Chapter 30: Atraumatic Care of Children and Families

Definition of Atraumatic Care

• Objective: Minimize or eliminate psychological and physical distress in children and their families within the healthcare system.
• Underlying Principle: Do no harm.
• Nurses' Role: Decrease exposure to stressful situations; prevent & minimize pain and bodily injury.

Key Principles of Atraumatic Care

1. Prevent or Minimize Physical Stressors

• Examples of Physical Stressors: Pain, discomfort, immobility, sleep deprivation, changes in elimination.
• Strategies:
  • Use numbing techniques (e.g., emla cream, buzzy bee).
  • Comfort holds and therapeutic hugging.
  • Decrease noise (move away from nurses station, quiet room monitors).
  • Pharmacological interventions.
  • Perform procedures safely and quickly.

2. Prevent or Minimize Parent-Child Separation

• Importance: Familiar faces provide comfort, especially for younger children.
• Strategies:
  • Provide comfortable accommodations (e.g., Ronald McDonald House).
  • Offer families the option to stay during invasive procedures.
  • Allow toys from home during procedures.

3. Promote a Sense of Control

• Challenges in Hospital: Loss of personal control over daily routines.
• Strategies:
  • Maintain child's home routine as much as possible.
  • Allow use of security items.
  • Empower families through education.
  • Engage families as active participants in care.

Therapeutic Communication and Play

• Goals: Emotional outlet and coping mechanisms.
• Strategies:
  • Therapeutic play to understand and manage procedures.
  • Educate children and families about hospital procedures.
  • Engage parents in active participation.

Child Life Specialist

• Role: Decrease child's anxiety and fear, encourage understanding and cooperation.
• Activities:
  • Prepare children for hospitalization and procedures.
  • Utilize therapeutic play.
  • Support coping and pain management.
  • Provide grief and bereavement support.

Comfort Holds

• Techniques:
  • Front to Front: Child's chest faces caregiver’s chest.
  • Back to Front: Child's back against caregiver’s chest.
  • Side Sitting: Child seated sideways on caregiver’s lap.
  • Cradle: Infant held face-up in caregiver’s arms.
  • Bear Hug / Swaddle.
• Uses: Shots, IV placements, blood draws, NG tube placement.
• Advantages: Children prefer sitting up to lying down; provides comfort.

Distraction Methods

• Techniques:
  • Pointing/wiggling toes.
  • Squeezing hand, counting, singing.
  • Visual distractions (e.g., ceiling pictures, bubbles).
  • Playing music or songs the child enjoys.

Procedure Phases

Before Procedure

• Goals:
  • Decrease anxiety for child and family.
  • Promote cooperation.
  • Support families.
  • Improve coping skills and recovery.
  • Build nurse-patient rapport.

During Procedure

• Tips:
  • Use firm, confident, and positive approach.
  • Allow expression of feelings.
  • Avoid using restraints if possible; use alternatives.
  • Distract older children.

After Procedure

• Activities:
  • Caretaker soothing and comforting.
  • Distracting with toys or puppets.
  • Allowing older children to express feelings.
  • Praising the child.

Invasive Procedure Guidelines

• Perform in treatment room: Maintain child’s room as a safe space.

Family-Centered Care

• Partnership: Involves the child, family, and healthcare team.
• Core Principles:
  • Respect child and family choices.
  • Recognize and accommodate cultural diversity.
  • Identify and expand family strengths.
  • Support family choices and flexibility.
  • Empower through education.
• Positive Outcomes:
  • Decreased anxiety, improved pain management.
  • Shorter recovery times.
  • Enhanced problem-solving and communication.
  • Reduced healthcare costs.

Communication & Education

• Effective Communication: Foundation of nurse-patient relationships.
• Strategies:
  • Eye-level and play incorporation with younger children.
  • Use age-appropriate developmental techniques.
  • Prioritize and chunk information.
  • Use visuals, interactive approaches, and teach-back methods.
  • Evaluate the learning process.
• Documentation: Essential for validating education provided.

Conclusion

• Chapter 30 Review: Address any questions in the following class session.