Hospitalization

Presented by: (Group 3)

3rd year

Presented to/

Dr/Lareen Seif

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Definition of Hospitalization:

Hospitalization is the placing of a patient in a hospital and it is a form of individual stressors.

Phases of hospitalization:

Phase of protest:

Observed behaviors during later infancy including: cries, screams, searches for parents with eyes, clings to parent, avoid and reject contact with strangers.

Observed behaviors during toddler hood including: Verbally attacks strangers e.g. go away, physically attacks strangers e.g. kicks, bites, hits and pinches, attempt to escape to find parent, behaviors lasting from hours to days.

Observed behaviors during preschool period including:

refusing to eat, sleep difficulty, cry for their parents, indirect expression for anger by breaking toys, refusal to cooperate during the self care activities.

Observed behaviors during later childhood including: loneliness, boredom, isolation and depression.

Phase of despair:

Inactive, withdrawn from others, depressed, sad, lonely, isolated, apathetic, uninterested with environment (food, play), uncommunicative, regress to earlier behaviors e.g. thumb sucking, bed wetting, use of pacifier, use of bottle), child’s physical condition deteriorating from refusal to eat , drink or move.

Phase of detachment:

Show increased interest in surroundings, interact with strangers, form new superficial relationships, appear happy.

If separation is avoided, children have the capacity to withstand any other stressors

Separation anxiety:

It is major stressors facing children from infancy throughout the preschool years, especially for children ages 16 to 30 months and also called anecdotic depression

Stressors of hospitalization:

Infant

Separation (highest age risk)

Stranger Anxiety (6-18 months)

Toddler

Separation anxiety

Loss of self-control

Disruption of routine

Preschooler

Regression (highest age risk)

Separation anxiety and fear of abandonment

Inability to distinguish fact/ fiction

Unable to understand reason for hospitalization

Loss of self-control

Fear of dark

Injury

School age

Loss of control/ privacy

Pain

Bodily Injury

Death

Adolescent

Aware of the physiologic, psychologic and behavioral causes of illness

Concerned with appearance

Separation from peer group

Loss of control/ privacy

Fear of altered body image

Reaction of child toward hospitalization

• Infants Reactions:

Crankiness and irritability caused by a disruption, or change, in their normal routine

Infants have an immediate reaction to pain or discomfort

Infants may not be able to verbalize their feelings, but can show their feelings through their actions (withdrawing from interaction, eating or drinking less than usual, crying, sleeping more or less than usual)

Stranger anxiety usually begins at about 6 months of age; being separated from a caregiver can be extremely difficult for an infant in the hospital

• Toddlers Reactions:

Fear of strangers

Separation anxiety

Toddlers often have an immediate physical response to

pain and unfamiliar surroundings, such as crying

A regression in established skills, for example, use of baby talk, wanting to be carried, or refusing to use the toilet

• Preschool-Aged Children Reactions:

Separation anxiety; fear of what might happen when a caregiver is not there

Display increased magical or fantasy thinking; fear that hospitalization is a punishment or was caused by something that he or she did or didn’t do

• School-Aged Children Reactions:

Fear of pain; real or imagined.

Fear of loss of control; fear of inability to return to doing what he or she was able to do before hospitalization.

Fear of loss of respect; loss of respect of parents as being seen as weak or not as strong as one “should” be.

Fear of loss of love; fear of loss of love due to causing a disruption in the family’s normal routine.

Stress over separation from school and friends.

• Adolescents Reactions:

Stress regarding separation from friends

Fear of loss of status among group of friends

Anxiety related to changes in physical appearance

Anxiety related to long term illness

Concern for privacy

Regression can occur during uncomfortable situations

Reaction of family toward hospitalization Alteration in roles

Anxiety

Lack of knowledge

Financial obligation.

Family members are anxious and fearful

Guidelines for admission Preadmission

Assign a room based on developmental age, seriousness of diagnosis, communicability of illness, and projected length of stay

Prepare roommates for the arrival of a new patient

Prepare room for child and family, with admission forms and equipment nearby to eliminate need to leave child

Admission Introduce primary nurse to the child and the family

Orient child and family to inpatient facilities, especially to assigned room and unit

Emphasize positive areas of pediatric unit

ROOM

Explain call light, bed control, television, bathroom, telephone, etc

UNIT

• Direct to playroom, desk, dining area, or other areas

• Introduce family to roommate and his or her parents

• Apply I.D band to child’s wrist, ankle, or both

• Explain hospital regulations and schedules (e.g. visiting hours, mealtimes, bedtime, limitations{give written information if available})

