-
Child life activities must
- be initiated asap after admission
- ongoing
- involved individual care plans and reassessed daily
-
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)
-
1965
- Vernon, Foley, Sipowicz, Schulman
- concluded emotional distress common during and after hospitalization
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Emotional support
success depends on us establishing a supportive, trusting relationship and that social support can modify impact
-
1980 Fassler
children were less upset when allowed to play and read non medical stories with staff members
-
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
-
Stress-point prep
designed to psychologically prepare child with lots of details for potentially painful or threatening procedures (older kids)
-
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
-
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
-
What do you feel when stressed?
- feel little or no control
- feel unable to change situation in order to remove threat or harm
-
Subjective aspects of stress
- social and cultural values
- individual differences in temperament
- prior experiences -HUGE
- developmental level
-
Threats to physical well being
- painful procedures
- unfamiliar and unpleasant sensory stimulation
- decrease of developmentally important activities
-
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
-
two aspects of psychological stress
- event or stimulus that causes stress
- individual's response to that stressor
-
response to stress (how we process)
- thoughts
- feelings
- physiological processes
-
what is emotional distress?
- when a person's feelings are unpleasant and intense
- feelings of:
- fear
- anxiety
- apprehension
- tension
- uncertainty or confusion
-
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
-
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
-
conscious stress?
child perceives the stress to be harmful
-
what is coping?
- what a person does in order to avoid, remove, minimize or get through stressful situation
- Two types:
- problem-focused
- emotion-focused
-
Problem-focused coping
- getting more accurate and complete info
- practicing ways of getting through the situation
- rehearsals
-
emotion-focused coping
- thoughts and feelings
- don't want details, but how they will feel and what to do to get through it
-
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
-
What is information processing?
various cognitive processes such as receiving, assimilating, interpreting, storing, recalling and applying new info to one's particular situation
-
Communication techniques
- consistent supportive interactions
- psychological preparation: dolls, etc
- anticipatory guidance- helping them anticipate
- play interactions
- expressive activities
-
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
-
Support:
engagement with others that leads to feelings of solidarity and trust, and an exchange of intimate communication
-
support is characterized by
- advocacy
- a focus on coping and competence
- developmental perspective
- family-centered approach
-
***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
-
Stress vulnerability
how children and their families tend to respond to any kind of stressful situation, not just healthcare
-
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
-
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
-
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
-
Level 1
- children were stable
- good prognosis
- well functioning family support
- tonsillectomy
- play/interact comfortably
- show minimal signs of stress
-
Level 2
- change in behaviors
- remaining length of hospitalization
- anticipated future admissions
- parental concern/frustrations
- inconsistent family support
-
Level 3
- chronic diagnosis
- future hospitalizations
- daily care and treatments
- possibility of premature death
- renal failure, cystic fibrosis
-
Level 4
current hospitalization poses threat to child of family's ability to cope
-
Level 5
- recent experience of ICU
- trauma/emergency room
- challenging life situations ie. quadriplegic, Taylor
- emotional needs not being met
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