Rudd 3e Sneak Preview

SNEAK PREVIEW

Become a better student and a BETTER NURSE

Davis Advantage offers a personalized, interactive learning platform with proven results to help you succeed in your course.

94% of students said Advantage improved their test scores.

“My grades have improved; my understanding about topics is much clearer; and overall, it has been the total package for what a nursing student needs to succeed.” — Hannah, Student, Judson University

Your journey to success BEGINS HERE!

Redeem your access code on the inside front cover of your text to access the tools you need to succeed in your course. Need a code? Visit FADavis.com to purchase access.

Durin Many pat and religi rounding both the must und how patie (Givler, B competen the cultur daily care to consid providing Dispar in the m Nurses sh surroundi pediatric ences rega ing cultu patients r See Chap

DEFINITION OF A FAMILY Evidence-Based Practice Bindman, S. W., Pomerantz, E. M., & Roisman, G. I. (2015). Do children’s executive function account for associations between early autonomy supporting parenting and achievement through high school? Journal of Educational Psychology, 107 (3), 756–770. http://doi.org/10.1037/edu0000017 CLINICAL JUDGMENT Role of the Pain Team A family consists of two or more members who interact and depend on one another socially, financially, and emotionally. Until the early 1960s, nuclear families consisting of a husband, wife, and children were the norm in the United States (Fig. 3–3). The exception was during the Great Depression, when multi- ple generations living in one household became more common because of economic necessity (Fig. 3–4). Nuclear families were portrayed by the media in television by The Adventures of Ozzie and Harriet and Leave It to Beaver. Single widowed parents were also shown with television shows such as The Andy Griffith Show. The 1960s saw tremendous turmoil caused by political, social, and cultural changes resulting from the Vietnam War and the emergence of civil rights for women and minorities. This study demonstrated a correlation between a mother’s autonomy support (providing instruction to identify, nurture, and develop the child’s inner thoughts, feelings, or actions) during the first 3 years of a child’s life, including warmth and cognitive stimulation, with subsequent achievement not only in kindergarten but also throughout middle and high school. Unhealthy Families Families with unhealthy communication and dynamics: ● Give inconsistent, noncongruent verbal and nonverbal messages. ● Humiliate, intimidate, or control communication. Evidence-Based Practice boxes focus on research-based care. ● Help children move forward in the decision-making process. ● Foster the child’s attainment of autonomy through support and guidance (Smith, 2019). ● Encourage interactions and consistently interact in a positive manner. ● Derive pleasure, companionship, kinship, and love from one another (Fig. 3–8). nected is a social norm and provides social connectedness that is essential in family life (Boyer et al, 2015). When evaluating fam- ily dynamics, the nurse should consider the following questions: ● How does the family exchange information, values, and emo- tional connections? ● Are messages supporting or attacking? ● Does nonverbal communication stifle verbal communication? ● Are love and support withheld when differences of opinion occur? Healthy Families Families characterized as having healthy communication and dynamics: ● Give clear, congruent, and consistent verbal and nonverbal cues. ● FLACC: Faces, Legs, Activity, Cry, Consolability Scale for the newborn to 7 years. This assesses the patient’s facial expres- sion, leg positioning and flexion, activity level, crying level, and consolability (Ascension, 2016). plementary or alternative therapies such as healing touch or aromatherapy. ● Play therapy distracts the patient from the pain with calm, devel- opmentally appropriate activities such as puzzles and coloring. Pain must be adequately assessed using the appropriate pain assessment tool. The following tools are commonly used in pediatric pain assessment: ● NIPS: Neonatal and Infant Pain Scale for newborns. This assesses the newborn’s cry, facial expression, respiratory pattern, position and flexion of the arms and legs, and level of alertness (Ascension, 2016). ● Faces Scale: The Faces Scale is only for patients ages 3 and older; the child must be developmentally able to read and recognize faces drawn with various levels of painful expres- sions. This pain scale asks the child to choose the face that best represents the pain level (Ascension, 2016). ● Visual Analog Scale for observers (VASobs): The VASobs is for children who have the developmental ability to use the traditional pain scale based on numbers 0 to 10 for pain rating (Crellin et al, 2021). Many pediatric hospitals offer a pain team as part of the multidisciplinary care team. The pain team is generally headed by an anesthesiologist, and its primary purpose is to assess and alleviate a patient's pain. In addition, the pain team is responsible for writing and ensuring follow-through on all pain-related medical orders and interventions. SAFE AND EFFECTIVE NURSING CARE: Understanding Medication

Specifically, siblings of the child who is ill may experience: ● Isolation ● Fear ● Feelings of being responsible because they had bad feelings about the sibling (magical thinking) ● Disruption in family roles and routines

● Problems in school ● Acting-out behaviors ● Sibling rivalry or jealousy ● Ambiguity

TEXT STEP #1 Build a solid foundation.

