide a forum for sharing experiences in common problems into foster growth and children who must undergo hospitalization -Today the organization has brought in its focus on childcare of care to include the community and the home -Increasing attention has been paid to the psychological and emotional effects of hospitalization during childhood -In response to greater knowledge about the emotional effects of illness and hospitalization hospital policies and healthcare services for children have changed -24 hour Parental and sibling visitation policy's and home care services have become the norm -Psychological preparation of children for hospitalization in surgery has become standard nursing practice -Many hospitals have a stand was child life programs to help children and their families cope with the stress of illness -Shorter hospital stays home care Day surgery also have help minimize emotional effects of hospitalization and illness on children

Factors influencing learning

-Developmental level> -Teenage parents often have very different concerns in older parents. Grandparents who assume long-term care for a child after need information that may not have been available when their own child was the same age. Developmental level influences whether a person learns best by reading printed materials using computer-based materials watching videos group discussion. Teaching must be adapted to the child developmental level rather than child chronological age -Language> -Family's home English is not the primary language may not understand -And interpreter for the deaf may be necessary for the person who is hearing impaired - Culture> -People tend to forget or disregard content with which they disagree. The nurse is teaching can be most effective it is cultural considerations are weighed and incorporated into the education -Previous experiences> -People who have other children may need less education about pregnancy care for infants in Child care -They may have additional concerns about meeting the needs of several children and about sibling rivalry Physical environment> -Let's consider privacy when discussing sensitive issues such as adolescence sexuality or domestic violence also called intimate partner violence. However a group discussion may prompt participants to ask questions of concern to all members of the group such as experiences they can expect during labor Organization and skill of the teacher> -Teacher must determine the teaching objectives develop a plan to meet those objectives and gather all materials before teaching -Nurse must determine the best way to present the material for the intended audience

Family centered communication

-Emphasizes that the family is intimately involved in the care of the child -Parents need to be supported while sustaining their parental role during their child's hospitalization -Is achieved one healthcare professionals can create partnerships with families recognizing that the family is essential to the child and that the family has a right to participate fully in planning implementing and evaluating the child plan of care -Means that the family should have a choice in how much care they provide -Commitment to family centered care means that the nurse respects the families diversity -In expanded definition of a family is required in the 21st-century because of term no longer refers to only the intact nuclear family in which parents raise their biological children -Contemporary family structures include Allison parents extended families with ants uncles or cousins parenting inter-generational families with grandparents parenting - Nurse truly believes that the child care in recovery are greatly enhanced when the family fully participates in the childcare

Play for the ill child

-Extremely important part of the hospitalization of a child -Can help reveal how a child is coping with the stress and the hospitalization -Instructor plays an outlet for the child to control events ideas and relationships -Play allows time for children to process and express their feelings and fears -I give the child control over his or her perception of the experience in provides an outlet for emotional release -Siblings also benefit from playing -Decreases potential negative affects of hospitalization by promoting expression of feelings and enabling control over stressful experience -Because plays familiar and comfortable for children child life programs provide opportunities for playing in a variety of healthcare settings including inpatient units I see you I'll patient Kleenex ER -A young child engages in make-believe play a school-age child joints others in a structured game in an adolescent uses a computer to communicate electronically with peers outside the hospital

Body language

-From the gentle caress Of holding an infant to sitting and listening intently to an adolescent story body language is a factor in communication -And open body stance and positioning invite communication and interaction -Whereas a closed body stance and positioning impaired communication and interaction -Using an open body posture improves the nurses understanding of children in the children's understanding of the nurse -Nurses need to learn to read children's body language and should become more aware of their own body language

Preschool loss of control

-Has a good deal of independence in self-care and has been given more independence at home school or day care -Some children expect to maintain their independence in the hospital -For example the preschooler may like to wander about the unit is not happy when restricted to the bed or room - Like the toddler a preschooler like familiar routines and rituals and can show someone regression is not allowed to maintain some areas of control -One five-year-old boy refused to have his dressing changed by the nurse who had cared for him the previous day she reported that he cried pull up the covers and said that she was mean this behavior was an usual for him and the nurse suspected that he had been told to do too many things and have not been given choices in response to nurse might say I know there have been many changes for you since you came to the hospital today we are going to decide together what is going to happen

Factors affecting a child response to illness and hospitalization

-How much child reacts is often related to the parents response to the illness in the child's age, level of cognitive development, preparation, previous experience, coping skills -For children who had previous illness or hospitalization how that events unfolded in the trails response to it will relieve affect a child's view a future experiences -Children with chronic diseases who undergo multiple hospitalizations have a different perception of illness than those who have occasional cold -A visit to a pediatricians office will show the wide range of responses that children exhibit -Some older children have more negative responses as they begin to associates are people colors in surroundings with What was for them and unpleasant experience -Intimidating to a child to be in a healthcare facility but a well-built facility that endeavors to make children less anxious and fearful and provides his face that engages children and a cognitive the appropriate way will result in a positive experience for children and families -Private spaces with the lounge rooms that have natural light and windows with a view are therapeutic -Play rooms that encourage children to explore and engage in therapeutic Lee positively affect the child experience -Access to school like across the room settings with and restrictive phone and computers is much appreciated by older children

Coping skills of the child and family

-How the child copes with illness or hospitalization is related to age, perception of the event, previous hospitalizations, encounters with the healthcare profession, support from others, the child and parents coping skills -Children use words behaviors in physical actions to help them through stressful situations -Child my also cope by ignoring or negating the event -Stress reactions depend on the child's age and developmental level -The younger child is more likely to use emotional expression well the older child and adolescent are more likely to withdraw our practice more self-control behaviors -For example although the younger child my scream and kick during a procedure the other child my remain stoic and say that it did not hurt even though I did -Children try to appear brave and meet self-imposed or parental expectations -Breathing such as blowing bubbles or party blowers are seeking helps with relaxation -Teaching coping mechanisms and practicing number for the procedure can help a child feel more control and successful -Distractions and imagery for older children are effective tools for coping -Child life specialist encourage parents to come for third child and provide security and they also prepare a child for a procedure by incorporating the five senses into the explanations -They encourage the child to have some control by offering appropriate task and use play as a way of normalizing the experience

