Preparing Children for Hospitalization; a Classroom Teaching Approach

Arlene Brett

Hospitalization is usually a traumatic experience, especially for a child. Often the hospitalization is planned, enabling parents and health care personnel to prepare the child for the experience. Other times i t is unexpected, allowing little time for emotional preparation.

Research has shown that preparation greatly reduces the damaging emotional effect of hospitalization on children. ' Some hospitals have programs to teach healthy children ahout hospitalization before they get sick or have to be hospitalircd. Tours of the hospital, along with explanations about equipment and routines, help familiarize children with the hospital so i t will not be such a strange and frightening place should they be hospitalized.

The classroom can be a good place to teach children ahout hospitals and other forms of health care. Children of kindergarten and elementary school age, because of their developmental level, can benefit from this type of knowledge. Familiarity with health care procedures can help the elementary school child cope more effectively with hospitalization.

'The needs of children vary according to age and stage of development. The major concern during infancy is separation from parents. Toddlers have problems not only with separation, but also with their need to establish independence, to satisfy their curiousity and to explore the world around them. These needs are often denied in the hospital. Preschool children often experience feelings of guilt brought on by their drive for independence, along wi th fears of mutilation of the body. They often feel that sickness and hospitalization are punishment for something they have done. Elementary school-age children usually have many of the same concerns as younger children: anxiety about separation; fear of loss of control; fear of mutilation; and feelings of being punished. In addition, these children have developed an intellectual curiosity and are looking for explanations. They have a much better command of language than younger children and are able to verbalize feelings. They are able to reason, to make generalizations and to understand the concept of time. They can comprehend cause and effect and postpone immediate gratification for a more long-range goal. They have a need to know and understand what is happening to them. Therefore school-age children have a greater potential for coping positively with hospitalization than yo tin ger chi Id ren . *

ADAPTIVE TASKS OF HOSPITALIZED C H I L D R E N Hospitalized children have the same developmental

needs that they had before their illness, but because of their

hospitalization, are also presented with a unique set of adaptive tasks. These tasks are:

dealing with discomfort, incapacitation and other symptoms of their illness or injury;

managing the stress of treatment and aspects of' hospitalization such as strange routines and separation from parents;

developing and maintaining relationship with thc health care personnel;

*maintaining a reasonable emotional balance without being overcome by anxiety, guilt. apprehension o r resentment;

maintaining a positive self-image and a sense ot competence; and

preserving relationships with family and friends.

Coping Skills

several) of the following coping skills are used: To deal with these adaptive tasks one or more (usually

denial; seeking relevant information and using intellectual

requesting assurance and emotional support; learning self-care; setting limited goals, thereby breaking the problem

rehearsing alternative outcomes; and finding a purpose or meaning by putting the problem

skills;

down into small manageable pieces;

into long-term perspective.'

L E A R N I N G ACTIVITIES

Several kinds of classroom activities for elementary school-age children can help them to develop the skills they need to cope with illness or hospitalization, particularly the skill of seeking information and using knowledge. These activities and materials can be expanded or adapted according to the ages and needs of the particular group of children.

Health care personnel and health careers centers can provide information about various health care personnel and their jobs in the hospital. This includes not only doctors and nurses, but also laboratory technicians. respiratory therapists, admitting clerks, dietary aides and others. The jobs could be explored from the point of view of career awareness: what training is required and what are the responsibilities. Puppets with appropriate uniforms representing health care personnel could be made and used to dramatize the various roles.

Relating to the hospital staff may be easier if children

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know a little about the staff members and the function of each of them. Children need to know that hospital staff members are real people and, in most cases, very caring people. Having a doctor, nurse or other health-care person visit the classroom and letting children become acquainted with them as a person can be helpful. Be sure this individual can relate well with children and provide them with information that they can understand and use.

A learning center on equipment for medical care can help children become familiar with these specialized materials. Thermometers could illustrate sterilization procedure, how to read thermometers, comparing temperatures in Centigrade and Farenheit, charting variations in individual temperatures and comparing what is the normal temperature for each child in the class. A stethescope and a blood pressure cuff could be demonstrated, and supervised experimentation by the children encouraged. Children could learn to pronounce and spell words like stethescope and sphygmomanometer. Children could look at x-rays and see the difference between a healthy and a broken bone.

A learning center identifying places in the hospital can describe the operating room, recovery room, emergency room, waiting rooms and admissions office. Pictures or models of lhese places could be constructed.

