Figure 6-1 The nurse helps the parents for an infants hospitalization.

To the hospital are more acutely ill, yet the time spent in the agency is shorter. Nursings role in the care of children is changing and expanding. In planning care for children, prevention is a key component as well as teaching for the child and the family. The nurse is frequently the first person who sees the child and family when they enter the health care system. The nurses ability to assess the child and family for physical, psychosocial, cultural, spiritual, and growth and developmental factors sets the stage for the plan care. The plan of care begins with admission to the health care facility. The completion of admission information includes previous data regarding the child and family as well as information regarding peers and play patterns, eating patterns, school history, normal activity patterns, fears, habits, primary language spoken, language development and level of understanding, usual reaction to pain, special routines, and perception of parents regarding prior or present hospitalizations. In addition, an assessment of basic needs and daily care planning information will be obtained. Most agencies have policies and procedures for admission. Many institutions have a form for parents to complete regarding the childs routines, prior illnesses, current medication, and specific adaptations needed for the child and the family. For example, a fearful child in pain may need to have pain medication and support before being interviewed. Always focus on the needs of the client and family in order to support and assist in mobilizing coping mechanisms rather than data gathering. The initial assessment determines the need for immediate care. After the family and child are made comfortable or stabilized, a more thorough physical assessment and health history may be obtained. The standard data collected are history of the client, allergies, nutritional intake, sleep, elimination, psychosocial information, spiritual and cultural factors, and the initial physical assessment. Data collected at the time admission are used to identify nursing diagnoses and to establish a plan of care: these are placed in the childs chart. Figure 6-2 shows an example of a pediatric admission form. Many agencies have standardized care plans based on the most common problems identified by the assessment. These care plans are also placed on the chart and are the basis of care. In addition to standardized care plans, many agencies are developing clinical paths or care paths for specific disease states. These tools assist the nurse in giving care based on protocols that result in more rapid recovery, prevention of complications, reduction of length of stay, and cost- containing care for the client and family. Protection / Safety Situation may arise during hospitalization that may jeopardize the safety and well-being of the child. Be ever mindful of who has custody of the child, and screen visitors if there are threats to the childs safety. Issues of custody, disputes among family members, and kidnapping of children are no longer remote problems for hospital personnel. Security measures have been

put in place in most pediatric unit with visible identification of parents, approved visitors, and personnel. Many units utilize electronic surveillance for visitors and monitoring devices for hospitalized children. Informed consent of the legal guardian is obtained at the time of admission for general treatment, including procedures such as IV insertion, specimen collection, and medication and oxygen administration. Separate informed consent of the legal guardian must be obtained for procedures such as lumbar punctures, chest tube insertion, and bone marrow aspirations. Federal guidelines state that children order than 7 years of age have the right to give assent (the childs voluntary agreement to participate in a research project or to accept treatment) for the treatment and research procedures. In most states, client older than 18 years of age can legally give informed consent. In addition, most states allow some exceptions for parental consent in cases involving emancipated minors. An emancipated minor is a child who has the legal competency of an adult because of circumstances involving independently without parents, or enlistment in the armed services. Choking and falls are also areas of concern with hospitalized children. To avoid choking, the environment PROFESSIONAL TIP ID Bands It is very important for all client to have a hospital identification (ID) band on at all times (Figure 6-3). It is equally important that all health care providers check the band for proper client identification before performing any procedure. Any childnot having an ID band needs to have the band replaced before treatment.