SEMINAR

1. SEMINAR ON - HOSPITALIZED
CHILD
PRESENTED BY
MR.NITESH YADAV
M.SC. NURSING 1ST YR
B.T.N.C. SAGAR M.P

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INTRODUCTION –
BASED ON THE THEORY THAT HOSPITALIZATION
CAN BE AN UNNECESSORY STRESS TO CHILDREN, ONLY THOSE
WHO CANNOT SUCCESSFULLY BE MANAGED ON AN AMBULATORY
BASIS ARE NOW ADMITTED TO THE HOSPITAL. THIS WAS NOT
ALWAYS TRUE. FOR EXAMPLE MOST CHILDREN WITH HEAD
INJURIES AUTOMATICALLY STAYED OVER NIGHT FOR
OBSERVATION. HOSPITAL NEED TO INTERRUPTION OF THE
GROWTH AND DEVELOPMENT.
THE CHILDREN IS REMOVED FROM DAILY RUTINE OF
HOME AND BROUGHT IN AN UNFAMILIAR SETTING CAUSING LOSS
OF CONTACT WITH SIBLING, RELATIVES AND PEERS.

3. Many childhood illness, such as febrile
convulsion , appendicitis , and asthma attacks
strike suddenly making advance preparation for
hospital admission . However, when
hospitalization planned ahead of time for
orthopedic ,second stage surgery preparation is
possible.

4.  The preparation a parent makes for a child
obviously varies according to the child age
and individual experience. No matter what
the child's ago age however parents
should be encouraged to above all convey
a positive attitude. The nurse can provide
further health teaching and clear up all
misunderstanding.

5. PREPARING THE INFANT-
 As because the infant cannot understand
explanation , preparation has to minimal.
 Special items such as favorite toy blanket,
should be packed.
 This objects provide care giver should
spend a great deal of time with an infant.

6. 2. PREPARING THE TODDLER AND
PRESCHOOLER-
 Three chief fears of the toddler and
preschooler are fear of abandonment and
separation and fear of mutilation.
 These children need preparation clearly
aimed at alleviating these fears.
 Bringing a favorite toy can be help.
 Child could be encouraged to play hospital
with dolls.

7. 3. PREPARING SCHOOL AGE AND ADOLESENT-
 Both school age and adolescents need
factual explanations of what will happen
during hospitalization.
 A hospital orientation program in which facts
of hospitalization are discussed.
 Interact the child with another child who had
undergone through the same condition.


8. 4. PREPARING THE CHILD OFA A DIFFERENT
CULTURAL BACKGROUND
 Make the assurance that proper care will be
provided to the child with any differentiation

9. PREPARING DISABLED AND CHRONICALLY ILL
CHILD
 Help children to maintain contact with their
families and school friends during a long
hospitalization period as they are staying in
hospital for long term care through phone
cells letter and open visiting.

10. PREPARING FAMILY CARE GIVERS
 planning for hospitalization begins as soon
as parents know that hospitalization will be
necessary.
 Easily parental anxiety regarding illness and
hospitalization is important because infant
and children can keenly sense to parents
stress.

11.  As a part of preparation parents should as
questions about the hospitalization so that
become familiar with the situation. It will help
to reduce anxiety.
 Advice parents to ask about the diagnostic
procedure required length of hospital stay
etc.

12. EFFECTS OF HOSPITALIZATION ON CHILD:-
Children may react to the stress of
hospitalization before admission. During
hospitalization and after discharge. A child's
conception of illness is even more importance
than age and intellectual maturity in predicting
level of anxiety before hospitalization. This may
or may not be affected by the duration of
condition or prior hospitalization. There fore
nurse should avoid over estimating the illness
concept of children with prior medical
experience.

13.  A number of risk factor make certain children
more vulnerable than others to the stress of
hospitalization.
 It has also been noted that rural children
exhibit significantly greater degree of
psychological upset than urban children ,
because urban children are familiar with
hospital.

14.  Because separation is such an important issue
of hospitalization for young children nurse
should be alert to children who passively
accepts all changes these children need more
support and care.
 The stressor of hospitalization may cause
young children to experience short and long
term negative out comes.

15.  Advise outcomes may be related to the length
and number of admission multiple invasive
procedure and anxiety of the parents.
 Common response includes regression
separation anxiety ,apathy ,fears, sleeping
disturbances ,especially children younger
than 7 years of age .

16.  Supportive practice such as family centered
care and frequent family visiting may lessen
the detrimental effect of such admissions.
 A child's pain experience indicates how the
overall hospitalization is experienced.
 Increasing length of hospitalization because
of complex medical and nursing care elusive
diagnosis , and complicated psychological
issues.

17.  Without special attention , to meet child's
psycho-social development needs in hospital
environment the detrimental consequences of
prolonged hospitalization may be severe.
 What the hospital means to pediatrics patient
depend upon their stage of maturity and
depend upon how accustomed they are to
being left with friend.

