Stress of Illness and Hospitalization

Subject: Child Health Nursing

Overview

Separation anxiety, hospitalization, loss of control, bodily injury, and pain, as well as the impact of the hospitalization on the children and parents, are some of the steps that lead to the stress of illness and hospitalization. Separation anxiety is a significant source of stress in children between the ages of 6 and 30 months. Anxiety over separation symptoms. When a parent leaves them, kids act out violently. Cries, screams, looking for a parent's eyes, clinging to a parent, avoiding and rejecting interaction with strangers are all manifestations. Another stressor that heightens the sense of threat and might have an impact on kids' coping mechanisms is loss of control. When a kid becomes ill suddenly and seriously, it is very difficult for parents to believe what is happening.

Stress of Illness and Hospitalization

Separation anxiety

A major cause of stress from ages 6-30 months is separation anxiety. Manifestations of separation anxiety is an:

  • Young children :
    • Phase of protest
    • Children react aggressively to the separation from a parent. Manifestations are cries, screams, searches for parent eyes, cling to a parent, avoid and reject contact stranger. Additional behaviors observe during toddlerhood are verbally and physically attacks strangers, for to parents to nearby etc.
    • Phase of despair
    • Manifestations are inactive, withdraw from others, sad, depressed, uninterested in an environment, uncommunicative, regressive to earlier behavior that is thumb sucking, bed wetting, request to eat and drink etc.
    • Phase of detachment
    • It is a most serious stage of separation is prolongs. Manifestations are increased in surroundings interacts with strangers, from new but a superficial relation appears happy and behavior represent a superficial adjustment to loss.
  • During early childhood
    • During this age, a child can tolerate a brief period of separation and are more inclined to develops substitute trust in other significant adults. Manifestations refusing to eat, difficulty in sleep, crying, continuously asking when the parents will visit or withdrawing from others. Anger breaking they are will visit or withdrawing from others, their toys, hit other children, refusing to co-operate during useful self-care activities. Nurses need to be sensitive to these less obvious signs care of separation anxiety in other to take appropriate actions.
  • Middle childhood and adolescents
    • They rank "BE AWARE FROM MY FAMILY" need parental security and guidance. Manifestations are even disliked school, they admit to missing its routine and wrong that they will not be able to complete, feeling of loneliness, boredom, isolation and depression.
    • School age children may need desire parental guidance or support from other adult but are unable or unwilling to ask for it because of culture expectations to act like a man or to be brave and strong.
  • Adolescents
    • In this separation from home and parents may be welcomed and appreciated events. However, loss of peer group contacts many develop severe emotional threat due to loss of group status, and loss of acceptance.

Loss of control

Loss of control is another stressor that increases the perception of threat and can affect children's coping skills. Most hospital situations decrease the amount of control a child feels. A major area of loss of control during illness and hospitalization are a physical restriction, altered routine, dependency for each age group.

  • Loss of control during infancy
    • Trust develop when loving care by a care provider. They control their environment through emotional expressions such as crying or smiling. Inconsistent care and deviations from infant daily routine may lead to mistrust.
  • During toddler
    • Manifestations are a temper tantrum. Their limitations and restrictions of movements will lead loss of control. When routine rituals example eating, sleeping, bathing, toileting, and play are disrupted, then change into repressive behaviors.
  • During pre-school period
    • They lost control due to physical restriction, altered routines, and enforced dependency. They are egocentrism and magical thinking which limits their ability to understand events because of they all experiences from their own self-referenced perspective so, without adequate preparation for familiar settings or experience, preschoolers fantasy explanation for such events are usually more exaggerated, bizarre and frighten than the actual facts.
  • During school-age children
    • Altered in,
    • Physical disability
    • Fears of death
    • Permanent injury
    • Loss of peer acceptance
    • These all may result in loss of control.
  • During adolescence
    • Due to illness, their activities will limit. They try to react to dependency with rejection, uncooperative or withdrawal.