A dramatic corner for role playing hospital experiences can be established. Items for role-playing might include a wagon labeled as an ambulance, blankets or a pad to represent a hospital bed, trays and dishes for serving food in bed, gowns, masks and other similar props. Many misconceptions about hospitalization can be clarified by an observant teacher during dramatic play.

In addition to role playing, children can dramatize hospital stories and situations using a flannel board or puppets. Appropriate props and characters can be provided or made by the children.

Basic informtion about the body can be provided in a learning center. Outlines of the body, diagrams of locations of organs, bones and muscles and books and pictures of how the body functions can be part of this center. Information about common childhood problems such as tonsillitis and broken bones could be included. Children who are interested in specific body parts can be directed to books such as Your Busy Brain, Your Growing Cells, Your Living Bones, Le Shan’s book, What Makes Me Feel This Way? and The Story of Your Ear by Silverstein and Silverstein.

Some hospitals have Child Life programs with personnel who specialize in educating children about illness and hospitalization. Arrangement may have t o be made to have a Child Life Specialist come to the school and share some of the activities she has developed, or for the class to tour the hospital.

IMPORTANT CONCEPTS One of the major adaptive tasks of hospitalized children

is dealing with being separated from family. Classroom stories and activities can emphasize visitation by families and the fact that some hospitals allow parents to stay over

Books describing illness and hospitalization for children include:

Title Author Emergency R. Beame Madeline L. Bemelmans The Hospital Book B. Elder Brian’s Trip R. Odor to the Hospital Curious George Goes H. Rey, M. Rey to the Hospital My Doctor H. Rockwell

I Want Mama M. Sharmat Jeff’s Hospital H. Sobol Book A Hospital Story S. Stein Elizabeth Gets Well A. Weber Mom, I Broke A. Wolf My Arm At the Hospital: S. Ziegler A Surprise For Krissy

Publisher Julian Messner. Inc Viking Press John Street Press Standard Publishinl CO. Houghton Mufflin

Macmillan Publish- ing Co. Harper and Row Henry Walck Inc.

Walker & Co. Crowell Co. The Lion Press

The Child’s World

These books can be read to the children or can be available for children to read themselves. Senqitive group of individual discuscion of the book5 can help clarify feelings and miscon-

1 ceptionr about hospitalization. School and public libraries may have copier of these or similar books available.

night. Some children think that once they are hospitalized, they will never go home again. Points about parental visits and going home from the hospital should be realistically emphasized.

The hospital itself should be characterized as a place of healing not hurting. Children need to know that while exploratory and corrective procedures sometimes cause discomfort, medications are available to relieve the discomfort. They need to be assured that it is natural and normal to cry and express feelings. I f fears associated with the possibility of permanent body damage or loss of body parts are expressed by children, they should be discussed and clarified.

It is important to be sensitive to the children’s feelings and to listen to their responses and reactions as they talk about illness and hospitalization. They may have heard stories about someone in the hospital or been hospitalized themselves. Encourage them to share these experiences and try to correct misconceptions. Although discussions about hospitalization should deal honestly with pain and separation, the positive aspect of illness and hospitalization (having mastered a difficult situation) should be emphasized.

School-age children have some of the same separation anxieties as younger children. They also have unrealistic as well as some very real fears about illness and hospitalization. However, their increased sense of reality

562 JOSH November 1983, Vol. 53, No. 9

and their ability to communicate give them an advantage REFERENCES over oreschool children in dealing with hospitalization. The

I . Prugh D. Staub E, Sands H. Kirschbaum R. Lenihan F . A \iudy Of the emotional reactions of children and families to hospitajiiatfon and

2. Petrilio M & Sanger S. Emotionoi Care of hospito/izeli children.

with its technology'-although frightening' can also be very interesting to children. Hospitalization can be a learning experience for them. For a properly prepared child

illness, J o ~ ~ r l h O p s y C h ~ u t r y lo: 70-106, ,es3,

hospitalization can result in a sense of accomplishment and increased self-esteem for having mastered a difficult situation.

Further information on publications and other resources on hospitalized children may be obtained from the Association for the Care of Children's Health, 3615

Philadelphia: Lippincott. 1980.

M e ~ ; c ~ ~ o , " , ~ ~ n ~ $ ~ Ph-vSrCffi ii'ness. New York: Plmlrn

Arlene Brett, EdD, Associate Professor, School of Education and Allied Professions. University of Miami,

Wisconsin Ave., Washington, D.C. 20016. Coral Gables, FL 33124.

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