Effect of Stay in Hospital on Patients

Question 1

Identify the main physical health hazards of hospitalisation.

Answer 1

• Bed rest

* HCAI

Question 2

Identify the effects of hospitalisation on adults.

Answer 2

• unfamiliar hospital environment
• entering the role of a patient
• loss of control
• depersonalisation
• institutionalisation

Question 3

Identify specific effects of hospitalisation on children.

Answer 3

• separation distress
• illness misconceptions
• faulty representation

Question 4

What are the main consequences of increased bed rest on health ?

Answer 4

Decreased muscle mass and increased body fat (decreased fitness and functional ability, which can result in loss of independence for elderly patients)

Question 5

How can the risk of HAIs be reduced ?

Answer 5

By the implementation of hospital infection control guidelines

Question 6

Why is the hospital environment problematic for patients ?

Answer 6

• unfamiliar environment
• privacy is often limited
• wards can be stressful places to stay (not conducive to recovery)
• staff wear uniforms
• a patient may interact with up to 30 members of staff in a day
• many objects in the environment are unfamiliar

Question 7

Describe the issue of “entering the role of a patient” in hospital stays.

Answer 7

Loss of familiar social roles from work and home results in the patient ‘role’:
•wear night-clothes during the day
•allowing parts of their body to be examined •little control over timing of meals, visits or when the main lights go out

Question 8

What do doctors as being “good” patients ? “bad” patients ? Which of these categories is more likely to make a better recovery ?

Answer 8

“Good patients” are perceived as being passive, not demanding much time etc. when in fact “Bad patients” (those asking questions, complaining etc.) understand their situations better and therefore are likely to make a better recovery.

Question 9

Explain the issue of “loss of control” associated with hospital stays.

Answer 9

-Restrictions are placed upon patients:
•therapeutically desirable restrictions (better for recovery)
•organisationally desirable (e.g. everyone gets lunch at the same time)

-As a result of these restrictions, reactance (feeling of anger when patient feels restrictions are unnecessary, and hospital staff often on receiving end of reactance)

-Patients can have an internal, or external recovery locus of control (measured through a recovery locus of control scale, RLOC) following a hospitalisation. Internal locus means they feel they control their recovery, whilst external locus means they feel their recovery is in the hands of the doctors etc.).
Patients with internal loci make better recoveries (since they know their behavior controls their recovery, more likely to adhere to treatment, carry out physiotherapy).

-Inpatient episodes can be used to boost a patients perception of self control

Question 10

Give an example of what a patient with an internal recovery locus of control might say.

Answer 10

It’s what I do to help myself that’s really going to make all the difference

Question 11

Describe an experiment performed to test the effectiveness of internal loci of control.

Answer 11

• Hysterectomy patients under general anaesthesia.
• Audio therapeutic suggestions and statements designed to reinforce the internal locus of control (e.g. it’s what you do that controls your recovery) played along with blank tape, because cortical audio evoked responses are not abolished by most general anaesthesia (so their cortex was still processing the information)
• When compared with a control group, they had shorter periods of bedrest following the operation, and a better recovery.

Question 12

Identify and define some the forms of control which may be lost in the process of a hospital stay ?

Answer 12

Behavioural control: perceived ease or difficulty of performing the particular behavior.

Cognitive control: How patient thinks about hospital experience they are having.

Decision control: perceived ease or difficulty of making decisions.

Informational control: perceived awareness of the information to assist them in increasing recovery or making decisions.

Question 13

Give examples of ways to aid patients in increasing the different forms of control which may be lost in a hospital stay. What is the benefit of improving these forms of control in hospital ?

Answer 13

Behavioral control: Teach patient to turn over in bed without pulling stitches, physiotherapy

Cognitive control: Encourage patient to focus on positive aspects of hospitalization

Decision control: Shared healthcare

Information control: Helping patient get reliable information from reliable sources

Improving these forms of control (i.e. preventing the patients losing them) can aid recovery.

Question 14

Define depersonalisation. Give an example of something a doctor might stay when depersonalising a patient. What is the problem with depersonalisation?

Answer 14

When your patient is treated as though he or she were either not present or not a person
“The stomach ulcer in bed nine”

Depersonalisation can reduce patient satisfaction in care.

Question 15

Why does depersonalisation occur ?

Answer 15

1) a way of distancing the doctor from the fact that the body they are treating belongs to a thinking and worried person (helps them not be emotionally involved)
2) may help practitioners deal with patients deteriorating or dying
3) overworked, stressed and tired doctors may lead to less personalised care

Question 16

Describe the process of institutionalisation which may occur as a result of hospital stay.

Answer 16

•In normal life people adopt a variety of roles each day
•In hospital the variety of roles they can adopt is reduced
When a patient stays in hospital for a long time,”deficits or disabilities arise in social and life skills”, difficult to adjust to normal life (due to lack of roles they adopted in hospital)

Question 17

Describe the trend for average length of hospital stay over the past few years. What is the implication of this trend over institutionalisation.

Answer 17

Average length of hospital stay has decreased, so institutionalisation less of a problem.

Question 18

What is the reason that children form attachment with their primary carers ? Describe the experiment done to provide evidence for this.

Answer 18

Because of the safety, security and comfort.
Experiment with rhesus monkey, presented with two surrogate parents: one providing him with food and one furry parent providing him with comfort. The monkey was spending most of his time with the latter, and was only comfortable playing when the latter was around. The monkey was curled up and uncomfortable playing when the furry surrogate parent was not present.

Question 19

Describe the separation distress and anxiety that children may feel during a hospital stay.

Answer 19

3 stages of separation:
•protest (cry, scream)
•despair (hopeless, not v active)
•detachment (if separation is prolonged, even if primary caregiver were to return, would not make a fuss and may even push them away)

Question 20

At what age does peak separation anxiety occur ?

Answer 20

Around 13 months.

Question 21

Give examples the misconceptions and faulty illness representation of children during a hospital stay.

Answer 21

•misconception:
-illness as punishment for being “bad”

•faulty illness representation:
-a haemophilia bug

Question 22

How may health professionals address the misconceptions and faulty illness representation of children during a hospital stay.

Answer 22

Health professionals should try and inform in best way possible, what is causing illness
and what it is they are experiencing.

Question 23

What are the impacts of hospitalisation on a child’s behaviour ? What is the timeline for these impacts ?

Answer 23

• may regresses sharply (e.g. toilet trained, go back to wetting themselves)
• nightmares (possibly about their experience, e.g. mean doctor)
• irritable (in older children, instead of nightmares or regression of behavior)

These may not occur until they have returned home

Question 24

How can we improve the experience of hospital for children?

Answer 24

• day surgery or outpatient treatment when feasible to reduce time in hospital
• preparation for hospitalisation (e.g. role play with toys, watching videos of child same age, visit ward beforehand.
• unrestricted parental visits
• nursing staff supporting and educating parents to care for their child in hospital (i.e. helping parents carry out small healthcare support tasks (e.g. train them to change catheter bags, help them feed the child)
• reduce the number of nursing staff dealing with a particular child (i.e. one key worker with child)
• communicate with the child (i.e. no perceived loss of control) as well as the parents