18.  Infant may be emotionally disturbed by
hospitalization.
 If the child doesn’t have close physical
contact with another human being may result
in emotional trauma.

19.  The most obvious effect is the recovery from
illness.
 Hospitalization provides an opportunity for
the children to master stress and feel
competent in their coping abilities.
 Hospital environment can provide new
socialization experience.
 Child can broaden their interpersonal
relationship.
 Psychological status of child also maximized.

20. Stressors of hospitalization and children
reaction –
a) SEPARATION ANXIETY -
Separation anxiety is major stress for
children of certain ages. It is usually begins
around 8 months ends at 3 year of age.
john bowl by describe three stages
the infant goes during separation anxiety.
I. Protest
II. Despair
III. Detachment

21.  PROTEST –
1. Observed behavior during later infancy –
• Cries
• Screams
• Searches for parent with eyes
2. Additional behaviors observed during
toddlerhood.
 Verbally attacks strangers [ eg. Go away ].
 Physically attacks stranger ( eg. Kicks bites
,hits , pinches). Attempts to escape to find
parents to stay.

22.  Behaviors may last from hours to days.
 Approach of stranger may precipite increased
protest.
2. DESPAIR –
Observed behavior –
 Inactive
 Withdraws from other
 Depressed sad
 Uninterested in environment
 Uncommunicative

23.  Regresses to earlier behavior (eg. Thumb
sucking, bed wetting, use of bottle)
 Behavior may last for variable length of time.
 Childs physical condition may deteriorate
from refusal to eat, drink, or more.

24. 3. DETACHMENT –
Observed behavior –
 Shows increased interest in surrounding
 Forms new but superficial relationships
 Appears happy.
detachment usually occurs after
prolonged separation from parents rarely
seen in hospitalize children.
behaviors represent a superficial
adjustment to loss.

25.  EARLY CHILDHOOD –
Separation anxiety is the greatest
stress imposed by hospitalization during
early childhood.
i. Children in the toddler stage demonstrate
more goal oriented behaviors.
ii. They may demonstrate displeasure on
parents return or departure by temper
tantrums or regression to primitive level of
development.

26. Temper tantrums , bed wetting, or other
behaviors are expression of anger or
response to stress.
• Pre - schooler are more secure
interpersonally them toddler , they can
tolerate brief period of separation from their
parents and are more include to develop
trust in other significant adults.
• The stress of illness usually renders pre
schooler less able to cope with separation.

27. • They may show separation anxiety by
refusing to eat, experiencing difficulty in
sleeping , crying quietly for their parents
withdrawing from other.
• They will express indirectly by breaking toys,
hitting, other children.

28.  LATER CHILDHOOD –
1. In school age child bring away from family
higher than any other fear associated with
hospitalization.
2. Hospitalization increase their needs of
parental security and guidance
3. Middle and late school age children may
react more due to separation from usual
activities and peer groups than to the
absent of their parents.

29.  Feelings of loneliness, boredom, isolation
and depression are common.
 School age children have irritability and
aggression towards parents withdrawal from
hospital personnel inability to relate to peer
rejection of siblings, subsequent behavior
problem in school.

30. b. LOSS OF CONTROL –
The major areas of loss of control in terms of
physical restriction , altered routine or rituals and
dependency.
Infants –
 In hospital setting routine may be established to
meet hospital staffs need instead of infant needs.
 Inconsistent care and deviation from infants
routine may lead to mistrust and decreased
sense of control.

31. TODDLER
 Toddler are striving for autonomy , and this goal is
evident in most of their behaviors.
 When their egocentric pleasures meet with obstacles
toddlers reaction with negativism especially tamper
tantrums.
 Loss of control result from altered routines and
rituals.
 It can cause regression to toddlers .
 Enforced dependency is a chief characteristics of
toddler during sick role most toddler react negatively
and aggressively to this.
 Prolong loss of autonomy may result in passively of
this.

32. PRESCHOOLER
 Preschoolers also suffer form loss of control
caused by physical restriction . Altered
routines , and enforced dependency.
 Their specific cognitive abilities which make
them feel omnipotent and all powerful also
make them feel out of control.
 This loss of control is a critical influencing
factors in their perception of and reaction to
separation , pain ,illness hospitalization.

33. SCHOOL AGE
 Because of their striving for independence
and productivity school age children are
particularly vulnerable to events that may
lessen their feeling of control and power.
 Altered family roles , physical disability ,fear
of death , abandonment or permanent
injuries , loss of fear acceptance , lack of
productivity and inability of cope with stress
according to perceived cultural expectation
may result in loss of control.

34.  One of the most significant problem of this
age in boredom .
 When physical or enforced limitation curtails
their usual abilities to care for themselves ,
school age children generally respond with
the depression hostility and frustration .

35. ADOLESCENT
 Adolescent struggles for independence , self
assertion and libration centers on the quest
for personal identity . Anything that interfere
with this poses a treat to their sense of
identity and result in loss of control.