COURSE : B.

SC (NURSING) III YEAR

SUBJECT NAME : CHILD HEALTH NURSING
UNIT : I. INTRODUCTION
Topics :
 Grief and Bereavement
 The Role of Pediatric Nurse in caring for a hospitalized child
 Principles of Pre and Post operative care of infants and children
DATE : 30.06.2020 FN

Prepared By
Dr. Zealous Mary, Professor
 GRIEF AND
BEREAVEMENT
 OBJECTIVES

By the end of this presentation learners will be able to:

 define the terms Grief and Bereavement
 explain the symptoms and types of Grief and Bereavement
 discuss the stages of Grief and Bereavement
 describe the coping strategies of Grief and Bereavement
 explain the management of Grief and Bereavement
 INTRODUCTION
 Grief is a multi faceted response to loss, particularly to the loss of
someone or something to which a bond was formed.

 The loss may be a person, thing, relationship, or situation.

 Children and adolescents may experience grief differently from adults.

 They may react differently to the death of someone close to them or

even when experiencing a loss just from being apart from their family,
whether in a group home or in foster care.

 Bereavement is the reaction of the survivor to the death of a family

member or close friend.
Definition: Grief

According to John Bowlby, Grief is the physical, emotional

Somatic, cognitive and spiritual response to actual or threatened loss
of a person, thing, or place to which we are emotionally attached.

Grief is psychological and physiologic responses a person

experiences after the loss of a significant person, object, or
relationship. 
.
 SYMPTOMS OF GRIEF
Grief is expressed physically, emotionally, socially, and spiritually.
 Physical expressions of grief often include , headaches, loss of
appetite, difficulty in sleeping, weakness, fatigue, nausea, aches, pains,
headaches, palpitations
 Emotional expressions of grief include feelings of sadness and
yearning. But feelings of worry, anxiety, frustration, anger, crying,
numbness, guilt are also normal.
 Social expressions of grief may include feeling detached from
others, isolating yourself from social contact, and behaving in ways
that are not normal for you.
 Spiritual expressions of grief may include questioning the reason for
your loss, the purpose of pain and suffering, the purpose of life, and the
meaning of death.
 TYPES OF GRIEF REACTIONS
Anticipatory Grief
 Anticipatory grief may occur when a death is expected.
 Anticipatory grief does not always occur.
Normal Grief/ Common Grief
 Normal or common grief begins soon after a loss and symptoms
go away over time.

Complicated Grief
 There is no right or wrong way to grieve, but studies have shown
that there are patterns of grief that are different from the most
common. It includes Minimal grief reaction and Chronic grief
reactions.
 STAGES OF GRIEF

Elizabeth Kubler-Ross, identified five stages of grief :

1. Denial (this isn’t happening to me!)

2. Anger (why is this happening me?)

3. Bargaining (I promise I’ll be a better person if...)

4. Depression (I don’t care anymore!)

5. Acceptance (I’m ready to go on with life)

 COPING WITH GRIEF

 Talk to family or friends

 Seek counselling
 Get enough sleep or at least enough rest
 Try and get some regular exercise
 Keep a balanced diet
 Drink plenty of water
 Drink alcohol in moderation
 Do what comforts, sustains & recharges
 Engage in social activities
 Seek spiritual support
 BEREAVEMENT
Definition:

 Bereavement is the period of sadness and loneliness that we

experience when we lose a loved one. When we experience
bereavement, we are trying to adjust to the loss. We typically
associate the feelings of loss during bereavement with the death of a
loved one. However, the loss can be due to many factors.

 Bereavement is a state of desolation (unhappiness) that occurs as the

result of a loss. Bereavement is the subjective response.
 EFFECTS OF BEREAVEMENT
 Physical effects of bereavement often include difficulty getting to
sleep, vivid dreams and long periods of wakefulness ,may lose
appetite. Some people feel tense and short of breath, or edgy and
restless; others feel slow and lethargic.
 Emotional effects of bereavement include grief, emptiness and
depression, anger, fear, mixed feelings.
 Social effects of bereavement may include feeling detached from
others, isolating yourself from social contact, and behaving in ways
that are not normal for you.
 Spiritual effects of bereavement may include questioning the reason
for your loss, the purpose of pain and suffering, the purpose of life,
and the meaning of death.
 STAGES OF BEREAVEMENT

