a stay in hospital: its effects on patients

Question 1

what does Jana 1944 say about bed rest?
do they think bed rest is good for you?

Answer 1

JAMA 1944: “The physician must always consider complete bed rest as a highly unphysiologic and definitely hazardous form of therapy, to be ordered only for specific indications and discontinued as early as possible”

Question 2

what group of people does bed rest effect the most?

what can it impact?

Answer 2

Bed rest affects elderly people the most

This can impact their ability to live by themselves through deterioration in fitness and loss of muscle strength

Question 3

What is HCAI and HAI?

How can these be reduced?

Answer 3

HCAI - Healthcare associated infections – infections acquired by hospital or other healthcare setting.

HAI - Hospital acquired infection (not present on admission, but present more than 48 hours after)

HCAI and HAI can be reduced by the adherence to hospital infection control guidelines

Question 4

hazards of bed rest?

Answer 4

• deterioration in fitness, loss of muscle strength
• particular problem in the elderly

Question 5

What are 5 ways the hospital environment differs from a regular social environment?

Answer 5

5 ways the hospital environment differs from a regular social environment:

1) Privacy is often limited
2) Wards can be stressful places to stay
3) Staff wear uniforms
4) A patient may interact with up to 30 staff in a day
5) Many objects in the environment are unfamiliar

Question 6

What leads to the patient ‘role’?
What are 3 parts of the patient role?

Answer 6

Loss of familiar social roles from work and home results in the patient ‘role’
3 parts of the patient role:
1) Wear night-clothes during the day
2) Allowing parts of their body to be examined
3) Little control over timing of meals, visits or when the main lights go out

Question 7

What kind of behaviours might make a ‘good’ or ‘bad’ patient?
Why is being a good patient not always a good thing in health care?

Answer 7

Behaviours that might make a ‘good’ patient:
1) Allows themselves to be examined
2) Takes treatment given
Behaviours that might make a ‘bad’ patient:
1) Doesn’t allow themselves to be examined
2) Questions treatments given
Being a good patient in healthcare may not always be the best thing, as the patient may not get as much attention as they should
This can lead to their understanding of their condition and treatment not being very good, which can affect adherence/ability to cope

Question 8

what are the 3 aspects of health locus control (loss of control)

Answer 8

• internal health locus of control
• powerful others health locus of control
• chance health locus of control

Question 9

internal health locus of control?

Answer 9

The belief that a person’s behaviour will have an effect on their health status (a patients own behaviour will impact their health status)

Question 10

powerful others health locus of control?

Answer 10

The belief that powerful other people can have control over an individual’s health status e.g doctor, nurses, family, friends

Question 11

chance health locus of control?

Answer 11

The belief that one’s health control is a matter of chance/fate or even luck

Question 12

what are the 4 other types of locus of control?

Answer 12

• behavioural control
• cognitive control
• decision control
• informational control

Question 13

what is behavioural control?

Answer 13

• Behaviour focussed on improving health/recovery
• Could be improved by teaching a patient behaviour to help recovery
• E.g teaching a patient how to turn in bed to not rip stitches

Question 14

what is cognitive control?

Answer 14

• How patient’s think about their health/recovery
• We may alter cognitions that will be helpful for health/recovery
• E.g after knee surgery, instead of the patient focussing on a painful recovery, tell them how they will get their independence back

Question 15

what is decision control?

Answer 15

• How involved patient’s are in decision making to do with their health
• E.g health procedures/medicine/exercises they are able to do

Question 16

what is information control?

Answer 16

• Different patients have different information needs
• Relates to how much a patient knows/understands about their health difficulty/treatment
• E.g describing to a patient the side effects/pain of treatment
• If we don’t provide this information, patients may seek this information from unreliable sources

Question 17

what is depersonalisation?

Answer 17

Depersonalisation is when your patient is treated as though he or she were either not present or not a person e.g the stomach ulcer in bed nine

Question 18

What are 3 different reasons health care professionals might depersonalise?

Answer 18

1) A way of distancing the doctor from the fact that the body they are treating belongs to a thinking and worried person?

2) Depersonalisation and distancing may help HCPs deal with patients deteriorating or dying - less attached - less emotionally affected

3) Overworked, stressed and tired doctors may lead to less personalised care (burnout)

Question 19

What does it mean to become institutionalised?

How does this occur in patients in hospitals?

What are ways in which institutionalisation is reduced in the NHS?

Answer 19

If someone becomes institutionalised, they gradually become less able to think and act independently, because of having lived for a long time under the rules of an institution.

In normal life people adopt a variety of roles each day

In hospital the variety of roles they can adopt is reduced

Patients can forget how to act in the role they had prior to their hospital stay, leading to them being institutionalised

Question 20

What are ways in which institutionalisation is reduced in the NHS?

Answer 20

1) Most procedures are conducted as out-patient procedures when possible (patient doesn’t stay overnight)

2) Increasing number of things such as home births

3) Procedures are becoming more efficient

4) Diagnosis is faster

Question 21

What emotions can be experienced by a hospitalised child?

Answer 21

Hospitalised children can experience separation anxiety and distress from being separated from their primary care giver

Question 22

What are the 3 stages of separation?
What is the peak age at which children trend to shows separation distress?

Answer 22

3 stages of separation:

1) Protest
* Excessively crying and calling for parents

2) Despair
* Infant has reduced activity and may appear helpless

3) Detachment
* Infant’s behaviour is back to normal, but if the parent returns, they can be rejected by the infant
15 months is the peak age at which children trend to shows separation distress

Question 23

What are misconceptions and faulty illness representation in children?
What is an example of each

Answer 23

• Children can have misconceptions and faulty illness representation as they try to make sense of what is happening to them
• A misconception may be that illness is a punishment for being bad
• A faulty illness representation Is a child trying to make sense of their condition e.g child believes a haemophilia (blood doesn’t clot properly) bug is eating through blood vessels, causing bleeding

Question 24

What are 3 Impacts of hospitalisation on a child’s behaviour?

When might these behaviours start?

Answer 24

3 Impacts of hospitalisation on a child’s behaviour:

1) Regression
* Patients may start bed wetting/having tantrums again after growing out of it

2) Nightmares
* New fears e.g. medical staff

3) Irritability
* Due to increased anxiety
These behaviours may not occur until the child has returned home e.g child following around parent when they didn’t use to do so

Question 25

What are 6 ways we can improve the experience of hospital for children

Answer 25

6 Ways we can improve the experience of hospital for children:

1) Day surgery or outpatient treatment when feasible

2) Preparation for hospitalisation e.g watching a video

3) Unrestricted parental visits

4) Nursing staff supporting and educating parents to care for their child in hospital

5) Reduce number of nursing staff dealing with child

6) Communicate with the child as well as the parents