SAFE AND EFFECTIVE NURSING CARE: Cultural Competence ● Developing a trusting relationship with parents by providing honest communication and strong clinical skills; these attrib- utes may help the parent feel comfortable leaving the child when they cannot be present at the hospital. ● Beginning discharge instructions as soon as the child is admit- ted, especially if the child has a long-term condition. ● Encouraging siblings to visit and bring familiar objects to the hospital; preparing siblings for what they can expect to hear, see, and smell; child life specialists are an excellent resource. Communication To facilitate communication with children and families from cultures other than their own, the nurse should: ● Include family members in interactions. ● Be an active listener. ● Be present when families and children need to talk. ● Observe verbal and nonverbal cues. ● Understand that family responses to wellness and illness strongly influence behaviors. ● Learn culturally appropriate interactions, such as whether to use eye contact and whether shaking hands is welcomed in the client’s culture. Be mindful of pauses and personal space. ● Repeat important information more than once and speak slowly. ● Avoid medical jargon, instead using terms family members can understand. ● Allow time for questions. ● Give information in the family’s native language. Use certified interpreters as necessary. ● Address intergenerational needs. Nursing Interventions to Assist Families When a child is admitted to a hospital, all family members are affected. Central themes related to increased family stress include parents experiencing a lack of control, changing roles, loss of family togetherness, demands on family coping skills, and a loss of financial support. Nurses can support the families of children they are caring for by: ● Communicating openly with the parents, which may just mean listening to the parent speak about his or her situation, child, or fears. ● Encouraging the parents to care for the child. ● Supporting the parental role and providing positive feedback on care and role fulfillment. CLINICAL JUDGMENT Legal Custody/Legal Power of Attorney With the increase of nontraditional families, nurses must be aware of who has legal custody (guardianship between parent or guardian and child where health care and education are determined) and who has legal power of attorney (where the parent or guardian gives another adult legal rights to make decisions). These questions must be asked upon admission to the hospital. SAFE AND EFFECTIVE NURSING CARE: Promoting Safety

Chapter 3 | Family Dynamics and Communicating With Children and Families 39

CHIL

Th e conv as one of a young c death usin use the w phemisms place or a children a concerns

66 Unit 2 | Psycho-Social-Cultural Assessment of the Child and the Family

● Do not promote decision making through communication. ● Neglect interactions because of lack of knowledge, time, or interest in the child, in addition to other barriers. Administration When administering end-of-life pain medication, the least in- vasive administration route should be chosen. Various routes are available, including topical, oral, IV, inhaled, and rectal. The various routes of administration allow the child to be free of the most invasive devices at the time of death. An example is mor- phine sulfate, pain medication is often given intravenously. If a patient does not have an IV line, the medication can be given orally as a liquid placed in the buccal cavity for absorption; if the patient cannot swallow the medication, it can be given as a topi- cal patch or via nebulizer in an inhaled form.

SAFE AND EFFECTIVE NURSING CARE: Cultural Competence Accidents or unintentional injuries are the leading cause of death in pediatrics (National Institutes of Health, 2017). Sud- den unexpected infant death (SUID) is a leading cause of death for infants 1 month to 1 year of age (Box 5-1). SUID most com- monly occurs from 2 to 4 months of age (American Academy of Pediatrics, 2021). Parents of newborns and infants up to 1 year should be educated on strategies to prevent sudden in- fant death syndrome (SIDS), such as the Safe to Sleep campaign that encourages parents to place infants on their backs to sleep (Fig. 5–1). This can reduce the incidence rate of SIDS by 50% (National Institutes of Health, 2017). One emerging SUID pre- vention method is providing new parents with a baby box that contains supplies to help parents care for the newborn. Once the supplies are removed, it becomes a safe, portable sleeping area for the newborn that has a firm mattress with a fitted sheet (Southern New Jersey Perinatal Cooperative, 2021) (Fig. 5–2).

4570_Ch03_033-054.indd 42

5/4/22 5:23 PM

FIGURE 51 Always educate parents to put their infants on their backs to sleep to help prevent sudden infant death syndrome by keeping the airway fully open.

FIGURE 5 provide su

Safe and Effective Nursing Care boxes summarize important safety concepts, focusing on Promoting Safety, Cultural Competence, and Understanding Medication.

FIGURE 33 A nuclear family (mother, father, child, or children).

4570_Ch05_065-076.indd 69

Reconciliation (adaptation to existing circumstances) entire family (Institute for Family-Centered Care, 2017) ● Assessing support and education needs for all family members ● Encouraging visitation and providing age-appropriate infor- mation for siblings Go to Davis Advantage to complete your learning: strengthen understanding, apply your knowledge, and prepare for the Next Gen NCLEX®. REFERENCES Altman, K., Dumas, M. S., Odden, S., Velez, L., & Weinhold, S. (2013). Structural-function theory in family nursing. https://prezi.com/h9jaz-uhfhrf/ structural-function al-theory-in-family nursing/ Angier, N. (2013, November 25). The changing American family . The New York Times . http://www.nytimes.com/2013/11/26/health/families.html? pagewanted=all&_r=0 Auxier, B., Anderson, M., Perrin, A., & Turner, E. (2020). Parenting children in the age of screens . https://www.pewresearch.org/internet/2020/07/28/parenting- children-in-the-age-of-screens/ Bindman, S. W., Pomerantz, E. M., & Roisman, G. I. (2015). Do children’s executive function account for associations between early autonomy support- ing parenting and achievement through high school? Journal of Educational Psychology, 107 (3), 756–770. http://doi.org/10.1037/edu0000017 Bowen Center. (2017). Bowen theory . https://www.thebowencenter.org/ NEW! Clinical Judgment boxes provide tips for applying critical thinking in clinical settings. Family-focused care benefits the child and the family. For the child, these benefits include decreased anxiety, reduced need for pain medication, and improved coping during hospitalization (Institute for Family-Centered Care, 2017). As for the family, members who participate in care conferences and in the child’s care feel empowered by being included in the decision-making process, which allows them to develop the skills to care for and support the child and decreases feelings of stress and dependency on others. The nurse’s role is to support the family and provide members with the knowledge needed for self-care. CLINICAL JUDGMENT Benefits of Family-Centered Care

