Reducing The Negative Impact Of Hospitalization On Children: Using Drawings As Therapeutic Communication

The Impact of Hospitalization on Children and Family

Question:

Discuss about the High Burden of RSV Hospitalization.

Children hospitalization is a stressful occurrence to both the child and the family. Children are separated from the family and introduced to a new environment that can lead to increased anxiety or negative perceptive toward hospital in the future (Mandell, 2008). Hospitalization of young kids is viewed as an extreme situation that disturbs the kid’s life as it includes health condition decline and separation from family and other social context (Wilson et al., 2010). Children are most affected when hospitalized as it changes child development process that leads to lasting consequences. Hospitalisation also causes anxiety to children that have impact on the child emotional state with social, psychological, and physiological components. It is therefore important to understand how to reduce negative impacts of children hospitalization in order to enable them develop normally. Nursing interventions are applicable to reducing children hospitability anxiety by 88.5% (Homaira et al., 2016). Therefore understanding developmental theories and hospitalized theories can help nurses reduce anxiety and enhance normal development among hospitalized children. The following write-up will discuss how nurses can use drawing to help hospitalized children and utilize the drawings as part of therapeutic communication with children. The write up will also discuss impact of hospitalization to children and family, and use of cognitive and psychological development theory to explain a 6 year old female hospital drawing. In addition, the write-up will identify nursing strategies that can be used to support family and children during hospitalization.

The drawing of what happens in hospital by a 6 years female captures several items and people who visit her. The drawing is shows a nurse/ caregiver who is on one side and the kid siblings on the other side. The drawing is proportionate and one can see the images are differentiated to understand the message from the child. Secondly, the drawing shows the items that the child interacts with. These items are a plate of food, syringe and needle, blood transfusion equipments, bathing trough, medicinal tablets. The drawing also shows the hospital symbol. The colours used in the drawing are realistic and consistent to stereotypes. In the drawing; the blood is painted in red, water in the bathing trough is shown in blue, nurse is painted blue, healthy dietary food is painted both green and small part red. The hospital cross symbol is also painted in red. The people in the drawing are drawn in the same way or differentiated by colour to differentiate between the caregiver and her visitors.

Drawing is an important tool to a hospitalized child. Drawing help hospitalized children to express themselves. First, drawing helps the children to express their inner desires and feelings (Drake and Winner, 2013). The child is able to communicate their inner desires. For instance, children are able to express their desired state of their room or environment. The children are also able to express their feelings that review their worrying issues. Drawing enables children to focus on their inner self and present their feeling that indicates their emotional status. Secondly, drawing helps hospitalized children to express their perceptions and observations about the issues they are facing. Drawing enables children to express traumatic memories experienced and thoughts about themselves and the environment (Li, Chung and Ho, 2011). Thirdly, drawing enables children to express their personality, intelligence, and development progress. The drawing and painting helps to show the progress that a child has made in terms of personality, intelligence, and overall development. A nurse can use children drawings to communicate with the child. Children reveal worrying issues through drawing. The nurse can use a child drawing to understand the pain expressed by the child in drawing (Stefanatou, 2008). The nurse can also use a child drawing as a measure of anxiety. The nurse therefore can utilize the information to formulate strategies that can reduce child anxiety while hospitalized.

The Use of Drawing as a Tool for Therapeutic Communication

Hospitalization has impact on child’s body emotionally, socially and physiologically. Hospitalization separates children with their parents and other siblings. The children get concerned that they are separated from the family and people that they socialize with to a new environment. The child might also feel rejected by separation. Secondly, hospitalization causes fear and pain to children. They wonders what is happening or going to happen. Children fear to be alone when they are left in hospital. Hospitalization also causes anxiety to children. They are worried about their body not functioning normally causing pain and discomfort. The children are also worried about their body not being like other kids’ body. The worries cause anxiety that have profound impact to children body development. Anxiety in children interferes with normal children development that leads to lasting consequences (Stefanatou, 2008). Lastly, hospitalization also has impact on children personality in the future. Therefore, hospitalization of children has many implications to child’s life and should be minimized to reduce the impact.

