The experience of hospitalization in children can be considered as a process of effort for returning to health and, on the whole, the regaining of the individual's status in the world. Nurse can ease this process by showing the importance of experience and feelings of individuals at the time of hospitalization and help people to adapt themselves to their new surroundings.

1. HOSPITALIZATION
EFFECT ON CHILDREN AND THEIR
PARENTS
SHIVANI THAKUR
Associate Professor

2. HOSPITALIZATION

3. INTRODUCTION:
 Many young adults will remember their time spends in
the hospital with fear and trembling because of the
loneliness and pain they felt at an age when they could
not cope alone with these feelings.
 The practices in use in some hospitals today have
changed little over the past 20 years, but in others they
have gone through a rapid transition. This has occurred
partially because of findings of research in the social
sciences, partially because of new thinking in child
psychology and partially because of social and
consumer pressure.

4. DEFINITION:
Hospitalization is admittance to the hospital as patient.

5. HOSPITALIZATION:
HOSPITALIZATION is;
1.a period of time when you are confined to a
hospital.
2. the condition of being treated as a patient in a
hospital.
3. insurance that pays all or part of
a patient's hospital expense.
4. placing for medical care in a hospital.

7. PURPOSES:
Scheduled
tests
Procedure
or surgery
Emergency
medical
treatment
Administra
tion of
medication
Stabilize or
monitor an
existing
condition

8. MEANING OF HOSPITALIZATION TO THE
CHILD:
Infants:
 Concern is being away from their parents.
 Change in familiar routine.
 Separation from love object.

9. TODDLERS:
 Separation from parents.
 Being away from their family.
 Punishment of misbehaviour.

10. PRE SCHOOLERS:
 Fear of damage to body.
 Fear of bodily harm or mutilation,
intrusive procedures.
 Considers own role in causation.

11. SCHOOLERS:
 Fears physical nature of illness.
 Separation from peer group.
 Fear of loosing control.
 Embarrassment.

12. ADOLESCENT:
 Anxious regarding loss independence.
 Concern about privacy.
 Able to explain illness.

13. PREPARATION OF ILL CHILD
FOR HOSPITALIZATION

15. PREPARATION FOR HOSPITALIZATION:
 Hospitalization is a traumatic event, but it can also be
a positive psychologic experience if proper
preparation is done.
 The main goals of nursing care is:
 Maintenance of health.
 Prevention of illness.

16. 1) PREPARING THE INFANT:
 Minimal preparation.
 Special items such as favourite toy, blanket,
should be packed.
 Care giver should spend a lot of time with an
infant.

17. 2) PREPARING THE TODDLER AND PRE-
SCHOOLER:
 Three chief fears are: fear of unknown, fear of
abandonment/separation and fear of mutilation.
Preparation aimed at alleviating these fears.
 Bring a favourite toy.
 Encouraged to play in the hospital with dolls and stuff
toys.

18. 3) PREPARING SCHOOL AGE AND ADOLESCENT:
 Orientation to the hospital.
 Interact the child with another child who had
undergone through the same condition and introduce
them as his/her friends.

19. 4) PREPARING THE CHILD OF A DIFFERENT CULTURAL
BACKGROUND:
Make the assurance that proper care will be provided to
the child without any differentiation.
5) PREPARING DISABLED AND CHRONICALLY ILL
CHILD:
Help children to maintain a contact with their families and
school friends through phone calls, letters & open visiting.

21. PREPARING FAMILY/CARE GIVERS:
 Planning for hospitalization begins as soon as possible.
 Easing parental anxiety regarding child.
 Orient the parents.
 Advice parents to ask questions.
 Answer all queries.
 Explanation.

23. IMPACT OF HOSPITALIZATION ON
CHILD:
CHILD
BEFORE
ADMISSION
HOSPITALIZ
ATION
DURING
HOSPITALIZATION
AFTER
DISCHARGE
STRESS
IMPACT

24. EFFECTS OF HOSPITALIZATION IN
CHILDREN:
Major stressors of hospitalization includes,
 Separation
 Loss of control
 Bodily injury &
pain
 Fear of unknown

25. CONTINUE....
Children’s reactions to these crisis are influenced by :
 Developmental age of child
 Previous experience with illness
 Separation from parents
 Coping skills (innate/acquire)
 Seriousness of the diagnosis
 Support system available

