Child’s Experience of Hospitalization

Question:

Discuss About The Nursing Practice Children An Young People?

The child who was engaged for the present analysis was a 4-year-old girl. Her name is not mentioned due to confidentiality issues. She extended cooperation for the activity to be carried out with success.  The child was brought into the ED a number of times and therefore was acquainted with the environment of the hospital. Though she had not been hospitalised in the setting, her frequent visits to the hospital were adequate for her to express her visualisations of a hospital drawing.

The drawing was a valuable one as it focused on the reflection of the child pertaining to a hospital environment. Though the drawing is not exact to what a norma hospital setting would actually look like, the drawing mentions some key aspects involved with such a setting. As per the child, she had drawn the picture in which she mentions to make a bed with many wheels that carry a patient. The patient, in this case, has a fractured leg. The physician is seen to be coming into the room from the door.

Hospitalization, or frequent visits to the hospital has been indicated to be a stressful experience for children of all age groups. The degree of anxiety that child bears have been well studied in the literature. Advanced nursing practice outlines a wide range of strategies based on recreational activities to enhance the quality of patient stay at the hospital (Fraser et al. 2017). According to Hockenberry, Wilson and Rodgers (2016) play can be an integral part of the care provided by a nurse to the child. One significant recreation activity is drawing that has been proved to be helpful for children to come out of their anxiety or negative feelings. In the present case, the child can be helped in overcoming her fears and anxiety related to stay at hospital through drawing. Drawing can enable the child to be not restricted to the physical barriers of the hospital. Encouraging her to draw her perceptions about the hospital and motivating her to explain what her feelings her can help in resolving any misunderstandings she might have pertaining to the hospital. Therapeutic play, in the from of drawing might enable her to learn more about how hospitals function in a precise and certain manner. This would eventually help her in combating challenges she is facing on the emotional front (Hughe and Lyte 2015).

Benefits of Therapeutic Play and Drawing

As opined by Rindstedt (2013) unstructured play, such as drawing, as undertaken by a child admitted to the healthcare unit, or visiting the care unit, can enable her to control ideas, relationships nd events. Drawing is a means of expressing one’s self and own ideas through which communication can be done with the outer world. In addition, drawing can also be perceived as a distraction method. One can be made to be distracted from illness and pain through such process. Research indicates that distraction is a significant tool within a clinical setting whereby patients get relief from pain. Normalisation of hospital experience can be achieved from the perspective of the patient if she is engaged in drawing. For increasing the range of motion in a child who is of school-going age and is visiting the hospital due to fracture, drawing can serve as a means of eliminating chances of boredom.

The impact of hospitalisation on children has been well studied in literature as this has wide implications for nursing practice within a clinical setting. According to Hockenberry, Wilson and Rodgers (2016), a child being admitted to the hospital undergoes a series of emotional changes that directly and indirectly influence the outcomes of medical and nonmedical interventions. Firstly, a child is deeply concerned about being separated from his parents. Separation from parents is perceived as fear, thinking it to b a rejection from the parent’s side. Anxiety and apprehension are extreme since the child has very less knowledge of the consequences of being admitted to the hospital. Wilson and Hockenberry (2014) in this regard state that a constant comparison is made by the child with other children of own age wherein differences are drawn out in favour of other. This implies that a child starts thinking himself to be different from others as with fewer capabilities and sound physical health.

Emotional outbursts are common for children who are admitted to hospitals. Crying and nagging, with the onset of anger and misbehaviour are common for children of all ages. These outbreaks are due to distress and feelings of loneliness, as a child is not able to cope up with the absence of his family members (Hopia et al. 2005). Children show variation in capacities regarding coping up with the stress of being admitted to the hospital. A major section of this population suffers from emotional disturbances whose degree varies from person to person. Repeated or prolonged hospitalisation enhances the risks of the same. The separation from parents causes the child to be emotionally upset. For children between six months and four years, the vulnerability is more.

Psychosocial Development and Cognitive Abilities in Children

Human development is starting from birth till death is a long process divided into different stages each with a set of salient features. At every stage, a person needs to be in a certain state of personal evolution. As physical changes drive the main process of development, the cognitive abilities help in the advancement of the brain’s development with increasing age. Psychosocial development is related to how a person adjusts to the society and shape the self-identity and relationships with others (Ball, Bindler and Cowen 2013). In the present case, the child is of four years age and an analysis of the cognitive and psychological theory of this age group would be beneficial in this regard.

