The document discusses the stressors and effects of hospitalization on children and families. It defines stressor and outlines the purposes, advantages, and preparations for hospitalizing a child. The document describes the effects of hospitalization on children, including separation anxiety and loss of control. It also discusses the effects on parents and the role of nurses. Coping strategies like child life programs and therapeutic play are presented.

1. PAL COLLEGE OF NURSING AND
MEDICAL SCIENCES
PRESENTATION ON
STRESSOR AND EFFECTOF HOSPITALIZATION
ON CHILD AND FAMILY
PRESENTED BY
MS.MANISHA SAMMAL
M.SC. NURSING 1 YEAR

2. SPECIFIC OBJECTIVES
 To introduce the topic.
 To define stressor.
 To enlist the purposes of hospitalization.
 To enlist the advantages of
hospitalization.
 To discuss the preparation of hospital for
child.

3.  To specify the effect of hospitalization on
child.
 To specify the effect of hospitalization on
parents
 To discuss the role of nurse.
 To illustrate the strategies of coping.
 To enlist the nursing responsibility

4. INTRODUCTION
 It is a stressful experience for both children
and their family. Hospitalization leads to
interruption of child’s active growth and
development. The child is removed from
daily routine loss of contact with siblings,
relatives and peers.

5. DEFINITION
A stressor is any event or stimulus that
causes an individual to experience stress.
“Barbara kozier”
Stress is the pressure experienced by a
person in response to life demands.
Selye

6. PURPOSE
 CHART

7. ADVANTAGES OF
HOSPITALIZATION
 Can get cure from disease.
 Prevent spreading of disease .
 Promote health .
 Promote psychological support.
 Promote socialization
 Increase chance for communication.
 Increase chance for interpersonal relation.

8. PREPARATION OF HOSPITAL
FOR THE CHILD
 Warm approach and concern of nurse.
 Orientation
 Calm and quiet environment.
 Rooming in
 Pleasing and attractive ward

9.  Introduction to physician in charge and
other health team member
 Child should be made familiar with the
equipment’s around him and their parents.
 Likes and dislikes of child related to food
 Family centered care.
 play and recreation in hospital.

10. EFFECT OF HOSPITALIZATION
ON CHILDREN
 Major stressor of hospitalization for sick
child-
 Separation anxiety
 Loss of control
 Bodily injury
 Pain
 Fear

11. SEPARATION ANXIETY
 Begins 6-30 month of age .
 It is also called as anaclitic depression.
 John Bowlby describe 3 stages of
separation anxiety :-
Protest
Despair
Detachment

12.  Protest
Later infancy
 Cries
 Screams
 Searches for parent with eyes
 Clings to parent
 Avoids and rejects contact with strangers

13. During toddlerhood
 Verbally attacks strangers (e.g. "Go
away")
 Physically attacks strangers (e.g., kicks,
bites, hits, pinches)
 Attempts to escape to find parent .
 Attempts to physically force parent to stay
 Behaviours may last from hours to days

14. a) Despair
- Inactive.
- Withdraws from other.
- Depressed, sad.
- Uninterested in environment.
- Uncommunicative.
-

15. - Regresses to earlier behaviour (e.g. thumb
sucking, bed- wetting, use of bottle).
- Behaviours may last for variable length of
time.
- condition may deteriorate from refusal to
eat, drink, or move.

16.  Detachment
Shows increased interest in surrounding .
 Interacts with strangers or familiar
caregivers .
Forms new but superficial relationships.
Appears happy.
Detachment usually occurs after
prolonged separation from parent; rarely
seen in hospitalized children .
 Behaviours represent a superficial
adjustment to loss.

17. Separation Anxiety in Each Age Group
Infant
 aware of the absence of parent and
become fearful.
 They can sense the anxiety their parents
are experiencing .
 To having basic needs of food and sleep
meet by parent and constraints of
hospitalization.

18. Toddlers
 Separation leads to anxiety.
 Nurses experience protest and despair in
this group.
 Fear of injury and pain
 Regressive behavior
 Temper tantrums

19. Preschooler
 Separation anxiety generally less than the
toddler
 Less direct with protests
 Cries quietly
 May be uncooperative
 Fear of injury
 Loss of control
 Guilt and shame

20. School Age Child
 Separation already experienced
 Fear of injury and pain
 Want to know reason for procedures and
like being involved and wants to make
choices .

