hospitalised child..crisis and nursing intervention...phases of crisis

1. CRISIS AND NURSING INTERVENTION

2. 12-06-2013
CRISIS AND NURSING INTERVENTION

3. LOGO
CRISIS AND NURSING
INTERVENTION
CHAPTER - 9

4. 12-06-2013
CRISIS AND NURSING INTERVENTION
DEFINITIONS
Crisis is an acute time
limited phenomenon
experienced as an over
whelming emotional
reaction to a stressful
event or the perception
of that event. It is the
struggle for equilibrium
and adjustment when
problems are perceived
as insolvable.
Crisis intervention is a
short term focuses on
the solving of the
immediate problem,
aims to establish the
former coping pattern
and problem solving
ability. It is usually
limited to 4 – 6 week
period after which
resolution will be
attained.

5. TYPES OF CRISIS
11-06-2013
CRISIS AND NURSING INTERVENTION
1 2 3
Maturational
-each
development
stage can be
referred to as
the same.
Situational
-arises from
an external
rather than an
internal
source.
Adventitious
–it is not a part
of every day life,
is accidental
and unplanned

6. CRISIS THEORY
Erich Lindermann - 1940s conducted study of the
grief reactions of close relatives of victims in a club
fire. This study formed the foundation of crisis
theory and clinical intervention. She showed that
preventive intervention in crisis situations could
eliminate or decrease serious personality
disorganisation and other psychological
consequences from the sustained effects of severe
anxiety.
Gerald Caplan -1960s defined crisis theory and
outlined crisis intervention. Caplan identified four
distinct phases of crisis.
12-06-2013
CRISIS AND NURSING INTERVENTION

7. 1206-2013

8. FOUR PHASES OF CRISIS PROCESS
1st phase - A person confronted by a conflict or
problem that threatens the self concept
responds with increased feelings of anxiety.
The increase in anxiety stimulates the use of
problem solving techniques in an effort to
solve the problem and lower anxiety.
2nd phase - If the usual defence response fails,
and if the threat persists, anxiety continues to
rise and produce feelings of extreme
discomfort. Individual functioning becomes
disorganised.
12-06-2013
CRISIS AND NURSING INTERVENTION

9. 3rd phase - If the recovering attempts fail, anxiety
can escalate to severe and panic levels, and
the person mobilises automatic relief behaviour,
such as withdrawal and flight. (compromising
needs or solutions should be made)
4th phase - If the problem is not solved, anxiety
can over whelm the person and leads to serious
personality disorganisations. This maladaptive
response can take the form of confusion,
suicidal behaviour, yelling and running
aimlessly.
12-06-2013
CRISIS AND NURSING INTERVENTION

10. Appraising Crisis Systematically:
Systematic process deals with recurrent actual or
potential crisises and the impact of these events.
The nurse establishes goals in collaboration with the
child,family and the interdisciplinary team members.
 The plans to care are then implemented through direct
intervention.
Systemic evaluation facilitates the child’s progress
towards his or her maximal level of function, especially
as it changes during the various stages of
development.
CRISIS AND NURSING INTERVENTION

11. Contents
12-06-2013
HOSPITALISED CHILD1
TERMINAL ILLNESS AND DEATH2
3 NURSING MANAGEMENT– COUNSELLING

12. HOSPITALISED CHILD
Preventive
Best ------ Promotive Hospitalisation
Curative

13. HOSPITALISED CHILD
Functions Of Hospitalisation
Provides diversion and relaxation minimise
Feel more secure threat
Lesser the stress separation to
Develop positive attitude to others the
Accomplish therapeutic goals child’s
Care for sick and injured development
Prevention of health
Promotion of health
Rehabilitation
12-06-2013
CRISIS AND NURSING INTERVENTION

14. PRINCIPLES OF HOSPITALISATION
1.Nurse should begin to build a working
relationship with the patients and the child from
the first contact with them.
2.Nurse should be aware that all behaviour is
meaningful.
3.Nurse should accept the parents and the child
exactly as they are.
4.Nurse should have empathy for parents and
children.
5.Nurse should let them know that their problems
are of importance, the nurse is there to aid their
solutions.

15. PRINCIPLES contd…
6.Nurse must be willing to acknowledge the
parents rights to their own decisions concerning
their children.
7.Nurse permits the parents and the child to
express even negative emotions.
8.Nurse should ask questions limited to a single
idea or reference.
9.Nurse should speak the language
understandable to parents and the child
10.Health team members should help the parents
to feel that there is unity among them.

