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Department: STUDENT VOICES

Caring for children and families

Top 5 things I learned

Le-Madison, Asia BSN, RN

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doi: 10.1097/01.NURSE.0000827132.57843.e7
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A pediatric hospital admission can induce a range of emotions, including fear, stress, and powerlessness in young patients and their families.1,2

Although healthcare is focused on the admitted patient, nurses must remember that care for parents and families is also important. Balancing care for the patient with care for the family is crucial for the well-being of the pediatric patient.2 During my third semester of nursing school, I spent 90 hours in the hospital setting working with kids and their families in the pediatric unit. Throughout this clinical rotation, I had the opportunity to take primary care of patients under the supervision of a registered nurse, which taught me important lessons to help improve care for young patients. Here are the top five things that I learned about working with children and their families:

1. Create a comfortable and safe environment.

The hospital can be scary for pediatric patients.1 Some young patients may not understand why they are in the hospital, and others may see their admission as a punishment. Patients may need reassurance that they did not cause their illness.3 Whatever the case may be, healthcare professionals must build trust and rapport with young patients. Show them that nurses are there to help them.

Make pediatric patients feel secure in their room and try to make their hospital stay feel less scary. Procedures should not be performed in safe spaces like the patient's room or bed. Take patients to the procedure room to keep the purpose of the rooms separate in the patient's mind.

2. Consider the pediatric patient's level of development.

Whether considering Jean Piaget's Stages of Cognitive Development or Erik Erikson's Stages of Psychosocial Development, keep in mind where patients are in terms of age and development.4 Use these models of development to modify care based on a patient's age.

Using Erikson's model, for example, a patient who is 2 years old is in Erikson's stage of Autonomy versus Shame and Doubt, which means that they have an increasing sense of control and want for independence.3 They also like to say “no” to many things. Nurses should keep these details in mind and support the child by offering choices, such as choosing between two options. This will come into play with nearly all aspects of nursing care involving children.

3. Encourage patients to participate in their care.

Pediatric patients can get involved with their care at a very young age. Considering a patient's age and level of development, is the child able to participate in their care? As in the previous example, a 2-year-old child can answer “no” to questions. Something as simple as allowing them to choose which arm gets a little hug from the BP cuff enables them to be involved. Children as young as 9 years old can make some informed medical decisions.5 Although parents and caregivers are the ultimate decision makers, it is important to inform pediatric patients of their options, so they can voice their opinions, helping to decrease their feelings powerlessness.

4. Support patient communication with familiar and accessible language and terminology.

Unfamiliar medical terms can cause discomfort and anxiety among young patients and their families.1 When talking to pediatric patients and their families about medical matters, use terms that they understand. Again, a young patient's ability to understand will depend on their age and level of development.6 Consider using a doll or stuffed animal to better explain a complex healthcare scenario to young patients.3

Additionally, not all family members will understand uncommon medical terminology. For example, a patient or their family may not know what renal calculi are, but they get a better understanding of what is occurring in the body if the term “kidney stones” is used. By using everyday terminology, the family gets a clearer understanding of the child's diagnosis and plan of care.7

5. Embrace patient- and family-centered care.

Parents and caregivers want to participate in the care of their child as this helps them better understand the plan of care and also eases their anxiety and stress related to the child's medical problems.7 As such, allow them to assist with care and decision-making. For example, caregivers can aid in swaddling, feedings, or even comforting during assessments or procedures. Provide family-centered patient rounds by developing a partnership with patients and their families.8

As the nurse, show caregivers support and encouragement to give them the confidence to provide care for the child, such as changing a diaper for or bottle-feeding a newborn baby. Providing coping support can help ease stress and anxiety among patients and caregivers.7 Notably, increased patient satisfaction can lower compassion fatigue among nurses.9 Even though the focus of care is on the pediatric patient, keep the caregiver in mind. Asking them if they need anything like water before leaving the room can show caregivers that the nurse cares about the well-being of the entire family.

Hospitalization of pediatric patients can be challenging and stressful to patients and their families. However, providing appropriate healthcare—including the use of effective communication strategies and tailored patient-centered care—can make a noticeable difference in the overall care and outcome of pediatric patients. Keeping these five useful tips in mind can help nurses provide the best possible care for pediatric patients and their families.

REFERENCES

1. Lerwick JL. Minimizing pediatric healthcare-induced anxiety and trauma. World J Clin Pediatr. 2016;5(2):143–150. doi:10.5409/wjcp.v5.i2.143.
2. Doupnik SK, Hill D, Palakshappa D, et al. Parent coping support interventions during acute pediatric hospitalizations: a meta-analysis. Pediatrics. 2017;140(3):e20164171. doi:10.1542/peds.2016-4171.
3. Hockenberry MJ, Rodgers CC, Wilson D. Wong's Essentials of Pediatric Nursing. Missouri, MO: Elsevier/Mosby; 2021.
4. Perry JN, Hooper VD, Masiongale J. Reduction of preoperative anxiety in pediatric surgery patients using age-appropriate teaching interventions. J Perianesth Nurs. 2012;27(2):69–81. doi:10.1016/j.jopan.2012.01.003.
5. Lipstein EA, Brinkman WB, Fiks AG, et al. An emerging field of research: challenges in pediatric decision making. Med Decis Making. 2015;35(3):403–408. doi:10.1177/0272989X14546901.
6. Wyatt KD, List B, Brinkman WB, et al. Shared decision making in pediatrics: a systematic review and meta-analysis. Acad Pediatr. 2015;15(6):573–583. doi:10.1016/j.acap.2015.03.011.
7. Rea KE, Rao P, Hill E, Saylor KM, Cousino MK. Families' experiences with pediatric family-centered rounds: a systematic review. Pediatrics. 2018;141(3):e20171883. doi:10.1542/peds.2017-1883.
8. Christian BJ. Translational research - developing partnerships between parents and pediatric nurses. J Pediatr Nurs. 2020;53:84–87. doi:10.1016/j.pedn.2020.05.021.
9. Waldron MK. Pediatric nurses' perceptions of patient satisfaction. Pediatr Nurs. 2021;47(1):17–22,37.
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