impact of hospitalization on stages of development

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Impact of Hospitalization on Child’s Stages of Development:

Impact of Hospitalization on Child’s Stages of Development Presented by:-Kirandeep Randhawa

Neonate (0-1 month):

Neonate (0-1 month) Primary concerns Bonding - trust is missing Sensory and motor deprivation- tactile, visual, auditory, kinesthetic, sensory overload.

Reactions :

Reactions Impairment of parent-infant attachment. Impairment of infant’s ability to respond to parents or family members. Impairment of parent’s ability to love and care for the baby. Risk of infant emotional and physical well-being. Risk of stress within the family constellation.

Nursing intervention :

Nursing intervention Provide care within a family centered context. Provide for continual contact between baby and the parents. Minimize isolation and strangers. Actively involve parents in caring for their baby provide for rooming in. Foster neonate sibling relationship as appropriate.

Contd….:

Contd…. Identify areas of infant deprivation or over-stimulation. Provide sensory motor stimulation as appropriate. Allow individually to begin to emerge. Provide consistent care taker.

Young infant (1-4 months):

Young infant (1-4 months) Primary concerns Separation - parents are learning to identify and meet the needs of their infant. Sensory motor deprivation Need -security, motor activity Comforting measures

Reaction :

Reaction Separation anxiety Development of trust is disturbed when infant is in hospital separate from mother Interference with development of a basic sense of trust.

Nursing interventions:

Nursing interventions Encourage mother to balance her responsibilities and minimize separation, stay in with infant and provide care for her baby. Meet the baby’s basic needs promptly and give infant’s attention. Provide opportunity for sensory stimulation, motor development and social responsiveess appropriate to infant’s age and condition.

Contd…:

Contd… Help parents to see child as a unique individual with needs and personal style, to acquire infant care skills.

Mid-aged infant ( 4-8 months):

Mid-aged infant ( 4-8 months) Primary concerns Separation from mother and family members, as the infant now recognizes mother as a separate person from self. Development of self- quieting behaviours.

Reactions:

Reactions Separation anxiety- carrying, terror, somatic upset, blank facial expression, extreme preoccupation. Emotional withdrawl and preoccupation Interference with development of basic trust. Interference with growth and achievement of developmental milestones.

Nursing interventions:

Nursing interventions To adjust schedule and home routines. Encourage mother’s presence and nurturing of her baby. Foster mother’s confidence and competence in a new role. Encourage parents to adjust schedule and home routine.

Old infant ( 8-12 months):

Old infant ( 8-12 months) Primary concerns Beginning definition to self- infant is aware of a growing ability to influence his or her environment. Separation- infant becomes more possessive of mother and clings to her at the time of separation.

Reaction :

Reaction Passiveness toward environment. Separation anxiety- tolerance is limited; fear of strangers, excessive crying, clinging and over dependence on mother.

Nursing intervention:

Nursing intervention Have the mother stay and care of her child. Relieve some of tensions and loneliness with transference object. Prepare the child for procedure. Provide for sensory and motor stimulation for development of appropriate age. Foster independence by giving them opportunity to play.

Toddler ( 1-3 years):

Toddler ( 1-3 years) Primary concerns Separation anxiety Change in routine and rituals Inability to communicate Loss of autonomy and independence Decrease in mobility.

Reaction :

Reaction Protest Despair Denial Regression

Nursing interventions:

Nursing interventions Provide rooming in, unlimited visiting. Opportunity for a child to express some of the feelings about the situation. Assure the parents are not punishing of abandoning child. Periods of comfort and reassurances that allow for the re-establishment of family bond. Set limits.

Contd…:

Contd… Ensure an age appropriate safe environment, no latex balloons. Establish trust by extra love. Regress to an early stage of development.

Pre-school child (3-5 years):

Pre-school child (3-5 years) Primary concerns Separation Unfamiliar environment Abandonment and punishment Body image and integrity Immobility Loss of control

Reaction :

Reaction Regression Repression Projection displacement/ sublimation Identification Aggression Denial and withdrawl Fantasy

Nursing interventions:

Nursing interventions Minimize stress of separation by providing for parental presence and participation in care. Identify defense mechanism apparent in the child and help child through the stressful situation by accepting, showing love and concern. Set limits for the child.

Contd….:

Contd…. Provide opportunity and encouragement for child to verbalize. Encourage activities with other childern.

School aged children( 5-12 years):

School aged children( 5-12 years) Primary concerns May fear loss of recently mastered skills. May worry about separation from school and peers. Mutilation fantasies are common. Increased concerns related to modesty and privacy.

Reactions :

Reactions Regression Separation anxiety, especially early school aged period. Negativism Depression Tendency to be phobic Fear include that of dark, doctors, hospitals, surgery, medication and death.

Contd….:

Contd…. Unrealistic fear like of needles, X-ray procedure and blood. Suppression of denial of symptoms.

Nursing interventions:

Nursing interventions Help parents to prepare the child for elective hospitalizations. Obtain thorough nursing history, including information regarding health and physical developments, hospitalizations, social and cultural background and normal daily activities, use this information to plan care. Provide order and consistency in the environment.

Contd….:

Contd…. Establish the enforce reasonable policies to protect the child. Respect the child’s need for privacy. Reassure a child having surgery.

Adolescents:

Adolescents Primary concerns Physical illness, exposure and lack of privacy may cause increased concern about body image and sexually. Separation from security of peers, family and school may cause anxiety.

Reactions :

Reactions Anxiety or embarrassment related to loss of control. Insecurity in strange environment. Rejection of treatment measures, even if previously accepted. Denial or withdrawal. Demanding or uncooperative behaviour.

Nursing interventions:

Nursing interventions Assess the impact of illness on the adolescent by considering factors such as timing, nature of illness, new experiences imposed, changes in body image and expectations for the future. Be aware of some misconception. Introduce the adolescents to the hospital staff and to the regular routines soon after admission.

Contd…. :

Contd…. Obtain a thorough nursing history that includes information about hobbies, school, family, illness, hospitalization, food habits, sexuality and recreation. Encourage adolescents to wear their awn clothes and allow them to decorate their beds or rooms to express themselves. Explain clearly all procedures, routines, expectations and restrictions imposed by illness.

Contd….:

Contd…. Be a good listener, maintain a sense of humor, be honest and respectful with the adolescent and family. Encourage continuation of education.

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