Stressors of Pediatric Hospitalization

Stressors of Pediatric Hospitalization

Major Stressors of Hospitalization

  • Separation Anxiety

  • Loss of Control

  • Bodily Injury

  • Pain

Erikson's Stages of Development

  1. Infant (0-1 years): Trust vs Mistrust

  2. Toddler (1-3 years): Autonomy vs Shame/Doubt

  3. Preschool (3-6 years): Initiative vs Guilt

  4. School Age (6-12 years): Industry vs Inferiority

  5. Adolescent (12-18 years): Identity vs Role Confusion

Piaget's Stages of Cognitive Development

  1. Sensorimotor Stage (0-2 years)

  2. Preoperational Stage (2-7 years):

    • Thinks literally

    • Uses transductive reasoning

    • Exhibits animism

    • Focuses on one aspect of a situation (centration)

    • Displays egocentrism

  3. Concrete Operational Stage (7-11 years):

    • Deduces logical relationships

    • Understands concepts of conservation (mass, volume)

    • Can reverse operations

  4. Formal Operational Stage (12-15 years):

    • Develops abstract thought

    • Adapts and employs flexibility in thinking

Separation Anxiety

  • Major Stress Period: Occurs primarily during middle infancy, specifically from 6-30 months.

Clinical Manifestations of Separation Anxiety:

  1. Stage of Protest:

    • Cries and screams when separated from parents

    • Searches for parents visually

    • Clings to parents

    • Avoids contact with strangers

    • Verbally/physically attacks strangers

  2. Stage of Despair:

    • Becomes inactive and withdraws

    • Shows signs of depression, sadness, and lack of interest

    • May become uncommunicative

  3. Stage of Detachment:

    • Displays increased interest in surroundings

    • May interact with strangers

    • Forms new, albeit superficial, relationships

    • Appears outwardly happy

Preventing/Minimizing Separation Anxiety

  • Collaboration with Family: Involves family members in the hospital experience

  • Use of Technology: Employ cell phones for increased contact with parents

  • Supportive Nursing:

    • Speak in a quiet tone of voice

    • Maintain eye contact during interactions

    • Use touch to comfort

    • Offer explanations to prepare the child for experiences

  • If Parents Cannot Stay:

    • Leave favorite toys and photographs from home with the child

Loss of Control

  • Resulting from:

    • Physical restrictions (e.g., being confined to a bed)

    • Changed routines (e.g., meal times, activity schedules)

    • Enforced dependency on caregivers

  • Psychological Impact:

    • Increases the perception of threat

    • Affects children's coping skills negatively

    • Exposure to different sights, sounds, and smells may be overwhelming

    • Can potentially slow development

Minimizing Loss of Control

  • Promote Freedom of Movement: Allow children to move as much as possible

  • Gain Child’s Cooperation: Engage them in their care

  • Preserve Parent-Child Contact: Involve parents in care routines

  • Maintain Routine: Try to stick to their home routines where possible

  • Establish a Daily Schedule: Create predictability in their day

  • Encourage Independence: Foster opportunities for children to make choices

  • Respect for Individuality: Recognize the unique needs of each child

  • Promoting Understanding: Provide information to help children grasp what is happening

  • Anticipatory Preparation: Prepare children for new experiences or procedures

Bodily Injury/Pain

  • Common Fears:

    • Fear of mutilation

    • Fear of bodily intrusion

    • Concerns about body image changes

    • Anxiety about disability

    • Fear of death

Preventing/Minimizing Fear of Bodily Injury

  • Preparation: Prepare the child for painful procedures

  • Modifying Techniques: Tailor procedural techniques based on the child’s age

    • Example: Apply bandages for reassurance after procedures

  • Assess Understanding: Evaluate the child's understanding of the procedure being undertaken