870 CHAPTER 22 Family-Centered Care of the Child During Illness and Hospitalization
BOX 22-6 NURSING ADMISSION HISTORY ACCORDING TO FUNCTIONAL
HEALTH PATTERNS*
Health Perception–Health Management Pattern
Why has your child been admitted?
How has your child’s general health been?
What does your child know about this hospitalization?
• Ask the child why he or she came to the hospital.
• If the answer is “For an operation or for tests,” ask the child to tell you
about what will happen before, during, and after the operation or tests.
Has your child ever been in the hospital before?
• How was that hospital experience?
• What things were important to you and your child during that hospitaliza-
tion? How can we be most helpful now?
What medications does your child take at home?
• Why are they given?
• When are they given?
• How are they given (if a liquid, with a spoon; if a tablet, swallowed with
water; or other)?
• Does your child have any trouble taking medication? If so, what helps?
• Is your child allergic to any medications?
What, if any, forms of complementary medicine practices are being used?
Nutrition–Metabolic Pattern
What is the family’s usual mealtime?
Do family members eat together or at separate times?
What are your child’s favorite foods, beverages, and snacks?
• Average amounts consumed or usual size of portions
• Special cultural practices, such as family eats only ethnic foods
What foods and beverages does your child dislike?
What are your child’s feeding habits (e.g., bottle, cup, spoon, eats by self, needs
assistance, any special devices)?
How does your child like the food served (e.g., warmed, cold, one item at a
time)?
How would you describe your child’s usual appetite (e.g., hearty eater, picky
eater)?
• Has being sick affected your child’s appetite? In what ways?
Are there any known or suspected food allergies?
Is your child on a special diet?
Are there any feeding problems (e.g., excessive fussiness, spitting up, colic)?
Are there any dental or gum problems that affect feeding?
• What do you do for these problems?
Elimination Pattern
What are your child’s toileting habits (e.g., diaper, toilet trained—day only or
day and night, use of word to communicate urination or defecation, potty
chair, regular toilet, other routines)?
What is your child’s usual pattern of elimination (bowel movements)?
Do you have any concerns about elimination (e.g., bed-wetting, constipation,
diarrhea)?
• What do you do for these problems?
Have you ever noticed that your child sweats a lot?
Sleep–Rest Pattern
What is your child’s usual hour of sleep and awakening?
What is your child’s schedule for naps? What is the length of naps?
Is there a special routine before sleeping (e.g., bottle, drink of water, bedtime
story, night light, favorite blanket or toy, prayers)?
Is there a special routine during sleep time, such as waking to go to the
bathroom?
What type of bed does your child sleep in?
Does your child have a separate room or share a room? If shares, with whom?
Does your child sleep with someone or alone (e.g., sibling, parent, other person)?
What is your child’s favorite sleeping position?
Are there any sleeping problems (e.g., falling asleep, waking during night,
nightmares, sleepwalking)?
Are there any problems in awakening and getting ready in the morning?
• What do you do for these problems?
Activity–Exercise Pattern
What is your child’s schedule during the day (e.g., preschool, day care center,
regular school, extracurricular activities)?
What are your child’s favorite activities or toys (both active and quiet
interests)?
What is your child’s usual television-viewing schedule at home?
What are your child’s favorite programs?
Are there any television restrictions?
Does your child have any illness or disabilities that limit activity? If so, how?
What are your child’s usual habits and schedule for bathing (e.g., bath in tub or
shower, sponge bath, shampoo)?
What are your child’s dental habits (e.g., brushing, flossing, fluoride supplements
or rinses, favorite toothpaste)? What is the schedule of daily dental care?
Does your child need help with dressing or grooming, such as hair
combing?
Are there any problems with these patterns (e.g., dislike of or refusal to bathe,
shampoo hair, or brush teeth)?
• What do you do for these problems?
Are there special devices that your child requires help in managing (e.g., eye-
glasses, contact lenses, hearing aid, orthodontic appliances, artificial elimina-
tion appliances, orthopedic devices)?
NOTE: Use the following codes to assess functional self-care level for feeding,
bathing, and hygiene; dressing and grooming; and toileting:
0—Full self-care
I—Requires use of equipment or device
II—Requires assistance or supervision from another person
III—Requires assistance or supervision from another person and equipment or
device
IV—Is totally dependent and does not participate
Cognitive–Perceptual Pattern
Does your child have any hearing difficulty?
• Does the child use a hearing aid?
• Have “tubes” been placed in your child’s ears?
Does your child have any vision problems?
• Does the child wear glasses or contact lenses?
Does your child have any learning difficulties?
What is the child’s grade in school?
For information on pain, see Chapter 5.
Self-Perception–Self-Concept Pattern
How would you describe your child (e.g., takes time to adjust, settles in easily,
shy, friendly, quiet, talkative, serious, playful, stubborn, easygoing)?
What makes your child angry, annoyed, anxious, or sad? What helps?
How does your child act when annoyed or upset?
What have your child’s experiences been with and reactions to temporary sepa-
ration from you (parent)?
Does your child have any fears (e.g., places, objects, animals, people, situations)?
• How do you handle them?
