This document provides an overview of hospitalization from several perspectives. It defines hospitalization and describes the phases a child may go through during hospitalization. It identifies common stressors for children of different ages related to hospitalization. It also outlines the typical reactions of children and families to hospitalization and guidelines for preparing children, units, and families for the hospitalization process. Finally, it discusses the nursing role in addressing the stressors of hospitalization and preparing for discharge and home care.

1. Hospitalization
Presented by: (Group 3)
3rd year
Presentedto/
Dr/Lareen Seif

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3. Definition of Hospitalization:
Hospitalization is the placing of a patient in a hospital and it is
a form of individual stressors.
Phases of hospitalization:
Phase of protest:
Observed behaviors during later infancy including:
cries, screams, searches for parents with eyes, clings to
parent, avoid and reject contact with strangers.
Observed behaviors during toddler hood including:
Verbally attacks strangers e.g. go away, physically
attacks strangers e.g. kicks, bites, hits and pinches,
attempt to escape to find parent, behaviors lasting from
hours to days.
Observed behaviors during preschool period including:
refusing to eat, sleep difficulty, cry for their parents,
indirect expression for anger by breaking toys, refusal to
cooperate during the self care activities.
Observed behaviors during later childhood including:
loneliness, boredom, isolation and depression.
Phase of despair:
Inactive, withdrawn from others, depressed, sad, lonely,
isolated, apathetic, uninterested with environment
(food, play), uncommunicative, regress to earlier
behaviors e.g. thumb sucking, bed wetting, use of
pacifier, use of bottle), child’s physical condition
deteriorating from refusal to eat , drink or move.

4. Phase of detachment:
Show increased interest in surroundings, interact with
strangers, form new superficial relationships, appear
happy.
If separation is avoided, children have the capacity to
withstand any other stressors
Separation anxiety:
It is major stressors facing children from infancy
throughout the preschool years, especially for children
ages 16 to 30 months and also called anecdotic
depression
Stressors of hospitalization:
 Infant
 Separation (highest age risk)
 Stranger Anxiety (6-18 months)
 Toddler
 Separation anxiety
 Loss of self-control
 Disruption of routine

5.  Preschooler
 Regression (highest age risk)
 Separation anxiety and fear of abandonment
 Inability to distinguish fact/ fiction
 Unable to understand reason for
hospitalization
 Loss of self-control
 Fear of dark
 Injury
 School age
 Loss of control/ privacy
 Pain
 Bodily Injury
 Death
 Adolescent
 Aware of the physiologic, psychologic and
behavioral causes of illness
 Concerned with appearance
 Separation from peer group
 Loss of control/ privacy
 Fear of altered body image

6. Reaction of child toward hospitalization
• Infants Reactions:
 Crankiness and irritability caused by a disruption, or
change, in their normal routine
 Infants have an immediate reaction to pain or
discomfort
 Infants may not be able to verbalize their feelings, but
can show their feelings through their actions
(withdrawing from interaction, eating or drinking less
than usual, crying, sleeping more or less than usual)
 Stranger anxiety usually begins at about 6 months of
age; being separated from a caregiver can be extremely
difficult for an infant in the hospital
• Toddlers Reactions:
 Fear of strangers
 Separation anxiety
 Toddlers often have an immediate physical response to
pain and unfamiliar surroundings, such as crying
 A regression in established skills, for example, use of
baby talk, wanting to be carried, or refusing to use the
toilet
• Preschool-Aged Children Reactions:
 Separation anxiety; fear of what might happen when a
caregiver is not there
 Display increased magical or fantasy thinking; fear that
hospitalization is a punishment or was caused by
something that he or she did or didn’t do

7. • School-Aged Children Reactions:
 Fear of pain; real or imagined.
 Fear of loss of control; fear of inability to return to doing
what he or she was able to do before hospitalization.
 Fear of loss of respect; loss of respect of parents as being
seen as weak or not as strong as one “should” be.
 Fear of loss of love; fear of loss of love due to causing a
disruption in the family’s normal routine.
 Stress over separation from school and friends.
• Adolescents Reactions:
 Stress regarding separation from friends
 Fear of loss of status among group of friends
 Anxiety related to changes in physical appearance
 Anxiety related to long term illness
 Concern for privacy
 Regression can occur during uncomfortable situations
 Reaction of family toward hospitalization
Alteration in roles
Anxiety
Lack of knowledge
Financial obligation.
Family members are anxious and fearful

8. Guidelines for admission
Preadmission
 Assign a room based on developmental age,
seriousness of diagnosis, communicability of illness,
and projected length of stay
 Prepare roommates for the arrival of a new patient
 Prepare room for child and family, with admission
forms and equipment nearby to eliminate need to
leave child
Admission
 Introduce primary nurse to the child and the family
 Orient child and family to inpatient facilities,
especially to assigned room and unit
 Emphasize positive areas of pediatric unit
ROOM
Explain call light, bed control, television, bathroom,
telephone, etc
UNIT
• Direct to playroom, desk, dining area, or other areas
• Introduce family to roommate and his or her parents
• Apply I.D band to child’s wrist, ankle, or both
• Explain hospital regulations and schedules (e.g.
visiting hours, mealtimes, bedtime, limitations{give
written information if available})
• Perform nursing admission history
GUIDELINES FOR SPECIAL HOSPITAL
ADMISSION
EMERGENCY ADMISSION
 Lengthy preparatory admission procedures are often
impossible and inappropriate for emergency
situations