 Accepting the loss is real

 Experiencing the pain of grief
 Adjusting to life without the person who has died
 Putting less emotional energy into grieving and putting
it into something new (in other words, moving on)
 COPING WITH BEREAVEMENT
 Do express your emotions
 Do take great care of yourself
 Do try to guard against accidents in home and ensure your home
is secure
 Ensure to consult a doctor if your health is a worry
 Don’t let family or friends hurry you in making important decisions
 Don’t enter into any financial arrangement you don’t understand
 Don’t allow the funeral rituals to be expensive
 Don’t turn to drugs, alcohol or smoke
 Don’t move your home while you are still grieving
 Take it at your own pace don’t hurry the healing process
MANAGEMENT OF GRIEF AND BEREAVEMENT

 Counseling
 Medication
 Support Groups
 Psychotherapy
The Role of Pediatric Nurse in caring for a
hospitalized child
 ROLE OF PEDIATRIC NURSE IN CHILD CARE

The role of the pediatric nurse is constantly changing. These changes are as a
result of expanding medical and nursing practice, emerging challenges in
different aspects of child care, consumer demands & technological
advancements. The role of the pediatric nurse may vary from one institution to
others, but basic responsibilities remain the same.
 Cont..
Provide family centered care with different approach to specific age group.
In neonates
•Encourage mother to balance her responsibilities and minimize separation with
confidence and competence.
•Basic needs of infant should be fulfilled promptly with attention.
•Mother can be allowed during procedures
•Tension and loneliness can be relieved by toys.
Cont..

In toddlers
Provide rooming-in and unlimited visiting hours to express child’s feeling. No
punishment to the child.
Home routine can be continued especially regarding sleeping, eating and
bathing.
Allow play and arrange physical setting to encourage independence.
Parents should provide love and understanding to help the child to restore
trusting relationship.
Cont..

In preschool children
Minimize stress by providing parental presence and participate in care.
Help the child to accept the stressful situations.
Encourage the child to participate in self care and hygiene.
Cont..

In school children

Help the child to identify problems and to ask questions.

Encourage the child in self care, play and to continue school work.
Help the parents to deal with their own anxieties.
Encourage parental participation in child care.
Cont..

In adolescent
Respect the need for privacy, recreation, personal preferences on
self care and food habits.
Provide opportunities for recreation, peer relationships, interaction
with other adolescent patients and expression of feelings.
OTHER ROLE OF PEDIATRIC NURSE

1. Primary care giver 6. Counselor

2. Coordinator and collaborator 7. Case Manager

3. Advocate 8. Recreationist

4. Health educator 9. Social worker and

5. Consultant 10.Researcher
Primary care giver:
 Pediatric nurse should provide preventive, promotive, curative and
rehabilitative care in all levels of health services.
In hospital, care of sick children includes comfort, feeding, bathing,
safety etc.
At community set up, basic responsibilities include health
assessment, immunization, primary health care & referral etc.
Coordinator & Collaborator:
 The nurse plays an extremely important role with the combination of
health care team members.
 Nurse maintains good inter personal communication with the child,
family and health team members.
 The nurse coordinates nursing care with other services for meeting
the needs of child. For ex: physician, social worker, surgeon,
physiotherapist, dietician etc.
Nurse Advocate:
The pediatric nurse acts as an advocate to safeguard the child’s
right, to assist & to provide best care from the health care team.
Nurse acts as a representative for the child, family & other health
care providers. Ex: it can range from consulting dietary department
for special foods to arrange team meeting to discuss plan of care with
other health team members.
Health Health Educator:
 The nurse’s goal of health teaching is to provide