Chapter 5 | End-of-Life Care 67 The family’s life-cycle stages are based on changes in the structure, function, and roles within the unit. Understanding a family’s current stage of development can assist the nurse in identifying areas where education and anticipatory guidance may be needed. Neuman’s System Theory Neuman’s system model views the family as an open system that responds to stresses in the environment. Stresses may be intrap- ersonal, interpersonal, or extrapersonal and result from internal, external, and created environments (Khatiban et al, 2016). Nurs- ing interventions are related to three primary areas of prevention: ● Primary prevention alleviates risk factors before the stress af- fects the client. ● Secondary prevention occurs after the stress affects the client and addresses symptoms. Case Study Family Conflict and Communication ● Tertiary prevention occurs when the nurse assists in mainte- nance factors to bring the individual back to the primary state (Khatiban et al, 2016).

provide

patient’s

KÜBLERROSS’S STAGES OF GRIEVING Palliative and hospice providers are dedicated to compassion- ate, family-centered care for pediatric patients and families liv- ing with a life-threatening or terminal condition. Palliative care focuses on relieving symptoms of a life-threatening or terminal condition (e.g., pain, dyspnea), while addressing associated psy- chological, social, and spiritual problems to maintain function and enhance quality of life. Palliative care services are available at any time during a terminal illness and may be ongoing for years (National Institute of Nursing Research, 2015). Hospice care for pediatric patients is provided at end of life to promote patient comfort and family involvement. It promotes a graceful, natural death rather than attempting to prevent death with treatment. The patient with a terminal diagnosis receives compassionate care focused on their comfort with as few invasive devices and procedures as possible. Hospice care can occur in any hospital unit or at home with visiting nurses and care aides. RODENBAUGH’S STAGES OF GRIEVING Reeling (stunned disbelief ) Denial (shock and disbelief ) Anger (toward God, relatives, the health-care system) Feelings (emotionally experiencing the loss) Dealing (taking care of the details, taking care of others) Bargaining (trying to attain more time, delaying acceptance of the loss) palliative care (PPC) creates opportunities to support the be- reaved. The specialized team is trained to care for children and families facing difficult circumstances. Teams typically include physicians, nurses, chaplains, psychologists, child life specialists, and social workers. One of the many benefits of the PPC team is the interdisciplinary and holistic approach to grief and be- reavement support that begins well before death and continues throughout the grieving process (Schuelke et al, 2021). The Riveras are a blended family in which the father brings two sons and the mother brings one son and one daughter. The children range in age from 3 to 15 years old. Mr. Rivera has re- cently become disabled and is unable to work. Mrs. Rivera works outside of the home five evenings per week as a waitress. Mr. Rivera is an autocratic disciplinarian, and Mrs. Rivera’s style is more democratic. The children have not bonded as a family, despite being blended for 3 years. Mr. Rivera’s physical situation does not allow him to do much around the home, except driving the children to their many after-school activities. Family conflicts are the result of many different personalities, financial concerns, differences in values, and differences in child-rearing. 1. Identify the conflicts in this family that have fostered poor communication. 2. What are the parent–child power struggles in play in this scenario? 3. What factors hinder the discussion of family values, issues, and other important topics? 4. What are the potential parental conflicts within this scenario? FIGURE 53 The multidisciplinary health-care team provides communication, support, and guidance during the death of an infant or child.

bout the

available

re, must des play- addition acknowl- family- ring the eath. with the nication ppropri- t. Com- nate and he end of

4570_Ch03_033-054.indd 44

5/4/22 5:23 PM

Chapter 3 | Family Dynamics and Communicating With Children and Families 53 Boyer, J. B., Campbell, S. W., & Ling, R. (2015). Connection cues: Activating the norms and habits of social connectedness. Communication Theory, 26 (2), 128–149. http://doi.org/10.1111/comt.12090 California State University, Northridge. (n.d.). Family development theory . http://www. csun.edu/~whw2380/542/Family%20Developmental%20Theory.htm AU: This Case Studies ask you to apply your knowledge in clinical contexts.

link didn’t work. Can you please double- check?

TABLE 31 The Grieving Process as Described by Various Theorists

e patient

HARVEY’S PHASES OF GRIEVING Shock, outcry, and denial (external response to loss) Intrusion of thoughts, distractions, and obsessive reviewing of the loss (internal response, isolation) Confiding in others to emote and cognitively restructure (integration of internal thoughts and external actions to move on)

EPPERSON’S PHASES OF GRIEVING

RANDO’S REACTIONS OF BEREAVED PARENTS

pmental d in their

4570_Ch03_033-054.indd 53

5/4/22 5:23 PM

Avoidance (confusion and dazed state, avoidance of reality of loss) Confrontation (intense emotions, anger, sadness, feeling the loss)

High anxiety (physical response to emotional upheaval) Denial (protective psychological reaction)

ndness and the

ient and

unication ounds or unication re team, mily and munica- ual basis rse must g, so the d family’s an differ nary care o provide

Reestablishment (intensity declines, and the parents resume their lives)

Anger (directed inwardly, toward another family member, or toward others)

Healing (recovering and reentering life)

Remorse (feelings of guilt and sorrow)

Acceptance (readiness to move forward with newfound meaning or purpose in one’s own life)

Case Study Family Conflict and Communication The End-of-Life Nursing Education Consortium (ELNEC) is an educational initiative dedicated to improving palliative care (American Association of Colleges of Nursing, 2021). The goal of the initiative is to ensure that all nurses are knowledgeable on palliative care, ensuring patients receive the highest-quality care during end of life. The education provides nurses and other health-care professionals the knowledge and skills to positively affect the lives of patients and their families while they are experiencing difficult end-of-life decisions. CRITICAL COMPONENT End-of-Life Nursing Education Consortium

Grief (overwhelming sadness) Reconciliation (adaptation to existing circumstances)

Tables summarize important information at a glance.

