HOSPITALIZATION

(Hospitalisasi Pada Anak)

Presented By : Dian Hadinata

AKPER YPIB MAJALENGKA

Preparing a Child for Treatments or Procedures

The developmental stage of the child guides

the type of preparation needed:

INFANTS

 Involve parents
 Include familiar object
 Soothe, distract, and hug after
treatment or procedure
TODDLERS AND PRESCHOOLERS

1. Involve parents
2. Offer simple explanations
3. Give permission to express
discomfort
4. Offer one direction at a time
5. Allow for choices, if possible
6. Use distraction
7. Hug after treatment/procedure
SCHOOL-AGE CHILD
All of the above, plus the following:

 Let them examine equipment

 Encourage verbalization of fears
 Offer small reward after
treatment/procedure, for example
sticker
ADOLESCENT

1. Provide privacy
2. Involve teen in treatment or
procedure
3. Explain treatment or procedure and
equipment
4. Suggest coping techniques
THE NURSE’S ROLE IN HOSPITAL ADMINISTRATION

 Nurses are responsible for admitting new patients

to the hospital unit.

 Empathy in responding to the fears of the child

and family members makes the admission
procedure stimulating and educational – a
positive experience for all.

 It is logical to dwell on the more pleasant

aspects, but not to the extent of saying that
hospitalization involves no discomfort.

 The parents may plan with the child what favorite

toy or book to bring.
 Perhaps more important than explaining certain
occurrences is listening to how the child feels and
encouraging questions.

 Parents should prepare them a few days, but not

weeks, in advance.

 The initial greeting should show warmth and

friendliness – smile and introduce yourself.

 A nurse who looks anxious causes unnecessary worry

for everyone concerned.

 The nurse remains available to answer questions that

might arise.

 When there is good relationship between the parent

and nurse, the child benefits from higher quality care.
NEEDS OF THE HOSPITALIZED CHILD
Infant
1. During infancy, rapid physical and emotional development takes
place. Infants are used to getting what they want when they
want it, and they show their displeasure quickly when illness
restricts the satisfaction of their desires.

2. One of the nurse’s major goals during this period is to assist with
the parent-infant attachment process and to promote
sensorimotor activities.

3. The nurse can serve as a role model by performing activities

with the infant, such as cuddling, rocking, talking, and singing.

4. Because the infant cannot understand explanations, the nurse

administers uncomfortable procedures as gently as possible and
returns the infant to the parents for consolation.
Toddler
1. The toddler’s world revolves around the parents, particularly
the mother.
2. Hospitalization is painful experience for toddlers. They
cannot understand why they are separated from their
mothers, and they become very distressed.

Nursing goals in the care of hospitalized toddlers are as follows:

 Reassure parents, particularly the child’s primary caregiver.

 Maintain the toddler’s sense of trust
 Incorporate home habits of the child into nursing care plans
 All the child to work through or master threatening
experiences through soothing techniques and play
 Provide individualized, flexible nursing care plans in
accordance with the child’s development and diagnosis.
 The continued reappearance of the parents as
promised is of value in reducing the child’s anxiety
and reestablishing his or her sense of trust.

 The home habits of the toddler are recorded and

used. A potty chair is provided if the child is trained.
Some regression in behavior is to be expected.

 A steady, calm voice communicates safety. Loss of a

small amount of the self-control they have achieved
usually results in resistance and negativism.

 Being truthful about things that may hurt prevents

the child from feeling betrayed. Preparation and
explanation are done immediately before a procedure
so that the child does not worry needlessly for an
extended time.

 Toddlers are encouraged to play with safe equipment

used in their care, such as bandages, tongue
depressors and stethoscopes.
Preschooler

1. The experience of hospitalization may be easier for preschool

children who have had outside contact ( e.g., nursery school and
kindergarten) than those who have never been separated from
their parents.

2. Explanations must be made in realistic terms, because preschool

children cannot understand abstract explanations.

3. At this age, the child is afraid of bodily harm, particularly

invasive procedures. The surgical patient must be shown the part
of the body that requires surgery.

4. The preschooler needs clear, understandable, and truthful

explanations. Children who ask questions should be
complimented and listened to; any misinterpretations should be
corrected.

5. When the child is finally discharged, he or she may be

demanding and irritable. Parents need the kind support of
hospital personnel to enable them to make informed decisions
and deal with these added strains.
School-Age Child

 Children of school age can endure separation from

their parents if it’s not prolonged.

 School-age children need to feel “grown up”. They

can participate in their care and be offered simple
choices to foster their feeling of independence.

 The education of the school-age child must

continue throughout any illness. This gives the
child a sense of continuity with the outside world,
provides periods of socialization, reinforces weak
academic areas, and reassures the child that he or
she can return to his or her peers after discharge.