21. Adolescence
 Separation from friends rather than family
more important .
 Fear of altered appearance .
 Will act as though not afraid when they
really are.
 Feeling of loneliness, boredom, isolation
and depression

22. LOSS OF CONTROL
 Loss of control increases the perception of
threat and affects their coping skills .
 Child lose control over routine self care,
usual task, and play as well as decision
related to care of their own bodies .

23.  The major area of loss of control in terms
of physical restriction, altered routines,
and dependency are discussed for each
group
1. Infants
2. Toddlers
3. Preschoolers
4. School age children
5. Adolescents

24.  Infants
 Develop attribute of healthy personality-
trust and was developed through loving
caring nature of nurturing person.
 Infant control their environment through
crying, or smiling.

25.  Toddlers
 Try for autonomy (play, daily activities,
communication, and motor skills).
 Disruption of routine (e.g. eating sleeping)
may lead to regression.

26.  Preschoolers
 Preschoolers magical thinking limits their
ability to understand events.
 Preschoolers understand explanation only
in terms of real events-preoperational
thinking.
 Preschooler deduct from the particular to
the particular- Transductive reasoning.

27.  School age children
 Following can lead to loss of control-
- Physical disability
- Fear of death
- Injury
- Altered family roles
- Hospital environment

28.  Adolescents
 Struggle for independence, self assertion
and liberation anything interferes with this
poses may cause a loss of control.
 Privacy.
 Anger and uncooperative behavior.

29. EFFECT OF HOSPITALIZATION
ON PARENTS
Parental reaction to the illness in their child
depends on the following factors:
 Seriousness of the threat to the child,
 Previous experiences with illness and
hospitalization,
 Medical procedure involved in diagnosis
and treatment
 Available support system.

30.  Personal ego problems
 Previous coping abilities,
 Additional stresses on the family systems,
cultural and religious beliefs,
 Communication patterns among the
family members.
 Separation from the child
 Aggressive behaviour.

31. Parental reactions:-
 Sense of helpleness
 Questioning the skills of staff.
 Accepting the reality of hospitalization.
 Needing to have information.
 Dealing with fear.
 Coping.

32. ROLE OF NURSE IN CARE OF
HOSPITALIZED CHILDREN
Care of Infants
 Encourage parents in meeting physical
and emotional needs.
 Minimizing separation by feeding child
etc.
 Providing family centered care
 Providing toys to relieve tension and
loneliness

33. Care of Neonate
 Rooming in .
 Sensory motor stimulation as appropriate.
Care of Toddlers
 Preserving the toddler’s trust in parents.
 Helping child express anger.
 Rooming in.
 Provide unlimited visiting hours.

34.  No punishment to child.
 Continue home routine.
 Provide familiar toys.
 Encourage child to play and be physically
active.

35. Care of Pre-school Children
 Minimize stress of separation.
 Parental participation in care.
 Rooming in
 Encourage self care and personal hygiene.
 Discourage negative reinforcement e.g. If
you are not listening to me. “I shall leave
you here”.
 Don’t blame child for hospitalization.

36.  Set limits for child and provide
opportunity to verbalize the feelings.
Care of School Children
 Prepare child and help parent for elective
hospitalization.
 Respect child need for privacy and
modesty during examination.
 Encourage child to watch TV, read etc. to
avoid bored.

37.  Help child to identify problem and to ask
question.
 Encourage for self care and personal
hygiene.
 Family centered care
 Allow child to express their fear, anxiety
and doubts.

38.  Care of Adolescents
 Help parents to prepare the child for
planned hospitalization.
 Provide orientation after admission.
 Nurse should routinely communicate with
them and provide needed information.
 Respect for privacy.

39.  Explain procedure and gain cooperation
 Guide for health promotion and
restoration activities.
 Recognize and respond to need of
hospitalized child.

40. STRATEGIES OF COPING &
NORMAL DEVELOPMENT
 The strategies used to adapt in hospital
environment are:
 Child life programs
 It focus on the psychosocial needs.
 A child life specialist plan activities to
provide age appropriate play time for
children either in playroom or child’s
room.