Communicating with families

-Include all involved family members essential step toward achieving a family centered care environment is to develop open lines of communication with the family -Encourage families to write down their questions -Remain non-judge mental -Give families both verbal and non-verbal signals that send a message of availability and openness -Respect and encourage feedback from families -Recognize that families come in various shapes sizes colors and generations -Avoid assumptions about poor family beliefs and values -Respect family diversity

Preschooler separation anxiety

-Less obvious and less serious than in the toddler -Although the preschooler may already be spending some time away from the parents at a daycare center or preschool illness as a stressor that makes separation more difficult -Young children have a good recall of their medical experiences so nurses must help to make their healthcare experience is positive by allowing children outlet for their feelings and stress -The preschooler expresses the same protest as a toddler but tends to be less direct -Nurse may find a preschooler quietly crying because his parents have told the child to act like a big boy or a girl -Children of this age they refuse to eat or take medications and can be generally uncooperative -They may repeatedly asked when their parents will be coming for a visit with access to refund the children my constantly call the parents... The signs indicate that the child is having difficulty coping with the situation

Trans cultural communication bridging the gap

-Need to be aware of their interactions throne values and believes -Also need to be aware of and respect the child and families values and beliefs -In working with children and families the initial nursing assessment should I dress values beliefs and traditions -The nurse can then consider ways in which culture might affect communication style methods of decision-making cultural obligations for nursing intervention and other behaviors related to healthcare practices -The nurse ascertain The following information related to the child and family including decision making practices, child rearing practices such as who are the primary care givers what are the disciplinary practices -What is the family structure to whom do the patient and family turn for support -Communication practices how is the information communicated to the rest of the family -Health and illness practices to family members seek professional help or rely on other resources for treatment and advice -Because language barriers can greatly affect the provision of healthcare effective communication with a child and family for him English is not the native language is an important challenge -The optimal approach to this issue is to access a trained interpreter or a family member or friend who is proficient in English -Do not use a child to interpret -Nurse can you see information obtained to Individualize a treatment plan and approach suitable for the child and family needs -For example if the parents of a child with an Orthodox Jewish religious background request a kosher diet the nurse facilitate the routine delivery of kosher meals -If the family of a child who has severe brain injury and request the services of a healer the nurse enables the family to arrange the visit -When the nurse communicates the families cultural preferences to other members of the healthcare team communication and holistic care are enhanced

The role of the professional nurse

-Nurse has a responsibility to provide the highest quality of care to every patient -The American nurses Association code of ethics for nurses provide skylines for ethical and professional behavior -Code emphasizes a nurse is accountability to the person community and profession -Nurse should understand the implications of this code is strive to practice accordingly -Professional nurses have a legal obligation to know and understand the standard of care imposed on them -It's critical that nurses meeting competence in a current knowledge base in their areas of practice -Standards of practice describe the level performance expected of a professional nurse as determined by an authority in practice -Perinatal nurses are held to the standards published by the Association of women's healthObstetric and neonatal nurses -AWHONN standards for a professional nursing practice in the care of his woman in newborns and standards for perinatal nursing practice and certification in Canada publish to go to nursing practice in shape institutional guidelines -Nurses who care for children can use ANA Society of pediatric nurses standards of care and standards of professional performance for pediatric nurses -Other standards of practice for a specific clinical areas such as pediatric oncology nursing and emergency nursing are available from nursing specialty groups -As healthcare continues to move toward family centered and community based Health services on nurses should expect to care for children and their families at the point of contact -Society of pediatric nurses has issued several position statements regarding the inclusion of pediatric nursing contact when planning undergraduate nursing programs in response to these changes in settings of care -Stevens address it's important issues as social determinants of health interdisciplinary collaboration in care, promotion accessibility to four range of services advocacy development

Researcher

-Nurse is contributing confessions knowledge by investigating theoretic or practice issues in nursing -Nursing does much more than simply borrow scientific knowledge for medicine and basic sciences -Nursing generates an answer is it's own questions based on evidence within its unique subject area -Responsibility to provide evidence-based patient centered care is not limited to nurses with graduate degrees -It's important that all nurses appraise and apply appropriate research findings to their practices rather than leasing care decision merely on intuition or tradition -Evidence-based practice no longer just an idea but an expectation of nursing practice -Nurses contribute to the body of professional knowledge by demonstrating an awareness of her value of nursing research and assisting a problem identification and data collection -Nurses should keep their knowledge current for networking a shower and research findings conferences by publishing by evaluating research journal articles

Feedback from children and families

-Nurse needs to be alert for both verbal and nonverbal cues -What do you mean checking with family members about their experiences satisfaction with communications teaching sessions and healthcare goals is an effective way to ensure that the healthcare providers obtain appropriate feedback -Do you enhance the delivery of care nurse should explain how this feedback will be used and nurse should listen and observe carefully to make sure that my family members are seeing a show you what they are feeling -Nourishes and then I find out only the child's primary care taker but also other family members integral to the child care -Support and physical cares often provided to the child by a family member other than a parent -Communicating with this important person will system nursing providing comprehensive family centered care - For example when one nurse was teaching a mother of a two-year-old child who was recently diagnosed with type one diabetes the mother reported that although she was her child's primary caregiver the child's grandmother frequently cared for the child while the mother was at work therefore the nurse should alter the teaching plan for diabetes care to include the child's grandmother

Collaborator

-Nurse often coordinates and manages the patient's care -Cara is improved by in an interdisciplinary approach as nurses work together with dietitians social workers physicians -Comprehensive and thorough interdisciplinary communication enhances the effectiveness of collaboration promotes critical thinking skills and improve the situation awareness -Managing a transition for my hospital or any other acute care setting to the patient's home or another facility involves discharge planning and collaboration with other healthcare professionals -The trend toward home care makes collaboration increasingly important -Nurse must be knowledgeable about community resources and appropriate home care agencies for this type of patient or problem and social work resources -Patients including parents of children are encouraged to participate in their care