Go to Davis Advantage to complete your learning: strengthen understanding, apply your knowledge, and prepare for the Next Gen NCLEX®.

Critical Component boxes highlight the essential information in each chapter.

The Riveras are a blended family in which the father brings two sons and the mother brings one son and one daughter. The children range in age from 3 to 15 years old. Mr. Rivera has re- cently become disabled and is unable to work. Mrs. Rivera works outside of the home five evenings per week as a waitress. Mr. Rivera is an autocratic disciplinarian, and Mrs. Rivera’s style is more democratic. The children have not bonded as a family, despite being blended for 3 years. Mr. Rivera’s physical situation does not allow him to do much around the home, except driving

children Pediatric

REFERENCES Altman, K., Dumas, M. S., Odden, S., Velez, L., & Weinhold, S. (2013). Structural-function theory in family nursing. https://prezi.com/h9jaz-uhfhrf/ structural-function al-theory-in-family nursing/ Angier, N. (2013, November 25). The changing American family . The New York Times . http://www.nytimes.com/2013/11/26/health/families.html?

5/4/22 5:24 PM

LEARN

STEP #2 Make the connections to key topics.

108 Unit 3 | Growth and Development of the Child

Developmental tasks are the sets of skills and competencies that are unique to each developmental stage. Certain tasks must be mastered for the child to progress to the next level. Develop- mental tasks for each stage are detailed in Table 7-1.

TABLE 71 Developmental Milestones

AGE

FINE MOTOR

GROSS MOTOR

Growth and Development

Birth to 1 month

Opens fingers slightly at rest

Arms and legs move together Holds chin up when lying on stomach Raises head and chest when lying on stomach Supports upper body with arms when lying on stomach Stretches legs out and kicks when lying on stomach or back Can roll from side to side Can sit unsupported by 7 or 8 months Supports whole weight on legs Pulls self up to stand Walks holding on to furniture May walk two or three steps independently Jumps Kicks ball Learning to pedal tricycle

SAFE AND EFFECTIVE NURSING CARE: Promoting Safety

2–3 months

Grasps toys, can open and close hands Eyes follow object to midline Blows bubbles

Childproofing Caregivers must be aware of growth and developmental mile- stones to prevent injury at different stages. In early childhood, care and consideration should be given to prevent falls, chok- ing, and aspiration of food or objects. Childproofing the home to prevent injuries is important.

Gastrointestinal Disorders

Mary Grady, DNP, RN CNE, CHSE Jill Matthes, DNP, RN CHSE

CRITICAL COMPONENT Reflexes

6–8 months

Bangs objects on table Can transfer objects from hand to hand Start of pincer grasp

LEARNING OUTCOMES Upon completion of this chapter, the student will be able to: 1. Describe general principles of growth and development.

CONCEPTS

During a well-child visit, the mother is concerned her 4-month-old baby is acting startled for no reason. She says he makes jerky movements during sleep and sometimes when awake. How will you address the mother's concerns using the following information? Nurses need to know normal infant reflexes and recognize when they are not present. Reflexes that remain can be a sign of growth and developmental issues and delays (Beckett & Taylor, 2019). A few of the most common reflexes to watch for include: • Tonic neck/fencing reflex—disappears around 4 to 6 months • Moro/startle reflex—disappears around 4 to 6 months • Babinski's—disappears by 1 year of age

Caring Collaboration Communication Evidence-Based Practice Professionalism Growth and Development Self-Care Family Health Promotion

2. Discuss cognitive growth and development according to Jean Piaget. 3. Discuss psychosocial growth and development according to Eric Erikson. 4. Discuss psychosexual growth and development according to Sigmund Freud. 5. Discuss social-moral growth and development according to Lawrence Kohlberg. 6. Discuss the theory of nature versus nurture. 7. Apply principles of family-focused care in approaches toward the child. 8. Analyze factors that affect growth and development. 9. Understand nursing applications of growth and development theories.

1 year

Can hold crayon, may mark on paper Begins to use objects correctly

Gastrointestinal Disorders

2–3 years

Learning to dress self Can draw simple shapes (e.g., a circle)

CLINICAL JUDGMENT Family-Centered Care

● Differentiation—simple to complex progression of achieve- ment of developmental milestones ● Example: The child learns to crawl before learning to walk. Variation at different ages is based on specific body structure and organ growth.

GENERAL PRINCIPLES OF GROWTH AND DEVELOPMENT

As part of family-centered care, nurses need to adapt their care and nursing interventions to the child's stage of growth and development. They will need to explain what is happening to a child in language and on a developmental level the family can understand. A child's caretaker should always be included in the child's care and interventions. Nurses need to remember that we are not caring for just a child, but for the entire family unit (Institute for Patient- and Family Centered-Care, n.d.).

4–5 years

Dresses independently Uses scissors Learning to tie shoes Brushes teeth

Goes up and down

Gastrointestinal Disorders

stairs independently

Growth and development are closely interrelated, interdepend- ent processes that are unique for each individual and influenced by factors such as genetics, environment, and nutrition. Growth, the increase in height and weight, and development, acquisition of skills and abilities, begin at conception and continue until end of life. Although highly individualized, growth and develop- ment follow an orderly pattern characterized by periods of rapid growth and plateaus (spurts and lulls): ● Cephalocaudal—starts at the head and moves downward ● Example: The child can control the head and neck before the arms and legs. ● Proximodistal—starts in the center and processes to the periphery ● Example: Movement and control of the trunk section of the body occurs before movement and control of the arms.

