Nursing Considerations for

Hospitalized Child

Chapter 40
Effects of illness and hospitalization
on children and families

Children’s understanding of health and illness.

 Young child – is likely to think that misbehavior toward his or
her mother caused on illness to occur if the two events occur
close in time.
 Older child – sometimes feel responsible or guilty about an
illness.
 Adolescents – often feel invulnerable and may believe that they
will never become ill or have an accident.
Effects of illness and hospitalization
on children and families

Infant ( by about 6 months of age ).

 Infants have developed an awareness of themselves
as separate from their mothers and fathers.
 Infants are able to identify primary caretakers and to
feel anxious when in contact w/ strangers.
 Hospitalization can be traumatic time for the infants.
Stages of separation anxiety

PROTEST
 Screaming, crying
 Clinging to parents
 Withdrawal from other adults
DESPAIR
 Sadness, depression
 Withdrawal or compliant behavior
 Crying when parents appear
Stages of separation anxiety

DENIAL
 Lack of protest when parents leave
 Appearance of being happy and content with everyone.
 Close relationships not established
 Developmental delay possible
Effects of illness and hospitalization
on children and families

TODDLERS AND PRESCHOOLER

 Toddlers and preschooler are beginning to understand illness
but not its cause.
 Toddlers consider the sun, an animal, bad behavior, or even
magic to be the cause of their illness.
 Separation from parents remains the major stressor for the
child.
Effects of illness and hospitalization
on children and families

SCHOOL-AGE CHILD
 Older children have a more realistic understanding of
the reasons for illness.
 Older children understand the functioning of their
body parts.
 The child may worry about pain, stitches and
bandages, and wonder if his or her body will return to
normal.
Effects of illness and hospitalization
on children and families

ADOLESCENT
 Adolescent become increasingly aware of
physiologic and behavioral causes of illness and
injury.
 Privacy and modesty are major concerns of
adolescents because their physical characteristics
are rapidly changing.
 Separation from peers, home and school are sited
as major stressor of hospitalization by adolescents.
Adaptation to hospitalization

SPECIAL UNITS AND TYPES OF CARE

 Emergency care
 Intensive care
 Preoperative and post operative areas
 Short stay units
 Isolations
 Rehabilitation
Strategies to promote coping and
normal development

 Childlife program
 Roaming-in
 Therapeutic play
Strategies to promote coping and
normal development

Therapeutic play
Infant and toddlers
 Play is important for toddlers
 Through play they explore environment and learn to identify with significant
people in their lives.
Preschooler
 The nurse can intervene to reduce the stress produced by
preschooler’s fears through the use of some kind of play.
 Playing with safe hospital equipment may help preschoolers
to work through feeling such as aggression.
Strategies to promote coping and
normal development

Therapeutic Play
School-age child
 School-age children often regress developmentally during
hospitalization demonstrating behaviors characteristic of an
early states as separation anxiety and fear of body injury.
Strategies to promote coping and
normal development

Therapeutic Recreation
Adolescents do need a planned recreation program to help
them meet developmental needs during hospitalization.
 Physical activities that provide an outlet for stress are
recommended.
 Give teenagers choices to assist them in regaining control.
Strategies to meet educational needs

 Parents, teachers, school nurse and other care providers may

need to plan together to meet child’s educational needs and to
establish an individualized education plan.
 The social aspects of school and peers should be considered.
 Maintain the child’s and family’s privacy by discussing with
them the information needed by others and obtaining written
permission before disclosing any information.
Preparation for procedures

 Specialtechniques can help child to

understand and cope with feelings about
procedures.
Preparation for surgery

A child’s surgical experience can be elective,

planned in advance, or a result of an
emergency or trauma.
Preoperative care

Psychosocial Preparation
 The goal of preoperative teaching is to reduce the fear
associated with the unknown and decrease stress and anxiety
associated with surgery.
Physical Preparation
 Preoperative procedures and guidelines vary among hospitals
and outpatient surgical centers.
Postoperative care

 Postoperative care of the child includes

both physical and psychologic care.
Preparation for long-term care

 Home care with support services such as

visiting nurses and physical therapists
 A long-term care facility
 A specialized rehabilitation center that can
provide care for an extended period
Preparation for home care

 Thenurse works with the social service

department, home agencies, and family to
plan for equipment, procedures and other
home care needs.
Assessing the child in preparation for
discharge

 When a child is to be discharged home, the

school district should be contacted and plans
for education made. This involves an
assessment of the child by the school district
and formulation of an individualized
education plan (IEP).
Preparing the family for home care

 Family may need to learn physical and

rehabilitative procedures for the child’s care.
Preparing parents to act as case
managers

Case manager – coordinate healthcare and to

prevent gaps and overlaps.
Saint Bernadette College of Health and
Sciences

*SLIM*