Communicating with children and families interventions

-Nurses working with children should determine the best communication approach for each child individually on the basis of the child's age and developmental abilities Play> -Play can greatly facilitate communicating with children -Approaching children at their developmental level with the Milyer forms of play increases their comfort and allows a nurse to be seen in a more positive less threatening role -Because plays an every day part of the children's lives and a method they used to communicate they are less likely to be inhibited when participating in play interactions -Through play children may express thoughts and feelings they may be unable to verbalize -Children's access to the World Wide Web and electronics social media sites has expanded the sources of health and illness information that children and families can obtain directly -Use of appropriate social networking sites is another vehicle for obtaining information and support for children -Nurses need to become familiar with some of the sites in order to evaluate them for appropriate and accurate information before recommending them to children and families -Storytelling> -Is a innovative and creative communications Strategy -It is also a skill that can be acquired and refined through practice -Familiarity With stories and frequent practice in storytelling increase in nurses confidence and competence as a storyteller -Storytelling can be a routine part of the nurses day -It's purpose is range from establishing rapport to approaching uncomfortable topics such as loss death here grief and anger -In storytelling there is a teller and a listener -Individual situations the child may be the teller or the listener although and a shirt story adult and child may take a turn in both roles -Explaining procedures and treatments> -Preparation before the procedure which includes explaining the reasons for the procedure and the expected sequence of events in our comes can greatly reduce a child fears and anxieties -Preparation enables a child to experience the mastery over events give the Chayanne time to develop effective coping behaviors and fosters trust in those caring for the child -Adequate preparation is the key to helping a child have a successful positive healthcare experience -The younger the child The closer in time to the event the child should be prepared for it. For example 3-year-old child will generally be very anxious and therefore should be prepared immediately before whereas squeeze children and teenagers would benefit from a longer preparation time so that they can develop strategies for dealing with the situation -Nurses to adequately explain procedures and treatments two children and families they themselves must first know what is involved -In this way nurses can properly describe the sequence of events and collect the developmentally appropriate information and equipment needed to assist with the procedure or treatment explanation -Depending on the child's developmental level the nurse provided sensory information describing a step-by-step what the child will see Here and feel and how long the procedure or treatment will last. For example in preparing a child for an IV line insertion the nurse can show the child the catheter or explain the purpose of the tourniquet and allow the child to put it on where to put it on the arm of a doll -The nurse should let the child smell an alcohol swab and feel it's coolness when applied to the skin -Show the child to place our room or procedures will occur may reduce some of the stress and anxiety associated with the unfamiliar environment -Assessing readiness> -The first step is to assess the child or families readiness to learn -Some children would preferred to be actively involved and interested in coming opinions and feelings and other children might be passive participants -Providing information> Once readiness has been established the nurse weekends to prepare the child using clear descriptive language appropriate to the child's developmental level. Use words familiar to the child and avoid medical jargon. Preparation should occur in environment that is free from other distractions so that the child in our family can focus on what is being said. Avoid information overload - Verifying understanding> -When the teaching or preparation is complete the nurse as a child and family member to repeat in their own words the information provided or if the teaching involves a procedure that the child or family member will perform there should be a return demonstration of the skill -Nurse takes opportunity to clarify any information that has been misinterpreted - Open and honest communication about treatments and procedures for facility achievement of the treatment goals —It's essential for the nurse to ensure that the children and family members can describe the treatment plan because nonadherence the treatment protocols can be a problem in some families -Various written verbal interactive and visual materials can improve comprehension and adherence -For psycho motor skill development return demonstration is important -Reinforcement with written materials in the families chosen language or at the families assessed literacy level provides a ready reference for the family after the child's discharge -Strategies for enhancing self-esteem> -Communication practices play in important role in the development of children self-esteem and confidence -The words adults choose your tone of voice in the place in timing of message delivery all influence a child's interpretation of the message -The interpretation may be positive negative or neutral -To enhance the child's self-esteem adults should strive for positive language -Allowing children to have a voice when Candace provided increases their self-esteem and empowers them in situations where they feel left out -Children are competent to understand information about their condition and treatments and should be included in the decision making -Nurses need to be careful not to overlook children appear reticent by excluding them from dialogue

Historical perspective

-Nursing care for children influenced by historic and social factors -Children have not always enjoyed the valued position that the Hold in most families today -In times of economic or social stability children have been viewed as expendable -In societies in which the struggle for survival is a central issue and only the strongest survive, the needs of children or secondary -And the well-being of children in the past depended on the economic and cultural conditions of the society -At times parents have you their children as property and children have been bought and sold being in some cultures sacrificed in religious ceremonies -In some societies infanticide Has been a routine practice -Children have been highly valued in their birth considered a blessing -Bude by society as miniature adults children in the past receive the same medical remedies as adults and during illness or cared for at home by family members just as adults were

Family education and empowerment

-Occurs when the nurse and other health providers take the time to educate parents about their child's condition and the skills they need to participate that's in sharing their continued involvement in planning and evaluating the plan of care -Families need support As they gain confidence in their skills and they need guidance to the system as a navigate through the healthcare experience -Communication is enhanced with families feel competent and confident in their abilities

Advocate

-One who speaks on behalf of another -Care can become in personal as the healthcare environment becomes more complex -Wishes and needs of children and families are sometimes just counted or ignored in the effort to treat and to cure -As a health professional who is close to the patient the nurse is an ideal position to humanize care and to intercede on the patient's behalf -As an advocate the nurse considers the family's wishes and preferences when planning and Implementing care -Nurse informs families of treatments and procedures ensuring that the families are involved directly and decisions and activities related to their care -Nurse must be sensitive to Family's values beliefs and customs -Nurses advocate for help from my friend and helper outfit for vulnerable groups such as children, victims of domestic violence, and others in the family -Nurses promote the rights of children and families by participating in groups dedicated to their welfare such as professional nursing societies, support groups, religious organizations, voluntary organizations -Through involvement with healthcare planning on a political or legislative level and by working as a consumer advocates nurses can initiate changes for better quality healthcare -Nurses possess unique knowledge and skills and can make valuable contributions in developing healthcare strategies to ensure that all patients receive optimal care