26. A) SEPARATION ANXIETY:
Commonly in middle infancy throughout the pre
school years, especially for children ages 16 to 30
months.
 PROTEST:
o Reacts aggressively
o Cry & scream for parents
o In-consolable
 DENIAL:
o Stop crying
o Depressed
o Less active & not interested in play

27. CONTINUE....
 DETACHMENT/DENIAL:
o Adjusted to the loss
o Becomes interested with the surroundings
o Forms new relationships

28. B) LOSS OF CONTROL:
The major areas of loss of control in terms of;
 Physical restriction
 Altered routine or rituals
 Enforced dependency

29. C) BODILY INJURY AND PAIN:
Reactions to pain at different developmental
periods;
 Infants: Squirming, writhing, jerking ,some
infants may cry loudly, where as others are
easily calmed by gentle hug.
 Toddlers: Localize the specific painful area.
 Pre-schoolers: Physical and
verbal aggressions.
 School age children: Fear of
illness, disability & death.

31. INDIVIDUAL RISK FACTORS:
RISK
FACTORS
SEPARATION
NON-
FAMILARITY
LENGTH OF
STAY
AGE OF
MATURITY
LESS KNOWLEDGE

32. COMMON
RESPONSE
Regression
Separation
anxiety
Apathy
Fears
Sleeping
disturbances
Emotionally
disturbed
Sensory
deprivation

33. SENSORY DEPRIVATION OCCURS:
 If the nursing personal do not take the proper
time to provide care.
 If the child doesn’t have close physical contact
with another human being may result in
emotional trauma.

35. BENEFICIAL EFFECTS OF
HOSPITALIZATION:
 Recovery from illness.
 Opportunity for the children to master stress and
feel competent in their coping abilities.
 New socialization experience.
 Broaden inter personnel relationships.
 Maximized psychological status.

37. CHILDS REACTION TO HOSPITALIZATION:
CONDITIONS REACTIONS
ILLNESS Threatens physiological and psychological
development
SICKNESS Pain, long sleepless periods, restrictions of feeds
and restraint of movement cause anxiety and
anger.
SEPARATION Emotional trauma
HOSPITALIZATION &
PROLONGED ILLNESS
Adverse reaction normal development

38. REACTIONS OF NEONATES:
 Interrupts the early stages of development.
 Impaired mother child relationship and family
integration.
 Impairment of bonding and trusting relationship.
 Inability of parents to love & care for the baby.

39. REACTIONS OF INFANTS:
 Separation anxiety and disturbances in development of
basic trust.
 Emotional withdrawal and depression.
 Interference of growth and delayed development.
 Fear of strangers, excessive cry, clinging & over
dependence on mother.

40. REACTION TO TODDLER:
 Protest- frequent crying, shaking crib, rejecting nurses.
 Urgent desire to find mother, showing signs of distrust
with anger and fears.
 Despair- Hopeless, looks sad, cry continuously and use
of comfort measures like thumb sucking, fingering lip,
and tightly clutching toy.
 Denial- Accepting care without protest.

41. REACTIONS OF PRE-SCHOOL CHILD:
 Defence mechanisms to adjust with stress.
 Regression, projection, displacement
identification, aggression, denial & fantasy.
 Show similar behaviour of toddlers.

42. REACTIONS OF SCHOOL-AGED:
 Fear, worry regarding mutilation, fantasies & need
privacy.
 Defence mechanism like regression, negativism,
depression, phobia,
un-realistic fear or denial
symptoms and conscious
attempts of mature
behaviour.

43. REACTION OF ADOLESCENT:
 Concerned with lack of privacy, separation from
peers or family & school, interference with body
image or independence or self concept &
sexuality.
 Anxiety related to loss of control.
 Insecurity in strange environment.
 Anger and demanding or un
co-operative behaviour.
 Rejection of treatment, depression,
denial/withdrawal.

45. PLAY ACTIVITIES FOR ILL HOSPITILIZED
CHILD:
Functions Of Play In The Hospital:
 Provides diversion & bring about relaxation.
 Security in strange environment.
 Reduces stress of separation & home sickness.
 Release tension & express feelings.
 Encourages interaction & develop positive attitude.
 Expression of creative ideas or interests.
 Accomplishing therapeutic goals.
 Places child in active role & provides opportunity to make
choices & be in control.

