Hospitalisasi pada Anak

Children’s Understanding of
Health and Illness

• Developmental Considerations
– Infant
• Separation (highest age risk)
• Stranger Anxiety (6-18 mos)
Children’s Understanding of
Health and Illness

• Developmental Considerations
– Toddler
• Separation anxiety
• Loss of self-control
 Children’s Understanding of
Health and Illness

• Developmental Considerations
– Preschooler
• Regression (highest age risk)
• Separation anxiety and fear of abandonment
• Inability to distinguish fact/ fiction
• Unable to understand reason for
hospitalization
 Children’s Understanding of
Health and Illness
• Developmental Aspects
– School age
• Loss of control/ privacy
– Adolescent
• Aware of the physiologic, psychologic and
behavioral causes of illness
• Concerned with appearance
• Separation from peer group
 Stressors of Hospitalization for
Children at Various Developmental
Stages
 Children’s Understanding of
Health And Illness
• Psychological Aspects
– Infant
• Issues with attachment
– Toddler
• Disruption of routine/ separation from
parents
– Preschooler
• Loss of self-control
• Fear of dark
• Injury
 Children’s Understanding of
Health and Illness
• Psychological Aspects
– School-aged children
• Pain
• Bodily Injury
• Death
– Adolescents
• Loss of control/ privacy
• Fear of altered body image
 The Effects of Hospitalization
on the Child and Family
• Children’s understanding of health
and illness is primarily based on their
cognitive ability at their
developmental level
• Previous experiences with healthcare
professionals
 The Effects of Hospitalizaiton on
the Child and theFamily
• Parents
– Disrupt usual routine
– Fears/ anxiety
– Coping abilities (made more difficult if
lack of financial, community or family
support)
• Siblings
– Fears
– Behavioral Disruption
 Adaptation to
Hospitalization
• Parents
– Tailor nursing care to family’s needs and
preferences
– Maintain positive communication with
family
– Ask for parents participation in care
– Explain all aspects of treatment, keep
family “in the loop”
– Provide information to family (ie
teaching materials etc.)
 Adaptation to
Hospitalization
• Siblings
– Inform siblings about their brother/
sister’s condition (using age-appropriate
language and concepts at their
developmental level)
– Encourage siblings to visit (as
appropriate)
– Discuss what to expect before the visit
w/ the child, then f/u on how they are
feeling after.
 Adaptation to
Hospitalization
• Scheduled Admission
– Child/ parent
• Preparation
– Tours
– Play
– Written visual material
– Child Life
– Talking with peers with similar experience
(adolescents)
Adaptation to
Hospitalization
 Adaptations to
Hospitalization
• Nurses can assist the parents in
preparing the child for hospitalization
by…
– Read stories about the experience
– Talk about going to the hospital
– Encourage child to ask questions/ draw
pictures
– Visit hospital beforehand
– Plan hospital stay/routine as much as
possible
– Be honest
FIGURE 17–2 The child’s anxiety and fear often will be reduced if the nurse
explains what is going to happen and demonstrates how the procedure will be
done by using a doll. Based on your experience, can you list five actions you can
take to prepare a school-age child for hospitalization?
FIGURE 17–3 Jasmine’s parents are taking the time to prepare her for
hospitalization by reading a book recommended by the nurse. Such material
should be appropriate to the child’s age and culture. Why do you think that having
the parents read this material is valuable?
 Adaptation to
Hospitalization
• Unanticipated admission
– Orientation to unit/environment
• Explain all of the procedures
• Opportunities for parents/ child to express
fears
• Stress-reduction methods
 Adaptation to
Hospitalization
• Special units and types of care:
– Short-stay unit
– Outpatient unit
– Ambulatory surgical unit
– General pediatric unit
– Emergency Departments
– NICU/ PICU
– Acute care or long-term rehabilitative
unit
 Adaptation to
Hospitalization
• Nursing care focuses on providing
family-centered care
– Promoting the child’s and family’s
coping strategies to deal w/
hospitalization
– Promoting optimal development and
safety
– Minimizing disruption of the child’s usual
routine
 Nursing strategies to Improve the
Illness/ Hospitalization
Experience of Parents/ Children

• Various Practice Settings

– Emergency Department
• Psychological considerations
– Same day surgery
• Thorough discharge teaching instructions
FIGURE 17–6 This child has just undergone surgery and is in the post anesthesia
care unit (PACU). Although the child’s physical care is immediate and important,
remember that both the child and the family have strong psychosocial needs that
must be addressed concurrently. It is important to reunite the family as soon as
possible after surgery.
 Nursing strategies to Improve the
Illness/ Hospitalization
Experience of Parents/ Children

• Practice Settings
– ICU
• Psychological considerations
– Parental decision making/ involvement in care
– Hospital Care
• Mediation administration
– Developmental considerations
 Nursing strategies to Improve the
Illness/ Hospitalization
Experience of Parents/ Children
• Hospital (con’t)
– Educational needs
• Individual education plan (IEP)
– Teaching
• Partnering w/ parents
 Adaptation to
Hospitalization
• Preparation for Procedures
– Psychological preparation
• Using language the child understands
– Physical preparation
• Signed consent, pre-medicate
– Performing the procedure
• Treatment room
 Assisting Children through
procedures

– Infant
– Toddler
– Preschool child
– School-age child
– Adolescent
 Strategies to Promote Coping and
Normal Development of the
Hospitalized Child
• These strategies help to meet the
psychosocial needs of the
hospitalized child
– Rooming in
– Child Life Programs
• Child life specialist
– Therapeutic Play
Assessing the child and family
in preparation for discharge
• Assess the family’s ability to manage
the child’s care
• ? Any special adaptation to home
environment/ or other facility
• Collaborate w/ parents to teach them
treatment procedures and proper
equipment use
– Have family member demonstrate
proper care of equipment, and any
procedures necessary
Professional Practice Standards for
Pediatric Nursing Practice
• Collecting health data
• Analyzing the assessment data in
determining diagnoses
• Identifying expected outcomes
individualized to the child and family
• Developing a plan of care that
prescribes interventions to attain
expected outcomes
• Implementing the interventions
identified in the plan of care