PSYCHOSOCIAL CHALLENGES EXPERIENCED BY PATIENTS ADMITTED

IN BONDO SUB-COUNTY HOSPITAL.

BY:
JOHN OTISO
D/CM/19031/5681

A RESEARCH PROPOSAL SUBMITTED TO KENYA MEDICAL TRAINING COLLEGE

IN PARTIAL FULFILMENT OF THE REQUIREMENT FOR THE AWARD OF DIPLOMA

IN CLINICAL MEDICINE AND SURGERY.

APRIL 2022.

Declaration
This research proposal is my original work and has not been presented for a diploma in any other institution.
Signature ……………………………… Date …………………..
JOHN OTISO
D/CM/19031/5681

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Supervisor’s approval
This research proposal has been submitted for review with our approval as Collage Supervisors.
Signature………………………………………… Date…………………………………
Name: Mr. Paul Ogai

Dedication

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I dedicate this research project to my Dad, mum my brothers and sister for

their endless support and encouragement throughout the project.

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Acknowledgement
I thank God for giving me a chance to navigate this research. I would also like to acknowledge

my parents, friends and my supervisor Mr. Ogai for guidance throughout the project proposal

preparation process.

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Table of contents

Declaration 1
Supervisor’s approval 2
Dedication 3
Acknowledgement 4
Table of contents 5
Abbreviations and acronyms 6
Definition of terms 7
Abstract 8
1.0 CHAPTER ONE 9
1.1 Background information 9
1.2 Problem statement 10
1.3 Justification 10
1.4 Research questions 11
1.5 Objectives 11
1.5.1 Broad objective 11
1.5.2 Specific objectives11
Chapter 2: Literature Review11

2.1 Chapter Overview11

2.2 Psychosocial issues amongst hospitalized patients11

2.3 Effects of Pro-longed Hospitalization14

2.4 How Patients are Helped in Hospitals15

3.0CHAPTER 3: METHODOLOGY 18

3.0 Introduction 18

3.1 Study design 18

3.2 Study area 18

3.3 Study population 18

3.4 Sampling size determination 18

3.5 Data collection methods 18

3.6 Selection criteria 19

3.6.1 Inclusive criteria 19

3.6.2 Exclusive criteria 19

3.7 Data collection tools 19

3.8 Data collection procedure 19

3.9 Ethical considerations 19

3.10 Data analysis and presentation 19

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3.11 Confidentiality

Reference 20

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Abbreviations and acronyms

BSCRH- Bondo sub-county Referral Hospital

NICU- Neonatal Intensive Care Unit
WHO- World Health Organization
KMTC- Kenya Medical Training College

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Definition of terms

Psychosocial-relating to the interrelation of social factors and individual thought and behavior.
Psychosocial issues- Un settling issues like family issues, financial issues, marital issues.
Admission -occurs when a medical decision for the need for inpatient care is made

by an appropriately qualified decision maker, a patient is accepted by a hospital inpatient

specialty service for ongoing management, and the patient is administratively admitted to the hospital.

Support network -refers to the people in your life that help you achieve your personal and professional goals

Dementia- a chronic or persistent disorder of the mental processes caused by brain disease or injury and marked

by memory disorders, personality changes, and impaired reasoning

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Abstract

Psychosocial issues in people admitted in Hospital are those issues affecting people mentally due to being

admitted in hospitals. These issues include financial issues, stress due to sickness, longing for family members

back at home at BSCRH patients admitted get stress majorly due to factors like lack of resources and spending

long days in hospital without the presence of relatives or next of keen.

Psychosocial issues have been recognized by WHO as a product of the ongoing interactions between individuals

and their social environments. This qualitative study will use participants currently admitted at BSCRH in order to

describe knowledge attitudes and practices of patients admitted.

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 1.0 Chapter One
1.1 background information

Being sick and hospitalized is not an easy or a regular occurrence, and may even be terrifying, traumatic, to the person

admitted or his/her relatives (Ami Rokach, 2020).

