Portfolio II: Objective 4 The potential psychosocial effects of hospitalization on the child can vary greatly. In general, the younger child may have less developed coping mechanisms and less understanding of what is happening to them during hospitalization. Illness and hospitalization can threaten children’s sense of self and have the potential to disrupt development. The stress of the hospital environment can cause fear, loss of control, and anxiety (Ricci & Kyle, 2009). Children can experience varying amounts of stress with illness, and at times will regress to old behaviors during stressful situations like hospitalization (Potter & Perry, 2009). Wilson, Megel, Enenbach, & Carlson (2010) interviewed children to explore their views of hospitalization. They found that children described their hospitalization experiences with negative feelings of being sad, mad, alone, and scared. They are unsure of what is going to happen to them in the hospital and want protection and companionship. The developmental level of the preschool child and their perspective of hospitalization and potential psychosocial effects will be discussed.
The preschool level child is between 3 and 5 years. This group may adapt to hospitalization with slightly more ease than infants and toddlers because of more verbal and developmental skills, but hospitalization can still have profound psychosocial effects on this group (Ricci & Kyle, 2009). Being in a strange environment while ill can be very scary and traumatizing for children. Children in this age group begin early causal thinking, and will link events together and assign them cause-and-effect. For example, the hospitalized preschooler may think her crying caused the nurse to give her a shot (Potter & Perry, 2009). Children in this age group have many fears, sprung from the mix of an extensive fantasy world and a concrete way of thinking; their reality is based on perceptions by the senses (Potter & Perry, 2009). Preschoolers fear bodily mutilation, intrusive procedures, and do not understand the body’s integrity (Ricci & Kyle, 2009). They may understand being sick and needing a hospital, but may not understand why. Preschoolers’ thinking is egocentric and magical. This can cause feelings of shame or guilt, believing that one is the cause for their illness. Magical thinking necessitates that nursing education and communication is concrete and on their level (Ricci & Kyle, 2009). This developmental age group takes words literally, and nurses need to be aware of this and careful with their interactions. Children under five are more vulnerable to emotional stress and responses to hospitalization (Ricci & Kyle, 2009). They may perceive illness or hospitalization as threats to their body or punishment for personal acts (Ricci & Kyle, 2009). Positive coping techniques to encourage in preschool aged children include distraction with books or games, music, teaching before procedures, and use of favorite toys (Ricci & Kyle, 2009). The developmental task for this age group is finding a balance between initiative and guilt (Potter & Perry, 2009). This can be threatened in hospitalization, where things are out of their control and there are limits to trying things on their own. Salmela, Salantera, & Aronen (2010) conducted research on how preschool-aged children cope with their hospital fears. The study found that the presence of parents and supportive staff, integration of play, and use of humor are essential coping mechanisms for this age group. Furthermore, it is important to empower preschool level children to express their fears and feelings, and ask for help when needed. These potential psychosocial effects of hospitalization on the preschool developmental level vary among individuals. The reaction and role the parent plays and the style of relationship the child and parent have is also a large factor in the hospitalization response of the child. The psychosocial effects on the child may vary among cultures as well. Language and communication barriers among parents of children and providers can have a negative impact on the quality of care delivered to the hospitalized child (Bethell, Simpson, & Read, 2006). It can be inferred that potential psychosocial effects on hospitalized children of different cultures may differ or go unaddressed. Trained interpreters should be utilized when there is a language barrier. In the Latino culture, the hospitalized child and family may have different fears or needs. Religion and family are very integrated into the cultural values of Latino families, and most place high value in their children (The Workgroup on Adapting Latino Services, 2008). Barriers to providing quality healthcare to Latino children and families include lack of access to health services, possible low level of health understanding by parents, and language and cultural differences (Kim-Goodwin & McMurry, 2012). Many Latinos use traditional health practices when treating their children's illnesses, which may include the use of certain foods, hot and cold practices, herbs, juices, "evil eye," healing bracelets, and coin on belly button practice (Kim-Goodwin & McMurry, 2012). Providing culturally sensitive care as nurses is extremely important because it is highly associated with positive outcomes and greater treatment adherence. Addressing the cultural differences in Latino children and families can help nurses minimize negative psychosocial effects of hospitalization. Knowing some Latino cultural values such as the importance of trust, compassion, and respect can help nurses providing care and developing a relationship with their patients. Nurses and healthcare personnel should try to be as respectful as possible when interacting with parents and use trained interpreters when needed. Nurses should be aware of the traditional gender roles usually assumed in Latino families (Kim-Goodwin & McMurry, 2012). Nurses need to be aware of the developmental stages, as well as individual cultural practices and beliefs, to help hospitalized children cope with their situation and care for their psychosocial needs. |