Do you think your child’s illness has changed the way he or she thinks about
himself or herself (e.g., more shy, embarrassed about appearance, less com-
petitive with friends, stays at home more)?
 CHAPTER 22 Family-Centered Care of the Child During Illness and Hospitalization
BOX 22-6 NURSING ADMISSION HISTORY ACCORDING TO FUNCTIONAL
HEALTH PATTERNS—cont’d
Role–Relationship Pattern
Does your child have a favorite nickname?
What are the names of other family members or others who live in the home
(e.g., relatives, friends, pets)?
Who usually takes care of your child during the day and night (especially if other
than parent, such as babysitter, relative)?
What are the parents’ occupations and work schedules?
Are there any special family considerations (e.g., adoption, foster child, steppar-
ent, divorce, single parent)?
Have any major changes in the family occurred lately (e.g., death, divorce, sepa-
ration, birth of a sibling, loss of a job, financial strain, mother beginning a
career, other)? Describe child’s reaction.
Who are your child’s play companions or social groups (e.g., peers, younger or
older children, adults, or prefers to be alone)?
Do things generally go well for your child in school or with friends?
Does your child have “security” objects at home (e.g., pacifier, bottle, blanket,
stuffed animal or doll)? Did you bring any of these to the hospital?
How do you handle discipline problems at home? Are these methods always
effective?
Does your child have any condition that interferes with communication? If so,
what are your suggestions for communicating with your child?
Will your child’s hospitalization affect the family’s financial support or care of
other family members (e.g., other children)?
What concerns do you have about your child’s illness and hospitalization?
Who will be staying with your child while hospitalized?
How can we contact you or another close family member outside of the
hospital?
Sexuality–Reproductive Pattern
(Answer questions that apply to your child’s age-group.)
Has your child begun puberty (e.g., developing physical sexual characteristics,
menstruation)? Have you or your child had any concerns?
Does your daughter know how to do breast self-examination?
Does your son know how to do testicular self-examination?
How have you approached topics of sexuality with your child?
Do you think you might need some help with some topics?
Has your child’s illness affected the way he or she feels about being a boy or a
girl? If so, how?
*The focus of the admission history is the child’s psychosocial environment. Most of the questions are worded in terms of parental responses.
Depending on the child’s age, they should be addressed directly to the child when appropriate.
opportunities for formal and informal family conferences
(Meert, Clark, and Eggly, 2013). Historically hospitals have had
restrictive visiting policies. Family-centered care started in
pediatrics with the increased recognition of child and family
separation trauma in the inpatient setting. Policies were
adapted first in pediatrics to allow for rooming-in, longer visit-
ing hours, sibling visits, and systems to allow families to
accompany patients off the unit for procedures (Institute for
Patient- and Family-Centered Care, 2013a). Nurses can help
families identify in-hospital resources that will encourage
extended visiting with the patient, such as areas where they can
store food and facilities where they can rest, shower, or do
laundry. Some hospitals have arrangements with nearby hotels
or other facilities that allow families to remain close by. Some
hospitals have replaced “visitor” badges with “family” badges in
871
Do you have any concerns with behaviors in your child, such as masturbation,
asking many questions or talking about sex, not respecting others’ privacy,
or wanting too much privacy?
Initiate a conversation about an adolescent’s sexual concerns with open-ended
to more direct questions and using the terms “friends” or “partners” rather
than “girlfriend” or “boyfriend”:
• Tell me about your social life.
• Who are your closest friends? (If one friend is identified, could ask more
about that relationship, such as how much time they spend together, how
serious they are about each other, if the relationship is going the way the
teenager hoped.)
• Might ask about dating and sexual issues, such as the teenager’s views
on sexuality education, “going steady,” “living together,” or premarital
sex.
• Which friends would you like to have visit in the hospital?
Coping–Stress Tolerance Pattern
(Answer questions that apply to your child’s age-group.)
What does your child do when tired or upset?
• If upset, does your child want a special person or object?
• If so, explain.
If your child has temper tantrums, what causes them, and how do you handle
them?
Whom does your child talk to when worried about something?
How does your child usually handle problems or disappointments?
Have there been any big changes or problems in your family recently? If so, how
have you handled them?
Has your child ever had a problem with drugs or alcohol or tried to commit
suicide?
Do you think your child is “accident prone”? If so, explain.
Value–Belief Pattern
What is your religion?
How is religion or faith important in your child’s life?
What religious practices would you like continued in the hospital (e.g., prayers
before meals or bedtime; visit by minister, priest, or rabbi; prayer group)?
an effort to demonstrate their commitment to input from and
collaboration with families.
When it is necessary for families to leave for work, sibling
care, or other schedule challenges, nurses can maintain the
child’s contact with the parents by frequently referring to them
and using distractions and strategies to help the child cope with
the family’s absence and to plan or anticipate the return of the
family member.
The PFCC core concept of providing or ensuring formal or
informal support involves the willingness to stay and listen to
parents’ verbal and nonverbal messages. Sometimes the nurse
does not give this support directly. For example, the nurse may
offer to stay with the child to allow the parents time alone or
may discuss with other family members the parents’ need for
extra relief. Often relatives and friends want to help but do not