C h a n g i n g Tr e n d s

in hospital care
preventive,
promotive and
curative aspects
of child health
 INDEX

▪ Introduction
▪ Modern trends/modern concepts of hospitalized child
1. Visiting 2. Rooming-in 3.Care by Parent Units 4.Parent Support Groups 5. Self-care

▪ Different types/Approaches of care on hospitals for pediatrics

1. Private care 2. Ambulatory care 3. Neighborhood Health Centre or Clinic 4.Emergency Facilities

5.Hospital Based and free Standing Facilities for 6. Minor Surgical Care 7. Pediatric Unit

8. Pediatric newborn and Pediatric intensive care unit (PICU)

9. Intermediate Care Unit 10. The Pediatric Research Center

11. Outpatient department’s hospitals

Introduction

▪ The hospitals are necessary places for providing the health care of
ill children. Previously, the care of ill child used to be completed at
their birth places or at their homes. Nowadays, the hospitals have
become a necessary organ of health chain, where all types of
health professionals can easily be made available.
▪ Previously, many young adults will remember their time spent in
the hospital with fear and trembling because of the loneliness and
pain they felt at an age when they could not cope alone with these
feelings. Nowadays needless to say, practices in use, in some
hospital today have changed little over the past 20 years.
 This is based on preventive, promotive, curative aspects of
the child health. There are modern trends/modern concepts
of hospitalized child which are as follows:

1. Visiting
▪ In earlier days, parents were permitted to visit their hospitalized child for only 1
hour once a month. Children were deprived from parental love. Today, many
hospital permits visiting from 2 to 8pm or from early in the morning to bed
time, while some hospital have flexible unlimited visiting at any time during
the day or night.
▪ If parents are unable to visit the child frequently , grandparents, aunts, uncles
or babysitters may visit instead.
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▪ Some hospital permits visiting by siblings between 2 and 12 years of age

during certain hours of the day. A parent must accompany a younger sibling
during the visit. Siblings of ill child are not permitted to visit of they have been
exposed to an infectious disease or have colds or other infection.
▪ If child’s room is restricted, some hospitals have a closed-circuit television or
telephone video system that allows two-way visit between the child and
visitors of all ages.
▪ If parents, family members, friends are not able to visit the hospital because
of difficulty in travelling or any other reason, tape recordings can be made
and played to the child to maintain some contact with home, thus, reducing
separation anxiety. Topics such as favorite story or song, talking letter from
the family, or just a conversation with the child are appropriate for recording.
 2. Rooming-in

▪ Parents should never be required to stay at a child’s bed side, but they are not
prohibited from doing so if they desire.
▪ The parents who stay during the day time in the pediatric unit, some hospital provide a
comfortable lounge or waiting room where they can relax. In some institution, meals
can be served to the parents in the child’s room so they can eat with their child or they
may eat in the hospital cafeteria or coffee shop. Food may be brought from home for
the child if there are no dietary restrictions and if the policy of the institutions permits.
▪ Parents usually mothers of seriously ill children may be encouraged to stay in the
hospital if they desire to do so and if facilities are available for their comfort. Some
hospital have rooms such as playroom in the pediatric unit where the parents may
sleep. Some hospitals have a wing of the hospitals or a motel type of accommodation
for parents and other relatives. The parents may sleep on a chair, a cot, a folding bed, or
a convertible chair in the child’s room if it is large enough
3. Care by Parent Units

▪ Some hospitals have care by-patient unit or family participation unit with
the child. This method of care has its root in the orient, where the whole
family becomes involved with the care of the sick. In this system, the
child gets attention when it is needed each day from a familiar person,
under the supervision of the nurse. When the parents are near, children
can continue to learn to grow throughout the hospital experience. In
these units, parents may be too anxious or guilty or just may not want to
participate in the care of their children in the hospital, others may
welcome the opportunity to give their children a sense of security through
their presence.
 4. Parent Support Groups

▪ Many support groups for parents meet outside the hospital, some hospital
started within the hospital for parents of hospitalized children. Such group
may be conducted by nurses, by play therapist or by child life programme
staff. In these groups, a non-threatening atmosphere is provided, where
parents may feel comfortable enough to move away from the hospital routine
and ventilate their feelings and concerns to relieve their anxiety and stress
 5. Self-care

▪ By the self-care framework nurses have the responsibility of assessing the

abilities of the hospitalized child and then helping the child to learn self-
care skills. The time and methods used in teaching these skills depend on
the child’s cognitive abilities, emotional state, and readiness to learn.
Different types/Approaches of care on hospitals
for pediatrics