Throws a ball overhand Hops on one foot

ED:We have set unnum- bered box here before callout for better layout. Is it OK?

CLINICAL JUDGMENT Failure to Thrive

AU: This is missing from the Refs list.

Source: Centers for Disease Control and Prevention (2021) .

Failure to grow and develop at an expected rate can mean that a child is failing to thrive. The diagnosis of failure to thrive (FTT) is given to children who fall below the fifth percentile ranges on height and weight charts. For infants, it usually presents first with an absence of weight gain or weight loss (Tagher & Knapp, 2020). Then a drop in height occurs followed by a drop in head circumference. FTT can have organic or nonorganic causes that contribute to developmental delays in the child.

PSYCHOINTELLECTUAL DEVELOPMENT

● Cognitive acts occur as the child adapts to the surrounding environment. ● The child’s experience with the environment naturally encour- ages growth and maturation. ● The child must accommodate new or complex problems by drawing on past experiences. ● There can be overlap between the child’s age and stage of development. Each stage does not start and end at exactly the same age for each child.

AU: This is missing from the Refs list.

The key theorist within cognitive development is Jean Piaget, a Swiss child psychologist (1896–1980). Piaget identified the following characteristics of cognitive development: ● Development is a sequential and orderly process, moving from stages that are relatively simple to more complex (Table 7-2).

107

4570_Ch07_105-118.indd 107

5/10/22 12:27 PM

4570_Ch07_105-118.indd 108

5/10/22 12:27 PM

Assignments in Davis Advantage correspond to key topics in your book. Begin by reading from your printed text or click the eBook button to be taken to the FREE, integrated eBook .

You’ll receive immediate feedback that identifies your strengths and weaknesses using a thumbs up, thumbs down approach. Thumbs up indicates competency, while thumbs down signals an area of weakness that requires further study.

Pre-Assessment for Gastrointestinal Disorders

Following your reading, take the Pre-Assessment quiz to evaluate your understanding of the content. Questions feature single answer, multiple-choice, and select-all-that-apply formats.

Online content subject to change upon publication.

After working through the video and activity, a Post-Assessment quiz tests your mastery.

Animated mini-lecture videos make key concepts easier to understand, while interactive learning activities allow you to expand your knowledge and make the connections to important topics.

Your dashboard provides snapshots of your performance , time spent, participation, and strengths and weaknesses at a glance.

• Cardiovascular Disorders • Renal Disorders

Maternal-Newborn Pediatrics

Your Personalized Learning Plan is tailored to your individual needs and tracks your progress across all your assignments , helping you identify the exact areas that require additional study.

Principles of Growth and Development Chapter 6 Respiratory Disorders Chapter 11 Cardiovascular Disorders Chapter 12 Gastrointestinal Disorders Chapter 15 Renal Disorders Chapter 16 Endocrine Disorders Chapter 17

APPLY STEP #3

Develop critical-thinking skills & prepare for the Next Gen NCLEX. ®

Real-world cases mirror the complex clinical challenges you will encounter in a variety of health care settings. Each case study begins with a patient photograph and a brief introduction to the scenario.

The Patient Chart displays tabs for History & Physical Assessment, Nurses’ Notes, Vital Signs, and Laboratory Results. As you progress through the case, the chart expands and populates with additional data.

Complex questions that mirror the format of the Next Gen NCLEX® require careful analysis, synthesis of the data, and multi- step thinking.

Immediate feedback with detailed rationales encourages you to consider what data is important and how to prioritize the information, resulting in safe and effective nursing care.

Test-taking tips provide important context and

strategies for how to consider the structure of each question type when answering.

ASSESS STEP #4 Improve comprehension & retention.

PLUS! Brand-new Next Gen NCLEX® stand-alone questions provide you with even more practice answering the new item types and help build your confidence.

High-quality questions , including more difficult question types like select-all-that-apply , assess your understanding and challenge you to think at a higher cognitive level.

Respiratory Disorders

Renal Disorders

Comprehensive rationales explain why your responses are correct or incorrect. Page-specific references direct you to the relevant content in your text, while Test-Taking Tips improve your test-taking skills.

Create your own practice quizzes to focus on topic areas where you are struggling, or to use as a study tool to review for an upcoming exam.

GET STARTED TODAY! Use the access code on the inside front cover to unlock Davis Advantage for Pediatric Nursing!

C ontents in Brief

U N IT 1 Pediatric N u rsing: An O v er v iew Chapter 1 I ss u es and T rends in Pediatric N u rsing

U N IT 4 Common Ill nesses or Disorders in Chi l dhood and H ome Care

2 1 5

Chapter 1 2 Respiratory Disorders Chapter 1 3 Cardio v asc ul ar Disorders

2 17

Chapter 2 Standards of Practice and E thica l Considerations U N IT 2 Psycho - Socia l- C ul t u ra l Assessment of the Chi l d and the F ami l y

25 1

Chapter 14 Ne u ro l ogica l and Sensory Disorders

2 87

Chapter 1 5 Menta l H ea l th Disorders Chapter 16 G astrointestina l Disorders

Chapter 3 F ami l y Dynamics and Comm u nicating With Chi l dren and F ami l ies Chapter 4 C ul t u ra l, Spirit u a l, and E n v ironmenta l I n fl u ences on the Chi l d

