Chapter 19- Family-Centered Care of the Child During Illness and Hospitalization

What is Family centered care means?

The family is just as important as the child in healthcare.

When a child is sick or hospitalized, it affects the whole family, not just the patient. Nurses and healthcare providers work WITH the family, not just for the child.

Why Family-Centered Care Is So Important?

Children:

• Depend on adults for safety, comfort, and decision-making

• Don’t fully understand illness or hospitalization

• Feel stress, fear, and separation anxiety very easily

Families:

• Know the child best

• Are the child’s main source of comfort and security

• Continue care at home after discharge

💡 Best care happens when nurses, children, and families work as a team.

How Illness & Hospitalization Affect Children?

Depending on age, children may experience:

• Fear

• Anxiety

• Anger

• Regression (bedwetting, thumb-sucking)

• Separation anxiety

• Loss of control

These reactions are normal, not misbehavior.

What are the stressors for Hospitalized Children?

• Separation from parents

• Fear of pain or procedures

• Loss of routine

• Strange environment

• Loss of control

What is the 3 phases separation Anxiety in young children?

1. Protest

   • Crying

   • Screaming

   • Clinging to parents

2. Despair

   • Quiet

   • Withdrawn

   • Sad

   • Appears calm but is not coping well

   • not interacting

   • not interested on things that they usually love

3. Detachment

   • Appears happy

   • Shows interest in others except to their parents/caregivers

   • BUT has emotionally detached (not a good sign)

➡ Family presence helps prevent this.

How toddlers react when they have separation anxiety?

•Plead with parents to stay.

•Look for parents who have left.

•Temper tantrums (best way: Ignore tantrums)

•Not complying with routines

Regression (Going backwards)

How preschoolers react when they have separation anxiety?

•Tolerates brief periods of separation

•Substitute trust in significant adults

•Stress of illness changes all of that

•See more subtle and passive separation anxiety behaviors

How older children react when they have separation anxiety?

• Separation from family and friends
  → They miss their support system and feel less secure alone.

• Unfamiliar environment
  → Hospitals feel strange, scary, and unpredictable.

• Not being able to make their own choices
  → They want independence and feel stressed when adults decide everything for them.

• Receiving treatments or diagnostic procedures
  → Fear of pain, needles, tests, or the unknown.

• Being away from usual activities and friends
  → Missing school, sports, hobbies, and social time causes distress.

Because of these fears, older children often feel:

• Lonely

• Bored

• Isolated

• Depressed

How adolescent react when they have separation anxiety?

They fear:

• Loss of peer-group contact
  → Being cut off from friends is very stressful.

• Loss of group status, leadership, and acceptance
  → They worry about falling behind socially or being forgotten.

Hospitalization makes adolescents feel:

• Different

• Embarrassed

• Out of control

• Less independent

How to help adolescence to feel better from their illness, being bored in the hospital?

Adolescents benefit from contact with other hospitalized teens

How Illness & Hospitalization Affect Families?

Parents may feel:

• Fear

• Guilt (“Did I cause this?”)

• Anger

• Helplessness

• Anxiety

• Exhaustion

Siblings may:

• Feel neglected

• Feel jealous

• Be scared (Before visiting them they need to be prepared. Tell them what’s going in with their sister/brother)

• Misunderstand the illness

Nurses care for the entire family unit, not just the patient.

What to do during if parent is absent?

Young children associate such inanimate objects with significant people

• A blanket may remind them of their parent

• A stuffed toy may feel comforting because it smells or feels familiar

Help children maintain usual contacts

Children cope better when they can still:

• Talk to parents

• See family members

• Stay connected with siblings and friends

This can be done through:

• Visits when possible

• Phone or video calls

• Photos or messages

Nursing Care of The Family during discharge

•Have a blanket and pillow in the car on the ride back home

•Take a basin

•Use a cup and straw for the child to drink unless contraindicated

•Give pain medication before leaving the facility

•Provide parents information about side effects of pain medication