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AboutContact Hours Awarded: 3.5 Course By: Read Course | Complete Survey | Claim Credit ➀ Read and LearnThe following course content The pediatric population presents unique challenges to nurses. The expert in nursing care of pediatric patients recognizes that the developmental stages play a pivotal role in the approach of each child. In this course, we will discuss how to care for children of each developmental stage, including expert tips and tricks for pediatric nurses. Introduction to Nursing Care of Pediatric PatientsPediatric nurses carry a heavy responsibility for caring not only for this vulnerable, highly diversified population with complicated and intermingled medical needs but also understanding the importance of their emotional needs. Their emotional needs must become the top priority. As nurses we are tasked with advocating and providing for the best interests of this sometimes-fragile population. We accomplish this by decreasing the stress and fear reactions that might occur if we do not strategize before we provide care to a child. Although regression is expected with hospitalized children of all ages, it is the nurse’s responsibility to foster growth and acclimation within the healthcare setting. Children have stated that their worst fears during hospitalization are those related to nursing interventions such as needle sticks during IV insertion or injections (1). As a former special education school nurse consultant for the emotionally impaired population, I cannot stress the significance of recognizing children’s emotional needs. If we take the time to address these needs prior to any hands-on procedure or even touching the child not only will our job be easier but also we will have respected the child’s personal space thereby earning his/her trust. This course will address many aspects of developmentally appropriate interventions in in a layout that is easy to comprehend and utilize in your practice. Children are resilient but we must give them a sense of control to build trust with healthcare providers. The primary guiding principles are to involve families in their care as the basis of creating a solid relationship with the child and facilitating success in their treatment. The secondary guiding principle with children is we must help them become aware of what they feel before we ask them to control their behavior (2). Some children may not be equipped to express their feelings depending on their age. They may not have the vocabulary to express those fears, anxieties, anger, happiness, and other feelings. We must guide them to express these feelings if not with words then with activities, otherwise those feelings are very likely to result in negative behavior. This course will give you up-to-date ideas, suggestions, and activities to improve your care to your pediatric population.
Current Practice in Nursing care of Pediatric PatientsAccording to the Center for Disease Control (CDC), in 2017 hospitalized pediatric patients in the United States comprised 6.6% of the total hospitalized patients across all ages with a total of 73,529 pediatric patients (3). Those pediatric patients admitted are complex with comorbidities in many cases. Currently nurses face increased patient caseloads in the hospital, homecare, and clinic settings and consequently their time is at a premium. The suggestions for interventions in this course will assist the nurse to provide care that is timely and diminish emotional meltdowns by understanding the child throughout his/her developmental stage. The way a nurse approaches his/her patients can do a great deal in encouraging a frightened or wary child. Research has shown children tend to be extremely resilient when well supported (2). Children who have access to protective factors are better able to overcome adversity and traumatic events. These protective factors are personal qualities such as personality; family connections; coping skills; feelings of control and self-confidence (4). Through adversity children can learn how to process life based on their own experiences, how they have dealt with those experiences in the past, and responses from others such as parents, nurses, and other healthcare providers. In short, children use these events to reflect back in a positive way for future stressful experiences. A pediatric nurse deals not only with the child but also with all the anxieties and demands of the parents. In addition a study by Tubbs-Cooley et al. (2019) found the intense intellectual pressures and time constraints of nurses are factors in the quality of care as much as patient volume and acuity. Nurses experience intense stress to complete their vital tasks with patients and this is another factor in their abilities to deliver quality care. Hospital administrators, nurse managers and nurses themselves must address this level of stress and the time constraints to help facilitate quality of care. Children are equipped with abilities to detect hidden stress and this reflects on how they perceive and react to a given situation.