33 1

35 9

Chapter 1 7 Rena l Disorders

4 0 1

Chapter 5 E nd - of -L ife Care

Chapter 1 8 E ndocrine Disorders

4 25

Chapter 6 Comm u nicab l e Diseases

Chapter 1 9 Reprod u cti v e and G enetic Disorders

U N IT 3 G rowth and De v e l opment of the Chi l d

Chapter 20 H emato l ogica l, I mm u no l ogica l, and Neop l astic Disorders

1 05

Chapter 7 G rowth and De v e l opment Chapter 8 Newborns and I nfants Chapter 9 T odd l ers and Preschoo l ers

Chapter 2 1 M u sc ul oske l eta l Disorders Chapter 22 Dermato l ogica l Diseases

1 0 7

119

Appendixes

17 3

Photo and Illu stration Credits

Chapter 1 0 Schoo l- Age Chi l dren

187

I ndex

Chapter 11 Ado l escents

199

xxiii

Family Dynamics and Communicating With Children and Families

Kathryn Rudd, DNP, RN, c-NIC, c-NPT Diane M. Kocisko, DNP, RN, NPD-BC, CPN

LEARNING OUTCOMES Upon completion of this chapter, the student will be able to: 1. Describe the process of healthy communication vs. unhealthy communication. 2. Describe the patterns of family communication.

CONCEPTS Behavior Caring Communication Evidence-Based Practice Family Health-care Technology Population Health Professionalism Teaching and Learning

3. Describe family dynamics. 4. Describe family theories. 5. Identify family function roles.

6. Describe family structures and the approaches to communication within each structure. 7. Identify age-specific approaches for communicating with parents, families, toddlers, school-age children, and adolescents. 8. Explain influences on communication, such as body language, tone, pitch, and environment. 9. Describe strategies for incorporating communication into assessment. 10. Describe communication with families during periods of emergency care. 11. Identify the role of family-centered care in caring for the hospitalized child.

Communication is influenced by culture, so the nurse must have cultural awareness to facilitate effective communication with clients (see Chapter 4). If the nurse does not have cultural awareness, this in itself demonstrates bias. In addition, it is im- portant to note that ill and hospitalized children may regress to a lower level of communication than their typical communication pattern. Process of Communication in Families The communication process in families possesses these characteristics: ● Bidirectional process: needs both sender and receiver ● Constantly in motion ● Transactional

COMMUNICATION AND FAMILIES

Communication is a two-way process by which information is exchanged between individuals with a common use of language, mannerisms, behaviors, or symbols.

Principles of Communication in Families

The manner of communication used by families provides infor- mation about the family style and the structure and function of family relationships. Functional communication influences the decision-making process and is based on mutual trust; dysfunc- tional communication inhibits nurturing and results in a de- crease in self-esteem and self-worth in communication partners.

36 Unit 2 | Psycho-Social-Cultural Assessment of the Child and the Family

● Irreversible ● Learned through culture and society ● Denotation: the dictionary meaning of a word ● Connotation: meanings and feelings associated with a word based on past experiences

● Nonverbal: ● Body language: An open stance is welcoming; crossed arms indicate coldness or displeasure. ● Gestures: ● Confirming behaviors such as nodding of your head or restating what you hear ● Nonconfirming behaviors such as tapping your foot, standing in the doorway, being in one’s personal space, or looking at your watch ● Paralanguage: Pitch, volume, and pausing Children are very aware of anxiety and fear in their caregiv- ers, which can be conveyed through both nonverbal and verbal behaviors. Speak slowly and be mindful of long pauses and the tone or manner in which you speak to the child. Nurses should practice effective listening; this key to successful communication requires active involvement in the communication process. Empathy enhances the communication process. Empathy is an understanding of a person’s feelings—not sympathy, which is not therapeutic. Responding positively to an individual helps develop communication skills, language, self-esteem, and trust. Typically, children communicate in a manner consistent with their developmental level (see Chapter 7 for growth and devel- opment information).

Patterns of Family Communication

While working with families, the pediatric nurse will observe a range of communication patterns (Fig. 3–1). These most com- monly include: ● Clear and direct, the most productive form of communica- tion, is a clear message directed to the appropriate family member. For example, “I’m irritated that you didn’t put the dishes in the dishwasher away as I asked you.” ● Clear and indirect is a clear message directed to the wrong family member. The mother tells the father: “I can’t stand it when people don’t put the dishes away when asked.” ● Masked and direct means an unclear message is delivered to the appropriate family member: “It’s really annoying when children don’t work hard in this family.” ● Masked and indirect communication is the least productive, characterized by an unclear message not directed to a specific family member: “Kids are all lazy” (Oster, 2017). Components of the Communication Process The importance of establishing good communication cannot be overstated because it affects all aspects of a child’s care. ● Verbal: ● Spoken words: Choose clear, concise language; avoid dis- tancing language such as assigning gender; and do not use avoidance language, such as euphemisms (e.g., “passed on” instead of “died”). ● Written words: Written communication, such as storybooks that highlight certain information, or journaling for adoles- cents; do not write directions above the reading level of the child or family, and do not use complex wording or medical jargon.

Barriers to Health Care Within Families

Although children learn health habits from their families, this does not occur in a vacuum; lifestyle is also influenced by com- munity and environment. The National Coalition on Health- care (2016) provides a framework for community health edu- cation through schools. It includes eight initiatives focused on health education, health promotion and literacy, health risks, and health behaviors influenced by family, peers, media, or the culture (U.S. Department of Health & Human Services, 2014). In addition, decision-making and goal-related skills are included to help enhance the community, the family, and the individual (National Cancer Institute, 2021). Another resource, National Health Education Standards (NHES), provides a framework for teachers, administrators, and policy makers to design or select curricula, allocate resources, and assess progress in education (Centers for Disease Control and Prevention, 2016). Access to health care varies among U.S. families. In 2015, 29 million Americans did not have health insurance despite the Afford- able Care Act (Kaiser Family Foundation, 2016). The term under- insured, which describes individuals or families who have insurance coverage considered inadequate, applied to 38 million Americans in 2019 (U.S. Census, 2020). The insurance status of uninsured or underinsured families affects their health-care practices. They may: ● Forgo treatment until a condition worsens ● Use emergency rooms for primary care in the absence of a relationship with or access to a primary care physician ● Miss follow-up appointments because of transportation, em- ployment, inadequate knowledge, and other barriers ● Lack resources to obtain needed medication to treat acute or chronic conditions

Clear and Direct

Hidden and Direct

Clear and Indirect

Hidden and Indirect

Communication in Families

FIGURE 31 Concept map of patterns of family communication.

