THE EFFECTS OF LONG-TERM HOSPITALIZATION AMONG CHILDRENS

BEHAVIOR

A Term Paper Submitted to the Faculty of the Graduate School of Nursing

Arellano University

In Partial Fulfillment of the Course Requirements in

Submitted by:
Mary Grace D. Estuya RN

Submitted to:
Bgen. Marlene R. Padua, AFP (Ret)
Oct 2014

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INTRODUCTION
Background of the Study
Hospitalization is one of the most stressful events that children and adults can experience.
Children and adults reactions to hospitalization, such as anxiety, fear, withdrawal, depression,
regression and defiance, can be more severe than their reactions to the illness (Froelich, 1984).
The most common concern of a hospitalized child are; (a) anxiety due to separation from family
and friends, (b) fear of the unfamiliar, (c) uncertainty about hospital rules and expectations, (d)
prior perception of hospitalization, (e) fear of body mutilation or death, (f) fear of pain and
discomfort, (g) thoughts of hospitalization as punishment, (h) loss of emotional and physical
control, (i) others perception of physical changes, (j) loss of independence and identify, and (k)
fear of rejection (Froelich, 1996). Most of all, the hospital is an unfamiliar environment that
disrupts the routine of daily living.
Other stressful factors of hospitalization may include frequent restrictions of activities
and forced dependence on other which can lead to feelings of vulnerability, and developmental
regression.in addition, anxiety aroused by diagnostic, radiological, or other presurgical screening
procedure can give rise to the fear of pain, fear of mutilation, and fear of death. When
hospitalized, children and adults must make an emotional adjustment to the illness (Brodsky,
1989).

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Statement of the Problem

This study aims to determine the effects of long-term hospitalization among childrens behaviors.
This study would specifically answer the following questions:
1. What are the factors contributing to the problems of long term hospitalization among
children
2. What are the impacts of long term hospitalization on the family members.
3. Based on the result of the study, what programs can be implemented to alleviate the
problems associated with long term hospitalization.
Research Paradigm:
Johnsons Behavioral System Theory addresses two major components: (1) the patient
and (2) nursing. The patient is a behavioral system with seven interrelated subsystems.
Each subsystem can be described and analyzed in terms of structure and functional
requirements. Each subsystem has the same three functional requirements: (1) protection, (2)
nurturance, and (3) stimulation. The system and subsystems tend to be self-maintaining and selfperpetuating as long as internal and external conditions remainn orderly and predictable. If the
conditions and resources necessary to their functional requirements are not met, or the
interrelationships among the subsystems are not harmonious, dysfunctional behaviors results.

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HEALTH CHANGE PROCESS

Behavioral system

Depende
ncy

Attachm
ent

External

HOSPITALIZA
TION

External

Aggressi
ve

Achievem
ent

Tension
Health or
Illness

SUBSYSTEM

Ingesti
ve

Sexual
Eliminat
ive

Figure 1: Relationship of long term hospitalization among clients change in behaviors based on Johnsons Behavioral model.

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Change
In
Behavior

The Seven Subsystems:

1.

Attachment/Affiliative Subsystem

probably the most critical because it forms the basis for all social organization

on a general level, it provides survival and security

its consequences are social inclusion, intimacy and formation and maintenance of
a strong social bond

2.

Dependency Subsystem

promotes helping behavior that calls for a nurturing response

Its consequences are approval, attention or recognition, and physical

assistance

A certain amount of interdependence is essential for the survival of social

groups

3.

Ingestive Subsystem

has to do with when, how, what, how much, and under what conditions we eat

fulfills the need to supply the biologic requirements for food and fluids

It serves the broad function of appetitive satisfaction.

The perspective is in the significance and arrangement of the social events

surrounding the occasions when food is eaten

4.

Eliminative Subsystem

addresses when, how, and under what conditions we eliminate

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the social and psychological factors are viewed as influencing the biological
aspects of this subsystem and may be, at times, in conflict with the eliminative
subsystem

Human cultures have defined different socially acceptable behaviors for excretion
of waste

5. Sexual Subsystem

serves the biologic requirements for procreation and reproduction

including, but not limited to, courting and mating, this response system begins
with the development of gender role identity and includes the broad range of sexrole behaviors

6.

Achievement Subsystem

Attempts to manipulate the environment

Functions to master and control the self or the environment to some standards of
excellence

Areas of achievement behavior include intellectual, physical, creative, mechanical

and social skills

7.

Aggressive/Protective Subsystem

functions in self and social protection and preservation

This follows the line of thinking of ethologists such as Lorenz and Feshbach
rather than the behavioral reinforcement school of thought, which contends that
aggressive behavior is not only learned, but has a primary intent to harm others.

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Society demands that limits be placed on modes of self-protection and that people
and their property be respected and protected

Conclusion
Hospitalization is a serious change that can affect a childs emotional
and developmental needs and adults emotional and physical needs.
Publications regarding short-term and long-term effects of hospitalization
state that as many as 30% of2hospitalized children experience emotional or
behavioral problems (Robb, 1999).
The behavioral system attempts to achieve balance by adapting to internal and environmental
stimuli. The behavioral system is made up of all the patterned, repetitive, and purposeful ways
of behaving that characterize each mans life.
A state of instability in the behavioral system results in a need for nursing intervention.
Identification of the source of the problem in the system leads to appropriate nursing action that
results in the maintenance or restoration of behavioral system balance.
Reference:
Alligood, M., Tomey, A., Nursing Theorist and their work, (5th Ed),
ELsivier(Singapore)
Froehlich, M. (1984). A comparison of the effect of music therapy and
medical
play therapy on the verbalization behavior of pediatric patients. Journal of
Music
Therapy, 21 (1), 2-15.

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Froehlich, M. (1996). Music therapy with hospitalized children: A creative arts

child life approach. New Jersey: Jeffrey Books.
Robb, S.L. (1999). Piaget, Erikson, and coping styles: Implications for music
therapy and the hospitalized preschool child. Music Therapy Perspectives,
17, 14-19.
Robb, S.L. (2000). The effect of therapeutic music interventions on the
behavior
of hospitalized children in isolation: Developing a contextual support model
of music
therapy. Journal of Music Therapy, 37(2), 118-146.

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