Psychosocial Care of Children in Hospitals Exam 1

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awilli10
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39326
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Psychosocial Care of Children in Hospitals Exam 1
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2010-10-03 14:39:03
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Psychosocial care esther exam child life theory
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From the skinny, white book
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  1. Child life activities must
    • be initiated asap after admission
    • ongoing
    • involved individual care plans and reassessed daily
  2. How to look for signs of emotional distress
    • observe behavioral patterns (crying, withdrawing, aggression,etc)
    • ask child to describe his/her fears/anxiety
    • monitor psychological indicators (pulse, BP)
  3. 1965
    • Vernon, Foley, Sipowicz, Schulman
    • concluded emotional distress common during and after hospitalization
  4. Emotional support
    success depends on us establishing a supportive, trusting relationship and that social support can modify impact
  5. 1980 Fassler
    children were less upset when allowed to play and read non medical stories with staff members
  6. Prep for healthcare procedures
    • play activities
    • specific sensory info
    • rehearsal
    • filmed modeling
    • teaching of coping skills
    • hand written notes goes into more detail on each
  7. Stress-point prep
    designed to psychologically prepare child with lots of details for potentially painful or threatening procedures (older kids)
  8. Effects of illness, injury and hospitalization
    • child's cog. development
    • physical development
    • perceptual development
    • emotional development (emo and cog go hand in hand)
    • social development
  9. What is stress?
    • ongoing interaction between a person and the environment
    • results in an emotional appraisal that the situation is threatening or harmful and you feel lack of control
  10. What do you feel when stressed?
    • feel little or no control
    • feel unable to change situation in order to remove threat or harm
  11. Subjective aspects of stress
    • social and cultural values
    • individual differences in temperament
    • prior experiences -HUGE
    • developmental level
  12. Threats to physical well being
    • painful procedures
    • unfamiliar and unpleasant sensory stimulation
    • decrease of developmentally important activities
  13. threats to psychological well being
    • loss of parental support
    • loss of perceived control or predictability
    • loss of relative autonomy-independence
    • loss of self-esteem
    • loss of sense of security
  14. two aspects of psychological stress
    • event or stimulus that causes stress
    • individual's response to that stressor
  15. response to stress (how we process)
    • thoughts
    • feelings
    • physiological processes
  16. what is emotional distress?
    • when a person's feelings are unpleasant and intense
    • feelings of:
    • fear
    • anxiety
    • apprehension
    • tension
    • uncertainty or confusion
  17. two parts of appraisal process
    • primary: initial judgment of whether a potential threat exists
    • secondary: whether and how a person can cope with the threat or harm
  18. what is unconscious stress?
    • any condition that threatens or injures a child's optimal functioning in some way and child is unaware of condition
    • ie: malnutrition, disease processes, radiation, environment
  19. conscious stress?
    child perceives the stress to be harmful
  20. what is coping?
    • what a person does in order to avoid, remove, minimize or get through stressful situation
    • Two types:
    • problem-focused
    • emotion-focused
  21. Problem-focused coping
    • getting more accurate and complete info
    • practicing ways of getting through the situation
    • rehearsals
  22. emotion-focused coping
    • thoughts and feelings
    • don't want details, but how they will feel and what to do to get through it
  23. How do you measure effective coping?
    • identify both stimulus and response
    • specific behaviors or processes being observed
    • short and long term consequences of those behaviors
  24. What is information processing?
    various cognitive processes such as receiving, assimilating, interpreting, storing, recalling and applying new info to one's particular situation
  25. Communication techniques
    • consistent supportive interactions
    • psychological preparation: dolls, etc
    • anticipatory guidance- helping them anticipate
    • play interactions
    • expressive activities
  26. Communication with families
    • assess their understanding and threat appraisal of each situation
    • provide family members with info and anticipatory guidance to reduce stress
    • refer families to other health team members
    • assist families in supporting and caring for children
  27. Support:
    engagement with others that leads to feelings of solidarity and trust, and an exchange of intimate communication
  28. support is characterized by
    • advocacy
    • a focus on coping and competence
    • developmental perspective
    • family-centered approach
  29. ***Variety of ways to provide psychosocial support***
    • spending supportive time with a child and family
    • before, during and or after significant health care events
    • communicating with children/families in ways
    • that reflect their natural language
    • respecting children’s/families/ different
    • characteristic needs
    • providing understandable, developmentally
    • appropriate and accurate information and reassurance
    • being empathetic and nonjudgmental (parents will
    • know if you are there because you care or because you’re just doing your job)
    • conveying sincere interest in child’s welfare
    • engaging child in play activities and
    • interactions
    • providing support and info to parents and other
    • significant family members
  30. Stress vulnerability
    how children and their families tend to respond to any kind of stressful situation, not just healthcare
  31. Stress vulnerability variables
    • chronological and dev. age
    • response to current and previous healthcare experiences
    • ability to communicate with healthcare people
    • degree and type of observed emotional distress
    • coping skills
    • responses to previous separation
    • current conceptions and misconceptions
    • fears and fantasies and concerns
    • cultural background
    • recent and current stresses
    • availability of support system
    • financial resources
    • circumstances of child's admission
  32. Health care variables
    • chid's diagnosis
    • nature of current and anticipated symptoms
    • anticipated procedures and treatments
    • course of child's recovery or deterioration
    • number and type of healthcare professionals involved
  33. Assessment of "stress potential"
    diagram
    • consideration needs to be made with all sets of factors in mind.
    • formalized rating system of 1-5
    • 1-lowest risk
    • 5-highest risk
  34. Level 1
    • children were stable
    • good prognosis
    • well functioning family support
    • tonsillectomy
    • play/interact comfortably
    • show minimal signs of stress
  35. Level 2
    • change in behaviors
    • remaining length of hospitalization
    • anticipated future admissions
    • parental concern/frustrations
    • inconsistent family support
  36. Level 3
    • chronic diagnosis
    • future hospitalizations
    • daily care and treatments
    • possibility of premature death
    • renal failure, cystic fibrosis
  37. Level 4
    current hospitalization poses threat to child of family's ability to cope
  38. Level 5
    • recent experience of ICU
    • trauma/emergency room
    • challenging life situations ie. quadriplegic, Taylor
    • emotional needs not being met

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