Hospitalization can be a source of particular distress for most people. The sources of stress for and threats to patients

arise from circumstances of the hospital setting, the behaviour of hospital staff, the patients' own behaviour and

the built hospital environment. Although anxiety and distress are negative states that most people would choose to

avoid anyway, they are particularly relevant when their influence on physical recovery is examined. The various

ways in which stress can slow recovery — and in which buffers against stress can speed recovery —

are of central importance to the training of physicians.

The importance of either physiological or psychological factors in determining health outcomes has also been well

established

been well established (ARYA Atheroscler. 2017)

1.2 Problem statement

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The process of treatment and hospitalization may produce a tremendous amount of stress in addition to that

which is precipitated by the illness itself.  Of concern is the assuming attitude people have on the importance of

mental health. Young children are particularly affected and are more likely to associate their experienced discomfort

of illness and hospitalization to understandable notions such as being away from home, and being separated from

parents.
Recent empirical data highlights that adverse effects of hospitalization have been found to be stronger when

relatives are not present (Ami Rokach2016), or when relatives are highly anxious and were not able to calmly

respond to them.

Illness and hospitalization is a traumatic, anxiety provoking and can lead to transient or long-term behavioural and

Psychological difficulties in children l. Estimates of the incidence of emotional problems resulting from hospital

experience have been reported to vary from 10% to 30% for severe psychological distress to as much as 90%

for slight emotional upset in hospitalized children.

Research indicates that the implications of hospitalization are often present quite strongly immediately after the

hospitalization, which generally subdues soon afterwards. Children, due to their limited maturity and life experience,

cannot adequately infer the true causes of their hospitalization, and might instead interpret their hospitalization

as a punishment for something they have done wrong (MUSC, 2022). It has been argued that hospitalization

can be a life crisis for children, which might further highlight and aggravate their experience of fear, loneliness

and frustration.

Arguably for some children, this is a crisis that if not mastered properly may result in blocks or distortion in

their process of development, and might be exceedingly damaging to their sense of identity and self-esteem.
While most of us do not enjoy getting injections, research on paediatric hospitalization has shown that procedures

involving needles and injection, or blood tests and transfusions often evoke a very distressing and fearful reaction.

1.3 Justification

Getting admitted in hospital is a problem that can drain one mentally and financially as one is away from the

support network, but There are ways you can help staff find any problems and treat or manage them, such as telling

hospital staff if one feels confused or ‘can’t think clearly’, or if one is feeling low or depressed.
Telling hospital staff if one is in pain, as it can affect mood and the ability to think and concentrate.
Talking about anything that is worrying with hospital staff or someone the patient trusts.
It will need participation of family members of someone in hospital, by telling hospital staff if they 

notice a sudden change in the person’s mental state, or if the person has dementia or depression. Also tell

staff about the person’s usual routines and preferences.

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1.4 Research questions

   1. What is the impact of being admitted at Bondo sub county hospital
   2. What is the impact of prolonged stay at Bondo sub county hospital
  3. What type of help do patients get from hospital, staff,

1.5 Objectives
1.5.1 Broad objective
       To describe psychosocial challenges experienced by patients admitted at Bondo sub county hospital

1.5.2 Specific objectives

1. To determine knowledge on Psychosocial problems among patients admitted at Bondo sub county hospital
2. To determine attitude towards Psychosocial problems among patients admitted at Bondo sub county
3. What type of help and support patients who are admitted receive at Bondo sub county.

Chapter 2: Literature Review

2.1 Chapter Overview
The issue of patients suffering from psychosocial issues while still under medication in various
hospitals across the country has been prevalent over time. This cuts across all patients’ age groups
but it’s more intense in some groups like children. This research gives an outline of the psychosocial
and mental effects to patients as a result of being hospitalized. The issue intensifies when the stay of
patients in hospitals happen to prolong. This research also shows the impact of the prolonged stay in
hospitals due to various reasons on patients.