Preschooler fear of injury and pain

-Preschooler feels mutilation the child who must have surgery affecting a limb or other body part feels greater fear -Does not understand body integrity -Report a predominant fear of pain and procedures that may cause pain such as injections and the drawing of blood -Procedures that can be painful should be performed in the treatment room so children see their hospital rooms are safe places -They often imagine treatments to be much worse than they are -Imagination can become extremely active during illness -The preschooler may believe that the illness occurred because of some personal fear or thought or perhaps because a child touched something or someone *Maintaining a safe place> It designated safe area can enhance the child security. For example intrusive procedures that Can Cause discomfort or anxiety might better be done in the treatment room rather than a child's room -The play room should also be a place for playing no treatments or administration of medications -Nurses consider the child's age and developmental level coping skills and parent child preference when deciding where to perform procedures that may be painful or distressing

Fear of injury and pain

-Previous experiences separation from parents restraint and preparation affect the reaction of infants and toddlers to pain and bodily injury -The young child views injury and pain concretely -Nurses who have worked with toddlers know that most toddlers react to any intrusive procedure wether is painful or not

Timing

-Recognizing the appropriate time to communicate information is a developed skill -A distraught child whose parents have just left for Work Is not ready for a diabetes teaching session -The session will be much more productive in the information better understood if the child has a chance to make the transition -The convenience of meeting a schedule should be secondary to meeting a child's needs -In the well or outpatient setting scheduling teaching sessions that adapt to a parents background and experiences including work schedule can enhance a child's for parents understanding of information -Example scheduling a teaching session during the late afternoon early evening or on a Saturday I share his increased attention because the parents are not distracted with needing to be at work or other demands on time

Tone of voice

-Spoken word comes to mind most often when communication is the topic -Communication Comprises not only what is said but also the way it is said -The tone and quality of voice often communicate more than the words themselves -Infants cognitive understanding of words is limited, their understanding is based on tone and quality of voice -A soft smooth voice is more comforting and soothing to infants in a loud startling harsh voice -Infants consents from the tone of voice whether the caregiver is angry or happy, frustrated or Calm -The nurse can assess how aware of and sensitive to these messages infants are by observing their body language -Infants are relaxed when they hear a calm, happy caregiver intense and rigid when they hear an angry frustrated caregiver -Children candy tact anger frustration joy other feelings that voice is convey even when the accompanying words are in congruent -This incongruity can be very confusing for children the nurse just drive to make words and their intended meaning's match -Verbal communication extends beyond actual words -All audible sounds convey meaning -In infants primary motive audible communication is crying -Crying is a cue to check basic needs including hunger pain discomfort such as a wet diaper and temperature -Cooing And babbling also her during the first year of life generally convey messages Of comfort and contentment -As children develop and mature they have larger vocabulary to express their ideas thoughts and feelings -The choice of words is critical in verbal communication the nurse needs to avoid talking down to children but should not expect them to understand Adult words and phrases -jargon should be avoided

Preparing to Child and family

-Stress defined as a non-specific responses the body to any demand made on it -Perceived stressors In the coping mechanisms lose to adopt all of that each person's adaptation to a stress producing situation -Preparing for hospitalization can decrease stress -During preparation the child and parent perceptions of the event can be explored -In addition previous experiences in the use of previous coping strategies can be identified and discussed -Variables that the nurse should consider or the child's age and developmental level involving the family timing child physiologic status and psychological status, setting, socio-cultural factors, the child's past experiences with illness and hospitalization -Preparation sessions should be planned -Teaching more effective if the nurse and family develop trust -Honesty and use of language appropriate for the child's age are imperative -When possible all of the child senses should be involved -Child should be allowed to see the intensive care area surgery area before being admitted, take a blood pressure of a stuffed animal, and all the mask that will be used in surgery -There should avoid using medical terms that children and their parents might not understand -Literal interpretations of some words can be confusing and scary to some children -Explain the opportunity to handle equipment can help children master the fear of hospitalization and treatment

Psychological benefits of hospitalization

-Stress of illness and hospitalization can enhance growth and development by promoting a child to use of coping skills and bolstering self-esteem -Children can increase their Self-confidence as they overcome anxiety and related to hospitalization and perhaps master some self-care skills -They feel positive about the recovery or increased ability to cope with any disability have -In addition hospitalization offers an opportunity for children to ask questions and obtain new information

Teacher

-Teaching begins early before and during a woman's prenatal care and continues through her recovery from childbirth learning to care for her newborn and itnto her care in women's health -Nurses who care for children prepare them for procedures, hospitalization, surgery using knowledge of growth and development to teach at various levels of understanding -Families need information as well as emotional support so that they can cope with anxiety and uncertainty of a child illness -Nurses teach family members how to provide care watch for important signs and increase the child's comfort -They also work with your parents and parents Ville children so that the parents are prepared to assume responsibility for care at home after the child has been discharged from the hospital -Nurses apply principles of teaching and learning to change the behavior of family members -Nurses motivate women children and families to take charge of and make responsible decisions about their own health -Effective teaching miss incorporate the family values and half believes -Nurses play in important role in preventing illness and injury through education and anticipatory guidance -Teaching about immunizations safety dental care socialization discipline -They offer guidance to parents with regard to child rearing practices and preventing potential problems -Answer questions about growth and development and assist families in understanding the children -Teaching often involves providing emotional support and counseling to children and families