• Perform nursing admission history

GUIDELINES FOR SPECIAL HOSPITAL ADMISSION

EMERGENCY ADMISSION

Lengthy preparatory admission procedures are often impossible and inappropriate for emergency situations

Focus assessment on airway, breathing, and circulation; weigh child whenever possible for calculation of drug dosages

Unless an emergency is life threatening, children need to participate in their care to maintain a sense of control

Focus on essential components of admission counseling, including:

a. Appropriate introduction to the family b. Use of child’s name, not terms such “honey” or “dear” c. Determination of child’s age and some judgment of

developmental age d. Information about child’s general state of health and any problems as allergies from any medical treatment e. Information about the chief complaint from both the parent and the child

ADMISSION TO INTENSIVE CARE UNIT (ICU) Prepare the child and parent for elective ICU

admission, such as for postoperative care after cardiac surgery

Prepare child and parent for unanticipated ICU admission by focusing on primarily on the sensory aspects of the experience and on usually family concerns (e.g. persons in charge of child’s care, schedules for visiting, areas where family can stay)

Prepare parent regarding child’s appearance and behavior when they first visit child in ICU

Accompany family to bedside to provide emotional support and answer questions

Prepare sibling for their visit; plan length of time for sibling visitation; monitor sibling’s reactions during visit to prevent them from becoming overwhelmed

Encourage parents to stay with their child: a. If visiting hours are limited, allow flexibility in

schedules to accommodate parental needs

b. Give family member a written schedule to visiting times

Assure the family they can call the unit at any time

Preparation of pediatric unit to hospitalization Tour of the Hospital or surgical area Health Fairs: Photographs or a videotape of medical

setting and procedures. Contact with peers who had similar experience Allowing the child to dress up as a doctor or a nurse

helps prepare the child for hospitalization, this helps the child adjust to treatment care and the recovery process.

Things that nurses can do to Prepare Child Read stories Talk about hospital and coming home Encourage child to ask questions Visit a hospital or surgical area and allow to touch

equipment Encourage child to draw pictures of what they think it

will be like Be honest and tell about pain

Preparation for Procedures

Take the child to a treatment room

Encourage a parent or loved one to provide comfort and support

Use developmentally appropriate terminology

Offer the child choices

Tell the child and family how they can help with the procedure

Do not threaten punishment for lack of cooperation

Do not force an unwilling parent to stay; encourage participation

Nursing role in hospitalization:

Hospitalization is a threatening experience for individuals as stressors encountered can lead to feelings of insecurity, such as:

1. Foreign environment.

2. Parting with the people who matter.

3. Lack of information.

4. Loss of freedom and independence.

1. Efforts to minimize the stressor or stressors, can be done by:

Prevent or reduce the impact of separation.

Prevent feelings of loss of control.

Reduce / minimize the fear of injury and body pain.

Efforts to prevent / minimize the impact of separation

Involving parents take an active role in childcare.

Modification of the treatment room.

Maintain contact with school activities.

Correspondence, meeting school friends.

Prevent feelings of loss of control

Avoid physical restrictions if the child can be cooperative.

If the child in isolation doing environmental modifications.

Create a schedule for therapeutic procedures, practice, play.

Giving children the opportunity to make decisions and involve parents in planning activities.

Minimizing the fear of bodily injury and pain

Psychologically prepare children and parents for action procedures that cause pain.

Make the game before the child's physical preparation.

Bringing parents whenever possible.

Show empathy. In elective action whenever possible actions performed by telling stories, pictures. Need to do a psychological assessment of the child's ability to

receive this information openly.

2. Maximizing the benefits of child hospitalization

Help the development of children by giving parents the opportunity to learn.

Provide opportunities for parents to learn about the child's illness.

Improving the ability of self-control.

Provide opportunities for socialization.

Giving support to family members.

3. Preparing children for treatment in hospital

Prepare wards according to the stage of the child's age.

Orient the hospital situation.

On the first day you should take:

1. Recommend nurses and doctors.

2. Recommend on another patient.

3. Give the identity of the child.

4. Explain the rules of the hospital.

Preparing for discharge and home care

It begins during the admission assessment Short and long term goals are established to meet

the child’s physical and psychosocial needs For children with complex care needs, discharge

planning focus on obtaining appropriate equipment and health care personnel for the home

Discharge planning is concerned with treatment that parent expect to continue at home

In planning nurse need to assess: 1-The actual and perceived complexity of the skill 2-The parents’ or child’s ability to learn the skill 3-The parents’ or child’s previous or present experience with such procedures

The skill is divided into steps and each step is taught to the family member until it learned

Return demonstration before the new skills are introduced

Provide an efficient checklist for evaluation Receive the instructions in written details about

home care

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