The children drawings in hospital can be discussed using psychosocial and cognitive developmental theories. The drawings in the case study are representative of children between 6-11 years old bracket. The drawings at this stage show a high level of competence indicating the fourth stage of Erikson psychosocial development theory. The drawings can be clearly seen and understood at this stage. The children in this level of development can clearly draw what happens in hospital. Their drawings comprised of equipments used for treatment, the nurse/ care giver, and visitors who come to pay visit. The children are therefore described to be in industrial Vs Inferiority stage of the psychosocial theory of development (Jolley et al., 2013). According to cognitive theory of development, children of this age drawings can be said to be at preoperational stage (Brooks, 2009b). The drawings are detailed and proportional. The children are able to draw people proportionally that can differentiate between adults and children. The drawing can also show details of different people in different hairstyle. For instance, nurse hairstyle can be different from the visitors’ hairstyle. The hairstyle between genders is also indicated in the drawing with siblings and mother having a different hairstyle. The drawings can also show emotions on the peoples’ face. Secondly, the drawings of children in this category have colours that are realistic and follow stereotype. The items are painted in their realistic colour or general colour stereotype. For instance, blood in the drawing can be drawn in colour red making the drawing more realistic, the hospital symbol can drawn in red making it look real in the drawing, the nurse can be painted blue in the drawing that is in line with the reality where most nurses or caregivers wear blue attires. The drawing may also contain several stereotypes. For instance, the water in a bathing trough can be drawn in colour blue which is a common colour that is used to show water in drawings, the drawing of a healthy dietary food can be painted in green. The green colour is used to signify a balance and healthy dietary meal. The other stereotype colour paint in a drawing can be syringe and needle shown in red. People generally fear injection as painful and the use of red colour signifies pain than has to be feared. The 6-11 year old hospitalized child drawing can also show ground lines. For example, the drawing can show a bathing trough on a surface ground line. The ground line shows start making the drawing to not look like they are hanging on the air. Lastly, the drawing can show a show a pattern of consistent to similar images. For example, a child drawing can show consistent pattern when drawing people. Therefore, children of age bracket 6-11 experience developmental changes that can be seen through their drawings.

Psychosocial and Cognitive Developmental Theories in Children’s Drawings in Hospitalization

Hospitalization of children has impact on their family emotionally, socially, physically and financially. The family feel apprehended and distressed. The family feel powerless about the helpless situation that their children are experiencing that cause apprehension and distress. Secondly, the family feel separated from their children. This makes the family members to feel lonely especially when the child is the only kid in the family. The family lacks enough time to spend with their children making it an awful experience. Thirdly, the family gets worried about their hospitalized children. The family is in panic mood without knowing what will happen to one of their family member. The worries lead to anxiety among the family member. The family members experience anxiety that have profound impact to their lifestyles. The family spend most of their time thinking about their children and travelling to see them in hospital. In some scenarios, children hospitalization requires the mother to accompany the child. The mother is therefore admitted beside her or his child. The mother spends much of her time in the hospital taking care and accompanying the child in hospital. The mother is then unable to attend to her normal routine either at workplace or home. The mother not going to work lead to them losing their jobs or payment from their employers or businesses.  Lastly, children hospitalization has impact on the family finances. The family has to cater for the child medical bill to keep them accessing medical attention. The family also has to incur transportation cost to periodically visit the child in hospital. The family has to stretch their budget to cater for their children condition that sometimes drains their financial accounts (Ranmuthugala, Brown and Lidbury, 2011). Child hospitalization is therefore an expensive unavoidable situation to the family.

Nursing strategies can be used to support both the child and the family and reduce negative impact of child hospitalization. The first applicable strategy is practicing calmness. Calmness help reduce tense and stress and can be attained by speaking confidently, composed and remaining strong no matter what the situation is (Brooks, 2009a). Nurses showing nervousness to kids or family can make them anxious thereby increasing the level of anxiety. Secondly, nurses can communicate and talk to the child and family through the experience. Nurses communicating to both the hospitalized child and the family help to recognize the fears that reduce anxiety as a result of fear of unknown. This reduces family and child fears in the hospital. Thirdly, nurses can employ distracts to hospitalized children. Distracts go long way by engaging the child in their interests letting them less dwell on their condition (Noorlander, Bergink and Van Den Berg, 2008). Distracts can include favourite TV shows, friends or pet. The fourth strategy can be being educational to both the child and the family. Being educational enables the child to learn new things and find pride in their new knowledge while appreciating the environment (Madden et al., 2009). Also being educative to parents can help reduce family’s fear of unknown about their hospitalized child. Fifth, nurses can allow children express themselves in drawings. The nurse can provide drawing materials to the child and let them draw. Drawings help children express their feelings, memories, and thoughts about their environment (Mandell, 2008). The nurses can then use the drawings as part of therapeutic communication. Nurses can also support hospitalized children by enabling physical comfort in the hospital. Most children fear hospitals because they associate hospital with feeling pain (Hegarty et al., 2009). The nurse can apply instant topical anaesthetic to improve the child comfort and they will feel less pain. The last but not the least, nurses can offer treat or play music to hospitalized children. Offering treat help the children change or adapt to an environment faster. They feel appreciated and dignified that change their perception and attitude in hospital. Playing music can act as anti-anxiety agent. Music elicits a variety of emotional and physical responses. For instance, playing slow tempos can be used to soothe the mind and relax muscles (Koukourikos et al., 2015). These strategies are important to reducing child hospitalization impact to both the child and the family.