Principles of teaching and learning

-The following principles were home nurses become effective teachers and the child bearing or child rearing setting -Real learning depends on the Readiness of the family to learn in the relevance of the content -Active participation increases learning. Never possible the learner should be involved in the educational process and not act as a positive listener or viewer. He discussion format in which I can participate stimulants for learningthan a straight lecture -Repetition of a skill increase retention and promotes a feeling of Competence -Praise and positive feedback are powerful motivators for learning. They are particularly important when the family is trying to master a frustrating task such as breast-feeding in and responsive infant or changing a wound dressing on a child -Roll modeling is effective for demonstrating behavior. Nurses must be aware that their behavior is scrutinized carefully at all times and then it maybe copied later -Conflicts and frustration and Peed and learning and should be recognized as resolved for learning to progress -Learning is in Hanst when teaching is structured to present simple task before more complex material. For example the nurse teaches how to care for the umbilical cord which is simple before teach you how to bathe and shampooing the newborn which is more difficult for inexperienced parents -Various teaching methods are necessary to maintain interest into illustrate concepts such as posters videos printed materials supplement lectures discussion -Models may be especially useful for teaching family planning for the process of labor or for teaching a child how do you say peak expiratory flow meter -Information retain better when presented in small segments over a period of time. Short hospital stay's do not support his practice making follow up care particularly important for some patients

Establishing rapport

-The nurses ability to convey genuine respect and concern during the first encounter -A non-judge mental approach and a willingness to assist family members and effectively caring for the child demonstrated the nurses interest in their well-being

The ill child family

-The nurses patient is an entire family -Where is acknowledges that the parents and family are the primary in continuing providers of care for the child -Older school children and adolescents are more custom to parental absence Parents> -Child's illness can create a situational crisis for the family - your children become the parent central focus and become very vigilant and committed to protecting the child the parental rule changes when the child is admitted to the hospital the parent who was in control before admission is now in a unfamiliar environment -Parents play a vital role in helping their children cope with their hospitalization -Parents and sister child with emotional support distraction and returning to the child's normal routime -One of the most reported stressful aspects of hospitalization for parents was the railing wishing of the care of their child to health professionals -Other factors included the limited or absence of opportunity to participate in decision making regarding the care of a child -Nurses are responsible for ensuring children and parents are prepared for hospital experiences are allowed to participate and characteristics and kept informed about the child's response to treatment —A period of denial can be followed by anger thing or can be directed at the nurse when the immediate crisis is over a period of depression can occur many times parents become exhausted both physically and psychologically -Encourage parents to express their feelings active listening and assisting with processing feelings in referral for counseling in social work services -Open parents to use reflective parenting as a parent-child relationship by naming the parents to understand their child thoughts feelings and intentions as beneficial -Parents marriage can be strained -This situation is a specially likely in marriages are already at risk even with both partners are at the hospital they may not have any time alone -All caregivers nOlder school children and adolescents are more custom to parental absence Parents> -Child's illness can create a situational crisis for the family - your children become the parent central focus and become very vigilant and committed to protecting the child the parental rule changes when the child is admitted to the hospital the parent who was in control before admission is now in a unfamiliar environment -Parents play a vital role in helping their children cope with their hospitalization -Parents and sister child with emotional support distraction and returning to the child's normal routime -One of the most reported stressful aspects of hospitalization for parents was the railing wishing of the care of their child to health professionals -Other factors included the limited or absence of opportunity to participate in decision making regarding the care of a child -Nurses are responsible for ensuring children and parents are prepared for hospital experiences are allowed to participate and characteristics and kept informed about the child's response to treatment —A period of denial can be followed by anger thing or can be directed at the nurse when the immediate crisis is over a period of depression can occur many times parents become exhausted both physically and psychologically -Encourage parents to express their feelings active listening and assisting with processing feelings in referral for counseling in social work services -Open parents to use reflective parenting as a parent child relationship by naming the parents to understand their child thoughts feelings and intentions as beneficial -Parents marriage can be strained -This situation is a specially likely in marriages are already at risk even with both partners are at the hospital they may not have any time alone -All caregivers need recognition support and education -Prices without support system will have more difficulty adjusting to the change in the family that is organized and adjustedeed recognition support and education -Prices without support system will have more difficulty adjusting to the change in the family that is organized and adjusted

Fear of the unknown

-The sights and sounds in the hospital can be frightening and confusing the children children may have questions such as where are the nurses wear a mask why is that alarm keep bringing am I dying -With disruptions in the child routines and rituals here she might wonder what will happen next -Understanding these fears can assist the nurse in structuring care and teaching in a way that avoids unnecessary anxiety

Therapeutic relationships developing and maintaining trust

-Trust promote a sense of partnership between nurses in families as becoming overly involved with the child or family can inhibit a healthy relationship -Because nurses are caring nurturing people in the profession demands that nurses sometimes become intimately involved in other peoples lives maintaining the balance between appropriate involvement and professional separation is quite challenging -Well the nurses become too emotionally involved or find them selves at the other end of the spectrum being under involved they loose effectiveness as objective professional resources -Family members may display feelings of incompetence fear and lose control by expressing anger withdrawal or dissatisfaction -Promote the parents feelings of confidence through education and empowerment -The nurse keeps parents were informed of the childcare through frequent phone calls and actively involved him and decision making -Teaching parent skills necessary to care for their child promotes confidence enhance his self-esteem and Foster's Independence -Nurse must be able to recognize their own personal and professional needs -Be aware of the motives for one spoons actions over early and has the nurses ability to understand the needs of children and families and to give Family some tools to manage care effectively *Maintaining a professional boundary requires that the nurse constantly be aware of the fine line between empathy and overinvolvement

Teaching through playing

-Used in preop teaching and teaching before a new painful procedure -Is this child's cognitive level before doing this -Hospital equipment often used in this type of play -Nurse my demonstrate taking a blood pressure and the child stuffed animal before putting the cuff on the child -Breathing treatment might be given to the child star before the child is given the treatment -Nurse may use drawings and diagrams to explain procedures or surgery -Uses play for children experiencing invasive painful procedures such as IV line insertion has been shown to be effective in teaching what to expect before the procedure in to improve coping skills