47. Play in infancy:
 Pleasure by touch & manipulation.
 5-6 months – infant repeat activities
 9 months – repetitive games (pat-a-cake)
 12 month - recognition & acknowledgement of other

48. Play in 2nd year:
 2 to 3 year – fascination with working part of toys, talking
on toy phone.
Third year:
 Child taught to share.
Pre-school:
 Competition, mastery of tasks, Genders roles
(House, Doctor)
School :
 Foot ball, basket ball

50. 1. PREPARE FOR HOSPITALIZATION:

51. 2. PREVENT/MINIMIZE SEPARATION:

52. 3. PREVENT/MINIMIZE BODILY INJURY:

53. 4. PROVIDE PAIN MANAGEMENT:

54. 5. MINIMIZE LOSS OF CONTROL:

55. 6. PROVIDE FOR DEVELOPMENTALLY
APPROPRIATE PLAY ACTIVITIES:

56. 7. PROVIDE OPPORTUNITIES FOR PLAY/
EXPRESSIVE ACTIVITIES:

58.  During hospitalization, care of the child focuses not
only on meeting physiologic needs, but also on meeting
psychosocial and developmental needs.

59. CONTINUE....
Several strategies are used to:
 Help children adapt to the hospital environment
 Promote effective coping
 Provide developmentally appropriate activities

60. CONTINUE....
These strategies include:
 Child life programs
 Rooming in
 Therapeutic play and therapeutic recreation.

61. 1. CHILD LIFE PROGRAMS:
 The department includes-
 Professional child life specialists
 Para-professionals
 Volunteer’s staff.
 Focuses on psychosocial need of child.
 Plan activities to provide age appropriate play.
 Helps to express their feelings about illness.

62. 2. ROOMING IN:
 Parent stay in the child’s hospital room & care for the
hospitalized child.
 Parents perform all of the child’s basic care or help
with some of the medical care.
 Improve communication between nurse & parent.

63. 3. THERAPEUTIC PLAY:
 Reduces stress caused by the illness and
hospitalization.
 Facilitates normal development.
 Child learns about health care.
 Gain knowledge about their illness.
 Express their feelings and anxiety.

64. CONTINUE....
 INFANTS: Transitional objects, such as a familiar
blanket or stuffed animal.
 TODDLER: who is restrained can be read familiar
stories.
 Can play with safe hospital equipments (bandages,
syringes without needles etc).
 PRE-SCHOOLERS: Crayons & colouring books,
puppets, felt & magnetic boards, recorded stories.
 SCHOOLAGE: Play with a toys. Enjoy collecting
disposable articles used in their care.

65. CONTINUE....
Nurse should have an opportunity to participate with
children play activities.
 Story telling-telling stories with themes.
 Water play during bath.
 Television-by instructing them
about programs.
 Needle play.
 Pre-post operative teaching.
 Art.

67. IMPACT OF HOSPITALIZATION ON THE
FAMILY:
FAMILY RESPONSES:
 Parents whose children have been admitted to the
hospital feel not only separation from their children but
also that other people are taking their place.
 In addition, they may have feelings of inadequacy as
others provide care for their children.

68. STRESSORS AND REACTIONS:
 Parents feel anxiety, anger, fear, disappointment and
possible guilty.
 Anxiety during a child’s illness interferes with a
parent’s ability to provide support to the child.
 Anxious parents are recognized by trembling, coarse
or wavery voice, restlessness, irritability, withdrawal
or erratic body
movements.

69. CONTINUE....
 Angry, hostile and aggressive behaviour toward
those caring for the child.
 Parents particularly with the first child, often feel
that the illness is due to some error that has been
committed and is their fault.
 If the child was an unwanted baby, the illness may be
considered punishment for the mother’s.

70. SPECIFIC CAUSES OF PARENTAL ANXIETY:
STRANGE
ENVIRONMENT
SEPARATION
SUFFERING
FEAR OF
FUTURE
FEAR OF
SPREAD OF
DISEASE
FINANCIAL
OBLIGATION
VIEW OF
SOCIETY

71. ROLE OF NURSE:
 If the parents blame them self for the child’s illness,
the nurse can explain the real cause of illness.
 If the parents are anxious because they feel that they
are not competent, the nurse can praise things they do
well to increase their self-confidence.
 If the parents need help with resolving guilt beyond
that which the nurse can give, they should be referred
to another helpful professional person.