According to Jean Piaget’s Stage Theory of Cognitive Development, there are four distinct stages of development in children; sensorimotor, preoperational, concrete, and formal. A child of age four years belongs to the preoperational stage (age 2-4 years). At this stage, the child has not yet developed the capability to conceptualise is an subtract manner and therefore in need of tangible physical situations. A child at this stage can classify objects in a simple manner, especially by pointing out significant features (Barrouillet 2015). In the present case, the child has been able to classify the objects she had witnessed at the hospital such as the bed, its wheels, the door and the subject of a physician. According to the authors, preoperational stage enables a child to engage in play and use preoperatory thoughts. A chid is better able to represent the objects through drawings and scribbles. The mental reasoning is highly developed in this stage though performing operations is still a challenge.

According to Erik Erikson’s Theory of Psychosocial Development, there are eight stages through which an individual passes starting from birth till death. At each stage, the individual is expected to demonstrate a set of skills that are to be mastered at before moving on the next stage. as per the theory,  child of age four years is at the second stage of lifespan, marked as Will. At this stage, the child is in a dilemma to show his autonomy or to remain in doubt and shame. As the child is now able to gain control over the motor abilities, he is no wanting to explore the surrounding. Children explore the world with much interest and show talent in constantly learning about what is there in the environment (Frye 2014). In the present case, the chid is seen to explore the world around her, observe the surrounding and make a note of everything learnt. The child had developed the ability to note down details of what is there in the surrounding as he had mentioned that the bed on which the patient was lying had many wheels and that the patient had suffered a fractured leg.

Stress and Coping Strategies for Parents and Children

Hospitalisation due to illness or other complications is stressful for both the child her family alike (van der Geest et al. 2014). Having own child admitted at the healthcare setting is quite stressful for the parent who is prone to suffer depression, stress and anxiety while the child is at the hospital. Stress in this regard is defined as the non-specific response provided by the body towards an environmental factor that is negative. The reaction coming up against the stress is at times a non-specific response that is mediated through an emotional response on an individual basis. Evidence suggests that stress experienced by parents have a profound impact on the health of the child along with the behavioural outcomes. If a parent is strong enough to combat the challenges coming in with the admission of the child, the child is better able to cope up with the illness he is suffering from. Different psychosocial mediators act as valuable determinants of stress across populations. Parents might start doubting the efficiency of the healthcare organisation if there is poor satisfaction related to service delivery, unfriendly staff and unfamiliarity with the policies and regulations of the setting. Research points out the different variables that exert a deep influence on the children and eventually on the families. These encompass the previous medical experience of the family, the development status of the child, the child-parent interaction, the illness’ severity and the coping style considered by the child. Individual factors, like the intellectual ability and temperament, contribute to the style of addressing the stress and demonstrating coping style (Ball and Bindler 2008).

Nurses are to pay an important role in caring for the child and supporting the family while the child is at the hospital. Paediatric care integrates within itself elements of love, affection, support, motivation, respect, encouragement and empathy. Nurses are to apply strategies for supporting the encouraging the child as well as the family at the time of hospitalisation (Wilson and Hockenberry 2014).

For addressing the needs of the child, the first measure that the nurse must take is to help in maintaining calmness. It is the duty of the nurse to provide a safe and comfortable environment to the child within which the patient is calm and is not stressed out or tense. The child is to be talked through the stay at the hospital so that there is no feeling of loneliness and rejection. The rationale behind this action is that if a child is stressed or tensed, recovery is slow (Ball and Bindler 2008). The nurse might engage the child in a creative activity as this acts as an anti-anxiety agent. Research indicates that activities such as the playing of music elicit different emotional and physical responses. Employing distractions help in taking the mind of the child off certain concerns by instilling a sense of keenness to know the unknown(Khin Hla et al. 2014). The nurse might encourage the child to share personal stories, mostly related to school or favourite shows.  A nurse needs to have the physical comfort of the child as the top priority. The main reason why a child is afraid to visit the hospital is physical pain. If a nurse is successful in making the child physically comfortable, there are no issues in treating her(Merz et al. 2016). When a child is being treated at a hospital, no particular solution might suffice. Depending on the experience of the patient at hospitals and the age of the child, strategies are to be laid out.