2.2 Psychosocial issues amongst hospitalized patients

In recent times, hospitals are designed to give patients a secure and conducive healing environment.
Patients in the healthcare system receive the most cutting-edge treatment possible. They gain by
using contemporary technology in the care of qualified professionals who are committed to their
work and who have the most recent knowledge of the human body and available treatments (Rollins,
2004). Even so, being ill and being hospitalized causes a considerable lot of psychological suffering,
making it one of the most upsetting things a person may go through (Hughes, 2001).

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One's life and routines are severely disrupted when they are admitted to the hospital, and they must
now begin to think of the hospital as their home for the duration of their stay as patients. Moreover,
patients and those who are typically in charge of the patient's health frequently live in a constant state
of worry about the patient's condition and are compelled to place their complete trust in the hospital's
medical staff to give them the proper care that steers hem towards recovery (Paul and Rattray, 2008).
Sellick and Edwardson (2007) makes it clear that, diseases are a significant source of stress for
people.

The body experiences constant stress as a result of the illness's various symptoms, which can include
weariness, immobility, and even loss of bodily control (Rowe, 1996). People who are hospitalized
may suffer from a variety of short- and long-term effects (Thomas and Bond, 1996). According to
Rattray et al. (2005), the body is stressed by elements that affect the patient's psychological well-
being in addition to physical pain and discomfort.

Being hospitalized is typically a traumatic and anxiety-provoking event, especially for kids. Children
are especially vulnerable to the negative impacts of illness, and being hospitalized is a stressful
experience that could have unfavorable repercussions on the children and their family (Kennedy et
al., 2004). In a way, the hospital is similar to a foreign nation where children must learn to adjust to
the customs, language, and timetables (Hall, 1987). They are more susceptible to the pressures
associated with adjusting to their disease and hospitalization because of their limits in cognition and
emotion as well as their dependency on others (Sartain, 2000).

Since the 1950s, there has been a sizable body of research on the impacts of pediatric hospitalization,
and this field of study is still important today (Rokach and Matalon, 2007). The social and emotional
repercussions of hospitalizing children are something that everyone who cares about their wellbeing
wants to keep to a minimum (Mah et al., 2006). In order to manage and feel strong and capable when
they are terrified, exhausted, or in pain, children are especially reliant on the safe and stable
environment of their home as well as the love and support of their family members. This is not just
an arbitrary requirement for kids; it's also a necessity.

According to Boyd and Hunsberger (1998), children depend heavily on their parents for daily
survival and wellbeing as they grow up, but when they are sick, they require their families' support
more than ever because they lack the coping mechanisms and emotional reserves to deal with the
extreme physical and emotional strain that hospitalization places on them. When a child's sickness is
severe enough to require hospitalization, they frequently report feeling alone and afraid because they

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are removed from the supportive and safe setting of their home and are instead required to live in an
unsettling, scary, and uncomfortable environment.

Because of this, in addition to the stress that the sickness itself causes, the process of treatment and
hospitalization may cause a great deal of stress. Children under the age of eight are especially
vulnerable and more prone to link their suffering from illness and hospitalization to relatable ideas
like being away from home and being separated from parents.

Recent empirical data shows that children are more likely to experience negative hospital outcomes
when their parents are absent or when they are extremely worried and unable to respond to the child's
needs calmly. Hospitalization and illness are distressing, anxiety-inducing experiences that might
cause short-term or long-term behavioral and psychological problems in kids (Hagglof, 1999).
According to estimates, the prevalence of emotional issues in hospitalized children ranges from 10%
to 30% for severe psychological distress to as much as 90% for minor emotional disturbance (Yap,
1988).

Anyone who is ill, especially while taking medication for pain or anxiety, may feel confused. The
difficulty is made worse by the hospital setting. People there trade in their belongings, including their
clothing and personal items, for hospital gowns. They are in an unfamiliar location devoid of their
customary routines and known landmarks (Pistoria, 2021). Hospitals frequently don't offer much
stimulation such as sights, sounds, and interaction with other people. People may be in a room with
blank white walls and dull, institutional-style furnishings alone or with a rude roommate. There
might not always be anybody available to talk to. The sound from a television can be the only
auditory source.

