To Hospitalisasi

pada anak
By. Ningning, S. M.Kep
Hospitalisasi……???

proses karena suatu alasan yg terencana

atau darurat, mengharuskan anak utk
tinggal di RS. menjalani terapi dan
perwatan sampai dipulangkan kembali
ke rumah

Perasaan yg sering muncul pd anak :

cemas, marah,sedih, takut & rasa
bersalah
Reaksi hospitalisasi

Infant
- usia 6 bln sadar thp perpisahan dg
ortu trauma terutama jika ortu
tdk tinggal dg anak
- Separation (highest age risk)
- Stranger Anxiety (6-18 mos)

fase separation
 3 fase separation
1. Protest :
- Screaming, crying
- Clinging to parent
- Withdrawl from other adults
2. Despair :
- Sadness, depression
- withdrawl or complaint behavior
- crying when parent appear
3. Danial :
- Lack of protest when parent leave
- Appearance of being happy and content
with everyone
- close relationship not estabilishe
- development delay posible.
Developmental Considerations
Toddler
- Separation anxiety : merupakan
stressor terbesar, takut keutuhan
tubuhnya terganggu atau berubah
- Loss of self-control :
ketergantungan  reaksi negativistik
dan agresive
Tugas perawat :
1. Jelaskan pada anak tentang
prosedur.
2. Anjurkan ortu > banyak dg anak
saat melaksanakan kebiasaan anak
Developmental Considerations
∞ Preschooler
- Regression (highest age risk)
- Separation anxiety and fear of
abandonment
- Inability to distinguish fact/
fiction
- Unable to understand reason for
hospitalization
School age
- Loss of control/ privacy
- Stress procedures regression or
behavior changes

Adolescent
- Aware of the physiologic,
psychologic and behavioral causes
of illness
- Concerned with appearance 
effect body image
- Separation from peer group, home
and school  mayor influence
Dampak pada anak dan keluarga

- Pemahaman sehat dan sakit 

kemampuan kognitif dan tingkat
perkembangan anak
- Pengalaman masa lalu dengan
pemberi pelayanan kesehatan
yg profesional
Pada orangtua :
perasaan muncul pd org tua 
takut, rasa bersalah, stress dan cemas
 t/u kondisi terminal

JANGAN DIABAIKAN

- tdk dpt merawat anaknya dgn baik

- Anak bertambah stress
Perasaan cemas dan takut
-cemas paling tinggi  saat menunggu
diagnosis penyakit anak nya.
- Takut  kehilangan anak t/u kondisi
terminal.
- Perilaku  sering bertanya ttg hal sama
berulang-ulang pd org yg berbeda,
gelisah, ekspresi wajah tegang dan
bahkan marah
Perasaan sedih
- anak dlm kondisi terminal,
tdk ada lagi harapan anaknya utk
sembuh, anaknya menjelang ajal
- Peilaku  perilaku isolasi atau tdk
mau didekati org lain, bahkan bisa
tdk kooperatif thd petugas kesehatan
Perasaan frustrasi

- Jika anak yg telah dirawat cukup

lama dan dirasakan tdk mengalami
perubahan, tidak ada dukungan
psikologis dari keluarga/kerabat.
- Perilaku  org tua tdk kooperatif,
putus asa, menolak tindakan, bahkan
menginginkan pulang paksa
Sibling (saudara kandung)
- Takut dan gangguan / perubahan
perilaku
- marah, cemburu, benci dan rasa bersalah.
Marah jengkel thd org tua yg
tdk memperhatikan
 Cemburu  merasakan org tua lbh
mementingkan saudaranya yg sedang
sakit
 Rasa bersalah  anak berfikir mungkin
saudaranya sakit akibat kesalahannya
Adaptation to Hospitalization
(intervensi)
1. Orangtua
- Mencegah / meminimalkan : libatkan
org tua berperan aktif dlm merawat
anak  tinggal bersama anak selama
24 jam (rooming in)
- Jika tdk bisa rooming in  anjurkan
sering kontak dg anak.
- Modifikasi ruang perawatan.
- Mempertahankan kontak dgn kegiatan
sekolah
- Tailor nursing care to family’s needs
and preferences
- Maintain positive communication
with family
- Ask for parents participation in
care
- Explain all aspects of treatment,
keep family “in the loop”
- Provide information to family (ie
teaching materials etc.)
2. Siblings
- Inform siblings about their
brother/sister’s condition (using
age-appropriate language and
concepts at their developmental
level)
- Encourage siblings to visit (as
appropriate)
- Discuss what to expect before the
visit w/ the child, then f/u on how
they are feeling after.
Scheduled Admission
 Child/ parent :
- Preparation :
- Tours
- Play
- Written visual material
Child Life
- Talking with peers with
similar experience
(adolescents)
Persiapkan anak
1.sebelum Masuk RS
- Siapkan ruang rawat sesuai dgn tahapan
usia anak dan jenis penyakit dgn
peralatan yg diperlukan 
Apabila anak harus di rawat secara
berencana, 1 – 2 hari sebelum dirawat,
dioreintasikan dgn situasi RS dengan
bentuk miniatur bangunan RS
2. hari pertama dirawat