Therapeutic play

-When a child is hospitalized one component of the child's plan of care is the use of therapeutic play -Differs from normal plate in its design and intent -Members of the healthcare team guided in activities are planned to meet the physical and psychological needs of the child -Interpretation of the child's play behavior and some types of play therapy required guidance by a train play therapist -Therapeutic play provides an emotional outlet, instruct and improve physiologic abilities -Supervise play with medical equipment helps reduce fear and separate reality from fantasy -Child life specialists are available

Effective management of conflict

-When conflict occurs it needs to be addressed in an expedient manner to prevent further breakdown in communication -Understand the parents perspective imagine yourself as a parent of a child in a hospital where your values and believes are exposed and scrutinized and try to understand the parents perspective better by encouraging them to share it - Determine a come and go and stay focused on it determined he agreed on result and work toward it by staying focus on a common goal the parties involved are more likely to find workable strategies to achieve the identified goal -Seek win-win solutions and complex should not be about who is right and who was wrong and affective conflict management focus is on finding a solution or by both parties win -Listen actively and critical to resolve situations conflict is the ability to listen and understand with the other person is saying and feeling. In active listening through receiver actively and empathetically listens to gain a better understanding of the actual and the implied message -Openly express your feelings talking about feelings as much more constructive then acting them out -The nurse might say I am very concerned about Jaime safety when you leave his side rails down -Avoid blaming each party owns part of the problem pointing fingers and blaming others will not solve the problem instead identify the part of the problem that each party owns and work together to resolve it -Summer The decision At the end of any discussion summarize what has been decided and identify who is responsible for follow up this process ensures that everyone is clear about the decision and facilitates accountability for implementing solutions

Visual communication

-eye contact is a communication connector -Making iContact helps confirm attention and interest between the individuals communicating -For people in some cultures direct eye contact may be uncomfortable the nurse should be sensitive to your responses were making eye contact -Clothing physical appearance and objects being held are visual communicators -Children may react to an individual's presence on the basis of a white lab coat, a bushy beard or a syringe or video game in the hand -The nurse states to think ahead and anticipate visual stimuli a child may find startling and those that may be pleasing and to make appropriate adjustments when possible -For example it is a routine practice for nurses to bring a medication in a syringe for insertion into a intravenous line -Unless the purpose of the syringe is immediately explained children might quickly assume they are about to receive an injection -Some children and some adults are visual learners -They learn best when they can see or read instructions, demonstrations diagrams or information -Using various methods of presenting and sharing information will increase comprehension for such children -Concepts can be presented more vividly by using developmentally appropriate photographs, videos, dolls, computer programs, charts and graphs then by using written or spoken words alone -The nurse needs to select teaching tools and materials that appropriately match the child's growth and developmental level

Listening

Attentiveness > -Should be intentional about giving the speaker undivided attention - Eliminating distractions whenever possible is important -For example the nurse she maintained eye contact, close the room door, illuminate potential distractions Clarification through reflection> -Using similar words the nurse expresses to the speaker what was heard and understood about the content of the message -For example when the child or family member says I hate the food that comes on my tree reflect a response would be when you say you were unhappy with the food you've been giving what can we do to change that -As a conversation progresses the nurse can move the child or a dialogue that identifies his nutritional foods a child would eat Empathy> -Identifies and acknowledges feelings expressed in a message -For example if a child is crying after a procedure the nurse might say I know it is uncomfortable to have this procedure it is OK to cry and you did a great job holding still Impartiality> -Nurse listens with an open mind -Example if a young adolescents shares that she is sexually active is mainly concerned about sexually transmitted diseases the nurse remains a supportive listener -The nurse can then provide her with educational materials and resources as well as discuss the possible outcomes of her actions in a manner that is open and not judge mental -Do you shift handoff descriptions of family must be shared objectively and impartially -Perceptions of families may Negatively affect how colleagues approach and interact with families -To enhance effectiveness of communication and maximize normal language patterns, the nurse focuses on talking with children rather than through them and develops conversations with children -Nurse must be in the eyes as well as the ears -Will not always be out in more so the just be alert to subtle cues in body language and physical closeness -Only then can one fully understand the messages of children -For example when the nurse enters a room to complete an initial assessment of it for y'all and observes a child turning away and beginning to suck your thumb the child is communicating about her basic security and comfort level although she has not said a word

Warning signs of under involvement

Avoiding the child or family calling in sick so as not to take assignment of a specific child - Asking to trade assignments for a specific child Spending less time with a particular child

preschooler guilt and shame

Because you're thinking is egocentric and magical preschoolers may believe that their illness is somehow related to a thought or deed -Let's believe can lead to feelings of guilt shame and increased stress at a time and the child has to cope with several other stressors -Because a child typically does not share these feelings with adults parents and caregivers must be aware of the possibility of guilt and shame in this age group -The nurses role is to assess the child for this type of thinking and through therapeutic communication -The child might be able to relate perceptions of what is happening -Do use puppet stalls and drawings can help children deal with their feelings -A tremendous decrease in anxiety can resolve and the nurse helps the child identify a perceived punishment and then reassurance a child that nothing the child did would cause the illness

Warning signs of overinvolvement

Buying gifts for individual children or families giving out ones home phone number competing with other staff for the child or families affection inviting the child or family to social gatherings excepting invitations to family gatherings visiting or spending time with the child or family during off duty time revealing personal information landing or borrowing money making decisions for the family about the child care

Caring for the siblings of an ill or hospitalized child

Caring for the siblings of an ill or hospitalized child

Parental response

Children have sharp observation skills and know when their parents are anxious and upset -This anxiety is transferred to the child and the child's anxiety then increases -If the parents talk outside their child's room or within hearing range child imagine what the parents are saying -All children especially preschoolers have a very active imagination and can invent elaborate stories to explain what is happening - Parents who do not answer the child questions for dont not tell the truth for fear for in the child only confuse the child and Can weaken the child's trust in a parent -The child wants to believe that someone is in control and that here she can trust that person -Some parents cannot be honest with her children because of their own fears and insecurities