Family Responses to Illness and/or the Hospitalized ChildIt is the nurses’ responsibility to promote a sense of security in pediatric patients. In fact, it is the most important item on our to-do list in the healthcare environment of pediatric patients. Feeling secure depends on a sense of physical and psychological safety. Parents are the most vital key to promoting this safety in the pediatric patient. Parent’s presence at the bedside is the best way to decrease anxiety and increase this sense of security in children. Nurses must do everything in their power to decrease parental stress and anxiety and that will directly impact the child’s positive coping abilities. There are many members in a healthcare facility that can provide support to a family with a sick child. For example, child life therapy, social work, chaplain support, and interprofessional support can all be supplemental to a family (19 & 20). In order to help families adapt to the hospitalization of the child the nurse should:
Please note that there are instances when a parent might not be the psychologically safe caretaker in the child’s life: this must be carefully discerned. Here are some examples of therapeutic communication with a child in nursing care of pediatric patients:
Adapted from Hurley (2018) and Fastaff (2015)
Developmental Considerations for Appropriate Nursing Care of Pediatric PatientsChildren face a loss of control, limits on their mobility, powerlessness, pain, and discomfort, to name a few emotions and negative consequences occurring while ill. It is the nurse’s responsibility to help children cope with medical procedures and their illness. The best way to facilitate this is through an atmosphere of trust. Trust is best created and fostered through strategies that are researched to be effective. There are strategies that occur across developmental stages and these will be addressed first before discussing specific strategies based on the developmental age groups. These age groups will be divided into infant, toddler, preschool, school age, and adolescence in this course. These groups will be explored below for the best nursing interventions using evidence-based practice. Therapeutic play will be addressed in the section following this one. General Nursing Care of Pediatric Patients Across the Developmental SpectrumThere are some interventions and principles that hold true for children of all ages. To provide the best nursing care to pediatric patients, pediatric nurses should strive to incorporate these principles into their practice regardless of the age of the developmental stage of the child. Children grasp information best when it is appropriate to their cognitive level of development. Offer choices to every child when performing even routine tasks such as obtaining his/her blood pressure. This will promote a sense of control in the child.
Create a daily schedule so that the child is aware of what to expect throughout his/her day. Use humor and laughter to lighten up the air with children. Use time-out coupons, for example three per procedure that the child can use to halt the procedure for 2 minutes (9). This gives control to the child to better cope with the procedure. A pre-surgical tour of the hospital can lessen anxiety and promote cooperation. Children need a regular schedule in the hospital that mirrors home life as much as possible, but that is also consistent from day to day in the hospital setting. Research has shown that without a regular schedule for children of all ages, a child can feel confused and insecure adding to emotional upheaval, stress, and adaptability (9). Nurses should stoop down to the child’s level physically. Eye to eye contact is important to develop a trusting relationship. The use of a short stool works well to get at their eye level. Introduce yourself and ask the child personal questions.
Nurses should smile at their pediatric patients. Children of all ages appreciate this approach from babies to adolescents. Who doesn’t like a friendly, calm approach? Regardless of the age of the child, use his/her name. It soothes children and parents alike. It shows respect for individuality and lessens anxiety in children and parents. Never refer to a child by his/her diagnosis. Children of all ages from toddlers through adolescence love to help. Through their role in their own care, it can alleviate stress and build trust. For example you could ask the child to hold your otoscope until you need it. Teach them the tools of the trade. At the same time you are educating about a possible career choice for one of them.
This activates the child to engage in your activity with helpfulness. Consider using a therapeutic dog in the hospital setting as a distraction and calming technique when appropriate (9). Animal assisted therapy has shown to improve the level of anxiety in parents and children. Check with your facility for approval of canine therapy. Or perhaps get permission for the child’s dog to visit in the playroom. Give children the same time and respect you would give to adult patients (10). This includes decision-making even when they are not able to make decisions on their own. This will enhance their sense of control over their own health. Secrecy and dishonesty increases a child’s sense of anxiety and fear and undermines trust with the nurse (10). Nurses should coach children to ask more questions and thereby increase satisfaction with their healthcare providers and more compliance with their disease processes (10). Never talk down to a child for example in a singsong voice. This is demeaning to him/her. Encourage parents to bring in posters, photographs, and other items from home to personalize the bedside. This may help the child to feel more comfortable in the hospital setting. Choose roommates for children, if possible, to promote socialization and foster growth in children. Sometimes nurses can advocate for children with similar disease processes or hobbies to room together in the hospital. This promotes a sense of community facilitating recovery and belonging. Remind children that their illness is not punishment. Explore this confusion in your pediatric patients. Sometimes children do not have the words to express their fears that they did something wrong to cause their illness or hospitalization. Use words and sentence length that matches the child’s level of understanding. A common way to measure this is the number of words in a child’s sentence should equal his/her age plus one (6). Use crayons and paper freely. First demonstrate by drawing yourself and encourage child’s expression. Give children time to feel comfortable with you. Speak to the parents first. Help children understand they can face their fears. Promote courage.
Give hope and courage to children through praise by stating how “brave” and/or “good” they are. Communicate with puppets, dolls, or stuffed animals first before asking questions directly of a young child. If a child is ticklish when you are examining his/her abdomen, place the child’s hand down first on his own abdomen and place your hand on top of his. Then slowly deviate off of his hand to examine the abdomen. Parents should not be asked to restrain their child. This interferes with the trust relationship the child has with his/her parent (6). Allow children to pick a toy out of the toy box to play with during the procedure and then afterwards they can pick a gift out of the box and return the toy. Involve the medical social worker to assist in therapy with pediatric patients. Tell children it is okay to cry, do not shame them for expressing this emotion. Stress the positive benefits of procedures.