From the write-up, children hospitalization is a stressful experience to both the child and the family. Child hospitalization causes fear, anxiety, worries and isolation that have an overall impact on the child development process.  Child hospitalization also causes loneliness, distress, worries, and helplessness to the family. Drawing is a powerful tool for children to express themselves during hospitalization. Drawings express their feelings, memories, and thoughts about the environment. Drawings are important as they serve as part of therapeutic communication to nurses. Nurses can practice calmness, employ distracts, play music, be educative, communicate through the experience and make physical comfort to reduce the impact of child hospitalization to both the child and the family.

References

Brooks, M. (2009a) ‘Drawing, visualisation and young children’s exploration of “big ideas”’, International Journal of Science Education, 31(3), pp. 319–341. doi: 10.1080/09500690802595771.

Brooks, M. (2009b) ‘What Vygotsky can teach us about young children drawing’, International Art in Early Childhood, 1(1), pp. 1–13. Available at: https://www.artinearlychildhood.org/artec/images/article/ARTEC_2009_Research_Journal_1_Article_1.pdf.

Drake, J. E. and Winner, E. (2013) ‘How children use drawing to regulate their emotions’, Cognition and Emotion, 27(3), pp. 512–520. doi: 10.1080/02699931.2012.720567.

Hegarty, M. et al. (2009) ‘Quality of life in young people with cystic fibrosis: effects of hospitalization, age and gender, and differences in parent/child perceptions.’, Child: care, health and development, 35(4), pp. 462–8. doi: 10.1111/j.1365-2214.2008.00900.x.

Homaira, N. et al. (2016) ‘High burden of RSV hospitalization in very young children: A data linkage study’, Epidemiology and Infection, 144(8), pp. 1612–1621. doi: 10.1017/S0950268815003015.

Jolley, R. P. et al. (2013) ‘Expressive drawing ability in children with autism’, British Journal of Developmental Psychology, 31(1), pp. 143–149. doi: 10.1111/bjdp.12008.

Koukourikos, K. et al. (2015) ‘The Importance of Play During Hospitalization of Children’, Materia Socio Medica, 27(6), p. 438. doi: 10.5455/msm.2015.27.438-441.

Li, W. H., Chung, J. O. and Ho, E. K. (2011) ‘The effectiveness of therapeutic play, using virtual reality computer games, in promoting the psychological well-being of children hospitalised with cancer’, Journal of Clinical Nursing, 20(15–16), pp. 2135–2143. doi: 10.1111/j.1365-2702.2011.03733.x.

Madden, S. et al. (2009) ‘Burden of eating disorders in 5-13-year-old children in Australia’, Medical Journal of Australia, 190(8), pp. 410–414. doi: mad10866_fm [pii].

Mandell, D. S. (2008) ‘Psychiatric hospitalization among children with autism spectrum disorders’, Journal of Autism and Developmental Disorders, 38(6), pp. 1059–1065. doi: 10.1007/s10803-007-0481-2.

Noorlander, Y., Bergink, V. and Van Den Berg, M. P. (2008) ‘Perceived and observed mother-child interaction at time of hospitalization and release in postpartum depression and psychosis’, Archives of Women’s Mental Health, 11(1), pp. 49–56. doi: 10.1007/s00737-008-0217-0.

Ranmuthugala, G., Brown, L. and Lidbury, B. A. (2011) ‘Respiratory syncytial virus–the unrecognised cause of health and economic burden among young children in Australia.’, Communicable diseases intelligence quarterly report, 35(2), pp. 177–84. Available at: https://www.ncbi.nlm.nih.gov/pubmed/22010512.

Stefanatou, A. (2008) ‘Use of drawings in children with pervasive developmental disorder during hospitalization: A developmental perspective’, Journal of Child Health Care, 12(4), pp. 268–283. doi: 10.1177/1367493508096203.

Wilson, M. E. et al. (2010) ‘The Voices of Children: Stories About Hospitalization’, Journal of Pediatric Health Care, 24(2), pp. 95–102. doi: 10.1016/j.pedhc.2009.02.008.

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