16. MODERN CONCEPTS OF HOSPITALISATION
Parent Support
Self Care
groups
Visiting
Care By
Parent Unit
CONCEPTS OF
HOSPITALISATION

17. VISITING
2 – 8 pm visiting- early morning to bedtime
Flexible unlimited visiting any time
Visiting is determined by child’s need to see parents.
If parents are unable to visit frequently,
grandparents, uncles or aunts may visit instead.
Siblings of 2 – 12 years are permitted in some
hospitals for certain hours and older siblings fro any
time.
Siblings should be accompanied by parent and who
have been exposed to infections is not permitted.
Tape recording could be made and played.

18. ROOMING- IN
Should not prohibit parents to stay at child’s
bedside if they desire.
Some hospitals provide a waiting rooms for
parents.
Sometimes they can have food with children.
If there is no dietary restriction, food should
be brought from home.
Parents of seriously ill children could stay
whole night if they desire.

19. CARE BY PARENT UNIT
Parents live with child, to involve whole family in care
of sick.
Child gets attention from familiar person.
Main fear about separation is eliminated.
When parents are nearby, children can continue to
learn and grow throughout hospital experience.
Nurses’ responsibility is to meet needs of child,
prepare parent for this, interpret medical procedures,
diagnostic tests, health teachings etc.
Nurse can observe parent’s skills, attitudes,
techniques and any problem in parent child relation.

20. PARENT SUPPORT GROUPS
Parents with common concern should
emotionally support and comfort.
This may be conducted by nurses, play
therapists or by child life program staff, who
act as facilitators or develop a support system
among parents.
Parents may feel comfortable enough to move
away from hospital routine and ventilate their
feelings and concerns to relieve anxiety and
stress.

21. SELF CARE
Assess abilities of child
Help to learn self-care skills.
Time and method depends on
child’s cognitive abilities, emotional
state and readiness to learn.

22. GROWTH AND DEVELOPMENT OF
HOSPITALISED CHILD
Professional team work is important
All members needed to foster in every area of
growth and development.
Hospitals may have school teacher or a
recreational specialist to create pleasant
situation.
Psychologists and psychiatrists help with
serious emotional problems.
Dietitian, physiotherapist work together
focusing different facet of growth, toward full
development

23. PLAY IN ILLNESS
3 year old Christie was due to receive a
course of radio therapy. A play program was
designed to prepare her for the experience,
which involved Christie lying on a large sheet of
paper on which her outline was drawn. The
purpose of this was to explain the importance of
lying still during the radio therapy session. To
emphasis this, a water spray was used to show
that when she moved it was difficult to spray the
correct part of her body.

24. FUNCTIONS OF PLAY IN ILLNESS
Diversional
activities
Social
development
Emotional
expression
Development
of moral
value
Creative
expression

25. TYPES OF PLAY
Dramatic play
Energy release
Creative play
PLAY

26. Drawings
TECHNIQUES OF THERAPEUTIC PLAY INCLUDE:
Stories
Music
Puppets
Pets

27. SUITABLE PLAY FOR VARIOUS AGE GROUPS

28. INFANT
• -Baby likes to pat and hug.
• -Toys should be soft to hug and provide
comfort.
• -Brightly coloured, washable toys.
• -Large enough that cannot be aspirated.
• -Have smooth edges.
• -Soft stuffed animals, soft balls, bath toys,
• -Rattles, pots and pans.

29. TODDLER
They may have favourite toys
Enjoys exploring drawers
Likes to place things in containers and
dump them out.
Dolls
Engages in parallel play.
Nest of blocks.
Push-pull toys
Telephone
Rocking horse or chair

30. PRESCHOOLER
It is the beginning stage of
cooperative play.
They exchange ideas with others.
 Engages in imitative play
Creative play, and dramatic play.
Crayons, simple puzzles
Paint with brush, finger paints
Dolls, dishes
Drums, horns
Video tapes.

31. SCHOOLER
Attention span increases, play is more organised,
more competitive.
Collection of things will be his hobby.
Doll house, dolls, puppets and music.
Skipping rope, dress up materials, table games,
bicycle.

32. ADOLESCENT
Play will not acquire great energy expenditure.
They pay attention to special interest.
Ball on string
Telephone, easy puzzles, radio, hand puppets, and
cut outs.

