Chapter 44

Reaction to Illness and Hospitalization

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Stressors of Hospitalization

Separation anxiety

Protest phase Cry and scream, cling to parent Despair phase Crying stops; evidence of depression Detachment phase Denial; resignation but not contentment May seriously affect attachment to parent after
separation

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Fig. 44-1. In the protest phase of separation anxiety, children cry loudly and are inconsolable in their grief for the parent.
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Fig. 44-2. During the despair phase of separation anxiety, children are sad, lonely, and uninterested in food and play.
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Fig. 44-3. Young children may appear withdrawn and sad even in the presence of a parent
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Loss of Control: Infants Needs

Trust Consistent loving caregivers Daily routines

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Loss of Control: Toddlers Needs

Autonomy Daily routines and rituals Loss of control may contribute to:

Regression of behavior Negativity Temper tantrums

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Loss of Control: Preschoolers

Egocentric and magical thinking typical of age May view illness or hospitalization as punishment for misdeeds Preoperational thought

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Loss of Control: School Age Children

Striving for independence and productivity Fears of death, abandonment, permanent injury Boredom

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Loss of Control: Adolescents

Struggle for independence and liberation Separation from peer group May respond with anger, frustration Need for information about their condition

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Effects of Hospitalization on the Child

Effects may be seen before admission, during hospitalization, or after discharge Childs concept of illness is more important than intellectual maturity in predicting anxiety

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Individual Risk Factors That Increase Vulnerability to Stresses of Hospitalization

Difficult temperament Lack of fit between child and parent Age (especially between 6 mos and 5 yrs) Male gender Below-average intelligence Multiple and continuing stresses (e.g., frequent hospitalizations)

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Changes in the Pediatric Population

More serious and complex problems Fragile newborns Children with severe injuries Children with disabilities who have survived because of increased technologic advances More frequent and lengthy stays in hospital

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Beneficial Effects of Hospitalization

Recovery from illness Increase coping skills Master stress and feel competent in coping New socialization experiences

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Stressors and Reaction of the Family

Parental reactions

Disbelief, anger, guiltespecially if sudden illness Fear, anxietyrelated to childs pain, seriousness of illness Frustrationespecially related to need for information Depression

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Stressors and Reaction of the Familycontd

Sibling reactions

Being younger and experiencing many changes Being cared for by nonrelatives or outside of the home Receiving little information about their ill brother or sister Perceiving that parents will treat them differently

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Altered Family Roles

Anger and jealousy between siblings and ill child Ill child obligated to play sick role Parents continue pattern of overprotection and indulgent attention

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Preparation for Hospitalization

Admission assessment Preparing child for admission Preventing or minimizing separation Minimizing loss of control

Promoting freedom of movement Maintaining childs routine Encouraging independence and industry

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Fig. 44-4. The initial admission procedures give the nurse an opportunity to get to know the child and to assess the child's understanding of the hospital experience.
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Fig. 44-5. When parents cannot visit, other significant persons can provide comfort to the hospitalized child.
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Fig. 44-6. For extended hospitalizations children enjoy having projects with other patients to occupy time.
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Fig. 44-7. Time structuring is an effective strategy for normalizing the hospital environment and increasing the child's sense of control.

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Preparation for Hospitalization contd

Preventing or minimizing fear of bodily injury Providing opportunities for play and expression

Diversional activities Toys Expressive activities Dramatic play

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Fig. 44-8. Play materials for children in the hospital need to be appropriate for their age, interests, and limitations.
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Fig. 44-9. Drawing and painting are excellent media for expression.
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Preparation for Hospitalization contd

Maximizing the potential benefits of hospitalization

Fostering parent-child relationships Providing educational opportunities Promoting self-mastery Providing socialization

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Fig. 44-10. Placing children of the same age group with similar illnesses near each other on the unit is both psychologically and medically supportive.
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Nursing Care of the Family

Supporting family members Providing information Encouraging parent participation Preparing for discharge and home care

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Care of the Child and Family in Special Hospital Situations

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Ambulatory or Outpatient Setting

Benefits Preparation of child can be challenging The stress of waiting Explicit discharge and follow-up instructions

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Isolation

Added stressor of hospitalization Child may have limited understanding Dealing with childs fears Potential for sensory deprivation

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Emergency Admission

Essentials of admission counseling Postventioncounseling subsequent to the event Participation of child and family as appropriate to situation

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Intensive Care Unit

Increased stress for child and parents Emotional needs of the family Parents need for information Perception of security from constant monitoring and individualized care

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Fig. 44-11. Parental presence during hospitalization provides emotional support for the child and increases the parent's sense of empowerment in the caregiver role.

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Key Points

Children are particularly vulnerable to the stressors of illness and hospitalization The three phases of separation anxiety are protest, despair, and detachment Feelings of loss of control are caused by unfamiliar environments, physical restriction, and altered routines

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Key Pointscontd

Children who are hospitalized may lack the opportunity to form new attachments in the strange environment of the hospital Nursing care is aimed at preventing or minimizing separation, minimizing fear of bodily injury, and maximizing the potential benefits of hospitalization The nurse should foster parent-child relations, provide education, and encourage socialization
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Key Pointscontd

Family reactions are influenced by the seriousness of the illness, coping ability, cultural beliefs, and family communication There may be deleterious effects on siblings of the hospitalized child Listening to parents verbal and nonverbal messages is key Admission to alternate settings will require additional intervention by the nurse

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Week 8 Perry Study Guide Chapters 49-55

1.

2.

3.

Chapter 49Hematologic Immunologicaudio student/Evolve Chapter 50---Genitourinary audiostudent/Evolve Chapters51-55 Skim/Scan power points
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Exam 4on week 10

75 % of test questions will be on Week 8 materialsincluding Chapters 4955 study questions---content On Monday---9/10We will continue with more specifics of Chapters 49-55 Specific diseases you should be familiar with as a nurse And .goals of treatment and nursing interventions.
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Nursing Interventions

This is where our focus as nurses is: How do we support and/or lead team in our unit (whether it is inpatient, outpatient, or in the community) This is where our critical thinking comes into our practice How does it gel in what you actually do? This is how we build in our practice, that it actually looks easy to the outsider.it is not!
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THESE ARE THE THINGS WE DO AFTER WE CONSIDER ALL THE THEORY, ANATOMY, PHYSIOLOGY, FAMILY DYNAMICS, INDIVIDUAL DYNAMICS, HOSPITAL STANDARDS, CASE MANAGEMENT, CRITICAL PATHWAYS. THESE ARE PROBABLY ONE OF THE MOST IMPORTANT THINGS YOU SEE OCCURRING ON THE UNITTHEY CAN HELP PATIENT FEEL BETTER, AND HEAL. WE ARE TESTED ON THESE FOR BOARDS/nCLEX
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Nursing Interventions