Separation anxiety. Infant and toddler

Infant and toddler-Common between six and 30 months -Separation is this age groups major stressor in his Traumatic to both the child and the parent -In the initial phase known as protest the child demonstrates distressed by crying and rejecting anyone other than the parents -The child appears angry and upset -During the despair Fais the child feels hopeless and becomes quiet and withdrawn -Cry and decreases in a child because Apathetic -The separation from the parent continues the child enters the detachment phase -During this phase the child again becomes interested in the environment and begins to play - Nurses may misinterpret this phase as a positive sign that a child has adjusted to hospitalization -In reality the child has given up -Parents return during this stage the child ignore them and the parents may think that the child does not want to see them -This reaction as a coping mechanism to protect the child from further emotional pain related to the separation -Nurses in acute care settings seem first two stages of separation protest and despair more frequently than the final stage detachment which is more common in long-term separations -Parents may misunderstand their child's behavior -They may even perceive the child reaction as a behavior problem -Nurses need to reassure Perez that this is reaction is normal to separation and the most children will not have permanent effects of this event -Has separation anxiety has evolved visiting times for pediatric patients have changed from ours to more flexible rooming-in situations -Infants and toddlers go through the stages of separation -For this age Groom the older the child more elaborate the child protest -The child not only cries but also making to the parent kick in general he create a scene -This behavior is a sign of healthy parent child attachment -The child may resist bedtime and eating and half temper tantrum's more frequently than normal for this age -Regression may occur in toileting and eating -Nurses need to explain to parents that regression is normal and to encourage parents to reinforce appropriate behavior while allowing the regressive behavior to occur -Suggest the parents to encourage to visit the child as needed to call any time of the day and when you return to bring a favorite toy or stuffed animal or something that reminds a child of the parent such as a picture or a piece of clothing

Open and closed body postures

Open> -Leaning toward other person -Arms loose at sides -Frequent iContact -Hans moving freely soft stance Head up calm slow movements Smiling friendly facial cues -Conversing at eye level closed> Leaning away from other person Arms folded across chest No I contact Hands on hips Rigid stance Head bowed Constant motion squirming Frowning negative facial cues Conversing at a level that requires the child to move to listen

Hygiene and Hospitalization

Pasteur, lister, Koch Who established that bacteria caused by many diseases supported the use of hygienic practices and hospitals in foundling homes -Hospitals began to require workers to wear uniforms in limit contact between children in the wards - In effort to prevent infection hospital words were closed to visitors -Because parental visit were noted to cause distress specially when parents had to leave parental visitation was considered emotionally stressful to hospital Children -In effort to prevent such emotional distress and spread of infection parents were prohibited from visiting children in the hospital -Because hospital care focused on preventing disease transmission and curing physical diseases the emotional health of hospitalized children received a little attention -And 20th century knowledge on nutrition and sanitation bacteriology pharmacology medication psychology increased changing dramatic changes in child's health -In the 1940s and 1950s medications such as penicillin and corticosteroids in vaccines against many communicable diseases save the lives of tens of thousands of children -Technologic advances in the 1970s and 1980s a lot more children to survive conditions that previously had been fatal such as cystic fibrosis -An increase in suicidal concern for children brought about the development of federalist supported programs such as school lunch programs WIC Medicaid

The school age child

Separation > -Is a custom to periods of separation from parents but as with the preschooler the separation becomes more difficult as stressors are added -The younger school-age child may already have been feeling separation anxiety related to starting school -Older children may be more concerned with missing school and the fear that their friends will forget them -The unfamiliar environment coupled with the regression scene and your children increase the likelihood that some separation anxiety will take place Fear of injury and pain> -Concerned with body disability and death -The child is more relaxed about having a physical examination or having the eyes or near examine what is uncomfortable with any type of genital exam -School age children want to know the reason for procedures and tests and ask relevant questions about their illness -Because they understand cause-and-effect they can relate actions to becoming ill - The parents may tell them that if they do not get enough rest wear warm clothes really nutritious meals they will get a cold -They become ill they associate their actions with the disease Loss of control> -Movers and shakers -They control their self care and typically are highly social —Do you like being involved in most filll their days with activities -Illness can change all these patterns of children of this age or physical limitations they can feel helpless and dependent -Anxiety in response to loss of control environmental changes and hospitalization experience can alter the way school age children appraise both the experience in the amount of resulting stress - can view the hospital experience as a threat -Use coping strategies that includes sleeping talking with others distraction with television music video games and play -Better able to deal with stressors of hospitalization because of their ability to reason and communicate their needs and feelings -Better able to understand the explanations provided by the healthcare providers -Often and satisfied when they are lacking information about their care -Friends are important to the children of this age group and they think that their friends will forget them while they are ill -They are accustomed to making choices about meals and activities -By capitalizing on their abilities and needs the nurse can encourage children of this age to become involved in their own care -Squeeze children can select their own menus assist with some treatments keep their rooms need a visit with other children when it is appropriate for both -With these opportunities for independence children maintain a sense of control in Hance her self-esteem and continue to work toward achieving a sense of industry