Chapter 3 | Family Dynamics and Communicating With Children and Families 37

● Allow for repetition of what caregivers have heard to ensure understanding. ● Be empathetic and sincere (FEMA, 2018; Lederman, 2016).

Communicating With Families: The Nurse’s Role When communicating with children and their families, the pediatric nurse should: ● Identify his or her role. ● Provide appropriate introductions for the nurse, caregivers, and family members. Identify the stakeholders and the car- egivers, including the child in the process. ● Document all telephone calls during office hours and after, and log all incoming and outgoing calls, advice given, and questions answered. Include the date, time, and who was in- volved in the communication process. ● Establish an appropriate setting to communicate information. ● Ensure privacy when leaving patient messages. ● Provide anticipatory guidance, a critical communication strategy that improves care and supports competence in caregiving by of- fering information, guidance, and education for family caregivers.

CRITICAL COMPONENT Emergencies Critical components and interventions during emergencies include: • Provide clear and concise information. • Do not make promises. • Inform family members that the physician will speak with them as soon as possible. • If possible, give them a private environment. • Call clergy, child life specialists, and social workers, if available, to offer support. • Use technology to stay connected.

Communication in the Age of Technology

CLINICAL JUDGMENT Health Insurance Portability and Accountability Act

● Parenting in some areas is harder than it was for parents 20 years ago because of smartphones and social media (Auxier et al, 2020). ● Eighty-nine percent of parents indicate their children ages 5 to 11 watch YouTube. ● Eighty-one percent of parents indicate their children ages 3 to 4 watch YouTube. ● Fifty-seven percent of parents indicate their children less than 2 watch YouTube (Auxier et al., 2020). ● As a result of the pandemic of 2020, it was found that children forced to stay at home because of lack of in-person schooling communicated more often and used fewer tools than those not in family homes (McMillan & Feng, 2020). ● Technology can provide and connect families with health-care information and professionals. ● Technology can also be a source of unsubstantiated information. ● Parents and adolescent children need to be provided reliable health care sources from reputable sources such as the Cent- ers for Disease Control and Prevention (CDC), World Health Organization (WHO), Johns Hopkins, or Mayo Clinic websites.

In 1996 the Health Insurance Portability and Accountability Act (HIPAA) was enacted to protect the privacy of patients’ health records and information. The law protects “individually identifiable health information” (U.S. Department of Health & Human Services, 2017). It also limits access to health information in any format (e.g., written, oral, facsimile, social media) to authorized individuals who have a “right to know.” “Right to know” includes disclosure of a person’s health information to individuals who have a direct need to know on a specific date in which that health-care provider is caring for the client. For example, if a coworker has had a baby in your institution and as a nurse you are caring for newborns on that floor but not this patient, it is unlawful for that nurse to look up his or her coworker’s baby’s information. Deviations from this federal law have resulted in imprisonment and fines for the offending individuals or institutions. Recent updates to HIPAA are related to increases in transmission security, cybersecurity, auditing, workforce screening, and the encouragement of reports of abuse (U.S. Department of Health & Human Services, 2017).

CRITICAL COMPONENT How Much Screen Time Is Too Much?

Communication With Family Members During Emergencies

Madigan, S., Browne, D., Racine, N., Mori, C., & Tough, S. (2019). Association between screen time and children’s performance on a developmental screening test. JAMA Pediatrics, 173 (3), 244-250. doi: 10.1001/jamapediatrics.2018.5056 This study found that excessive screen time in children is associated with delayed development. These researchers studied 2,441 children, of which 50% were boys, and found that higher levels of screen time were associated with delayed development (Madigan et al., 2019). The researchers identified that excessive screen time affected physical, behavioral, and cognitive outcomes (Madigan et al., 2019).

When families are under stress during emergencies, communica- tion can be challenging. Nurses can help ensure their message is

received in trying times with these strategies: ● Provide a quiet environment for conversation. ● Communicate slowly. ● Avoid medical jargon. ● Sit down and face caregivers at eye level. ● Allow plenty of time for questions. ● Avoid giving false hope.

38 Unit 2 | Psycho-Social-Cultural Assessment of the Child and the Family

Barriers to Effective Communication

deviations in hearing that may prevent the child from reaching developmental milestones, such as turning the head toward a sound, being soothed by the voice of a caregiver, mimicking sounds heard, and learning to talk. These primary skills of communication must be obtained before the development of the communication process. Infections passed from the mother and the antibiotics used to treat such infections may cause ototoxicity and alter hearing. In addition, chronic ear infections or infections transmitted in utero can cause limitations in hearing.

