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Mosby items and derived items © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

Chapter 44Chapter 44

Reaction to Illness Reaction to Illness and Hospitalizationand Hospitalization

2Mosby items and derived items © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

Stressors of HospitalizationStressors of Hospitalization

Separation anxietySeparation anxiety Protest phaseProtest phase

• Cry and scream, cling to parentCry and scream, cling to parent Despair phaseDespair phase

• Crying stops; evidence of depressionCrying stops; evidence of depression Detachment phaseDetachment phase

• Denial; resignation but not contentmentDenial; resignation but not contentment• May seriously affect attachment to parent after May seriously affect attachment to parent after

separationseparation


Fig. 44-1. In the protest phase of separation anxiety, children cry loudly and are inconsolable in their grief for the parent.


Fig. 44-2. During the despair phase of separation anxiety, children are sad, lonely, and uninterested in food and play.


Fig. 44-3. Young children may appear withdrawn and sad even in the presence of a parent


Loss of Control: Infants’ NeedsLoss of Control: Infants’ Needs

Trust Trust Consistent loving caregiversConsistent loving caregivers Daily routinesDaily routines


Loss of Control: Toddlers’ NeedsLoss of Control: Toddlers’ Needs

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

Regression of behaviorRegression of behavior NegativityNegativity Temper tantrumsTemper tantrums


Loss of Control: PreschoolersLoss of Control: Preschoolers Egocentric and magical thinking typical of Egocentric and magical thinking typical of

ageage May view illness or hospitalization as May view illness or hospitalization as

punishment for misdeedspunishment for misdeeds Preoperational thoughtPreoperational thought


Loss of Control: School Age ChildrenLoss of Control: School Age Children

Striving for independence and productivityStriving for independence and productivity Fears of death, abandonment, permanent Fears of death, abandonment, permanent

injuryinjury BoredomBoredom


Loss of Control: AdolescentsLoss of Control: Adolescents

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


Effects of Hospitalization Effects of Hospitalization on the Childon the Child

Effects may be seen before admission, Effects may be seen before admission, during hospitalization, or after dischargeduring hospitalization, or after discharge

Child’s concept of illness is more important Child’s concept of illness is more important than intellectual maturity in predicting than intellectual maturity in predicting anxietyanxiety


Individual Risk Factors That Increase Individual Risk Factors That Increase Vulnerability to Stresses of HospitalizationVulnerability to Stresses of Hospitalization

““Difficult” temperamentDifficult” temperament Lack of fit between child and parentLack of fit between child and parent Age (especially between 6 mos and 5 yrs)Age (especially between 6 mos and 5 yrs) Male genderMale gender Below-average intelligenceBelow-average intelligence Multiple and continuing stresses Multiple and continuing stresses

(e.g., frequent hospitalizations)(e.g., frequent hospitalizations)


Changes in the Pediatric Changes in the Pediatric PopulationPopulation

More serious and complex problemsMore serious and complex problems Fragile newbornsFragile newborns Children with severe injuriesChildren with severe injuries Children with disabilities who have survived Children with disabilities who have survived

because of increased technologic advancesbecause of increased technologic advances More frequent and lengthy stays in hospitalMore frequent and lengthy stays in hospital


Beneficial Effects of Beneficial Effects of HospitalizationHospitalization

Recovery from illnessRecovery from illness Increase coping skillsIncrease coping skills Master stress and feel competent in copingMaster stress and feel competent in coping New socialization experiencesNew socialization experiences


Stressors and Reaction of the Family Stressors and Reaction of the Family Parental reactionsParental reactions

Disbelief, anger, guilt—especially if sudden Disbelief, anger, guilt—especially if sudden illnessillness

Fear, anxiety—related to child’s pain, Fear, anxiety—related to child’s pain, seriousness of illness seriousness of illness

Frustration—especially related to need for Frustration—especially related to need for informationinformation

DepressionDepression


Stressors and Reaction of the Stressors and Reaction of the Family—cont’d Family—cont’d