Bodily injury and pain

Fear of bodily injury and pain is the 3rd cause of stress among children.

  • Young infant
    • Generalized body responses of rigidity or thrashing (violent). Eyes tightly closed, mouth open.
  • Older infant
    • Localized body response with deliberated withdrawal of stimulated areas, eyes are open, pushing the stimulus away after it is applied example IV cannula.
  • Young child
    • Loud crying, screaming, verbal expressions that is OW, OUCH, attempts to push stimulus away it is applied, clings to parents, nurse or other significant people.
  • School age child
    • Altered family roles, physical disability and fears of death, permanent injury, lack of peer acceptance, lack of productivity and inability to cope with stress according to perceived cultured expectation may result in loss of control among school age children.
  • Adolescent
    • The Less vocal protest, less motor activity, more verbal expression, increased muscle tension and body control.

Effect of hospitalization on the children

  • Young children
    • Initial and alone (detachment) toward parents, frequently followed by dependency behaviors, nightmares, hyperactivity, temper tantrums, food finickiest (choose), attachment to blanket or toy, resistance to going to bed.
  • Older children
    • Anger toward parents and jealousy towards others that is siblings.

Parents reaction towards hospitalization

  • Disbelief
    • Means of refusal or reluctance belief. Especially if an illness is sudden and serious in nature, then it is very hard to believe.
  • Anger or guilt
    • After the realization of the situation, parents react with anger or guilt or both.
  • Fears, anxiety, and frustration are expressed by parents
    • Here fear and anxiety concerned to the seriousness of illness and treatment procedure. Frustration is often related to lack of information regarding disease process and treatment protocol.
  • Depression
    • This usually occurs when the acute crises are over, parents may worry about and miss their other children who may be left in the care of friends/neighbors.

Siblings reaction

  • Siblings reaction to sister or brothers illness and hospitalization are loneliness, fear, and worries. Their main reactions are anger, jealousy, and guilt.

Effects on the siblings

  • Young people are going through a lot of changes.
  • Cared after by a caregiver who is not a family member outside the home.
  • Had little knowledge of their sick brothers or sisters.
  • Believed that their parents were treating them differently than they had before their sibling was admitted to the hospital.

 

 
Things to remember
  • A stress of illness and hospitalization occurs in certain steps like; Separation anxiety, Loss of control, Bodily injury and pain, Effect of hospitalization on the children and Parents reaction towards hospitalization.
  • A major cause of stress from ages 6-30 months is separation anxiety. Manifestations of separation anxiety.
  • Children react aggressively to the separation from a parent. Manifestations are cries, screams, searches for parent eyes, cling to a parent, avoid and reject contact stranger.
  • Loss of control is another stressor that increases the perception of threat and can affect children's coping skills.
  • Parents can't believe their child illness, especially if an illness is sudden and serious in nature, then it is very hard to believe.


     
Questions and Answers

Stress of illness and hospitalization

Separation anxiety

Between the ages of 6 and 30 months, separation anxiety is a significant stressor. The following are signs of separation anxiety:

  • Phase of protest:
    • When a parent leaves them, kids act out violently. Cries, screams, looking for a parent's eyes, clinging to a parent, avoiding and rejecting interaction with strangers are all manifestations. Toddlers may also verbally and physically attack strangers, their parents, people in the neighborhood, etc.
  • Phase of despair:
    • Inactivity, withdrawal from others, sadness, depression, lack of interest in one's surroundings, a lack of communication, and a return to previous behaviors such thumb sucking, bedwetting, and requests for food and drink are examples of manifestations.
  • Phase of detachment:
    • The separation is in its most serious level at this point. Increased manifestations include interacting with strangers, forming brief new relationships, appearing content, and acting in ways that only partially address loss.
       
