Case study of a high-risk neonate failing to thrive post-extracorporeal membrane oxygenation and post-necrotizing enterocolitis

Infants discharged from neonatal intensive care units (NICUs) often face a long journey of chronic illness, family stresses, and financial burdens. Health care professionals involved in acute care need to be aware of the far-reaching repercussions of neonatal illness. This report presents a case study of a low-income, single mother from a rural community and her son, a neonatal intensive care unit (NICU) graduate post-extracorporeal membrane oxygenation (ECMO) and post-necrotizing enterocolitis (NEC) discharged with a gastronomy tube (g-tube) and failure to thrive (FTT), from his birth to 10 months of age. Family-focused interventions aimed at improving growth and developmental delays and providing family support will be discussed.

Growing up in the hospital: Part II, Nurturing the philosophy of family-centered care

This article is the second in a series that addresses the issues of "growing up in the hospital." Whereas the first article focused on the child and the complex growth and development issues surrounding indefinite hospitalization, this article will focus on the family, the philosophy of family-centered care, and how nursing practice can nurture this ideal when working with children who must "grow up in the hospital."

Clinical case study: pediatric gas gangrene

Gas gangrene is a rare, serious infection. Untreated, it can rapidly be fatal. Accurate nursing assessments and timely interventions are needed to prevent loss of limb and potential loss of life.

[Impairment of parents by illness in the child--on the internal status of parents in in-patient psychotherapy of children]

When a child is admitted to inpatient psychotherapeutic treatment it regularly becomes evident that the necessity of such a major change in the life of the family also constitutes a major shock for the parents. Based on experience gained in group psychotherapy with parents, the underlying narcississtic wounds are examined. Aside from aspects of social ostracism and the necessity--often experienced as discrimination--of accepting help from professionals, the most painful wound is related to the fact that through its illness--which is also an expression of family dynamics--the child also detaches itself from significant emotional needs of the parents. The admission to inpatient treatment repeats manifestly a separation which the child has already attained in part. Working through the shock experience can lead to further steps of separation and initiate a reciprocal individuation between parents and child.

Growing up in the hospital: Part I, Let's focus on the child

Major advances in medical research and technology have made it possible for many children with complex chronic illnesses to survive, including those who just a few years ago would have died (Hobbs & Perrin, 1985). One goal of health care professionals who care for these children is, and continues to be, discharge of the child to the family and community whenever possible. Complex medical and nursing care, elusive diagnoses, complicated psychosocial issues, and inconsistent community resources often mean discharge must be prolonged. Focusing on the creation of innovative methods for integrating the growth and developmental needs of these special children is a challenging and often overlooked aspect of our pediatric nursing practice. This article is one of a series that will address the issues of growing up in the hospital. What are the implications for the child, family, and professional nurse? What strategies can we devise to assist our patients through what may be a very lengthy and complex hospital course?

Self-reported fears of hospitalized school-age children

This research examines the fears of 82 hospitalized school-age children 8 to 11 years of age as self-reported on the Child Medical Fear Scale (CMFS) (Broome, Hellier, Wilson, Dale, & Glanville, 1988). The variables of age, gender, yearly income level, health status (acute or chronic), and the score on the Trait scale of the State-Trait Anxiety Inventory for Children (STAIC), (Spielberger, Edwards, Lushene, Montuori & Platzek, 1973) were examined. Fear of separation from the family, having shots and finger sticks, having to stay in the hospital for a long time, and being told that something was wrong with them were the fears with highest mean scores. Children with higher trait anxiety and from families with lower yearly income reported a higher amount of fear. Pediatric nurses are encouraged to perform fear assessments and provide individualized interventions that anticipate fear reactions in order to assist school-age children to cope with sources of fears during hospitalization.