72. COPING STRATEGIES FOR PARENTS:
 Obtain accurate information about the child's progress.
 Avoid making too many decisions at once, deal with each
situation one step at a time.
 Talk to other families who have been in a similar
situation.

73. CONTINUE....
 Have `time out' with family and friends.
 Eat well and take some time to do something relaxing
i.e. listening to music
 Ensure that siblings receive accurate information
from you at a level they can understand.

74. RESEARCH AND JOURNALABSTACT:
1. The concept of hospitalization of children from the view point of
parents and children.
[Iran J Pediatr. Jun 2011; Vol 21 (No 2), Pp: 201-208]
 ABSTRACT:
OBJECTIVE: The aim of this study is to reveal a clear picture of the
meaning of hospitalization in children, to show the experience and
behaviour of hospitalized children and to discover the meaning and
understanding of hospitalization in them.
METHODS: This study is a phenomenology study of qualitative
research. The objective group consisted of children 7–11 years old and
their parents hospitalized in the children’s ward of 22 Bahman
Hospital and the surgery ward of 15 Khordad Hospital during the study
(2008). In the method of sampling, an object group of 20 (12 children
and 8 parents) were chosen and interviewed.

75. FINDINGS: The analysis of the interviews and the written
narrations of the participants led to the extraction of 6 inner
themes consisting of sickness, environment, reciprocal
relationship, parents’ personal problems, mental and emotional
matters and a spiritual dimension; all of which define a specific
aspect of the experience of hospital in children and parents.
CONCLUSION: Nurses can ease the process of hospitalization by
showing the importance of experience and feelings of individuals
at the time of hospitalization and help people to adapt themselves
to their new surroundings. This matter can enable the nurses to
utilize methods of helping in the adaptation of individuals and
thus guide the unique powers present in every individual to ease
and quicken recovery.

76. 2. Nursing support for parents of hospitalized children.
[Issues in Comprehensive Paediatric Nursing 2009
Sep;32(3):120-30]
 ABSTRACT:
OBJECTIVES: The aim of the study is to describe the quality of
nurse-parent support in Iranian parents of hospitalized children
in paediatric sites.
METHODS: This was a descriptive study using a convenience
sample. Two hundred and thirty parents (183 mothers and 47
fathers) with hospitalized children took part in this survey that
used the Nurse Parent Support Tool (NPST). This validated
instrument has 21 items and 4 subscales (Informational Giving
and Communication Support; Emotional Support; Appraisal
Support and Instrumental Support) and was translated into
Farsi.

77. RESULTS: The total mean of the NPST was M = 4.1 (SD = 0.7).
There was a significant difference between gender of the
parents and the Instrumental Support subscale. Also, there
was significant difference between among education level of
parents and Emotional Support. In addition, there was
significant difference related to the gender of the child and
Information Giving and Communication Support and Appraisal
Support. There was no significant difference in any of the
subscales when analyzed for length of hospitalization, kind of
diseases and age of children.
CONCLUSIONS: The findings indicate that parents received a
high level of support from nurses. Nurses can promote the
quality of family care and should be aware of the importance of
the several types of nursing support in meeting the requests of
parents. It is important that nurses continue to develop their
knowledge about types of communication with the family,
especially in providing support for the parent role.

78. SUMMARIZATION:
So today we had discussed about the followings;
 Definition of hospitalization.
 Meaning of hospitalization to the children.
 Preparation of child and parents for hospitalization.
 Effects of hospitalization on child and parents.
 Nursing responsibility in care of child and parents.
 Research abstract related to the topic.

79. BIBLIOGRAPHY:
BOOKS:
 Ghai O.P. “Essential Pediatrics” ,seventh edition
published by CBS publishers & distributors, page no.
96-98.
 Marlow R. Dorothy and Barbara “ Textbook of
Pediatric Nursing” 6th edition. Page no. 250-256
 Gupta Piyush “Essential of pediatrics” published by
jypee brothers.
 Singh Meharban, “CARE OF THE NEWBORN” 6th
edition, publishe by sagar publications. Page no.-40-59

80. INTERNET:
 kc.vanderbilt.edu
 www.ncbi.nlm.nih.gov
 www.childlife.org
JOURNALS:
 Iran J Pediatr
 Issues in Comprehenssive Pediatric Nursing