HOSPITALIZED CHILD
Aarti Sharma
[Link] (N)1st year
INTRODUCTION
In spite of best preventive and promotive health
care, some children become sick and need
hospitalization. Preparation for hospitalization is
an important to prevent psychological or
emotional trauma of hospitalization.
DEFINITION
Hospitalization is admittance to the hospital as a
patient.
HOSPITAL ENVIORMENT FOR
SICK CHILD
1. SOCIAL ENVIRONMENT :- it means the
people around in the hospital which includes
member of health team and other patients and
relatives of their family. This is a strange
social environment for the child.
2. PHYSICAL ENVIRONMENT :- it means
the setting or place and the things around
which include the ward or room, machines ,
equipments . These are stressful for the child.
3. CHANGE IN ROUTINE:- children may
have to undergo various diagnostic and
therapeutic procedures which are stressful for
both the children and their family. It leads to
altered nutritional and sleep pattern and reduce
appetite and may cause anxiety in the child.
PREPARATION OF HOSPITAL ENVIRONMENT FOR THE CHILD
INFANTS :-
• Bring your child's favorite toy, blanket or
stuffed animal.
• Nursing staff should know about the baby
schedule.
• Patients remain calm.
• Bring music that helps relax your baby.
• Keep routines as normal as possible.
TODDLER
• Use simple words that your child will understand.
• Tell truth.
• Allow your child to choose his or her favorite
things to bring to the hospital.
• Read books about going to the hospital.
• Encourage your child to use play medical kits and
dolls to act out his or her understanding of the
experience.
SCHOOL-AGE
• Let your child know that you will answer any of
his or her questions.
• Talk about your child's fears and questions
openly and honestly.
• Help your child understand exactly why he or she
needs a certain procedure or to be hospitalized.
• Encourage child’s friends to visit
• Continuous school work .
ADOLESCENT
• Include your adolescent in any discussions and
decisions about his or her healthcare experience.
• Encourage your adolescent to ask questions about
hospital care, procedures and schedules.
• Allow and support your adolescent's privacy. •
Provide journal and read books
• Be patient with mood swings. Leave alone.
REACTION OF HOSPITALIZATION ON CHILD AND FAMILY
REACTION ON PARENTS /RESPONSE OF PARENTS
The factors include:-
i. Lack of information and knowledge related to
child’s illness.
ii. Fear of procedures and treatment of child
iii. Fear of unknown that what will happen to child
in future
iv. Fear of financial burden on family.
REACTION OF CHILD ON HOSPITALIZATION
IT DEPENDS UPON THEIR AGE AND STAGE
DEVELOPMENT •
Infants reaction are mainly separation anxiety and
disturbance of development of basic trust , when
the infant is separated from mother and when
illness and hospitalisation .
• Emotional withdrawal and depression are
found in the infants of 4 to 8 months of age ,
interference of growth and delayed
developments also found.
• Older infants 8 to 12 months of age may
have limited tolerance due to separation
anxiety which is found as fear of strangers ,
excessive crying , clinging and
overdependence on mother
REACTIONS OF TODDLERS
The toddlers PROTESTS by frequent crying
, rejecting nurses attention , urgent desire to
find mother and showing signs of distrust
with anger and tears ,especially when with
mothers.
In DESPAIR , the toddler becomes
hopeless , apathetic , anorectic ,looks sad ,
cry continuously or intermittently and use
comfort measures like thumb sucking ,
fingering lip and tightly clutching a toy.
In DENIAL ,the child reacts by accepting
care without protest and represses all
feelings. The child does not cry in the
absence of mothers and may seem more
attached to nurses.
REACTIONS OF PRESCHOOL CHILD
• The preschool children adopt various mental
mechanisms (defence mechanisms) to adjust with
the stressful experiences of hospitalization and
prolonged illness.
They react by exhibiting regression ,projection ,
replacement , identification , aggression , denial ,
withdrawal and fantasy
The stage of PROTEST in preschool children is
usually regression
REACTIONS OF SCHOOL AGED CHILDREN’S
The school aged children are concerned with fear,
worry, fantasies, modesty and privacy.
They react with defence mechanisms, like
regression, separation anxiety, negativism,
depression, phobia, unrealistic fear suppression
of denial of symptoms and conscious attempt of
natural behaviour.
REACTIONS OF ADOLESCENTS
• Adolescents are concerned with lack of
privacy , separation from peers or family and
school , interference with body image or
independence or self concept and sexuality.
• They react with anxiety related to loss of
control and insecurity in strange environment
They may show anger and demanding or un co-
operative behaviour or increased dependency on
mothers and staff.
They may adopt mental mechanism like
intellectualization about disease , rejection of
treatment , depression ,denial or withdrawal
EFFECTS OF HOSPITALISATION
ON THE FAMILY
• Break in the unity of family.
• Separation from the children.
• Feeling of inadequacy as others care for their
children .
• They feel anxiety, anger, fear, disappointment ,
self blame, and possible guilt feeling due to lack
of confidence and competence for caring the
child in illness and wellness.
• Parental anxiety
• Strange environment in the hospital.
• Society will look upon the illness as a reflection
of something wrong with the parents
ON THE CHILDREN
The stressors of hospitalisation may cause
children to experience short- and long-term
negative outcomes.
Adverse outcomes may be related to the
length and number of admissions, multiple
invasive procedures, and the anxiety of
parents.
Common responses include regression,
separation anxiety; apathy, fears, and sleeping
disturbances, especially for children younger than
7 years of age.
Supportive practices, such as family centred care
and frequent family visiting, may lessen the
detrimental effects of such admissions
Research also indicates that a child's pain
experience determines how the overall
hospitalisation is experience
What are common stressors that
hospitalized children may experience?
loss of bodily control
forced dependence
loss of competence
fear of bodily mutation or deformities
fear of loss of bodily functions
fear of pain
fear of death
fear of anesthesia (unknown sleep)
isolated from peers and school
limited caregiver involvement
NURSING CARE OF
HOSPITALIZED CHILD
IN NEONATE:
Rooming in and sensory motor stimulation.
Provide family centred care with different
approach to specific age group
IN INFANTS
Encourage mother to balance her
responsibilities and minimize separation
Mother can be allowed during procedure ,
providing toys to relieve tension.
IN TODDLERS :
Rooming in , unlimited visiting hours to
express child's feelings, no punishment to
the child, home routines can be continued ,
allow play , encourage independence ,
encourage family interaction.
IN PRESCHOOLER:
Provide parental participation in care , plan
to shorten the hospital stay, careful
preparation for all procedures by privacy
and explanation, encourage the child to
participate in the selfcare and hygiene,
remove fear , reassure the child.
IN SCHOOLCHILDREN :
Help the parent to prepare child for elective
hospitalisation , provide privacy , thorough
nursing history should be obtained for plan
of care , explain the procedures and its
purpose , encourage play , self care and
continue schoolwork
IN ADOLESCENTS:
Prepare the parents for planned hospital
admission , available hospital facilities
should be explained soon after admission,
respect the personal preference on selfcare
and food habit , explain all procedure.
CONCLUSION:-
Illness and hospitalisation are traumatic, anxiety
provoking and can lead to transient or long-term
behavioural and psychological difficulties in
children. Children, due to their limited maturity
and life experience, cannot adequately infer the
true causes of their hospitalisation, and might
instead interpret their hospitalisation as a
punishment for something they have done wrong.
THANK YOU