Sibling reactionsSibling reactions Being younger and experiencing many Being younger and experiencing many

changeschanges Being cared for by nonrelatives or Being cared for by nonrelatives or

outside of the homeoutside of the home Receiving little information about their Receiving little information about their

ill brother or sisterill brother or sister Perceiving that parents will treat them Perceiving that parents will treat them

differentlydifferently


Altered Family RolesAltered Family Roles

Anger and jealousy between siblings and ill Anger and jealousy between siblings and ill childchild

Ill child obligated to play sick role Ill child obligated to play sick role Parents continue pattern of overprotection Parents continue pattern of overprotection

and indulgent attention and indulgent attention


Preparation for HospitalizationPreparation for Hospitalization

Admission assessmentAdmission assessment Preparing child for admissionPreparing child for admission Preventing or minimizing separationPreventing or minimizing separation Minimizing loss of controlMinimizing loss of control

Promoting freedom of movementPromoting freedom of movement Maintaining child’s routineMaintaining child’s routine Encouraging independence and industryEncouraging independence and industry


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.


Fig. 44-5. When parents cannot visit, other significant persons can provide comfort to the hospitalized child.


Fig. 44-6. For extended hospitalizations children enjoy having projects with other patients to occupy time.


Fig. 44-7. Time structuring is an effective strategy for normalizing the hospital environment and increasing the child's sense of control.


Preparation for Hospitalization—Preparation for Hospitalization—cont’dcont’d

Preventing or minimizing fear of bodily Preventing or minimizing fear of bodily injuryinjury

Providing opportunities for play and Providing opportunities for play and expressionexpression Diversional activitiesDiversional activities ToysToys Expressive activitiesExpressive activities Dramatic playDramatic play


Fig. 44-8. Play materials for children in the hospital need to be appropriate for their age, interests, and limitations.


Fig. 44-9. Drawing and painting are excellent media for expression.


Preparation for Hospitalization—Preparation for Hospitalization—cont’dcont’d

Maximizing the potential benefits of Maximizing the potential benefits of hospitalizationhospitalization Fostering parent-child relationshipsFostering parent-child relationships Providing educational opportunitiesProviding educational opportunities Promoting self-masteryPromoting self-mastery Providing socializationProviding socialization


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.


Nursing Care of the FamilyNursing Care of the Family

Supporting family membersSupporting family members Providing informationProviding information Encouraging parent participationEncouraging parent participation Preparing for discharge and home carePreparing for discharge and home care


Care of the Child and Care of the Child and Family in Special Hospital Family in Special Hospital

SituationsSituations


Ambulatory or Outpatient SettingAmbulatory or Outpatient Setting

BenefitsBenefits Preparation of child can be challengingPreparation of child can be challenging The stress of waitingThe stress of waiting Explicit discharge and follow-up Explicit discharge and follow-up

instructionsinstructions


IsolationIsolation

Added stressor of hospitalizationAdded stressor of hospitalization Child may have limited understandingChild may have limited understanding Dealing with child’s fearsDealing with child’s fears Potential for sensory deprivation Potential for sensory deprivation


Emergency AdmissionEmergency Admission

Essentials of admission counselingEssentials of admission counseling ““Postvention”—counseling subsequent Postvention”—counseling subsequent

to the eventto the event Participation of child and family as Participation of child and family as

appropriate to situationappropriate to situation


Intensive Care UnitIntensive Care Unit

Increased stress for child and parentsIncreased stress for child and parents Emotional needs of the familyEmotional needs of the family Parents’ need for informationParents’ need for information Perception of security from constant Perception of security from constant

monitoring and individualized caremonitoring and individualized care


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.


