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Admission into hospital can be an anxious and unsettling time for a child, whether it is for a planned eye procedure or as a result of an eye injury. There is a lot you can do to make the hospital experience as positive as possible to reduce stress and anxiety for both child and parent.
It is advisable to have a dedicated ward for children. It should be bright, clean, and colourful. You can use simple drawings to decorate the walls and ceilings. Colourful curtains and bedspreads will also brighten up the ward.
If a child is visually impaired, it is necessary to make the area around them as free from obstacles as possible. Checking that the child is properly acquainted with their surroundings will help to ensure that they are safe and feel more confident. Painting doors, windows, door handles, and sign boards in contrasting colours will help a child with low vision navigate more easily and feel more at ease in a new environment.
It is important to be kind and to show your concern for the children in your care. Spend time with children and talk to them in a language they can understand. By listening to children and treating them with respect, you build their confidence and make it possible for them to voice their fears or concerns.
When talking to children, it is important to try and sit next to them or to crouch down so that your head is at approximately the same height as theirs. This will help you to avoid ‘talking down’ at them, which children can find intimidating.
Children like being called by their name or nickname - you can ask the parents what name the child prefers.
Allow parents or carers to stay with their children as much as possible. In most hospitals, the only place a parent is not allowed to enter is the operating theatre.
If a child needs to stay overnight, strongly encourage parents to stay with them. This will support the child's recovery and reduce anxiety and pain.
Where possible, conduct all treatments (apart from operations) with the parents present. The nurse or doctor can describe the treatment in simple terms to the parent before it begins. The parent can then explain this to the child in a manner that the child will understand.
The parent or guardian should hold the child during treatments or interventions as this reduces the stress of the child and makes it easier for the doctor or nurse to work quickly and efficiently.
Play is very important to children. Do what you can to support and encourage children to play. A play area should be available for children and this can usually be provided, even if the area is small. Allow children to play with their siblings (under supervision), provided that it will not affect their recovery.
Play can also be used to alleviate children's fear and prepare them for their stay in hospital - some hospitals even have dedicated ‘play specialists’ to work with children.
Encourage parents to role play with their child to win their confidence. For example, parents can let the nurse pretend to instil eye drops into their own eye; this will show the child that it is safe and will help them know what to expect.
Distraction is also a helpful technique. For example, getting children to focus their attention on a toy or a game before a blood test can help to reduce their anxiety and pain.
When appropriate, nursing staff should show parents the treatment or ongoing care the child is going to need after discharge from the hospital, such as putting on an eye patch, instilling eye drops, or putting in eye ointment (see page 16). Parents should be encouraged to assist with these and to take over doing the procedure when they feel ready. This will make parents more confident and able to look after their child once they leave the hospital.
In most instances, going home after a successful eye operation is a happy occasion. However, if a child has lost their vision, or has a poor visual outcome, they and their parents need additional support. Ensure that the parents understand what additional services are available and encourage them to make use of them, including low vision care and rehabilitation. Parents may need further support, particularly if they are distressed (see box). It is important that parents get help, as the child should not be discharged into a stressed family setting.
If parents are told bad news (for example, if their child will lose an eye or the sight in one eye) they may react in a number of ways. Some become withdrawn as they take in the information, while others may become aggressive and demanding. Both these reactions are quite normal, and represent a response to stress or grief: the grief of losing the completely healthy child they thought they had.
Be patient and kind, but honest. If parents become distressed, offer to talk to them again later in the day or the following day. Always try to keep these appointments as doing so instils confidence and trust.
It may be advisable to enlist the help of professional counsellors, where available, as they have skills in counselling.
Encourage parents to form self-help groups. Put parents of children with the same problems in contact with each other so that they have someone to talk to who shares their experiences and concerns. These counsellors should help the parents to discover ways to tell the child. A counsellor can be present with the parents when the child is being told. This takes time and should not be rushed.
In addition, the child (and parent) may have started to feel secure in a hospital environment and may be fearful of going home. Counselling may be required, which will include guidance on the roles of family members once the child is at home.
If a child has become blind, the parents will need guidance on how to communicate with and behave towards their child. This is a very large and important topic which goes beyond the scope of this article; however, the following are some ideas to discuss with parents:
Two helpful books are Show me what my friends can see and Helping children who are blind - see Useful Resources on page 11.
If there is a counsellor or occupational therapist, refer the child and parent for their advice and support.
This article gives some suggestions for making the hospital environment less intimidating and more friendly for children and their parents. It should be possible to adapt these ideas to suit your particular work environment, at very little cost. Taking time to consider the needs of both the child and parent in hospital will assist in the child's recovery and raise the profile of the hospital in the eyes of the community.
Caroline Ayilo, Paediatric nurse, Gertrude's Garden Children's Hospital, Kenya. gro.seitreg@oliyac.
Dianne Pickering, Registered General Nurse, Norfolk and Norwich University Hospital, UK. firstname.lastname@example.org.
Fay Gallant, Registered Paediatric Nurse. James Paget Hospital, Norfolk, UK.
Ingrid Mason, CBM Capacity Development Officer and Medical Advisor, PO Box 58004, 00200 City Square, Ring Road Parklands, Nairobi, Kenya.