information to the childparents and significant other about prevention

of illness, promotion or health maintenance.
Characteristics of nurse teacher includes
4 C's
C — Confidence
C — Competence
C — Communication
C — Caring & empathy
Nurse Consultant:
The pediatric nurse can act as consultant to guide parents for
maintenance and promotion of health. For ex: Guiding parents about
feeding practices, accident prevention.
Nurse Counselor:
Providing guidance to parents in health hazards of children and
health them for own decision making in different situations.
Case Manager:
 The pediatric nurse should organize care, monitor and evaluate
patient treatment for successful outcome.
 She/he acts as a manager of pediatric care units in hospital clinics
and community.
Recreationist:
 The pediatric nurse plays supportive role for the child to provide
play facilities for recreation and diversion.
 It helps to decrease crisis imposed by illness or hospitalization
Social Worker:
Pediatric nurse can participate in social services or refer child & family
to child welfare agencies for necessary support.
Nurse researcher:
 Research is an integral part of professional nursing.
 Pediatric nurse should participate or perform research activities.
 It helps to provide basis for changes in nursing practice,
improvement in the child health care and evaluate the care.
ROLE OF PEDIATRIC NURSE
The pediatric nurse's role is unique because of developmental
immaturity and vulnerability of children. The goals of nursing care of
children, based on primary health care are:
I. Promote the healthy maturation as a physical, intellectual and emotional
being within the context of his family and communities (primary level).
2. Provide health care for the child who requires treatment from disease(s)
(secondary level).Dealing with the child's disabilities (tertiary level). Therefore,
the role of the pediatric nurse includes:
I. In Primary Level:
Through health education to child and his parents and providing child's
basic needs and immunization, she can:
1. Maintain child's health.
2. Help the child achieves his optima9 growth and development.
3. Prevent diseases and their complications.
II. In Secondary Level:
The nurse has to provide care to sick children and their families by:
I. Assessing their needs.
2. Planning for care.
3. Implementing the plan.
4. Evaluating children's condition.
5. Providing heath teaching to children and their parents
III. In Tertiary Level:
The nurse should assist children to return to their maximal level of
functioning following illness and /or disabilities.’As a nurse depends on
Education
Experience
Job structure
Professional demand
Preventive care
Promotive care
Curative care
Health education
Restoration health
Co-ordination
Nursing task and skill:
• General nursing care:
• Monitoring of vital signs
• Administration of fluid and electrolytes and drugs
• Diagnostic and therapeutic procedures.
• Nursing procedures
• Resuscitation skills
• Specialized nursing and monitoring skills
• Vaccination
• Prevention of nasocomial infection
• Universal precaution
Through the international activities of WHO (world health
organization), IMCI-(Integrated Management of Child hood Illness),
UNICEF (United Nations International Children and Emergency Fund)
and other health agencies are providing to develop the level of child
health care throughoutthe world.
Now days the child care is very much improved it includes;
• Hospital environment for a sick child
• Advanced changes in medical and nursing care
• Expansion in independent role of the paediatric nurse
• Paediatric nurse practionnaire.
• Paediatric clinic nurse specialist.
• Paediatric nurse master clinicians.
 SUMMARY
The role of nurse in helping child and family members for coping
with stress of hospitalization and illness is complementary and
supportive. The pediatric nurse must be aware about the feelings
of both parents and children.
Principles of Pre and Post operative care of
infants and children
 OBJECTIVES

By the end of this presentation learners will be able to:

 describe the principles of pre and post operative care of infant
and children
 explain the Nursing care phases of pre and post operative
care of infant and children
 discuss the hospital environment for sick child
 INTRODUCTION
 The infants and children have different types of surgical problems
than that of adults. Especially the Congenital Malformation are the
important causes of surgical interventions in children.

 Surgery can be planned or unplanned i.e. elective or emergency.

 It is potentially stressful experience for children.

 Potential threat for surgery to the children are physical harm, pain,
injury, death, separation from parents, strange and unknown .
Contd…
 Preparation of children for surgery is an important aspect and
should be based on child’s age , development stage, level of
personality and past experience.
 It should begins with preparation for admission to the hospital.
 In emergency surgical intervention, preparation should be done in
modified way but basic approach should be same.
PRINCIPLES / ROLE OF NURSE IN THE
PRE-OPERATIVE PHASE

1. Pre-operative Assessment
2. Obtaining informed consent
3. Pre operative teaching.
4. Pre-operative Preparation.
5. Premedication.
6. Psychological preparation
1. Pre-operative Assessment

a. The purposes of pre-operative visit.

b. History collection.

c. Physical Examination.

d. Investigation

e. Risk Assessment.
a. The purposes of pre-operative visit
• Establish rapport with the child and the parents
• To collect history
• For special investigation
• Assess the risk of anaesthesia.
• Start pre-operative management
• Discussion about pre-operative and plan the anaesthetic
management.

b. History collection
• About Chart review, Present illness, Family History, Previous
illness & Allergic history.
c. Physical Examination
Full examination must be done even if it’s a minor surgery.

General: color, activity, weight, dehydrated, & type of

breathing.

Systemic assessment

d. Investigation

Routine investigation : urine analysis & CBC

To Rule out medically fit

More investigation, if the child has any medical diseases.

