42 Unit 2 | Psycho-Social-Cultural Assessment of the Child and the Family
● Worry ● Anger ● Denial ● Anxiety ● Depression ● Fear ● Guilt 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 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. ● 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. ● Problems in school ● Acting-out behaviors ● Sibling rivalry or jealousy ● Ambiguity ● 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 THEORY
Communication theory was identified by Schudder in the early 1900s and first published in 1980. This theory states that all liv- ing beings communicate, although the manner of communica- tion is different (Boyer, Campbell, & Ling, 2015). Staying con- 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. ● 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). 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 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. ● 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.
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.
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