  • During early childhood
    • At this age, a kid is able to handle a brief time of separation and is more likely to build substitute adult trust. Constantly inquiring when their parents would visit, sobbing, refusing to eat, or withdrawing from others are some manifestations. Anger can cause someone to break their will, stop visiting others, stop playing with toys, hit other kids, or stop cooperating with helpful self-care activities. In order to respond appropriately, nurses must be aware of these less evident symptoms of separation anxiety.
  • Middle childhood and adolescents
    • They prioritize parental security and guidance as a "be aware from my family" necessity. They admit to missing the routine and work they won't be able to do, as well as feeling lonely, bored, alone, and depressed. They even detest going to school.
    • Children of school age may need parental guidance or other adult support, but they may be unable or unwilling to ask for it due to cultural expectations that they should behave like men or be brave and strong.
  • Adolescents
    • These occurrences of separation from one's home and parents may be valued and embraced. However, a serious emotional danger can arise when peer group contacts are lost as a result of losing acceptance and group standing.
    • Loss of control:
      • Another stressor that heightens the sense of threat and might have an impact on kids' coping mechanisms is loss of control.
    • Loss of control during infancy:
      • When a caregiver provides tender care, trust is developed. They exert emotional control over their surroundings by grinning or sobbing. Mistrust might develop as a result of inconsistent care and alterations to an infant's daily routine.
  • During toddler
    • Temper tantrums are manifestations. Their limitations and movement restrictions will result in loss of control. When daily rituals like eating, sleeping, bathing, using the restroom, and playing are disturbed, repressive behaviors develop.
  • During pre-school period
    • Physical confinement, changing routines, and forced dependency cause them to lose control.
  • During school-age children
    • Altered in,
      • Physical impairment.
      • A fear of dying.
      • Persistent harm.
      • Loss of approval from peers.
    • Any of these could lead to a loss of control.
  • During adolescence
    • They will have fewer activities due to illness. They attempt to respond to dependency by being disagreeable, rejecting, or withdrawing.

Bodily injury and pain:

A third source of stress for children is their fear of suffering physical harm and pain.

  • Young infant
    • Generalized stiffness or thrashing of the body (violent). Open mouth and tightly closed eyes.
  • Older infant
    • Eyes are open and the body reacts locally, pushing the stimulus away after it has been applied, as in the case of an IV cannula.
  • Young child
    • Loud crying, screaming, OW and OUCH verbalizations, attempts to push away the applied stimulus, and clinging to parents, nurses, or other important people.
  • School age child
    • Children of school age may lose control due to altered family roles, physical disabilities, fears of death and permanent injury, lack of peer acceptance, a lack of productivity, and an inability to handle stress in accordance with perceived cultural expectations.
  • Adolescent
    • Less vocal protest, less movement, more verbal expressiveness, more body control, and more muscle tension.

Effect of hospitalization on the children

  • Young children
    • The first sign of parental aloneness (detachment) is frequently followed by dependency behaviors, nightmares, hyperactivity, temper tantrums, picky eating, attachment to a blanket or toy, and resistance to bedtime.
  • Older children
    • Anger toward one's parents and envy of one's siblings.

Parents reaction towards hospitalization

  • Disbelief
    • Methods of disbelief or hesitation. It is quite difficult to believe when a disease strikes suddenly and severely.
  • Anger or guilt
    • Parents react out of anger, guilt, or both after realizing the circumstances.
  • Fears, anxiety and frustration are expresses by parents
    • Fear and anxiety are thus related to the severity of the sickness and the course of treatment. A common source of frustration is ignorance of the disease process and recommended course of treatment.
  • Depression
    • Parents may worry and miss their other children who may be placed in the care of friends or neighbors after the intense crying has subsided.

Siblings reaction

Loneliness, dread, and worries are the siblings' responses to a sibling's illness and hospitalization. Their primary responses are rage, envy, and guilt.

Effects on the siblings:

  • Youth are going through a lot of changes.
  • Cared after by a caregiver who is not a family member outside the home.
  • Had little knowledge of their sick brothers or sisters.
  • Believed that their parents were treating them differently than they had before their sibling was admitted to the hospital.

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