- Kenalkan perawat dan dokter yg akan

merawatnya
- Orientasikan anak dan org tua pd rg
rawat serta fasilitas
- Kenalkan dgn ps anak lain yg akan
jadi teman sekamarnya
- Berikan identitas pd anak, mis : papan
nama anak
- Jelaskan aturan RS yg berlaku dan
jadwal kegiatan yg akan diikuti
- Lakukan pengkajian riwayat
keperawatan
- Lakukan pemeriksaan fisik dan
pemr lainnya sesuai dgn program
Nurses can assist the parents in
preparing the child for hospitalization
by…
- Read stories about the experience
- Talk about going to the hospital
- Encourage child to ask questions/
draw pictures
- Visit hospital beforehand
- Plan hospital stay/routine as much
as possible
- Be honest
 FIGURE 17–2 The child’s anxiety and fear often will be reduced if the nurse explains what is going to
happen and demonstrates how the procedure will be done by using a doll. Based on your experience, can
you list five actions you can take to prepare a school-age child for hospitalization?

JaW. Ball and Ruth C. Bindler © 2006 by Pearson Education, Inc.

Child Health Nursing: Partnering with Children & Upper Saddle River, New Jersey 07458
Families All rights reserved.
 FIGURE 17–3 Jasmine’s parents are taking the time to prepare her for hospitalization
by reading a book recommended by the nurse. Such material should be appropriate to th
e child’s age and culture. Why do you think that having the parents read this material is valuable?

© 2006 by Pearson Education, Inc.

Jane W. Ball and Ruth C. Bindler Upper Saddle River, New Jersey 07458
Child Health Nursing: Partnering with Children & Families All rights reserved.
Unanticipated admission
 Orientation to unit/environment
- Explain all of the procedures
- Opportunities for parents/
child to express fears
- Stress-reduction methods
• Special units and types of care:
- Short-stay unit
- Outpatient unit
- Ambulatory surgical unit
- General pediatric unit
- Emergency Departments
- NICU/ PICU
- Acute care or long-term rehabilitative
unit
• Nursing care focuses on providing
family-centered care
– Promoting the child’s and family’s coping
strategies to deal w/ hospitalization
– Promoting optimal development and safety
– Minimizing disruption of the child’s usual
routine
• Preparation for Procedures
– Psychological preparation
• Using language the child understands
– Physical preparation
• Signed consent, pre-medicate
– Performing the procedure
• Treatment room
Assessing the child and family in
preparation for discharge
• Assess the family’s ability to manage the
child’s care
• ? Any special adaptation to home
environment/ or other facility
• Collaborate w/ parents to teach them
treatment procedures and proper
equipment use
– Have family member demonstrate
proper care of equipment, and any
procedures necessary
 Pain management

Pain Assessment: Subjective

Pain Assessment : Objective
- kaku tubuh, memukul, menangis keras,
dan gelisah.
- Kulit kemerahan (wajah k/marah)
- Peningkatan Tek darah, respirasi dan
nadi.
- Dilatasi pupil
- Saturasi oksigen menurun
Pain Management
 Non Farmakologi :
- Melibatkan orangtua
- Menyiapkan anak tanpa alat2 yg
dpt menyebabkan pemikiran nyeri
pada anak.
- Distraksi
- Stimulasi pada kulit
- Hadiah
 Farmakologi : obat-obatan