 The nurse’s presence during unfamiliar procedures

is comforting.
Adolescent
1. Adolescents, in particular, experience feelings of loss of
control during hospitalization.

2. When feelings of independence, self assertion, and identity

are threatened, the adolescent may respond by
withdrawal, noncompliance, or anger.

3. Adolescents can understand the implications of their

disease both in the present and in the future, and they are
capable of participating in decisions related to treatment
and care. The nurse who recognizes these skills and
encourages their practice helps patients gain confidence in
their intellectual abilities, thus increasing their sense of
independence and self esteem.

4. Roommate selection, although often overlooked, is

extremely important for this age-group. Adolescents
usually do better with one or more roommates than in
single rooms.
THE CHILD’S REACTION TO HOSPITALIZATION

It depends on many factors such as:

age
amount of preparation given
security of home life
previous hospitalizations
support of family and medical personnel
child’s emotional health
The MAJOR CAUSES of stress
for children of all ages

Separation

Pain

Fear of body intrusion

SEPARATION ANXIETY

Separation anxiety occurs in infants age 6

months and older and is most pronounced
at the toddler age.

There are three stages of separation

anxiety:

a) Protest
b) Despair
c) Denial or detachment
Manifestation of Separation Anxiety in Young Children

PHASE OF PROTEST
• Observed Behaviors During Later Infancy
• Cries
• Screams
• Searches for parents with eyes
• Clings to parent
• Avoids and rejects contact with strangers

Additional Behaviors Observed During Toddlerhood

• Verbally attacks strangers
• Physically attacks strangers
• Attempts to escape to find parents
• Attempts to physically force parent to stay
• Behaviors possibly lasting for hours to days
• Protests, such as crying, often continuous, ceasing only with
physical exhaustion
• Increased protests precipitated by approach of stranger
PHASE OF DESPAIR

1. Inactive
2. Withdrawn from others
3. Depressed, sad
4. Uninterested in environment
5. Uncommunicative
6. Regresses to earlier behavior ( e. g. thumb
sucking, bed-wetting, use of pacifier)
7. Behaviors lasting for variable length of time
8. Child’s physical condition deteriorating from
refusal to eat, drink, or move
PHASE OF DETACHMENT

 Shows increased interest in surroundings

 Interacts with strangers or familiar
caregivers
 Forms new but superficial relationships
 Appears happy
 Detachment occurring usually after
prolonged separation from parent; rarely
seen in hospitalized children
 Behaviors representative of a superficial
adjustment to loss
PA I N
The accepted definition of pain is that
“pain is whatever the experiencing
person says it is, existing
whenever the experiencing person
says it does”.
This includes verbal and nonverbal
expressions of pain. Freedom from pain is a
basic need and right of the infant and child.
To increase awareness of pain during patient
assessment, pain has come to be considered
a “fifth vital sign.”
The nurse should ask the child about pain using pain
rating scale. Children may sometimes refrain from
complaining if they believe they will receive an
injection to relieve the pain.

 Infants - pain may be assessed according to a

behavior scale that includes tightly closed
eyes, clenched fists, and a furrowed brow

 Toddler – crying may be caused by anxiety and

fear rather than by the degree of pain.

On the other hand, chronically ill children may not

grimace or cry when in pain, but withdraw from
interacting with their surroundings.
Strategies to Minimize the Effects of Separation

 The nurse should obtain a thorough, detailed

history that specifically identifies the child’s
daily routine.

 The nurse caring for the child must be aware

of the child’s separation behaviors.

 The child is allowed to cry. Even if the child

rejects strangers, the nurse provides support
through physical presence. This includes
spending time being physically close to the
child, using a quiet tone of voice, appropriate
words, eye contact, and touch in ways that
establish rapport and communicate empathy.
Strategies to Minimize the
Effects of Separation

 Parents should tell the hospitalized child

the reason for leaving.

 Convey the expected time of return in

terms of anticipated events.

 Parental visits should be frequent.

Strategies to Minimize the Effects of
Separation

 Other children also appreciate familiar articles from

home, particularly photographs, a radio, a favorite toy
or game, and their own pajamas. The importance of
treasured objects for school-aged children may be
overlooked or criticized.

 The sights and sounds in the hospital that are

common place for the nurse can be strange,
frightening, and confusing for children. It is important
for the nurse to try to evaluate stimuli in the
environment from the child’s point of view and to
make every effort to protect the child from frightening
and unfamiliar sights, sounds, and equipment.
NURSING DIAGNOSIS

 Altered Family Processes related to situational crisis

(threat to role functioning, hospitalization of a child)

 Powerlessness related to health care environment

 Anxiety/Fear related to situational crisis, threat to role

functioning, change in environment
 Make the
CHILD’S
HOSPITALIZATION
A Happy Experience !