42.  Some of the activities are designed to
assist children in working through feeling
about illness. Eg: Playing with medical
equipment
 Child specialist & nurses formulate plan
together to assist children with particular
needs.

43.  Rooming in
 parent stay in the child’s hospital room.
 Some hospitals provide cots, others have
special built-in beds & in some
institutions parent stays in a separate room
on the unit is available.

45. Therapeutic play
 Play presents an opportunity to deal with
the fears & concerns of health experiences
are called therapeutic play.
 Assess the child’s knowledge of his or her
illness.
 Way to release tensions caused by stress
or aggressive impulses.

46. Therapeutic recreation
 Telephone contact with other teenagers .
 Visits from friends should be encouraged.
 Interactions with other teenagers.
 Giving them options & letting them
choose an evening recreational activity
can promote their feelings of
independence.

47. NURSING RESPONSIBILITY
1. Preparing child and families for
hospitalization.
2. Admitting the child to the facility.
3. Addressing the effect of hospitalization
developmentally.
4. Preparing the child and family for
surgery.
5. Maintaining safety during hospitalization.

48. 6. Providing basic care for the hospitalized
child.
7. Providing play, activities, and recreation
for the hospitalized child.
8. Promoting schoolwork and education
during hospitalization.
9. Addressing the needs of family
members.
10. Preparing the child and family for
discharge.

49. CONCLUSION
 It is a stressful experience for both
children and their family. Hospitalization
leads to interruption of child’s active
growth and development. The child is
removed from daily routine loss of contact
with siblings, relatives and peErs.

50. SUMMARY
 In the topic stressor and effect of
hospitalization on child and family today
we have discussed about its introduction,
definition of stressor, its purposes, its
advantages, preparation of hospital for
child the response of parents, child’s
reaction on hospitalization and role of
nurse.

51. RECAPTULIZATION
 Define stress?
 Enlist the purposes of hospitalization of
child?
 Enlist the advantages of hospitalization?
 Enlist the reaction of toddler to
hospitalization?
 Enlist the strategies of coping?

52. RESEARCH ARTICLE
Research statement
Effects of stress on mothers of hospitalized
children in a hospital in iran
Author
Hasan Tehrani, Mohammad
Haghighi , Hasan Bazmamoun
Objective
To investigate the impact of different
stressors in mothers of hospitalized
children.

53.  Methods : In this cross-sectional study,
225 mothers of hospitalized children in the
pediatric ward of Besat hospital were randomly
selected and studied. Data collection tool was a
two-part questionnaire gathered by interviewing
the mother. The first part included demographic
information of the patients. The second part
included questions regarding stressors in four
different categories; child-related factors,
environmental factors, socioeconomic factors and
health professional factors. SPSS 16.5 was used
for statistical analysis and data were analyzed by
one way ANOVA and T test.

54.  Results : In the child-related factor
category, fear of child death (84%); in the
socioeconomic factor category, fear of
disease in the other siblings (84%); in the
environmental factor category, unpleasant
odors in the ward (56%); and in the health
professional category, not enough
explanation about inserting IV lines,
(54.2%) constituted the most important
factors.

55.  There was a meaningful correlation
between the stressors and the mothers' age
and occupation, child age, days of
hospitalization, types of admission and
health insurance coverage, but there was
no meaningful correlation between
stressors and other factors.
 Conclusion: Professional and in depth
training programs should be provided for
health care providers and nursing staff
regarding dealing with mothers of
hospitalized children.

56. REFERENCE
 Marlow R Dorothy, Redding A Barbara .Textbook
of pediatrics,6th Ed.2010.Elsevier publisher.P.no.-
42.
 Wong's. Essential of Pediatric Nursing: 1st Ed.
Elsevier publication, P .no- 661-665.
 Hasan Tehrani, Mohammad Haghighi , Hasan
Bazmamoun:Effects of stress on mothers of
hospitalized children in a hospital in iran.
iranian journal of child neurology.volume 6.
(INTERNET)published on 2012 Page(s) -39-
45. Available from
https://pubmed.ncbi.nlm.nih.gov/24665279/