MENNONITE COLLEGE OF NURSING
at
Illinois State University
Nursing Care Of Children 317
Reaction to Hospitalization
SEPARATION ANXIETY
FEAR OF PAIN AND BODILY INJURY
ANXIETY DUE TO LOSS OF CONTROL
I. INFANTS (birth to 1 year)
Prior to Attachment
at 6 months - none
After 6 months protest
despair
denial
Nursing Action
1. Rooming in, unlimited visiting
Encourage parents to stay.
Include parents in care plan.
2. Become surrogate parent with
thorough, detailed knowledge of
care routine.
3. Provide physical presence when
crying.
4. Provide familiar environment
with toys, blanket and p.j.'s,
bottle, tape of parents.
1 month - diffuse body movement brief
loud crying
After 6 months - reaction depends on:
1. memory of prior pain
2. parental reaction
3. offers resistance
1. Preparation of little use
2. Perform painful procedure ASAP
3. Remove painful stimuli (meet
needs)
4. Encourage parental touching,
stroking, holding
THEORISTS:
ERIKSON
Trust vs. mistrust (meet needs)
PIAGET
Sensory/Motor (allow exploration of
environment)
FREUD
ORAL
Explores everying orally
SEPARATION ANXIETY
FEAR OF PAIN AND BODILY INJURY
II. TODDLER (12 months - 3 years)
1. Respond in same manner as older
infants.
2. May become physical and/or
verbal when parents leave.
Nursing Action
1. Same as with infant.
2. Plus talk about parents and
home.
ANXIETY DUE TO LOSS OF CONTROL
(very egotistical)
1. Poorly defined body boundaries.
Intrusive procedures are just as
anxiety producing as painful
procedures.
2. React to pain with intense
emotional outbursts and physical
resistance, may be hostile kicking, hitting, biting.
1. Resistance or limitation of
motor skills - immediate threat
to sense of security
(restraints).
2. Altered routines and rituals decreased sense of stability
and control (eating, toileting,
ADL, playing).
3. Enforced dependency leads to
negativity expressed as temper
tantrums.
1. Give permission to express
feelings.
2. Use band-aids.
1. Gain detailed information about
home routines and duplicate as
much as possible.
THEORISTS:
ERIKSON
Autonomy vs. Shame.
PIAGET
Sensorimotor until 2 years
Pre-conceptual 2-4 years
FREUD
ANAL
gains control over body orifices
SEPARATION ANXIETY
FEAR OF PAIN AND BODILY INJURY
ANXIETY DUE TO LOSS OF CONTROL
III. PRE-SCHOOL (3-6 years)
1. May regress due to illness.
2. Normally can substitute trust in
other significant adult.
3. May react by:
a. refusal to eat
b. quiet crying
c. sleep disturbances
d. asking often when parents
will visit
e. indirect expression of anger
against toys; hitting or
refusing to cooperate
Nursing Action
1. Same as before, plus:
2. Talk about home
3. Have familiar items
1. Believes can postpone painful
procedures forever.
2. Poorly developed body integrity
concept (fears insides will leak
out).
3. Concerned about mutilation.
4. By age 4 - may develop some
self-control but also may develop
psychosomatic illnesses.
5. Reacts to stress with:
aggression, verbal expression,
regressing to dependency.
1. Caused by:
physical restraints, altered
routines, enforced dependency.
2. "Egocentrism" and "magical
thinking" limit understanding.
Fantasy is often worse than
fact (hospitalization is
punishment for real or imagined
misdeeds).
1. Allow to express feelings.
2. Accept regressive behavior but
encourage appropriate behavior.
3. Use term "fixed" rather than
"cut" or "remove".
1. Alter routines as much as
possible, allow physical
mobility; avoid intrusive
procedures.
2. Encourage expression of feelings
through play and direct action.
3. Remove magical thinking - orient
to reality.
4. Anticipatory preparation.
THEORISTS:
ERIKSON
Initiative vs. Guilt
SEPARATION ANXIETY
PIAGET
Intuitive
FEAR OF PAIN AND BODILY INJURY
FREUD
OEDIPAL
ANXIETY DUE TO LOSS OF CONTROL
IV. SCHOOL AGE (6-12 years)
1. Young: may require parental
presence, support and guidance.
2. Mid-to-late: react to loss of
usual activities and peer group.
3. May need/desire support and
guidance but may not be able to
ask.
4. Feels lonely, isolated, bored,
depressed.
1. Fears bodily harm and death.
Focuses on disability and uncertain recovery.
2. Less fear of pain - by 9-10 can
describe pain.
3. Concerned over effects of
procedure...
a. What's it for?
b. Does it hurt?
1. Feelings of control and power
decreased by:
a. altered family roles.
b. physical disabilities.
c. fear of death, abandonment,
or permanent injury.
d. loss of peers.
e. lack of productivity.
f. inability to cope with
Nursing Action
1. Give clock to anticipate visits.
2. Plan visits with friends or
phone calls.
3. Continue school activities.
4. Socialize with own age group.
c. How does it make him better?
d. What injury or harm could
result?
4. Seeks information about illness.
5. May procrastinate.
stress.
2. Boredom - depression, hostility,
frustration.
1. Allow to express feelings.
2. Acknowledge fears and concerns.
3. Stress reason for painful procedure and evaluate
understanding.
1. Provide anticipatory
instructions.
2. Allow mobility.
3. Allow jointly planned care.
THEORISTS:
ERIKSON
Industry vs. Inferiority.
PIAGET
Intuitive until 7 years.
Concrete Operations 7-12 years.
FREUD
LATENCY.
SEPARATION ANXIETY
FEAR OF PAIN AND BODILY INJURY
ANXIETY DUE TO LOSS OF CONTROL
V. ADOLESCENT (13-18 years)
1. Loss of peer contact, group
status, and control.
2. Loss of group acceptance.
Nursing Action
1. Plan visits with peers and
parents.
2. Plan means of keeping in touch
with peers.
3. Keep active in school or
activities.
4. Familiar articles from home.
5. Own age roommates.
1. Emphasis on normalcy.
2. Views injury, illness, pain,
disability, death as it effects
his view of himself.
3. Asks many questions, rejects
others, withdraws, questions
care.
4. Responds with overconfidence,
conceit, know-it-all attitude.
5. Concerned about privacy.
6. Psychosomatic complaints.
1. Anything that interferes with
adolescent struggle for
independence, self-assertion,
and liberation poses threat to
sense of identity.
2. Illness is a major situational
crisis.
3. May respond with rejection,
withdrawal, uncooperativeness,
self-assertion, anger, frustration. May isolate self from
peers until he can compete on
equal basis.
1. Allow expression of feelings and
concerns.
2. Help develop coping mechanisms.
3. Provide privacy.
1. Mobilize AMAP.
2. Collaborative planning.
3. Age appropriate communication.
THEORISTS:
ERIKSON
Identity vs. Role Confusion.
PIAGET
Formal Operations.
FREUD
GENITAL.