Supplemental training and experience in pediatric nursing is imperative to properly assess for the potential psychosocial effects of hospitalization on our most precious patients.
Nursing Interventions
monitoring input and output; assess for weight change every 12 hours, assess skin turgor, assess urine concentration and clarity, document findings. Assess vital signs, monitor for hypotention and tachycardia as these are signs of dehydration. Maintain patent IV site to ensure IV fluid replacement. Assess IV site frequently throughout shift for signs of infiltration, swelling, redness or discomfort. Clarify with another RN, all doses of medications and IV settings for the pediatric patient. Monitor labs and patient for signs of infection secondary to use of immunosuppressive medicines and use of steroids for HSP treatment.
The psychosocial aspects of nursing care are equally important when caring for the school-aged pediatric patient and the patient's family. Encourage the parent(s) or a trusted adult caregiver to board with the school aged patient at all times during the hospital stay to alleviate fears. Encourage comfortable, loose fitting clothes from home as the school aged patient is becoming more aware of self and developing a need for privacy. With this in mind, always knock gently before entering the patients room. Encourage items of comfort to be brought in from home. Allow child to see and touch equipment while providing concise explanations as the school aged patient finds comfort in concrete concepts. Encourage the school aged patient to relate the hospital experiences to similar experiences out of the hospital. Be prepared for the younger school aged patients to regress in order find a familiar comfort zone and for the older school aged children to become unbelievably stoic and mask fears with defiance. Support open communication with your patient and family. Utilize humor whenever appropriate. Be honest, yet not excessive, when answering questions concerning a possible painful procedure. Trust must be gained with the school aged patient. Teaching must be provided at discharge concerning the risks, signs, and symptoms for reoccurrence of HSP. “Patients with nephritic or nephritic syndromes, however, have a 20% risk of permanent renal impairment. HSP patients should therefore be followed up for 6 months to ensure there is no renal involvement, and those with nephritis or nephrotic syndrome investigated further, treated aggressively and followed up closely” (Sinclair 2010, p 118).
Cultural Influences
Nursing
interventions must be flexible and adaptive to each individual patient
and family. Cultural influences are one of many variances that must be
addressed to provide holistic nursing care. The Hispanic population is
growing four times faster than the general population in this country
according to the U.S. Census done in 2005. The characteristics of cultural
diversity are not taught in most nursing programs. The responsibility
falls on the RN to expand their knowledge base to ensure culturally
sensitive nursing care. Hispanics face healthcare issues above and
beyond the average Caucasian with health insurance. There are many
additional barriers; namely language barriers and cultural prejudices.
Nursing care is more effective when the parents of the Hispanic
pediatric patients are bilingual. If this is not the case the RN should request that a bilingual family member to be present during times of teaching, decision making and especially at discharge.
Education and income levels can affect decision making in care, especially follow up care. If the family feels disrespect and dissatisfaction concerning their healthcare experience, this can lead to further withdraw by the parents (Mayo, Sherrill, Sundareswaran & Crew 2007). It is important to ask that a bilingual family member be present during times of teaching and decision making, especially at discharge. There is always the risk of information lost in translation. This risk is increased if the nurse is not bilingual. It is imperative that a certified medical interpreter phone service be provided by the hospital or pediatricians office. This service is extremely expensive for the facility but vital to quality and safety of care. Yet setbacks in care can occur with the interpreter service. There is less time for assessment and teaching because the interpreter process is time-consuming. Patients/parents possibly provide less valuable information to the nurse by way of the interpreter. A sense of trust is lost with a three-way phone conversation.
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