33. A research study conducted by Uttara Chari,
Uma Hirisave, and L. Appaji in 2012 reported
the benefits of play therapy in paediatric
oncology. The study was conducted with a 4
year old girl diagnosed with acute lymphoblastic
leukaemia and outcome was examined using a
combination of qualitative and quantative
assessments. The play therapy manifested in
better illness adjustment and general mental
well being, enhanced coping and normalisation.

34. In this study the child initially inhibited, avoided
medical toys and engaged in rudimentary play. Her
affect was considered and the interaction with the
researcher was limited. As sessions progressed, she
became active and engaged in various types of play.
Her initial avoidance of medical toys followed by
repeated enactment of medical procedures carried
out on her reflects the mechanism of play therapy in
facilitating catharsis and mastery through re-
enactment of stressful experiences. Thus as
sessions progressed, child’s play become similar to
those of healthy children indexing normalisation. This
reflects enhanced coping and use of adaptive
defences in play sessions.

35. SCHOOL
Public school teacher is employed by local board of
education in paediatric ward.
Use of television, radio or computerised self
instruction program enhances contact with school
system.
If child is too ill to return to school, continuing class is
important as a link with outside world.
Child will keep busy, feels useful and important.
This help child to return to school after cure.

36. PREPARATION FOR HOSPITALISATION
 Varied emotional changes
 Unknown environment
 Exposed to unfamiliar equipment
 Witnessing frightening sights and
sounds
 Unfamiliar procedures.
www.themegallery.com Company Logo

37. • For well children who
do not need immediate
hospitalisation
• For children who are
scheduled for
hospitalisation
• For all children of all
age group
• booklets, films and
puppet shows.
• pre admission parties
should be conducted.
• Familiarising the
hospital before
admission and pre
hospital counselling

38. BASIC BELIEFS REGARDING CHILDREN
• The family is the basic unit of society
• Each child needs love and security to develop
feelings of trust and self esteem.
• Each child is an unique individual with
different needs based on his or her family
background, level of growth and development
and degree of illness
• Nurse seeks to promote, maintain and restore
health in both children and their parents.

39. • Each ill child should be under the accountable
care of one professional nurse.
• The family and child should be included in
planning for therapeutic and nursing
interventions and for implementing and
evaluating the plan of care.
• Within a safe environment, the ill child needs
expert physical care, emotional support, play
that allows for expression of feelings to
promote continued growth.

40. • Parents who have trusted relation with nurses
feel welcome whenever they visit and
participate in child care.
• Family members and terminally ill child who
are at great stress should be emotionally
supported so that child can die with dignity
and with feeling of being loved.
www.themegallery.com Company Logo

41. GUIDELINES
HOSPITAL ADMISSION
• Assign a room based on
child’s developmental age,
seriousness of diagnosis,
communicability of illness
and length of stay.
• Preparing the roommates
for the new patient.
• Prepare room for the child
and family
• Introduce primary nurse
• Orient to the inpatient facility.
• Facilities in the room
• Unit ( play room, dining room, lab)
• identification band.
• hospital regulations and schedules
• Perform nursing admission list
• vital signs, anthropometric
measurements
• Obtain specimens
• physical examination.
PRE- ADMISSION ADMISSION

42. Emergency admission
• Appropriate introduction
• Use of child’s name
• Determination of child’s age
and some judgment made
about developmental age
• chief complaint from both
parents and child.
• general state of health,
sensitivity to medication,
previous hospitalisation.
ICU admission
• Prepare child and parents
for elective ICU admission.
• Guide the child’s
appearance and behaviour.
• Emotional support and
answer questions.
• Prepare sibling visit.
• Encourage parents to stay
with child.

43. REACTIONS TO HOSPITALISATION
Physiological reactions
• Temperature elevations: as
response to infections
• Convulsions : resulted from rise
in temperature
• Immobilisation
• Anorexia, vomiting and
diarrhoea
• Nutritional deficiencies
• Fluid and electrolyte imbalance
• Inconsistent weight loss
• Lack of growth
Psychological reactions
• Separation anxiety
• Stranger anxiety
• Sleep deprivation
• Loss of self control
• Fear of darkness
• Fear of death
• Sensory overload

44. REACTIONS OF EACH AGE GROUP
Neonates
• Interruption in the early stages of
development
• Impairment of bonding and trusting
relationship
• Inability of the parents to love and care for
the baby and inability of baby to respond to
parents
www.themegallery.com Company Logo

