1. Preparation for Hospitalization and Medical Procedures

2. Hospitalization  Can be very scary experience  Unknown medical staff approach children and are oftentimes wearing masks  Unusual odors  New environment  Parents are sometimes absent  Actual medical procedures can be frightening and painful  They are usually not feeling well to begin with

3. Medical Procedures During Hospitalizations  1/3 of hospitalized children suffer transient or long-term psychological reactions  What are some common medical procedures that children might experience while being hospitalized?

4. Methods of Preparation  Not empirically validated  Group tours and discussions  Bibliography  Puppetry  Play therapy

5. Types of Programs  Modeling  Filmed modeling  Puppetry  Coping skills training  Deep muscle relaxation  Imagery distraction  Positive self statements

6. Factors Influencing Effectiveness  Age  Knowledge  Separation issues  Prior experience  Previous reaction  Self-efficacy vs trauma  Timing  Abstract cognitive capacity in older kids  Parents  Anxious mothers  Parenting style

7. Goals for Preparation Programs  Expectations/Predictability  Surgical holding areas  Hospital gown/shirt  Identification bracelets  Meet with surgical team  Pre-Operation visit  Waiting rooms

8. Goals for Preparation Programs  Encourage trusting relationships  Child participates in procedure  Child given control over rest periods  Child given choices  Staff make effort to know patient ’ s likes/dislikes, hobbies, school interests  Child told truth  Child has access to toys/blankets  Allow parents to sleep in patient ’ s room

9. Goals for Preparation Programs  Providing emotional support  “ I understand ” statements to communicate empathy  Reward children for specific cooperative behaviors  Reassuring physical touches may help relax child

10. Goals for Preparation Programs  Providing age-appropriate information  Tell child what to expect (don ’ t lie)  Specific information about how to behave is often better than detailed explanations about why certain things are done  Provide sensory information (smells, sounds)

11. Preparing Infants  Stressors:  Separation from parents  Having many different caregivers  Seeing strange sights, sounds, smells  New, different routines  Interrupted sleep  Day and night confusion

12. Preparing Infants  Keep routines  Bring favorite security item  Let nursing staff know about baby ’ s schedule  Parents remain calm  Be patient with infant  Hard to comfort, console, clingy  Distract, rock, comfort

13. Preparing Toddlers/Preschoolers  Stressors  Being left alone  Having to stay in strange bed/room  Loss of comforts of home, family  Being in contact with unfamiliar people  Painful procedures  Medical equipment that looks scary

14. Preparing Toddlers/Preschoolers  Read books about going to hospital  Interactive play with dolls  Simple explanations  “ The doctor will fix your arm ” vs. “ The doctor is going to make a cut in your arm. ”  Anesthesia is “ being put to sleep ” vs “ help you fall asleep during operation and wake up afterwards ”  Tell the truth: “ It will hurt (like … ), but it won ’ t last long ”  Establish “ procedure free zones ”  Stay with child during hospitalization

15. Preparing School Age  Stressors  Being away from school/friends  Thinking he/she is in hospital because he/she is being punished  Loss of control  Pain  Needles/shots  Dying during surgery

16. Preparing School Age  Take tour  Make sure child knows why is having surgery in words they understand  Have child explain back their understanding  Read books  Give as many choices as possible  Explain benefits of surgery  “ after your knee is healed, you will be able to play soccer again. ”  Encourage child ’ s friends to visit  Have someone stay with child as much as possible  Let child know it ’ s acceptable to cry and be afraid

17. Preparing Teenager  Stressors  Loss of control  Being away from school/friends  Having a part of his/her body damaged or changed in appearance  Fear of surgery and risks  Pain  Dying during surgery  Fear of the unknown  Fear of what others will think about them being sick in hospital

18. Preparing Teenager  Allow teen to be part of decision making process (e.g., encourage to make list of questions)  Read books  Ask friends to visit/send cards  Journal  Bring comfort/game items from home  Personalize space  Be patient with mood swings – allow them to be alone if needed  Let them know it ’ s acceptable to cry/be afraid  Be truthful  Honor privacy requests

19. Website  http://www.chop.edu/kidshealthgalaxy/k hg.shtml