The routines and procedures of hospitals might be confusing. For instance, people may experience
frequent nighttime awakenings that prevent them from getting the rest they require. They might not
be able to find their way around a strange, dark room. It could be intimidating with all the testing and
the intricate equipment.

Even more perplexing are intensive care units (ICUs). ICU patients are often left alone, without any
windows or clocks to help them keep their bearings. Sleeping disturbances may result from
electronic monitor beeps, constant bright light, and frequent interruptions for blood draws, IV tube
changes, or medication administration (Pistoria, 2021). People who are fatigued are more likely to
get disoriented and confused. Sometimes a person's bewilderment is so extreme that they experience
ICU psychosis, a sort of delirium.

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Family members should alert hospital staff if patients exhibit especially confused conduct so that
they are not mistakenly believed to be acting normally. If the condition, substance, or stressful event
that caused the delirium is removed, it can typically be treated (Pistoria, 2021).

People can experience such confusion that they are unable to comprehend why they are in the
hospital. They might grow agitated and attempt to leave the bed or take other actions that might be
dangerous to them or others. They could mistakenly perceive the behavior of another person as a
threat and retaliate by posing a threat to themselves. When this happens, having a friend or family
member around may help them feel more at ease. Pistoria (2021) affirms that, sometimes a hospital
employee watches over patients around-the-clock to keep them from doing anything risky. Rarely,
people who are disoriented are put under physical restrictions or given modest dosages of an
antipsychotic medication.

2.3 Effects of Pro-longed Hospitalization

Every person who is admitted to a hospital is deprived of their personal things, forced to wear
revealing one-size-fits-all clothing, prodded and poked by strangers, and loses practically all aspects
of personal space. Most people find it disconcerting to be thrust into a situation like this, and most
kids find it considerably more frightening. Additionally, hospitalization has a variety of long-term
developmental implications when comparing babies to teenagers.

Children in hospitals often experience periods of separation anxiety from parents and other loved
ones between the ages of one and five. The potential impacts of prolonged hospitalization owing to a
diagnosis of a serious illness are more likely to affect young children under the age of three than
older children. Based on Freud's theory of psychosexual development, they are more vulnerable.

According to a 2012 Neurology study, older individuals' cognitive impairments more than double
following a hospital stay, reducing their ability to think clearly and recall information. The impact
increases with hospital stay length. Delirium is one of the factors and acts as an abrupt change in
mental function that affects 20% of hospital patients. While in the hospital, many patients become
confused, disoriented, and agitated. The effects of delirium, traditionally assumed to be transient,
may really linger and result in a long-term deterioration in cognitive function, according to doctors
(Cemental, 2021).

An extended hospital stay has been linked to cognitive decline, functional reliance, and a larger load
of comorbidities, according to a recent study by Bo et al. (2016). Better functional status, the
existence of cognitive impairment, and walking difficulties have all been linked to prolonged length
of stay in a hospital (Bo, 2016). Patients who had dementia and delirium together were more likely to

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have their hospital discharges delayed. Just as poor nutritional status is a significant predictor for
older persons, caregiver support and burden among dementia patients are key predictors of prolonged
length of stay. Clinical factors, including the primary admitting diagnosis and the load of
comorbidities, have been demonstrated to be crucial (Lenzi et al., 2014).

The importance of post-discharge care in determining acute hospital length of stay cannot be
overlooked. According to Elwood et al. (2009), factors such as the patient's discharge destination—
particularly to community hospitals and nursing homes—and the quality of post-release care
provided by caregivers—have a significant impact on how long they stay in the hospital. The most
important determinants, in particular, have been identified as the availability of caregiver support and
assistance, the existence of dementia, and admission to intermediate and long-term care (ILTC)
facilities.