9.  Focus assessment on airway, breathing, and
circulation; weigh child whenever possible for
calculation of drug dosages
 Unless an emergency is life threatening, children need
to participate in their care to maintain a sense of
control
 Focus on essential components of admission
counseling, including:
a.Appropriate introduction to the family
b.Use of child’s name, not terms such “honey” or
“dear”
c. Determination of child’s age and some judgment of
developmental age
d.Information about child’s general state of health and
any problems as allergies from any medical treatment
e.Information about the chief complaint from both
the parent and the child
ADMISSION TO INTENSIVE CARE UNIT (ICU)
 Prepare the child and parent for elective ICU
admission, such as for postoperative care after cardiac
surgery
 Prepare child and parent for unanticipated ICU
admission by focusing on primarily on the sensory
aspects of the experience and on usually family
concerns (e.g. persons in charge of child’s care,
schedules for visiting, areas where family can stay)
 Prepare parent regarding child’s appearance and
behavior when they first visit child in ICU
 Accompany family to bedside to provide emotional
support and answer questions
 Prepare sibling for their visit; plan length of time for
sibling visitation; monitor sibling’s reactions during
visit to prevent them from becoming overwhelmed
 Encourage parents to stay with their child:
a. If visiting hours are limited, allow flexibility in
schedules to accommodate parental needs

10. b. Give family member a written schedule to visiting
times
 Assure the family they can call the unit at any time
Preparation of pediatric unit to hospitalization
 Tour of the Hospital or surgical area
 Health Fairs: Photographs or a videotape of medical
setting and procedures.
 Contact with peers who had similar experience
 Allowing the child to dress up as a doctor or a nurse
helps prepare the child for hospitalization, this helps the
child adjust to treatment care and the recovery process.
Things that nurses can do to Prepare Child
 Read stories
 Talk about hospital and coming home
 Encourage child to ask questions
 Visit a hospital or surgical area and allow to touch
equipment
 Encourage child to draw pictures of what they think it
will be like
 Be honest and tell about pain
Preparation for Procedures
 Take the child to a treatment room
 Encourage a parent or loved one to provide comfort and
support
 Use developmentally appropriate terminology
 Offer the child choices
 Tell the child and family how they can help with the
procedure
 Do not threaten punishment for lack of cooperation
 Do not force an unwilling parent to stay; encourage
participation

11. Nursing role in hospitalization:
Hospitalization is a threatening experience for individuals as
stressors encountered can lead to feelings of insecurity, such
as:
1. Foreign environment.
2. Parting with the people who matter.
3. Lack of information.
4. Loss of freedom and independence.
1. Efforts to minimize the stressor or stressors, can be done
by:
 Prevent or reduce the impact of separation.
 Prevent feelings of loss of control.
 Reduce / minimize the fear of injury and body pain.
Efforts to prevent / minimize the impact of separation
 Involving parents take an active role in childcare.
 Modification of the treatment room.
 Maintain contact with school activities.
 Correspondence, meeting school friends.
Prevent feelings of loss of control
 Avoid physical restrictions if the child can be
cooperative.
 If the child in isolation doing environmental
modifications.
 Create a schedule for therapeutic procedures, practice,
play.

12.  Giving children the opportunity to make decisions and
involve parents in planning activities.
Minimizing the fear of bodily injury and pain
 Psychologically prepare children and parents for action
procedures that cause pain.
 Make the game before the child's physical preparation.
 Bringing parents whenever possible.
 Show empathy. In elective action whenever possible
actions performed by telling stories, pictures. Need to do
a psychological assessment of the child's ability to
receive this information openly.
2. Maximizing the benefits of child hospitalization
 Help the development of children by giving parents the
opportunity to learn.
 Provide opportunities for parents to learn about the
child's illness.
 Improving the ability of self-control.
 Provide opportunities for socialization.
 Giving support to family members.
3. Preparing children for treatment in hospital
 Prepare wards according to the stage of the child's age.
 Orient the hospital situation.
On the first day you should take:
1. Recommend nurses and doctors.
2. Recommend on another patient.
3. Give the identity of the child.
4. Explain the rules of the hospital.

13. Preparing for discharge and home care
 It begins during the admission assessment
 Short and long term goals are established to meet
the child’s physical and psychosocial needs
 For children with complex care needs, discharge
planning focus on obtaining appropriate equipment
and health care personnel for the home
 Discharge planning is concerned with treatment that
parent expect to continue at home
 In planning nurse need to assess:
1-The actual and perceived complexity of the skill
2-The parents’ or child’s ability to learn the skill
3-The parents’ or child’s previous or present
experience with such procedures
 The skill is divided into steps and each step is taught
to the family member until it learned
 Return demonstration before the new skills are
introduced
 Provide an efficient checklist for evaluation
 Receive the instructions in written details about
home care
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