NURSE’S ROLE IN

MINIMIZING
STRESS
 Prepare for hospitalization
 Prevent/minimize separation
 Minimize loss of control
 Prevent/minimize bodily injury
 Allow for regression
 Developmental activities, play therapy
 Maximize potential benefit of
hospitalization
 Remove fear of unknown
 Common practice, No set standards
 Tour, puppet show, books, videos & films
 In advance 1 week for 4-7yrs child, longer for
older children
 Sometimes not possible to prepare
 Emotional effects should be considered
first than the physical care
 Collaborate with families at all levels of
health care
 Empower them to discover their strength,
confidence, choices, decisions
 Systematic collection  Assign room based on
of data about the child developmental age
and family  Introduce primary nurse
 Guidelines for to child and family
formulating the  Orient the child and
nursing diagnosis family to inpatient
 Assess the usual health facilities
habits at home  Apply identification band
 Also perform physical  Explain the hospital
assessment before routines
planning care
Preparing child for
Admission assessment
admission
 2. PREVENTION or MINIMIZING
SEPARATION
 Primary goal is to prevent separation among
children under five years of age through
family centered care.

• If the child rejects strangers, Support

through Physical Presence : Quiet tone of
voice, Appropriate words, Eye contact, Touch to
establish rapport.

• Maintain Contact with Parents : If behaviour

of detachment evident, Talk about parents,
encouraging the child to remember them.
 Frequent Parental Visits

FamiliarSurrounding increase the child's

Adjustment to separation

Maintain usual Contact : continuing School

lessons, visiting with friends, letter, telephone
 Feelings of loss of control results from
separation, physical restriction, changed
routines and magical thinking
 Most of these can be minimized through
individualized planning of nursing care
 Promoting freedom of movement

 Maintaining child’s routine

 Encourage independence

 Promoting understanding

 Allow for regression

 Younger children react most strenuously
to any type of physical restriction or
immobilization.
 Nurse should access parent’s preferences
for assisting, observing and waiting
outside the room.
◦ Temporary immobilization may be necessary for some
interventions

◦ - Parent's Lap better than Restraints

◦ - Increasing Mobility: Increasing mobility by transporting
children in carriages, wheel chairs, carts or wagon and
provide them with a sense of freedom
◦ -if isolation is necessary, environment can be altered to
Increase Sensory Freedom (moving the bed towards the
window, opening window shades etc)
 Maintaining child's routine

• Nursing Admission History provides

baseline
• Nurses have set schedule but child is
unaware of it
• Minimize the distruption in child's
routine and establish a daily schedule
• (suitable for school age and
adolescent )
 Encouraging independence

• Respect for individuality & Decision

Making

• Perform activity with little or no help.

• Join in planning care, making choices

in food selections, continuing school
activities
 Promote understanding

•All children are vulnerable to

misunderstanding causes for stressors
such as illness and hospitalization.

•Anticipatory preparation and provision

of information help to lessen stress &
increase understanding
• As Quick as possible
• Maintain Parent-Child contact
• Repeat the reason of procedure
• Drawing and Doll play helps to remove
misconceptions

• Give information according to cognitive level

 PREPERATION FOR PROCEDURE

 Psychological preparation
 Using language the child understands
◦ Physical preparation
◦ Signed consent, pre-medicate
◦ Performing the procedure in the Treatment room
 Nurse should understand that every
behaviours are meaningful
 Try to maintain child’s routine
 Allow the primary care giver to be with
the child
• Provide for developmentally appropriate
play activities and every hospital should
have a play therapy room attached to
pediatric ward
• Play is essential to the child’s mental,
emotional, and social wellbeing
• Activities may need to be adjusted or
limited based on child’s age and any
special needs
Jane W. Ball and Ruth C. Bindler © 2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
Child Health Nursing: Partnering with Children & Families All rights reserved.
• Strengthening of family coping
behaviours & Emergence of new coping
strategies
 fostering parent-child relationship

 providing educational opportunities

 provide self mastery

 Providing socialization
PRINCIPLES OF PRE&POST

OPERATIVE CARE
 PRE OPERATIVE CARE
1.Psychological preparation
• Giving simple concise and age appropriate
information to the child and family
• Explain the procedure and post operative
equipment in a play full way to prevent fear of
unknown.
• Clarify doubts and queries of parents and child
1.Physical preparation
• Free of respiratory complications & signs of malnutrition
• Good hydration is needed before NPO
• Provide bath and mouth care in the morning
• Inspect &clean the part involved in surgery
• Child should be given warm and loose hospital gown
• Check identification band
• Premedication
• Record bowel and bladder pattern
• Get the consent form
 POST OPERATIVE CARE

1. Immediate post operative care

2. Care after recovery
3. Observe for post operative complication
4. Health teaching
1.Immediate post operative care
• Receive the child in recovery room with detail
information
• Position the child properly to prevent aspiration
• Monitor vital signs
• Observe the surgical site
• Fluid management
2. Care after recovery
• Protect from injury
• Urinary catheter should be connected to drainage bag
• Check the activity level , general condition and
adequacy of ventilation.
• Sedatives are used
• Pain management
• Intake output chart
• Change position and progressive ambulation is
required.
3.Observe for post operative complication
• Observe patient’s skin color and temparature
changes.
• Watch for signs of shock
• Observe for other signs such as hemorrhage ,
abdominal distention , hypoxia and infection
• Notify physician if any of the above signs are present.
4.Health teaching
• Demonstrate post operative exercises
• Educate dietary requirement for the child
• Teach home care
Thank you