Stressors of Hospitalization and Children’s Reactions

Separation Anxiety Protest

Crying and screaming, clinging to parent

Separation Anxiety Despair

Cessation of crying; evidence of depression

Separation Anxiety Detachment

• Denial; resignation but not contentment

• Possible serious effects on attachment to parent after separation

Toddlers Separation

• Plead with parents and try and find parents that left

•Throw temper tantrums, refuse to comply

•Regress to previous level of development

Preschooler Separation

•Refuse to eat

•Cry quietly

•Ask when parent is coming to visit

•Break toys or refuse to cooperate

School-Aged Separation

• Distressed of separation from family and friends

• Fear of Tx/loss of choices

• Wants to know why

Adolescents Separation

• Separation from peers cause major anxiety

• May have major impact on adolescent’s life

Children’s Response to Illness

Fear of the unknown

Separation anxiety

Fear of pain or mutilation

Loss of control

Anger

Guilt

Regression

Loss of Control

•Increases perception of threat

•Affects coping skills

•Overwhelming stimuli

-Slow or restrict growth

Effects of Hospitalization on the Child

•Effects may be seen before admission, during , after discharge

•Child’s concept of illness is more important than intellectual maturity in predicting anxiety

•Child may or may not be affected by previous hospitalizations

Individual risk factors

• “Difficult” temperament

•Lack of fit between child and parent

•Age (especially between 6 months- 5 yrs)

•Male gender

•Below-average intelligence

•Multiple and continuing stresses (e.g., frequent hospitalizations)

Changes in the pediatric population

•More serious and complex problems

•Fragility of newborns

•Severe injuries in children

•Children with disabilities who have survived because of increased technologic advances

•More invasive and traumatic procedures

• Increasing length of hospitalization

Parental reactions

•Overall sense of helplessness

•Questioning the skills of staff

•Accepting the reality of hospitalization

•Dealing with fear

•Coping with uncertainty

•Seeking reassurance

Sibling reactions

•Experiencing many changes, being too young to understand them

•Cared for by nonrelatives or outside of home

•Receiving little information about the ill brother/sister

•Perceive that parents will treat sick child differently

Preparation for hospitalization

•Preparing child for admission

•Preventing or minimizing separation

•Preventing or minimizing parental absence

Minimizing loss of control

• Promoting freedom of movement

• Maintaining child’s routine

• Encouraging independence and industry

Admission assessment

• Assess usual health habits

• Insight to potential reaction to hospitalization

• Home medications

- Herbal or complimentary products

•Physical assessment

Preparing child for admission

Prehospitalization counseling

•Avoid needless anxiety

•Establish trust

•Primary nursing is ideal

•Room selection

Nursing Interventions

•Preventing or minimizing separation

•Parental absence during infant hospitalization

•Minimizing loss of control

•Preventing or minimizing fear of bodily injury

Promoting freedom of movement

•Maintaining child’s routine

•Encourage independence

•Promoting understanding

Providing opportunities Play, Expressive activities

• Diversional activities

• Toys

• Expressive activities

• Creative expression

• Dramatic play

Maximizing the potential benefits of hospitalization

•Fostering parent-child relationships

•Providing educational opportunities

•Promoting self-mastery

•Providing socialization

Nursing Care of the Family

•Supporting family members

•Providing information

•Encouraging parent participation

•Prep for discharge & home care

Isolation

•Added stressor of hospitalization

•Limitations in child’s understanding

•Dealing with child’s fears

•Potential for sensory deprivation

•Environmental changes

Emergency admission

•Most traumatic of hospitalizations

•Little time for prep because of sudden onset

•Overuse of emergency departments

•Participation of child and family as appropriate to situation

Intensive care unit

•Child’s and parents’ stress is increased

•Emotional needs of the family must be met

•Parents need information

•Critically ill children become the focus of parents’ lives

Preparation for diagnostic & therapeutic procedures (Psychologic)

• Age-specific guidelines for preparation

• Developmental and cognitive ability

• Establish trust and provide support

• Parental presence and support

• Provide an explanation

Performance of the procedure

• Expect success

• Involve the child

• Provide distraction

• Allow expression of feelings

Postprocedural support

• Encourage expression of feelings

• Positive reinforcement

Preoperative care

• Parental presence

• Preoperative sedation

Postoperative care

• Continuous monitoring

• Vital signs assessment

•Managing pain

• Respiratory tract infection

• Patient education

• Discharge instruction

Compliance

•Clinical judgment

•Self-reporting

•Direct observation

•Monitoring appointments

•Monitoring therapeutic response

•Pill counts

•Chemical assay- drug amount in body

Compliance strategies

•Organizational

•Treatment

•Behavioral