The Importance of Caring, Consistency, and HumilityChildren of all ages must feel a sense of love from their caregivers. Children are barometers of emotions in those people surrounding them. These emotions can influence negative behavior in hospitalized children. This is a basic tenet but vitally important to working effectively and compassionately with the pediatric population. Children are more likely to push past anxiety and have a sense of safety if surrounded by genuine caring from nurses. Love can best be demonstrated in those quiet moments shared with children, holding, stroking their arm, and/or sharing some fun activity. Children are naturally resilient but need basic emotions of love and trust to foster this resiliency. Sometimes one successful episode is all a child needs to feel that they can complete a procedure or tackle the impossible. How do we show kindness, yet firmness? How do we show empathy and respect in Nursing care of pediatric patients? These personality traits flow from our inner core but can be learned. Humility allows us to offer choices both to parents and children. We MUST keep this in mind when working with the pediatric population because this will give both parents and children a sense of control. Many negative emotions in a child flow from a loss of a sense of control. When working with children, this author was always very clear to the child about her expectation that the child would only be able to stay in the health room for 15 minutes but he/she could choose whatever activity would help him/her regroup and get back to the classroom. The following strategies were offered: a short nap, reading a short book to the child, a small snack, hot compress, cold compress, or relaxation exercises. The author was always successful with this approach because the child felt affirmed, respected, and in control which also created an atmosphere of trust.
Labeling FeelingsHelping children to understand their feelings and label them is an instrumental step in helping them to gain control of the situation and their emotions. Rachel Wagner in her book Flip It reiterates the root to all behavior is feelings (2). She states we must help them identify these feelings before we ask them to control them. Through the use of feeling charts, (see Appendix A) in Nursing care of pediatric patients we can assist our patients by helping them talk about what they are feeling, by giving them the words for these emotions, such as anger, frustration, happiness, sadness, confusion, or disappointment, and others. Then explaining that these feelings are usually temporary, normal, and it’s okay to feel them. Competency = less anxiety (2).
Let’s Talk About ResiliencyNurses need to assess a family’s resilience that is described as the family’s ability to handle stress and challenges (12). Nurses can help families learn new skills and reinforce confidence in family members to deal with the stress of illness or injury in the child. Sources of support to build resilience in the family are church, family coping mechanisms, flexibility, and social support (12). Nurses can help families see their strengths and transfer competence from their past stresses in life to this event. There are strategies to strengthen resiliency in children and by doing so children are less anxious, better behaved, and more in control. An important key reminder about resiliency is that we aren’t born with it, we develop it over time with each success, each positive opportunity, and even small words can grow it. Children do not need parents (or nurses) to solve their problems. Resiliency is enhanced when children solve their own problems. Children actually need to experience discomfort to learn that they are capable of adapting, learning, and solving. This builds competence. (12) How do you build resiliency in kids in Nursing care of pediatric patients? According to Katie Hurley (12), nurses should:
Developmental Strategies with Infants(0-12 months)We must remember that infants are learning to develop trust in their first year of life. They use all of their senses to develop this trust, such as vision, hearing, taste, smell, and touch. To care for infants in the healthcare setting the nurse should (11):
Developmental Strategies with Toddlers(1- 3 years old)Toddlers are learning much about their environment through exploration and trying to make good choices. Slowly they are learning self-control (9). To care for toddlers in the healthcare setting the nurse should (9):
Developmental Strategies with Preschool Children(3 years – 6 years)Preschoolers have a very active imagination and are very concrete in their thinking. They see everything from their own point of view. To care for preschoolers in the healthcare setting the nurse should:
Developmental Strategies with School Age Children(6 years – 12 years)School age children want explanations for everything and are usually satisfied with this approach. They want to examine and understand how the equipment works. They have lots of ‘why’ questions. They have a heightened concern about their body and anything that might mean injury or pain to their body. This concern extends to their possessions (6). To care for school age children in the healthcare setting the nurse should:
Developmental Strategies with Adolescent Children(12 years – 18 years)This age group fluctuates between child and adult thinking and behavior (6). To care for adolescent children in the healthcare setting the nurse should:
Therapeutic Play in Nursing Care of Pediatric PatientsChildren use play to make sense of their world, to categorize the collective whole of their being with their interactions, dreams, missteps, and joyful attitudes. As nurses, we must facilitate this play through our contact with our youngest patients. Play is very individualized, each child deciding his/her favorite play activity. Therapeutic play decreases negativity, provides motor activity outlet, and helps the child cope. Play provides the child with an active role and control of the situation, and distracts from procedures that cause stress (1). Here are some examples of therapeutic play:
Expressive therapy (13) works well with children oftentimes because they are hands-on learners and express their emotions the same way. Here are some examples of expressive therapies that can help children address fear, anxiety, stress, and pain:
