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Treatment and its effect for

A father said with very sad facial
expression :

“ I feel that I ‘ve lost my son,..... He is now totally different

from my beloved son like he used to be...... He is so strange to
me now.....
Why should it happen to my son,.... Why my son.......”

( He talked in a very soft-sad voice, his eyes was red and wet )
“....... I feel I was being trapped... Yes
this treatment trapped me and my son.
They pushed me to agree on something
that I hated
very much. I am in a deep resentment.
They acted like salesman promoting
products to buy.
Tell me .....do they guarantee my child
recovery ????

( His voice was louder mixed with

sadness and anger)
And then we was involved in discussion :

“I feel relieved if you can understand

me,....my feeling....., that I
disappointed, ........ and doubtful
whether my step is right.
Do I have to let the treatment go on or
I’d better stop it ......”
“Lets say,...I am a naturalistic, I always try hard very
natural in rearing my kid and now my son have to be
bombed by those chemical medication, antibiotics..... And
it’s so painful” I am angry, I hate .....all.

When I asked about an alternative medicine, they said

this medication had been proved through researches for
years. But I also understand that there is always errors in
every research .So why don’t we try an alternative
medicine ? Why didn’t they give me any suggestion or
open a discussion to this way of treatment.”
Effect of treatment



Physical Effect of treatment
Nausea and vomiting
Hair loss
Mucosal ulcers
Anemia, infections and bleeding
Effects on liver, lungs, pancreas, heart,
gonads, etc…..
Unpleasant sensory and emotional
experience related to real or potential
damage of tissues ( The International
Association for the study of Pain, 1979)
Subjective and unique
Pain sources : real and unreal
Cause stress
Pain Assessment
Believe the patient’s complaint of pain
Assess the severity of the patient’s pain
Assess the psychological state of the
Take detailed history of the complaint of
Perform a careful physical examination
Pain Assessment ( con…..)
Order, and personally review, any
necessary diagnostic investigations

Consider alternative methods of pain

control during the initial evaluation

Assess the level of pain control after

starting treatment
a. Chronic pain
b. Acute pain
Bone Marrow Punction : F = 2 ,G = 9, H = 3
Lumbal Punction : E = 2, F = 4 , G = 6, H = 2
Intra venous : D = 3 , E = 3 , F = 5, G = 3
Used to be Recently

Neonates, babies, Idea :

small children pain free pediatric :
are not “ procedure for
given accurate children don’t
therapy for pain need to be painful “

Neurological immaturity
Should be developed
caused a young child will not
really feel the pain
Psychological effects of treatment
Inability to concentrate
Terrifying nightmares, insomnia
Patient’s conflict
Good patient role ?
Expected to be
• cooperative,
• dependent,
• helpful
• pleasant
• quiet
• without demanding
excessive attention

Personal conflict, marital or familial conflict, carrier conflict

Emotional State Behavior Manifestation Manifestation of
Support Needed
•Shock • Be Angry •Letting the feeling out
•Denial •Complaint •Hearing without
•Helpless •Rejection any judgment
•Making him/her
•Conflict role •Irritable
• Difficult situation •Need information
•Want to “run” •Difficult to believe •Helping to cope
•Demanding •Giving information

Feeling to be understood
Faster Acceptance process
Faster adjustment process
Better coping
Social effect of treatment
• Inactive in social life  social isolated
• Expensive medical cost
• Other expenses
• Social labeled / stigma
• worried about financial fulfillment for the
other family member
Social Support

• Emotional
• Instrumental
• Information
• Appraisal
Social support perceived by
leukemia children and parents
( Gamayanti, 2002 )
Emotional support :

• Provide most by close relatives

• Spouse role ?
• Doctors, nurses, psychologist
• Parents association
The Child

- Influenced by parents
emotions, especially mother

- Be happy if allowed to and be able to play

- Being visited by friends ??

Instrumental support :
• expensive treatment
• worried about financial fulfillment for the
other children
• mostly were supported by grandparents
or close relatives
• free medication and financial support
• hospital payment reduction / poor family
aids program  inconvenient and
ashamed to neighbors
Information support

• needed very much especially in after the

diagnosis, in the beginning and first month of
the treatment
• not clear enough or difficult to understand
• what kinds of information are needed ?
• well educated and low educated parents
• information leaflet and booklet were very
• what are the children want ?
Appraisal support

• Needed by high and low educated

• Different manifestation