Effect of parental participation on hospitalized child behavior

A short-term longitudinal descriptive evaluation of current levels of parents' participation in the care of a child hospitalized with leukemia was conducted to identify varying levels of parent participation and their relationship to the child's behavior during hospitalization. A positive relationship between the number of activities a parent participates in and the child's behavior during hospitalization was revealed.

Traffic and noise in children's wards

OBJECTIVE

To measure pedestrian traffic volumes and noise levels in paediatric open bay areas and discuss their impact on the care of sick children.

METHODS

Between August and October 1992, we recorded the number and duration of entrances to two open bay areas comprising eight and ten beds respectively in a ward for infants and a ward for older children. Eight 24-hour periods (1200 to 1200) Friday to Saturday were assessed. Noise levels in decibels dB(A) were measured at 15-minute intervals.

RESULTS

In an average 24-hour period, 5.5 (SD +/- 1.3) patients in the infants' ward and 9.5 (SD +/- 0.6) patients in the children's ward received 617 (SD +/- 85) and 683 (SD +/- 64) visits by 104 (SD +/- 20) and 110 (SD +/- 2) individuals respectively. The maximum numbers of visits per hour were 57 (SD +/- 14) and 54 (SD +/- 8) visits between 1500 and 1600 hours on Friday for each ward. Visits tended to be brief; 225 (SD +/- 23) and 217 (SD +/- 34) visits were of less than one minute's duration. The maximum noise levels of 57.3 dB(A) (SD +/- 6.3) and 64.6 dB(A) (SD +/- 3.5) occurred at 1000 Saturday and 1900 Friday and coincided with peak traffic volumes.

CONCLUSIONS

Open bay areas generate high traffic volumes and coincident noise. Consideration should be given to either modifying or abolishing open bay areas and to general noise control measures.

Perioperative approach to children

There has been a tremendous amount of progress in the perioperative approach to the child since Levy wrote "Psychic trauma of operations in children and a note on combat neurosis" nearly 50 years ago. Recognition of prolonged behavioral derangements following the anesthetic-surgical-hospital experience and the prominent role that the parent and physician play in modifying these have dramatically changed the contemporary pediatric perioperative care. Of paramount importance is the psychological preparation of family and child. With increasing outpatient or same-day admission surgery and free-standing surgical centers, preoperative preparation will, of necessity, increasingly become the responsibility of the pediatrician.

Psychosocial policies in hospitals serving children: comparative characteristics

This investigation identified and assessed the extent to which hospitals are implementing psychosocial services to meet the needs of children and their families. Following up a similar survey in 1981, a comprehensive questionnaire was sent to the directors of pediatric nursing at pediatric hospitals and general hospitals with pediatric residency programs in the U.S. and Canada. Data were analyzed in a variety of ways to determine the relation between characteristics of pediatric hospitals and general hospitals; Canadian and U.S. hospitals; and hospitals with short, medium, and long lengths of pediatric patient stay. Overall, pediatric hospitals provided more psychosocial services than did general hospitals, and more of these services were implemented in 1988 as compared to 1981. No consistent trends were evident among hospitals when countries or lengths of pediatric patient stay were compared.

A multidisciplinary approach to pediatric pain: an empirical analysis

A comprehensive assessment and multidimensional approach are critical for optimal outcomes in pediatric pain management. The purpose of this article is to describe the structure, function, and results of a multidisciplinary pain team composed of individuals from nursing, pediatric medicine, and pharmacology. The team's activities, including individual consultation on a school age/adolescent unit, are described.

Stress Appraisals of Hospitalized School-Age Children

This study investigated the influence of health status as acutely or chronically ill, gender, and trait anxiety on the stress of 82 hospitalized children ages 8 through 11. Two aspects of stress were examined: (a) the specific events appraised as stressful, and (b) the appraised stressfulness of the global event of hospitalization. Findings indicated that chronically ill children identified more intrusive events and acutely ill children identified more physical symptoms as stressful; children with high levels of trait anxiety were more likely to appraise hospitalization as stressful. Gender did not have a significant influence on stress.