Key PointsKey Points

Children are particularly vulnerable to the Children are particularly vulnerable to the stressors of illness and hospitalizationstressors of illness and hospitalization

The three phases of separation anxiety are The three phases of separation anxiety are protest, despair, and detachmentprotest, despair, and detachment

Feelings of loss of control are caused by Feelings of loss of control are caused by unfamiliar environments, physical restriction, unfamiliar environments, physical restriction, and altered routinesand altered routines


Key Points—cont’dKey Points—cont’d

Children who are hospitalized may lack the Children who are hospitalized may lack the opportunity to form new attachments in the opportunity to form new attachments in the strange environment of the hospitalstrange environment of the hospital

Nursing care is aimed at preventing or Nursing care is aimed at preventing or minimizing separation, minimizing fear of minimizing separation, minimizing fear of bodily injury, and maximizing the potential bodily injury, and maximizing the potential benefits of hospitalizationbenefits of hospitalization

The nurse should foster parent-child The nurse should foster parent-child relations, provide education, and encourage relations, provide education, and encourage socializationsocialization


Key Points—cont’dKey Points—cont’d Family reactions are influenced by the Family reactions are influenced by the

seriousness of the illness, coping ability, seriousness of the illness, coping ability, cultural beliefs, and family communicationcultural beliefs, and family communication

There may be deleterious effects on siblings of There may be deleterious effects on siblings of the hospitalized childthe hospitalized child

Listening to parents’ verbal and nonverbal Listening to parents’ verbal and nonverbal messages is keymessages is key

Admission to alternate settings will require Admission to alternate settings will require additional intervention by the nurseadditional intervention by the nurse

Mosby items and derived items © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

Week 8Week 8Perry Study Guide Chapters 49-55Perry Study Guide Chapters 49-55

1.1. Chapter 49—Hematologic Chapter 49—Hematologic Immunologic—audio—student/EvolImmunologic—audio—student/Evolveve

2.2. Chapter 50---GenitourinaryChapter 50---Genitourinary

audio—student/Evolveaudio—student/Evolve

3. 3. Chapters—51-55 Skim/Scan power Chapters—51-55 Skim/Scan power pointspoints


Exam 4—on week 10Exam 4—on week 10

75 % of test questions will be on Week 8 75 % of test questions will be on Week 8 materials—including Chapters 49-55 materials—including Chapters 49-55 study questions---contentstudy questions---content

On Monday---9/10—We will continue On Monday---9/10—We will continue with more specifics of Chapters 49-55 with more specifics of Chapters 49-55

Specific diseases you should be familiar Specific diseases you should be familiar with as a nursewith as a nurse

And …….goals of treatment and nursing And …….goals of treatment and nursing interventions. interventions.


Nursing InterventionsNursing Interventions

This is where our focus as nurses is:This is where our focus as nurses is: How do we support and/or lead team in our How do we support and/or lead team in our

unit (whether it is inpatient, outpatient, or in unit (whether it is inpatient, outpatient, or in the community)the community)

This is where our critical thinking comes into This is where our critical thinking comes into our practiceour practice

How does it gel in what you actually do?How does it gel in what you actually do? This is how we build in our practice, that it This is how we build in our practice, that it

actually looks easy to the outsider….it is not!actually looks easy to the outsider….it is not!


Nursing Nursing InterventionsInterventions

THESE ARE THE THINGS WE DO AFTER WE THESE ARE THE THINGS WE DO AFTER WE CONSIDER ALL THE –THEORY, ANATOMY, CONSIDER ALL THE –THEORY, ANATOMY, PHYSIOLOGY, FAMILY DYNAMICS, PHYSIOLOGY, FAMILY DYNAMICS, INDIVIDUAL DYNAMICS, HOSPITAL INDIVIDUAL DYNAMICS, HOSPITAL STANDARDS, CASE MANAGEMENT, STANDARDS, CASE MANAGEMENT, CRITICAL PATHWAYS.CRITICAL PATHWAYS.

THESE ARE PROBABLY ONE OF THE MOST THESE ARE PROBABLY ONE OF THE MOST IMPORTANT THINGS YOU SEE OCCURRING IMPORTANT THINGS YOU SEE OCCURRING ON THE UNIT—THEY CAN HELP PATIENT ON THE UNIT—THEY CAN HELP PATIENT FEEL BETTER, AND HEAL.FEEL BETTER, AND HEAL.

WE ARE TESTED ON THESE FOR WE ARE TESTED ON THESE FOR BOARDS/nCLEXBOARDS/nCLEX

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