CHAPTER 10

IN THE HOSPITAL: THE SETTING, PROCEDURE

AND EFFECTS ON PATIENTS

LARAIB ZAINIAB (S23-0060)

SAWERA ASGHAR (S23-0072)
 History
◦ Ancient Greeks
Establishment of temples where sick people would pray and receive cures .
Roman military, who established separate barracks for their ill and disabled soldiers.
◦ 1st Institution
Associated with Christian monasteries and had a broad charitable purpose:
to help the less fortunate members of society. As a result, these facilities housed not only sick people,
but also orphans, the poor, and even travelers who needed lodging.
◦ 18th and 19th centuries
◦ These institutions became more specialized in two ways.
◦ First, they began to restrict admissions to people who were both sick and judged to be members of
the ‘‘worthy poor’’—that is, those who could make contributions to society.
◦ Second, hospitals became more medically specialized. Wards were established for different illness
categories.
◦ Until the 20th century, hospitals had always had a well-deserved bad reputation as places that gave
miserable care and ministered exclusively to poor people, who often died from infections they did
not have when they entered. Sick people from the upper and middle classes were treated at home.
◦ Early 20th century
◦ Hospitals had gained a much more positive reputation and were attracting patients from all social
classes.
ROLES, GOALS, AND
COMMUNICATION
Role
◦ Hospital roles vary widely, including doctors, nurses,
administrators, technicians, and support staff. Each
plays a crucial part in providing healthcare, from
direct patient care to managing operations and
ensuring a smooth functioning environment.
Goal
◦ The primary goal of hospitals is to provide high-
quality healthcare services to patients. This involves
diagnosis, treatment, and prevention of illnesses or
injuries. Additionally, hospitals aim to ensure patient
safety, promote medical research, and contribute to
community health. The specific goals can vary based
on the hospital’s mission, size, and specialization.
Communication
◦ Effective communication in a hospital is essential for
patient care. It involves clear exchanges of
information among healthcare professionals, patients,
and support staff.
BEING HOSPITALIZED
add many negative aspects to person’s sick-role experience:
limits privacy,
restricts the individual’s activity,
requires a high degree of dependency on others,
and presents events that can be very distressing.
RELATION WITH MEDICAL STAFF
Psychosocial issues of patients
Anxiety
Worry about what the problem is?
How illness will influence their lives?
What the treatment will be like?
Depersonalization.
 Burnout among health care professionals
◦ State of psychosocial and physical exhaustion that results from chronic exposure
Perceived to high
inadequacy levels of stress
of professional
Depersonalization accomplishment
and little personal control.
◦ Three psychosocial components of burnout:

Emotional Exhaustion
SICK-ROLE BEHAVIOR
IN THE HOSPITAL
◦ Relations between patients and practitioners in the
Hospital are affected not only by the behavior of the
Medical staff, but by the patient’s behavior, too.
 Type of patients

Good patientsProblem Seriously illNot seriously

Type of problem patients
patients ill
 Emotional Adjustment in Hospital
◦ COGNITIVE PROCESSES IN COPING
1. One cognitive process many patients engage in after becoming ill or injured is attributing blame—
trying to answer the question, ‘‘Who’s at fault for my condition?’’
◦ Blaming others helping patients cope is by providing
◦ Blaming self psychological sessions during their
Both relate to poor adjustment. stay
2. Helpless
Some patients enter the hospital feeling quite helpless right from the start.
Hospital environments induce patients to believe their involvement in the treatment process is irrelevant.
 Coping Styles

Problem- Emotion-
Focused Focused

Avoidant- Social-
Coping Coping
PREPARING PATIENTS FOR
STRESSFUL MEDICAL
PROCEDURES
◦ Preparing people psychologically for surgery has
important implications for their recovery: among
patients with Similar medical conditions, the more
anxiety they feel Before surgery
 These approaches are generally
Designed to give the person one or
more of the following Types of control:

Psychological Behavioral control

Preparation for
Surgery Cognitive control

Informational control
PSYCHOLOGICAL PREPARATIONS
FOR NONSURGICAL PROCEDURES

EducationClear CommunicationEnvironmentSupportive Staff

 When the hospitalized patient is a Child
◦ HOSPITALIZATION IN EARLY YEAR OF CHILDHOOD
Separation distress is young children’s normal reaction of being upset and crying when they are
separated from their parents, particularly in unfamiliar surroundings. After a prolonged or difficult stay in
the hospital, young children often display anxious behavior at home. They may begin having nightmares
or become very clinging and unwilling to let their mothers out of their sight.
◦ HOSPITALIZED SCHOOL AGE CHILDREN
The cognitive ability of school-age children progresses rapidly, but they sometimes retain earlier
misconceptions about their illnesses or develop new ones. Increased cognitive abilities allow them to think
about and worry about the outcomes of their illness or treatment. Being away from friends and
schoolmates can lead to feelings of loneliness, boredom, and concern about losing friends or status in their
social groups. As children get older—particularly when they are entering puberty—they tend to become
more embarrassed by exposing their bodies to strangers or needing help with ‘‘private’’ activities, such as
toileting,

Age Experience
 Helping children cope with being hospitalized
◦ One or both parents (or another very familiar adult) should accompany and remain with the child at
least until he or she is settled into the room. Many parents stay much longer, taking advantage of
opportunities hospitals provide today for a parent to ‘‘room-in’’ with the child, especially when the
patient is very young or very seriously ill.
Give frequent hugs and praise

Hold your child's hand during tests and procedures

distract your child with stories and pictures

 Health psychologists play a crucial role in assisting hospitalized
patients by addressing various psychological and emotional aspects
of their well-being

Stress Management

HOW HEALTH
PSYCHOLOGISTS Behavioral Interventions
ASSIST
HOSPITALIZED Pain Management
PATIENTS
Patient Education

Supportive Counseling
 Tests for psychological assessment of medical patients

Minnesota Multiphasic Personality Inventory (MMPI)

This test has the person respond in a true-false format to over 500 statements, such as, ‘‘I would rather win
than lose a game’’.
 Millon Behavioral Medicine Diagnostic (MBMD)
is a self-report test that was developed to assess specific psychosocial factors and decision-making issues
that are known to be relevant for medical patients. It consists of 165 items.
Psychosocial Adjustment to Illness Scale (PAIS)
The PAIS consists of just 46 items, and the person responds to each item on a 4-point scale, such as ‘‘not at
all,’’ ‘‘mildly,’’ ‘‘moderately,’’ or ‘‘markedly.’’ This test is available in two forms—one that patients can fill
out on their own and one that is administered by an interviewer. It was designed to assess seven
psychosocial characteristics of the client’s life, each of which has been associated with adjustment to
medical illness.
PROMOTING
PATIENTS’ HEALTH
AND ADJUSTMENT
◦ Health psychologists are working to enhance their
Effectiveness in helping clients and to develop
stronger Relationships with medical professionals
 When the illness is terminal
◦ Terminally ill child
◦ Terminally ill young adult
◦ Terminal illness in older adults
THREE TYPE OF STRESS
◦ Physical effect
◦ Changing lifestyle
◦ End is near
PSYCHOSOCIAL
ADJUSTMENTS TO
TERMINAL ILLNESS
◦ Psychosocial adjustments to terminal illness involve
coping with the emotional, social, and existential
challenges associated with the recognition of a life-
limiting condition.
 The decision regarding where a person spends their final
moments—whether in a hospital, at home, or in hospice—is
A PLACE TO deeply personal and depends on various factors

DIE— Hospital

HOSPITAL,
HOME, OR Home

HOSPICE? Hospice
 Article: The attitudes of healthcare professionals
towards nurse–physician collaboration
1.To examine the attitudes of healthcare professionals towards nurse–physician collaboration
2.To explore the level of satisfaction among healthcare professionals with regard to quality of
collaboration between nurses and physicians.
Study design
◦ A descriptive comparative study design was used in this study.
◦ study was carried out in intensive care units, surgical department and medical department at Assiut
University Hospital.
Sample
◦ The healthcare professionals involved in the study were 338, 139 nurses, 158 internship nurses and
41 physicians.
◦ Questionnaire
◦ one is the personal characteristics data sheet as age, gender, marital status, work settings, years of
experience and educational qualification. Second one is the Jefferson Scale of Attitude towards
Nurse–Physician Collaboration (JSANPC)
◦ CONCLUSION
◦ the current study revealed that internship nurses are not satisfied with the level of collaboration
between nurses and physicians. Staff nurses are satisfied with level of collaboration and they also
have got more positive attitude comparing to physicians and internship nurses, while physicians in
the second step after staff nurses in satisfaction with collaboration.