Uncontrolled blood sugar, stroke, or lack of mental stimulation during the duration of the stay are
some more hypotheses. Hospital patients frequently experience boredom because there may not be
much to do but watch a small number of channels on an overhead TV or peruse a very modest
selection of books and periodicals (Cemental, 2021).

A hospital stay for older adults may highlight previously hidden health conditions and limitations.
Patients who spend the majority of their time in hospitals bedridden weaken and become less capable
of resuming to their everyday activities following release because of this. According to research,
one-third of patients over the age of 70 and more than half of those over the age of 85 leave the
facility with a higher level of impairment than when they entered.

This indicates that these individuals will be less capable of taking care of themselves after being
discharged. That despondency can have a significant psychological impact.

Patients' time in hospitals can have a profound impact on their lives. It causes severe disturbance to
routine and isolates people. Family members of the patients have lives of their own and cannot spend
the entire day by a patient's bedside to provide company. Even busier are nurses and nursing
assistants. The patient has a tougher time remembering his or her life outside of the hospital and how
to restart it after being discharged the longer they are there. Even after discharge, recovery may be
slowed down by the immune system due to the stress of this interruption and seclusion.

2.4 How Patients are Helped in Hospitals

To ensure understanding and deliver appropriate care, health care professionals and their patients
must communicate effectively.

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Studies in ambulatory settings show that higher drug adherence and better results are related to
patient and clinician agreement on the diagnosis and treatment plan. The lack of a prior relationship,
the rapid pace of clinical care, and the changeable character of inpatient medical teams provide
particular obstacles to the patient-physician interaction in hospital settings. Important conclusions
about the interaction between hospitalized patients and healthcare staff have been drawn from earlier
studies.

Patients in teaching hospitals have trouble comprehending their doctors' level of training, and the
majority of hospitalized patients are unable to identify their doctors or nurses with accuracy. Patients
commonly lack the ability to identify their diagnoses, as well as the names, uses, and side effects of
their drugs, when they leave the hospital. In addition, doctors frequently underestimate how well
patients comprehend the treatment plan when they leave the hospital and could fail to identify
patients with low health literacy.

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 CHAPTER THREE

METHODOLOGY

3.0 Introduction

This chapter describes the study area focusing on geographical location and

many other aspects including study design, sample size determination, sampling method,

selection criteria, data collection, data analysis, data presentation, data quality control, study

limitation and ethical consideration.

3.1 Study design

Descriptive cross-sectional study will be used

3.2 Study area

The study will be carried out at BSCH, located at Bondo Sub County in

Siaya County.

3.3 Study population

The study population are all patients admitted at Bondo sub- County hospital

3.4 Sampling size determination

I will determine the sample size using Andreus Fischer’s method of (1994) where the respondent

greater than 10000 formula nf = n/1 + (n/n)

Where n = standard sampling size (when population is less than 1000)

N = The estimated of population size = 100

Nf = 384/1 + 384/100

Nf = 384/1 + (384 + 100)

Nf = 384/4.84

Nf = 79

Desired sample size = 79 respondents.

3.5 Data collection methods

3.6 Selection criteria

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3.6.1 Inclusive criteria

All patients admitted and willing to participate

3.6.2 Exclusive criteria

Patients admitted and not willing to participate

3.7 Data collection tools

Structured interview schedule will be used to obtain data

3.8 Data collection procedure

The questionnaires will have to be physically delivered to the patients.

3.9 Ethical considerations

Ethical approval will be sought from the Bondo Sub-county Hospital Ethics and Research

Committee

Before each interview,the researcher will obtain consent to record the interview.

3.10 Data analysis and presentation

Data collected will be analyzed using excel and pie charts and presented in forms of tables, pie

charts.

3.11 Confidentiality

The interviews will be conducted in a private setting within the health facility. Patient name will not be

recorded on the questionnaire. The information that I collect from this study will be kept confidential. The

information will be put away and no one but the researcher and his supervisors will be able to see it.

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