45. INFANT
 Stressors
 Separation
anxiety
 Stranger
anxiety
 Painful invasive
procedure
 Immobilization
 Sleep
deprivation
 Sensory
overload
 Responses
 Sleep awake
cycle
disrupted
 Feeling
routines
disrupted
 Displays
excessive
irritability
 Rejection of
feed
 Crying
 Nursing
implications
 Rooming-in
 Homely
routine
 Topical
aesthetics
 Promote a
quite
environment

46. TODDLER
Stressors
 Separation anxiety
 Reactions of
toddlers are
expressed as
protest, despair,
denial and
regression.
 Protest
 Despair
 Denial
 Regression
 Loss of autonomy
and control
 Fear of bodily
restraint,injury
Reactions
 Frightened to
sleep in supine
position
 Think as a
punishment
 Wonder why the
parents are not
rescuing
Nursing
implications
 Encourage
parental presence
 Allow the parent
to hold the child in
her lap to do any
procedure
 Give choices
 anaesthetics
 Explain the
procedure in
sequence
 Provide night light

47. PRESCHOOLER
Stressors
 Separation
anxiety
 Loss of self
control
 Bodily injury
 Painful
invasive
procedure
 Fear of dark
Responses
 Displace
difficulty in
separating
 Fear of ghost
 Fear of body
part loss
 Fear of pain
 Aggression
 Regression
Nursing
implications
 Encourage
parental
presence
 Give choices
 anaesthetics
 Explain the
procedure in
sequence
 Provide night
light

48. SCHOOLER
 Stressors
 Loss of self control
 Separation from
family and friends
 Bodily injury
 Painful invasive
procedure
 Fear of death
 Loss of privacy
 Loss of own
control
 Responses
 Displays increased
sensitivity to the
environment
 Demonstrates
detailed cause for
illness
 Nursing
implications
 Encourage parental
presence
 Utilise topical
anaesthetics
 Explain all the
procedure
 Encourage peer
interaction

49. ADOLESCENT
Stressors
 Lack of control
 Lack of privacy
 Fear of lack of
body integrity
 Fear of
disfigurement
 Fear of death /
disability
 Separation from
peer group
 Loss of privacy
Responses
 Anger
 Regression
 Withdrawal
 Bargaining
 Depression
Nursing
implications
 Include the
adolescent in
plan of care
 Encourage peer
group interaction
 Parental
involvement
 Explain each
steps of
procedures prior

50. EFFECTS OF HOSPITALISATION
ON THE FAMILY OF CHILD
PARENTS
 Stressors
 Strange environment
in the hospital
 Separation from the
child
 Unknown events and
outcomes
 The suffering of the
child
 Spread of infections to
other members in
family
 Unbearable financial
obligations
Reactions
 anxiety, anger, fear,
disappointment,self
blame,guilt
 The anxiety interferes
with the parent’s
ability to care the
child, support.
 This anxiety could be
recognised by the
trembling,coarse
voice, restlessness,
irritability and
withdrawal.
Nursing implications
 Recognise the need
for support
 Encourage to obtain
help from other family
members or friends
 Maintain parent child
relationship
 Parent support group
and care by parent
unit
 Psychological support
 Counselling
 Encourage to perform
the tasks

51. SIBLINGS
Stressors
 Younger child
 Experiencing
the changes
 Cared for
outside by care
providers
 Received little
information
about their
sibling
Reactions
 Anger
 Resentment
 Jealousy
 Guilt
Nursing
implications
 Explanation
about the
condition
 Provision for
sibling to
remain home
 Sibling visits

52. DISCHARGE FROM HOSPITAL
• plan for discharge with the assistance of parents, child
and other health team members.
• A discharge preparation involves education for family
• The preparation of discharge begins during the
admission assessment.
• Short and long term goals are established to meet the
child’s physical and psychosocial needs.
• For children with complex care needs, discharge
planning focuses on obtaining appropriate equipment
and health care personnel at home.
• The teaching plan involves levels of learning, such as
observing, participating with assistance and finally,
acting without help.
• All families need to receive detailed written instructions

53. OBJECTIVES OF PLANNING FOR DISCHARGE
1. To make certain that the care given in
the hospital will be continued as
necessary at home – the nurse can
assist the parent and child to meet the
objective by educating them concerning
the illness and the essential
requirements for care.
2. To share information with other
appropriate community resources or
agencies to enable them to assist the
parents and the child to continue care
at home.

54. LOGO