Coping with unplanned childhood hospitalization: effects of informational interventions on mothers and children

Two types of information, separately and in combination, were evaluated for their effects on the process and outcomes of maternal and child coping with unplanned childhood hospitalization. One hundred eight mothers of hospitalized children, 2 to 5 years old, were randomly assigned to one of four study groups. Child behavioral information and parental role information had positive effects on maternal state anxiety as well as on parental support and participation in their children's care during hospitalization. Ten to 14 days following hospitalization, positive main effects were shown for child behavioral and parental role information on mothers' state anxiety levels and for child behavioral information on children's negative behaviors.

Somatic, cognitive and emotional characteristics of abused children in a psychiatric hospital

A systematic review of medical records of one hundred consecutive admissions to a children's psychiatric inpatient unit was conducted to assess specific somatic, cognitive and emotional characteristics that distinguish sexually abused children from other hospitalized children. Sexually abused children were characterized by: a lower performance IQ, higher incidence of parasomnia prior to admission, longer length of hospital stay, and comparatively small physical stature.

A comparison of play behaviors in two child life program variations

The purpose of this naturalistic study was to describe the play of children in hospital playrooms and to determine whether the type of child life program focus (i.e., playroom/group vs. nonplayroom/individual) impacts on the frequency and types of play behaviors exhibited. Despite differences in hours of availability, length of experience of staff, complexity of play spaces, and number of activities, the type of program focus was not found to affect significantly play frequency or type. There were, however, trends for more educative and therapeutic play to occur in the playroom-focused setting. Instead, child variables of gender and length of hospitalization were related to types of play exhibited, and the type of illness and whether the child was previously hospitalized were related to certain nonplay behaviors. Implications are drawn for additional study of play in child life contexts.

Support for rural families of hospitalized infants: the parents' perspective

The provision of family-centered care in the hospital arena has become a national commitment. Recognizing and supporting the family's role means evaluating whether attitudes, policies, and practices address the immediate and the long-term needs of the total family rather than just the current needs of the child. Results of a study to determine parents' perceptions of supportive services available in the hospital immediately following the birth of their child with special health care needs are reported. In-depth interviews with mothers living in rural areas were conducted. Mothers emphasized the importance of access to their child; the need for timely, honest, straightforward information about their child's condition and progress; the intense emotional reaction to the intensive care environment; and the importance of an early link to community-based early intervention services. Overall, parents conveyed the importance of recognizing the family as an integral part of the child. Implications and recommendations for family-centered services are discussed.

The sibling group: beginning to meet the needs of child siblings of psychiatrically hospitalized children

Child siblings of children admitted to psychiatric hospitals often find themselves in a unique and potentially isolating situation. Because of the crisis affecting all family members and the focus of both parents' and professionals' energies on the identified patient, this sibling group is often overlooked. This paper describes an educational and supportive group designed by the authors to begin to address the needs of this population and offered as part of the family-services component of a child and adolescent psychiatric unit. The group serves multiple functions by diminishing the non-hospitalized children's sense of isolation, offering them education and support, and providing the treatment providers an opportunity to assess the needs of the inpatient's sibling. The authors describe a highly structured format that facilitated group members' participation.

Emotional responses to paediatric hospitalisation

This paper reports on an investigation of the emotional adjustment by children and their parents to paediatric hospital admission for planned ear, nose and throat surgery. It discusses the first phase of that adjustment and the importance of the initial clinic consultation in shaping subsequent coping. The study developed directly from clinical practice and the findings are expected to feed back into practice. The assessment of an experimental approach to preparation, which tests the efficacy of a fresh appraisal of the way in which children and their parents are prepared for this elective surgery, is studied. While there are important findings that relate to all three phases of the experience, that is, the pre-admission, in-hospital and post-hospital adjustment phases, the impact of the initial clinic consultation alone is discussed in relation to the implications for practice arising from the study.