4. Pre-operative preparation for surgery

 History collection , physical examination & investigation

 Preoperative fasting

 Providing information to the child / parents & gaining a consent

 Collect or Prepare of the blood product

 Physical preparation

 Preoperative medication

 Organize appropriate staff and equipment in the theater

POST OPERATIVE CARE OF INFANTS AND CHILDREN

 Nursing responsibility in the post- operative

management include meeting both physical and
psychological needs of the child.
 Operation bed and necessary articles to be kept ready
for receiving the child and to provide immediate post
anesthesia care in the recovery room or in the pediatric
unit.
POST OPERATIVE NURSING CARE PHASE

I. Transportation to Recovery
II. Initial post-operative care
III. During the Hospital stay
IV. Discharge Criteria
II. Initial Postoperative care
 Do not leave the child unattended
 Ensure the safety, airway, breathing, temperature and pain management
 Keep monitoring vitals
 Prevention of infection
 Maintaining the fluid and electrolyte balance
III. During Hospital stay

 Measuring levels of recovery

 Keep monitoring the Vital Signs
 Hygienic measures
 Administration of medication
 Reassurance
IV. Discharge criteria
 Nurses plays a vital role in post-op care
 Informing parents to contact the hospital, about any concerns or
problems and ensuring they have hospital contact number
 Ensures better follow-up and compliance
 Clear post-operative instructions and explanations given to
parents/ child
 Reducing the patient’s anxiety
 Emphasis on follow up care
 HOSPITAL ENVIRONMENT FOR A SICK CHILD

Many young children will remember their time spent in the hospital
with fear and trembling because of loneliness and pain they felt at
an age when they could not cope alone with these feelings
 GUIDELINES FOR ADMISSION

Preadmission
Assign a room based on developmental age, seriousness of
diagnosis, communicability of illness and length of stay.
Prepare room for child and family with admission forms and
equipments.
 Cont…

Admission
Orient primary nurse to child and family
A pediatric unit should be happy and attractive place with
cheerful home like surrounding.
It should have colourful walls with suitable pictures
Furniture should be attractive and colourful without any
poisonous paints any projections and sharp edges.
Floors should not be slippery and safety measures should be
maintained.
 Cont..
The pediatric unit have separate areas of facilities for different types of
ill child, treatment room, examination room, play room, dinning room and
pantry, waiting room for visitors and parents, consultation room, teaching
room for visitors, store room, bathroom for children and adults, nurses
station, doctors room etc..
The pediatric unit must meet the needs of children and their parents.
The physical environment of pediatric unit should be pleasing by
maintenance of cleanliness and orderliness of furniture and equipment.
 Cont..

Various modern concepts in hospital environment like

Visiting
Rooming in
Care by parent unit
Parent support groups
Self care and play
All these prepared a new and comfortable environment for child
and his care
 Cont..

Preparation for hospital environment

The prevention is a strong component of nursing care.
The maintenance of health and prevention of illness are the
goals
The children especially if they are to be spread, the
psychological or emotional trauma of hospitalization, be prepared
for this possibility
 Cont..

Little can be done to prepare the infant, but for older child more
can be accomplished in terms of preparation for hospitalization are
Booklets
Films
Puppet shows
Or other creative means can be used to prepare the child who
does not immediately require treatment in a hospital.
 Cont..

•Plans can also be made to have children visit and tour the hospital
to orient them to the physical environment and to some aspects of
care provided.
•Nurses may also go into schools to talk to children about the
hospital experience
•Hospital community and school programme aimed at educating
parents to deal their children with the hospital environment.
 Cont..

•Hospitalization may be a traumatic event for children but it can be

a positive psychologic experience for them if they are prepared for
it properly.
•If children are properly prepared hospitalization can be a growth
experience for them contributing their self esteem.
 SUMMARY

The majority of the conditions requiring surgery in children are

of average severity, occurring in otherwise normal,
healthy children. Pre- operative preparation in such instances is
not unduly difficult and post- operative care is usually
uncomplicated.
 REFERENCES

 Kaplan and Sadock's Synopsis of Psychiatry 10th edition; Page-62)

 Report on Grief and Bereavement Research, Center for the
Advancement of Health, 2004)
 Taylor – Fundamentals of Nursing, 2007, LWW
 Kozier – Fundamentals of Nursing ,2007,Pearson
 Potter – Basic Nursing ,2008,Elsevier
Nelson text book of pediatrics
kliegman\stgeme\blum\shah\tasker\wilson 21 edition
IAP text book of pediatrics fifth edition rohit agrwal TU sukumaran
Marlow’s textbook of pediatric nursing South Asian edition