The pediatric nurse can facilitate effective communication by identifying potential barriers to client/family communication and removing them when possible. Barriers to effective commu- nication may include: ● Physical abnormalities such as cleft lip or cleft palate. ● Physiological alterations such as hearing or visual impairment (Fig. 3–2). ● Cognitive barriers may affect perceptions, expression, or con- crete or abstract thinking. For example, this may include the ability to understand and use jargon, sarcasm, or irony. ● Avoidance or distancing language, such as acting out, denial, projection, rationalization, or trivializing (Koehly, 2017). ● Environmental noise. ● Cultural differences, particularly when the message sender does not focus on the beliefs, values, goals, and outcomes of the child and family (see Chapter 4 for further cultural factors). ● Language barriers, hearing or speech difficulties. ● Psychological alterations: children with disabilities have communication rights that must be met by the health-care practitioner. ● Sender and receiver biases. ● Closed-ended, yes-or-no questions: use only when the nurse needs focused information. ● Ignoring family and psychosocial issues (Koehly, 2017). Additional barriers are described in Box 3-1.

FIGURE 32 Child using American Sign Language for the word love.

BOX 31 | Barriers to Communication Barriers to communication with children and families include: 1. Closed-ended questions with yes-or-no answers 2. Prejudiced or preconceived messages based on race, age, ethnicity, culture, gender, lifestyle, wealth, appearance, or status 3. Preconceived messages based on the practitioner’s beliefs of what constitutes correct family structure, function, or roles 4. Unaddressed fears of the child or the caregiver 5. Child, family, or caregiver not being treated with respect 6. Insufficient information 7. Not answering minor questions, such as those related to diet 8. Failure to include parents in the care plan 9. Parents not being treated as partners in their child’s care 10. Failure of nurses to understand parent–child relationships 11. Failure to meet the developmental needs of the child 12. Failure to consider cultural aspects or speaking in nuanced language that is specifically culturally based

CLINICAL JUDGMENT Protection for Individuals With Hearing Disabilities

“Title III of the Americans with Disabilities Act (ADA) prohibits discrimination against individuals with disabilities by places of public accommodation” (42 U.S.C. §§ 12181–12189). Private health-care providers are considered places of public accommodation. As noted by the National Association of the Deaf (2017), “The U.S. Department of Justice issued regulations under Title III of the ADA at 28 C.F.R. Part 36. Health care providers have a duty to provide appropriate auxiliary aids and services when necessary to ensure that communication with people who are deaf or hard of hearing is as effective as communication with others. 28 C.F.R. § 36.303(c).”

CLINICAL JUDGMENT Hearing Screenings

Hearing screenings are performed before discharge on all infants born in the hospital. This evaluation detects

Chapter 3 | Family Dynamics and Communicating With Children and Families 39

DEFINITION OF A FAMILY

SAFE AND EFFECTIVE NURSING CARE: Cultural Competence

A family consists of two or more members who interact and depend on one another socially, financially, and emotionally. Until the early 1960s, nuclear families consisting of a husband, wife, and children were the norm in the United States (Fig. 3–3). The exception was during the Great Depression, when multi- ple generations living in one household became more common because of economic necessity (Fig. 3–4). Nuclear families were portrayed by the media in television by The Adventures of Ozzie and Harriet and Leave It to Beaver. Single widowed parents were also shown with television shows such as The Andy Griffith Show. The 1960s saw tremendous turmoil caused by political, social, and cultural changes resulting from the Vietnam War and the emergence of civil rights for women and minorities.

Communication To facilitate communication with children and families from cultures other than their own, the nurse should: ● Include family members in interactions. ● Be an active listener. ● Be present when families and children need to talk. ● Observe verbal and nonverbal cues. ● Understand that family responses to wellness and illness strongly influence behaviors. ● Learn culturally appropriate interactions, such as whether to use eye contact and whether shaking hands is welcomed in the client’s culture. Be mindful of pauses and personal space. ● Repeat important information more than once and speak slowly. ● Avoid medical jargon, instead using terms family members can understand. ● Allow time for questions. ● Give information in the family’s native language. Use certified interpreters as necessary. ● Address intergenerational needs.

SAFE AND EFFECTIVE NURSING CARE: Cultural Competence

FIGURE 33 A nuclear family (mother, father, child, or children).

Legal Requirements for Interpretation The 1964 Civil Rights Act states that no person should be de- nied the benefits of or experience discrimination in any pro- gram receiving federal assistance based on race, color, gender, or natural origin. The Supreme Court determined that discrimi- nation based on language amounts to discrimination based on natural origin. This legally requires health-care institutions to provide language accessibility for patients. Many states, such as California, New Jersey, and Washington, have enacted health-care interpreter certification as directed by the National Council on Interpreting in Healthcare, which advocates for the development and implementation of national standards of practice for interpreters in health care (Chen, Youdelman, & Brooks, 2007; Friedman, 2014; National Conference of State Legislators, 2016). Facilities not covered by federal funds may still be subject to individual state laws (National Conference of State Legislators, 2016). The lack of trained medical inter- preters in a health-care setting puts children and families at risk and is a form of discrimination.

FIGURE 34 An extended family may have three generations of a family living together.

Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 Page 15 Page 16 Page 17 Page 18 Page 19 Page 20 Page 21 Page 22 Page 23 Page 24 Page 25 Page 26 Page 27 Page 28 Page 29 Page 30 Page 31 Page 32 Page 33 Page 34 Page 35 Page 36 Page 37 Page 38 Page 39 Page 40 Page 41 Page 42 Page 43 Page 44 Page 45 Page 46 Page 47 Page 48 Page 49 Page 50 Page 51 Page 52 Page 53 Page 54 Page 55 Page 56 Page 57 Page 58 Page 59 Page 60 Page 61 Page 62 Page 63 Page 64 Page 65 Page 66 Page 67 Page 68 Page 69 Page 70 Page 71