The adolescent

Separation> -And sure whether they want their parents with them when they are hospitalized -Others in response to the stress of illness become more dependent and want their parents nearby -A third group cannot decide what they want in this situation can be frustrating to parents -All of these responses are consistent with normal adolescent growth and development -Because of the importance of the peer group separation from friends is a source of anxiety to the adolescent -The peer group will support the ill friend -Some adolescents are reluctant to visit friends in the hospital either because of their own health fears or because the reality of illness and someone their age is difficult for them to handle -Hospitalized adolescence may be upset if their friends simply go on with their lives excluding them -It's important to provide special activity areas another opportunity for the adolescent to meet and interact with other hospitalized adolescents Fear of Injury and pain> -To the adolescence appearance is crucial -And illness or injury that changes in our lessons self perception can have a major impact -Even children who have seemingly adjusted to a chronic disease in the earlier years may have difficulty during adolescence simply because they do not want to be different -The adolescents who have diabetes may not want to eat different foods or take time out from an activity for injections - Adolescence do not want attention drawn to them so they may eat the wrong foods in skip their medication -Give the impression that they are not afraid even if they are -Think that being cool means being in control -Me question everything or appear overly confident -Because of their concern with their bodies they are guarded when any areas connected with sexual development are examined -Nurses need to be sensitive to adolescence concerns and reassure them that they are normal -They may believe that they are invincible and that nothing can hurt them or cause death they may take risk in being on adhere it to treatment because they do not see the consequences of their behavior Loss of control> -Giving them some control of avoids endless power struggles -Behaviors exhibited in response to loss of control include anger with drawl general and cooperativeness -Desire autonomy, social acceptance, increase self-esteem -Including adolescents in discussions regarding their plan of care helped him take control -Asking about the adolescence perspective will lead to feelings of involvement and responsibility -Control issues can cause a major conflict between adolescents and parents -Parents often feel like ping-pong balls is your balance back and forth by a child who wants to help one minute and rejects it to the next -Parents who do not understand growth And development can become frustrated and angry over such behavior -I don't listen to me also feel that they are losing control of their social lives as They sit on the sidelines of activities -Time to plan for the separation allows a greater sense of control than an unplanned hospitalization

Admitting the child to a hospital setting

Taking a history> -Does not consist of series of questions but to serve as of collaboration between nurse and the family -Nurses acknowledge parents concerns -Recognize the family's needs the nurse can structure each admission to fit the child and family -Looking up the information already obtained by other departments can prevent repetition however critical data regarding allergies and medications taken at home and recent illness history must be obtained again -Hospital policies may be altered due to the child condition, for example, starting an IV infusion for severely dehydrated child -A parent who has just been told that her child may have a terminal disease might have difficulty remembering the dates of the child immunizations -In the situation and the nurse should provide the parent with support and assistance in mobilizing coping mechanisms and support systems rather than focusing on data gathering -Initial inspection> -Baseline data> -Physical exam is thorough and special attention is given to the body system or systems involved in the child's chief complaint -Admission forms have an outline of the child's body and watch the nurse should indicate bruises scratches or skin markings -Data collected our mission is used to formulate child plan of care

Societal changes

—As European settlements expanded on the north American continent during the 17th and 18th centuries children were valued as assets to the community because of the desire to increase the population and share the work -Public schools for established in the courts began to view children as minors and protect them accordingly -Devastating epidemics of smallpox, diphtheria, scarlet fever, measles took their toll on children in the 18th century. Children often died of these diseases within one day -In 1748 William Cadogan Essay upon nursing discouraged and healthy child care practices such as waddling infants in three or four layers of clothing and feeding them thin gruel Within hours after birth -He urged mothers to breast-feed there and friends and identify certain practices that were thought to contribute a childhood illnesses -Despite the efforts child care practices were slow to change -Play in the 18th century the health of children improved with certain advances such as inoculation against small pox -With the flood of immigrants to eastern American cities in the 19 century infectious diseases florist as a result of crowded living conditions inadequate and unsanitary food and harsh working conditions for men women and children -Children frequently worked 12 to 14 hour days in factories in their earnings were sensual to survive family -Most serious 19th century were caused by poverty and overcrowding infants -Infants were fed contaminated milk sometimes from tuberculosis-infected cows -Milk was carried to the cities and purchased my mothers who had no means tp refrigerated it -Infections diarrhea was a common cause of infant death -During the late 19th century conditions begin to improve for children and families -Lillian Wald Vitiated public health nursing at Henry Street settlement house in New York City or nurses top mothers and their homes -In 1889 in Milke distribution Center open in New York City to provide uncontaminated milk to sick infants

Communicating with children and families assessment

—Do not overlook the child's participation in providing information many children want to provide input about to convey formation and participate in their own care -A thorough assessment of the child's communication skills presumes that the nurse understands developmental milestones and can relate comprehension and communication skills to the child's cognitive and emotional development and language abilities -During the initial assessment of the child and family the nurse should describe routines and provide information about what the child and family can expect during their visit -The families level of health literacy is an important component of a communication assessment -Miscommunication related to low health literacy has consequences for patients such as not adhering to medication or recommended treatment routines or not being able to decipher medical forms -Assessment data that might suggest poor health literacy and family members include avoidance of reading for filling in the hospital forms giving rationale for not reading such as seeing if you got the wine glasses at home being unable to provide an appropriate help history or waiting too long before seeking medical help -Providing instructions and explanations in language the caregiver understands as well as having the caregiver repeat or demonstrate back in the instructions can increase understanding and adherence

Family centered care

—Family centered maternity and childcare are integral For comprehensive care given by maternity / pediatric nurses -Defined as an innovative approach to the planning, delivery, evaluation of healthcare that is grounded in a mutually beneficial partnership between patients, families, healthcare professionals -Some barriers to effective family centered care or lack of skills and communication, so negotiation, developing relationships -Other areas that interfere with the complete implementation of family centered care or lack of time, we are losing well, lack of support from the healthcare system in from other healthcare disciplines -One particular useful skill and family centered care and validation, which means excepting one family member says for does as a valid expression of thoughts and feelings

Components of effective communication

—In addition to words, the tone, quality of voice, I contact, physical proximity, visual cues, overall body language conveying messages -These nonverbal communications are often undervalued yet comprise a significant portion of total communication -Confusing communication techniques to be used with children and families the nurse considers cultural differences particularly with regard to touch and personal space -Effective communication provides an important link between parents and providers that is based on honesty, caring, respect, direct approach -Serves to eat stressful experiences for children and families, provide the required information for the child to the QR preventative care, and it facilitates appropriate transitions from the hospital to home -Affective communication can empower children in situations where children are experiencing a loss of control and diminished autonomy