Specific Play Activities for Specific Procedures (6):
Cultural ConsiderationsIt is imperative that nurses consider the cultural influences of the children they care for in the nursing care of pediatric patients healthcare setting. Cultural competence includes understanding the values, beliefs, and customs of ethnic groups and how these influence health decisions by that family. All behavior must be judged based on the context of the culture in which it occurs (6). Sometimes children of a minority do not trust that nurses of a majority culture respect them or understand them. This can cause fear and stress in that child and contribute to loneliness and helplessness. Here are some useful tips to facilitate appropriate interventions (6):
Reducing Pain and DiscomfortAny measures to reduce pain and discomfort are the nurse’s responsibility. Nurses must assess both parents and the child for the level of security, fear, and resistance to the procedure. In addition, differentiating between fear and pain is vital to the correct approach by the nurse (1). Nurses must support children through parental participation and communication (1). Untreated pain in infants and young children may lead to increased pain perception and chronic pain in adolescents and adults (14). Pain research has found that children who show more active behavior during the procedure such as crying and flailing oftentimes rate these procedures as less painful than children who cope passively (7). For this reason we want to always encourage children and parents that it is normal to cry when something is painful. Children should never be shamed or made to feel guilty for crying or screaming. In order to lessen pain and discomfort the nurse should:
Lessening Pain and DiscomfortIn order to lessen pain and discomfort based on age specific strategies the nurse should (9) do the following per appropriate age group. Infants
Toddlers
Preschoolers
School Age Children
Adolescents
Nursing Care of Pediatric Patients with Special Healthcare NeedsAs a former special education school health consultant for children in grades kindergarten through 12th grade, this author became proficient at reading students’ needs or discerning when she could not determine their needs and had to rely on other cues. This pediatric population encompasses many complex health issues that may be chronic and lifelong. Beneath all of the tubes, devices, special needs equipment, there is a child who is like many children without special needs. They are longing to be seen, to be heard, and to be accepted as they are. Some suggestions for nurses when interacting with this population are (17):
ConclusionThe pediatric population requires nurses in nursing care of pediatric patients who embrace the cohesive bond between parents and child. The nurse must work well with both to enhance the best care possible for the family. Advocacy takes on many forms as a pediatric nurse; the parent, the child, and the family unit must all be promoted and supported. Nurses make the difference and their care is multiplied through each patient and each hospitalization. Pediatric nurses through dedication and mutual problem solving with families show responsiveness to children’s experiences, age, and development to meet the child in his/her world. References + Disclaimer
Disclaimer:Use of Course Content. The courses provided by NCC are based on industry knowledge and input from professional nurses, experts, practitioners, and other individuals and institutions. The information presented in this course is intended solely for the use of healthcare professionals taking this course, for credit, from NCC. The information is designed to assist healthcare professionals, including nurses, in addressing issues associated with healthcare. The information provided in this course is general in nature and is not designed to address any specific situation. This publication in no way absolves facilities of their responsibility for the appropriate orientation of healthcare professionals. Hospitals or other organizations using this publication as a part of their own orientation processes should review the contents of this publication to ensure accuracy and compliance before using this publication. Knowledge, procedures or insight gained from the Student in the course of taking classes provided by NCC may be used at the Student’s discretion during their course of work or otherwise in a professional capacity. The Student understands and agrees that NCC shall not be held liable for any acts, errors, advice or omissions provided by the Student based on knowledge or advice acquired by NCC. The Student is solely responsible for his/her own actions, even if information and/or education was acquired from a NCC course pertaining to that action or actions. By clicking “complete” you are agreeing to these terms of use. ➁ Complete SurveyGive us your thoughts and feedback ➂ Click CompleteTo receive your certificate Want to earn credit for this course? Sign up (new users) or Log in (existing users) to complete this course for credit and receive your certificate instantly. Which selfWhat self-care skill does the nurse expect 4-year-olds to be capable of performing? Four-year-old children can put on a shirt and can fasten it if the buttons are large. Four-year-olds will be able to comb, but not part, their hair.
When a nurse brings a dinner tray to a 4When a nurse brings a dinner tray to a 4-year-old child hospitalized with pneumonia, the child says, "I'm too sick to feed myself." What is the best response by the nurse? "Try to eat as much as you can."
What is the primary nursing goal for a hospitalized preschool?The major nursing care plan goals for a child who is hospitalized include increased ability to perform self-care activities, relief of anxiety, and an increased sense of power of family in making decisions and absence of injury.
What would the nurse instruct the parent to refrain from doing if a 4What would the nurse instruct the parent to refrain from doing if a 4-year-old child has nightmares on a routine basis? Sleeping with the child--If a child has nightmares, the parent should avoid sleeping with the child.
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