1. Private care:
▪ A physician, either a pediatrician or a general practitioners, provide care
for children in the home and in the hospital when necessary. Many
pediatrician work closely with pediatric nurse practitioners on a collegial
basis in providing such care. Parents feel more secure if they can
telephone the office of a known physician or a pediatric nurse practitioner
about any problems of the child. For this reason, usually a specific time is
set aside each day when such calls can be received. Telephone calls
concerning emergencies are handled at any time of the day or night.
Before advice can be given over the telephone, the parents’ capabilities
in describing symptoms and in providing care must be known
 2. Ambulatory care
▪ Ambulatory care facilities should provide a needed range or a services, be locally
accessible, and focus on health promotion, illness prevention and health maintenance.
▪ Quality pediatric health care can be given in neighborhood health centre or clinics, out-
patients department of hospitals, emergency facilities and hospital based or free
standing facilities for surgical care.
 3. Neighborhood Health Centre or Clinic

▪ The neighborhood or clinics are primarily concerned with the care of children and the
guidance of their parents. If sickness occurs, the child may be cared at the clinic for a mild
temporary illness or referred to another facility in further treatment.
 4. Emergency Facilities

▪ Facilities where emergency care is given, may be located in hospital emergency

department or in community based emergency centers. They have been designed
primarily to fulfil a need for convenient, accessible, low-cost medical servces.
▪ These community-based emergency care facilities are relative new to the health care
field. They have been designed primarily to fill a need for convenient accessible low
cost medical services. Some of them provide services at all hours of the day and night
and on weekends, combining many to the functions of hospital emergencies room.
▪ The activity and drama often seen in an emergency room may be very frightened to
children. To reduce their anxiety when an emergency does occur, they may be taken
to an emergency facility under non-stressful condition and oriented to the for play in
this stressful environment should be a vital part of care to reduce children’s anxiety to
a tolerable level.
 5. Hospital Based and free Standing Facilities for Minor
Surgical Care

▪ The advantage of care given in an ambulatory setting is that the child does not have to
remain away from home for more than a few hours, resulting in less trauma and family
disturbance and less chance of infection from seriously ill children in the inpatient
hospital setting. Parents must assume responsibility for the pre-operative routine
preparation usually carried out by nurses in the hospital including post-operative are:
 6. Pediatric Unit

▪ Hospitalized children are usually segregated by care requirement or by age or by both,

children need are adequate provision for care, protection from physical danger
eg.infection and accidents, and protection from a psychologically threatening
environment. In the pediatric unit the surrounding should be home like and cheerful.
7.Pediatric newborn and Pediatric intensive care unit (PICU)

▪ Newborn and pediatric intensive care unit for the critically ill are found in
many pediatric hospitals and the large pediatric departments in general
hospital in some states. Newborn infants who are critically ill are transferred
from local hospital to these centers for care. These units based on electrical
instrument related to vital signs and other physiology of newborn and
pediatric.
 8. Intermediate Care Unit

▪ Here children who have been in the intensive care can be moved if their conditions
have improved. These children may still be too ill for care in a standard pediatric unit.
 9.The Pediatric Research Center

▪ Some children’s hospital have pediatric research centers where little understood
diseases are under investigation. These centers give nurses an opportunities to provide
comprehensive care to children.
10.Outpatient department’s hospitals.

During the 19th Century, hospitals in America began

to provide services for outpatients.

▪ Increasing number of private physicians use the outpatient department

for children with the problems requiring careful diagnosis and
treatment, such as complex medical or surgical problems or
psychological difficulties.
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▪ Because of awareness of the needs to avoid the possible trauma of

hospitalization and the possibility of cross infection, more children with
pneumonia, abscesses, or urinary or other infections can be treated on an
outpatient basis if there is a responsible adult in the home to provide care.
▪ One of the newer functions of the staff in outpatient departments to provide
genetic counseling.
▪ One of the function of nurse is to provide health teaching for parents. The
nurse needs to be approachable-one who listens, teaches and cares-in order
to make such communications a learning situation for the parent and child.
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▪ Parents who bring a child to the outpatient clinic may feel not only
anxious about the child’s condition. But also guilty about their possible
role in causing the illness. The nurse can help parents discuss feelings
openly and alleviate some distress.
▪ A play area is essential in the outpatient clinic, so that the child’s
attentions can be diverted and parents can have time for a conference
with the nurse.
Summary
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