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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).
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FIGURE 51 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 33 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
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