Hospitalisasi in

childhood

IDK II
Hospitalization

Can be traumatic for everyone Child

Separation from loved ones
Unfamiliarity with the hospital setting
Frightening hospital equipment
Unpleasant medical procedures are
major souces of stress for children
Hospitalization
Why???
Children do not understand the nature
of their illness
They may believe hospitalization is their
own fault
Sometimes view pain
Physical symptoms as the result of being
bad
Hospitalization as punishment for their
misbehavior
Hospitalization
Hospitalization need not to be an entirely
negative experience.

Children & family members benefit from

careful preparation for hospital stay.

Sudden illnesses or accidents preclude

direct preparation, but positive
interventions are still helpful at the
hospital and upon return
Stressor saat perpisahan

1. Cemas perpisahan (separation

anxiety)
2. Hilang kontrol
3. Nyeri dan cedera tubuh
1.Cemas perpisahan
(Separation anxiety)
Fase protes
Berlangsung beberapa jam sampai beberapa hari
Menangis terus berlanjut
Bila didekati orang asing, protes bertambah

A. Laten Infancy
Menangis
Berteriak
Mencari-cari ortu
Tdk mau lepas dr ortu
Mhindari & menolak interaksi dg org
asing
1. Cemas perpisahan
(Fase protes)
B. Toddlerhood
Mengusir orang asing secara verbal
dan fisik
Mencoba lari untuk mencari orang
tua
Mencoba memaksa secara fisik agar
ortu tdk pergi
1. Cemas perpisahan
(Separation anxiety)
Berhenti menangis
Anak tidak aktif
Fase Putus
Menarik asa
diri dari OrLa
Depresi
Tidak tertarik dg lingkungan
Tdk komunikatif
Regresi
Keadaan memburuk bila anak menolak makan
Lamanya bervariasi ( tergantung tipe anak )
1. Cemas perpisahan
(Separation anxiety)
Fase Perpisahan
Minat thd lingkungan
Interaksi dg org asing
Terlihat gembira
Terjadi setelah perpisahan yang
lama
Menunjukkan penyesuaian thd
lingkungan
 2. Hilang Kontrol
Bayi
Pemenuhan kebutuhan staf RS bukan
kebutuhan bayi
Askep yang inkonsisten & deviasi pada
aktifitas sehari-hari misturasi dan
kontrol diri

Toddler
Restriksi gerakan gg aktv harian &
ritualnya ketergantungan hilang
kontrol diri pd anak
 2. Hilang Kontrol
Prasekolah
Kemampuan kognitif tbatas
Merasa malu
Takut
Hilangnya kontol diri
 2. Hilang Kontrol
Usia Sekolah
Keterbatasan fisik
Takut akan kematian, cedera menetap
Kehilangan penerimaan dr teman sebaya
produktifitas hilang kontrol

Remaja
Mketergantungan & depersonalisasi
Reaksi thd ketergantungan tdk
kooperatif & menarik diri
 3. Nyeri & Cedera Tubuh
Karakteristik respon tiap tahap tumbang thd nyeri
Bayi
Kekakuan tubuh
Reflek lokal menarik diri dr area yg
distimulasi
Menangis keras
Respon tubuh volunter thd area yg
distimulasi
Restriksi fisik dg mendorong stimmulasi
untuk menjauh
 3. Nyeri & Cedera Tubuh
Toddler & presekolah
Menangis keras
Berteriak
Ekspresi verbal : Aduh!!!, Sakit..!!!
Menolak stimulasi sblm terjadi
Tdk kooperatif shg butuh restrain fisik
Meminta prosedur di hentikan
Memeluk erat ortu atau orang yg dikenal
Butuh dukungan emosi spt pelukan
Lelah dan gelisah bila nyeri berlanjut
Tingkah laku dpt dilihat sblm prosedur dilakukan
 3. Nyeri & Cedera Tubuh
Usia Sekolah
Respon tlihat saat prosedur blangsung
Perilaku menunda Tunggu dulu..!!! saya
tdk siap!!
Kekakuan otot

Remaja
Ekspresi verbal Kamu menyakiti saya..,
Aduh sakit!!!
Aktifitas motorik berkurang
Ketegangan otot dan kontrol tubuh
Stressors and reaction of the family of
the child who is hospitalized

Parental Reaction
Seriousness of the threat to the child
Previous experience with illness or
hospitalization
Medical prosedures involved in diagnosis and
treatment
Available support system
Previous coping abilities
Additional stresses on the family system
Cultural and religious beliefs
Communication patterns among family
members
Stressors and reaction of the family of
the child who is hospitalized
Sibling Reaction
Loneliness, Fear and worry main reactions :
anger, resentment, jealousy and guilty.
Craft (1993)
Being younger and experiencing many changes
Being cared for outside the home by care
providers who are not relatives
Receiving litlle information about their ill
brother or sister
Perceiving their parents to be treating them
Differently as compared with before their
siblings hospitalization
 Stressors and reaction of the family of
the child who is hospitalized
Altered Family Roles
One of the most common reactions of
parent is specialized and intensified
attention toward the sick child
Rivalry between sibling
Parents may have difficulty perceiving
the childs recovery and therefore
continue the pattern of overprotection
and indulgent attention
Illness may also result in childrens loss
of status within either their family or
peer group
 Nursing Diagnoses
Anxiety/fear r/t separation from accustomed
routine and support system; unfamiliar
surroundings
Anxiety/fear r/t distressing procedures
Acute pain r/t (specify)
Deficient activity r/t impaired mobility,
musculoskeletal, impairment, confinement to
hospital, effects of illness
Activity intolerance r/t generalized weakness,
fatigue, imbalance between oxygen supply and
demand, pain or discomfort
Risk for injury/trauma r/t unfamiliar environment
therapies hazardous equipment
 Diagnosa Keperawatan
Cemas b/d perpisahan dg aktv rutin & support system :
lingkungan yg tdk dikenal

Tujuan :
Anak akan malami ppisahan yg minimal

Kriteria Evaluasi
a. Anak akan mdpt pberi asuhan yg konsisten
b. Ortu mengunjungi anak sesering mungkin
c. Ortu bpartisipasi dalam askep
d. Anak berespon positif thdp proses hospitalisasi
e. Anak mdiskusikan ortu & hal lain yg tkait dg klg
f. Klg menunjukkan pengertian thdp TL sbg respon
ppisahan
 Intervensi Keperawatan
Rawat scr konsisten anak dg metode perawat
primer
Atur waktu kerja & jadwalkan kontak personal dg
anak
Anjurkan ortu utk tinggal selama mungkin
Berikan lingkungan yg hangat dan penerimaan thd
anak dan klg
Anjurkan ortu & anggota klg lain utk mplihatkan
rasa sayang pd anak
Respon TL anak thp perpisahan sbg suatu yg
normal
- Biarkan anak menangis
- Berikan support dg kehadiran fisik