Presented By Sweety P Paul

Hospitalization is a frightening experience for the child whether it is elective, planned in advance or the result of an emergency or trauma.

Stress is the non specific response to stressors or demands made on the body.

Sources of stresses
Psychological Physiologic Environmental Biological Chemical

Separation from parents and absence of trusted adults. Physical harm or body injury Strange and unknown environment

Loss of self control. autonomy and privacy

Previous experience with illness and hospitalizations.

Cultural and religious influences Parent child relationships Childs innate and coping skills

The major stress from middle infancy through out the pre school years at the age of 6 30 months is separation anxiety also called as anaclitic depression.

Altered sleeping feeding and elimination patterns (0-5 months). Stranger anxiety (5-7 months) separation anxiety(7-9 Months)


1.

Stages of separation anxiety(Robertson)

Protest

2.

Despair
Denial

3.

Refuse to eat, difficulty in sleeping, crying quietly for their parents. With drawing from others.

Feeling of loneliness ,boredom ,isolation and depression .

Fear of loss of group status, Loss of group acceptance, loss of peer group contacts

Physical restriction

Altered routine or rituals

Dependency

Mistrust Decreased sense of control

Negativism Altered routines and rituals Enforced dependency

Physical restrictions. Altered routines Enforced dependencies Magical thinking Egocentric

Altered family roles Physical disabilities Fear of death Abandonment Permanent Injury Loss of fear acceptance Lack of productivity Inability to cope with stress Boredom

Independence
Self assertion Liberation intellectualization

Bodily injury and pain

Distress Cry Decreased heart rate Physical resistant Un cooperativeness

Kicks, screams and pulls away during procedures Upset and cry

Threaten to loss of body parts Push the offending person away Try to secure the equipment

Upset Use of certain words

More concerned about Privacy

Tendency to cling the parents Demanding parents attention Vigorous opposition to any suppression New fears

Resistant to go into bed Withdrawal and shyness Hyper activity Tempertandrum Regression to newly learned skills

Older children
Emotional coldness followed by intense demanding dependence on parents Anger towards parents

Jealousy towards siblings

Recovery from illness Competent in the coping ability Socialization experience Educational experiences

Factor affecting parents reaction

Cultural and religious beliefs Additional stresses on the family system Previous experience with illness or hospitalization Communication pattern among family members Personnel ego strength Fear, anxiety and frustration Depression and worry about other children

Loneliness,fear,worry as well as anger,jealosy and guilty Being younger and experiencing many changes Being cared for outside the home by care providers Receiving little information about their ill brothers and sisters Perceiving that their parents treat them differently compared with their siblings hospitalization

Nurses role in minimizing stressors during hospitalization

1 Prepare for hospitalization 2 Admission assessment 3 Preparing child for admission 4 preventing or minimizing separation 5 Minimizing loss of control a)Promoting freedom movement b)maintaining childs routine c)Encouraging independence d)promoting understanding

6preventing or minimizing fear of bodily injury 7 providing developmentally appropriate activities 8Providing opportunities for play and expressive activities a) diversional activities b)toys c)expressive activities d) creative expression

Fostering parent child relation ship Providing self mastering Providing socialization

Provide family centered care Allow Rooming in Providing opportunities for Therapeutic play and expressive activity, Nurse as a care giver-Use of knowledge techniques and skill to provide physical aspects of care As an educator- teach and provide anticipatory guidance to parents As an advocate-Take effort to reduce interruption of the infants sleeping. Promotes nutrition and normal growth and development minimize separation from family. Promote need for privacy Encouraging independence Preventing and minimizing body injury Promoting freedom of movements Maintaining childs routine

Thank you