Role of Nurses in Supporting Children and Families

As stated earlier, the level of stress and anxiety of the parents and family members have a profound impact on the anxiety level of the child. The family members are therefore to be helped out through their feelings (Ullrich et al. 2017). The four dimensions of family support include the provision of information about the treatment plan for the child and supportive communication; parental support that is based on enhancing parental role; support on the emotional front that enables successful coping with emotional responses; caregiving support that improves quality  of care provided (Ball et al. 2016). Since the family is the continuing provider of child care, they are to be encouraged to actively participate in the care planning process. Family participation reliefs them from stress and anxiety. Viewing them as vital members ensure that patin recovery is fast. In addition, the family is to be educated about the developmental stage in which the child is at present. This information would be crucial for them to provide input regarding how care can be of optimal quality(Hughes and Lyte 2015).

In conclusion it can be stated that for a nurse to care for a child within a clinical setting it is imperitive that the perceptions of the child regarding the care unit is well understood. This facilitates the care delivery process as a comprehensive care approach is put foward in this case. The impact of hospitalisation is far reaching for both the child and the family members.It is crucial that a nurse addresses the concerns of the child as well as those of the family members as both are equally important for achieveing best outcomes.

References

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Ball, J.W., Bindler, R.C. and Cowen, K.J., 2013. Child health nursing. Prentice Hall. pp. 175-205.

Ball, J.W., Bindler, R.C., Cowen, K. and Shaw, M.R., 2016. Principles of pediatric nursing: Caring for children. Pearson. pp. 349-372.

Barrouillet, P., 2015. Theories of cognitive development: From Piaget to today. pp. 223-256.

Fraser, J., Waters, D., Forster, E. and Brown, N., 2017. Paediatric Nursing in Australia: Principles for Practice. Cambridge University Press.pp. 436-489.

Frye, D., 2014. Children’s theories of mind: Mental states and social understanding. Psychology Press. p. 215-256.

Hockenberry, M.J., Wilson, D. and Rodgers, C.C., 2016. Wong’s Essentials of Pediatric Nursing-E-Book. Elsevier Health Sciences. pp. 676-677.

Hopia, H., Tomlinson, P.S., Paavilainen, E. and Åstedt?Kurki, P., 2005. Child in hospital: family experiences and expectations of how nurses can promote family health. Journal of clinical nursing, 14(2), pp.212-222. John Wiley & Sons. United States.

Hughes, J. and Lyte, G. eds., 2015.  Developing nursing practice with children and young people. John Wiley & Sons. p. 56-59.

Khin Hla, T., Hegarty, M., Russell, P., Drake?Brockman, T.F., Ramgolam, A. and Ungern?Sternberg, B.S., 2014. Perception of pediatric pain: a comparison of postoperative pain assessments between child, parent, nurse, and independent observer. Pediatric Anesthesia, John Wiley & Sons. United States. 24(11), pp.1127-1131.

Merz, E.C., Landry, S.H., Johnson, U.Y., Williams, J.M. and Jung, K., 2016. Effects of a responsiveness–focused intervention in family child care homes on children’s executive function. Early childhood research quarterly, Elsevier. United States. 34, pp.128-139.

Rindstedt, C., 2013. Pain and nurses’ emotion work in a paediatric clinic: Treatment procedures and nurse-child alignments. Communication & medicine, Equinox. Denmark. 10(1), p.51.

Ullrich, C.K., Rodday, A.M., Bingen, K.M., Kupst, M.J., Patel, S.K., Syrjala, K.L., Harris, L.L., Recklitis, C.J., Chang, G., Guinan, E.C. and Terrin, N., 2017. Three sides to a story: Child, parent, and nurse perspectives on the child’s experience during hematopoietic stem cell transplantation. Cancer. John Wiley & Sons. United States pp. 3159–3166.

van der Geest, I.M., Darlington, A.S.E., Streng, I.C., Michiels, E.M., Pieters, R. and van den Heuvel-Eibrink, M.M., 2014. Parents’ experiences of pediatric palliative care and the impact on long-term parental grief. Journal of pain and symptom management, Elsevier. United States. 47(6), pp.1043-1053.

Wilson, D. and Hockenberry, M.J., 2014. Wong’s Clinical Manual of Pediatric Nursing-E-Book. Elsevier Health Sciences. p.78-109.