Psychological characteristics of families with a sick child. Psychological characteristics of a child with somatic diseases State educational institution of secondary
10.2. Patterns of child development
Biological model.
Psychosexual model, tasks of sex education for boys and girls.
Cognitive.
Behavioral.
Social and cultural.
Features of the development of disabled children.
Dependence and independence of children.
Rewarding and punishing children.
Stages of modeling children's behavior.
Helping parents with issues of children's behavioral reactions.
10.3. Constitutional anomalies
Clinical signs of constitutional abnormalities. The vital needs of a child with exudative-allergic, neuro-arthritic and lymphatic-hemoplastic type of constitution.
Nursing assessment of the condition and modeling of the nursing process for children of various age groups.
Illness and child. Life needs of a sick child and his family
The vital needs of a sick child, his family and ways to satisfy them.
The influence of the disease on the growth and development of the child.
Problems associated with hospitalization.
Personal reactions to illness.
Internal picture of the disease.
Methods of nursing influence on the formation of the internal picture of the disease.
Children's ideas about the effect of drugs on the body and the treatment process itself.
Therapeutic game.
The child's understanding of the processes of dying and death.
Parents' attitude towards their child's illness.
A disabled child in the family.
Modeling the nursing process of the adequacy of the child's illness level.
The role of the sister in organizing the interaction between the child and the family, the child and the surrounding world during illness.
Ethical issues in caring for sick children.
Creating psychological comfort in the process of interaction between sister, patient, and parents.
Nursing process for respiratory diseases
AFO of the respiratory organs.
Causes of the disease, predisposing factors.
Main clinical symptoms and syndromes during the development of ARVI in children.
Features of organizing the nursing process for children of different age groups with ARVI.
Principles of drug treatment, possible side effects of pharmacotherapy.
Therapeutic and preventive measures: acupressure according to Umanskaya, the use of immunomodulators; hardening activities, etc.
Acute pneumonia. Causes of the disease, predisposing factors. Main clinical symptoms and syndromes of pneumonia. Features of the course of pneumonia in newborns, premature infants, children of the first year of life and adolescents. Possible complications. Features of the organization of nursing process for children of different age groups with pneumonia. Principles of drug treatment. Possible side effects of pharmacotherapy. Aerotherapy. Breathing exercises. Physiotherapy. Prevention of pneumonia. Rehabilitation program for pneumonia. Principles of dispensary observation of children who have suffered acute pneumonia.
Additional laboratory and instrumental research methods for respiratory diseases. Preparing patients for the study. Modern additional research methods: biochemical blood testing; general and bacteriological sputum tests; instrumental method of examining the respiratory system; X-ray examination method; assessment of additional data from laboratory and instrumental research methods.
Psychological support for patients and their parents during research.
Congenital heart defects. Reasons for development
Nursing process for diseases of the cardiovascular system and rheumatism
AFO of cardio-vascular system.
Pathophysiological processes.
Risk factors.
Defects of the “white” and “blue” type.
Main clinical manifestations.
Modern diagnostic methods.
Preparing the patient for diagnostic studies.
Psychological support for the patient and his relatives.
Modern ideas about palliative and radical therapy.
Indications and contraindications for surgery.
Peculiarities of psychology of patients with congenital heart disease. Psychological support for the patient and relatives.
Rehabilitation program for patients with congenital heart disease.
Features of the nursing process for children with congenital heart disease.
Tactics of nursing intervention in the development of dyspnea-cyanotic attacks. Standard for providing emergency care by a medical professional.
Nursing process for rheumatism
Rheumatism: definition, its place in the collagenosis system. Etiology of rheumatism, predisposing factors. Basic clinical criteria of rheumatism. Principles of pharmacotherapy. Possible side effects. Primary and secondary prevention of rheumatism. Features of the nursing process for patients with rheumatism. Rehabilitation of patients with rheumatism. Clinical observation of the patient after discharge.
Nursing process for allergies in children
The place of allergies in the structure of childhood morbidity.
Predisposing factors, etiology, mechanism of development.
Systemic allergies, anaphylactic shock, Lyell's syndrome, Stevens-Johnson syndrome, serum sickness.
Main clinical symptoms of systemic allergies.
Localized allergies are the main clinical manifestations: dermatoallergoses, respiratory allergoses (bronchial asthma, allergic rhinitis, stenosing laryngotracheitis, polynoses).
Food and drug allergies. Main symptoms.
Features of the nursing process for allergies in children, prediction of the development of emergency conditions and the scope of nursing interventions for them.
Problems of family and child with allergies. Help your sister in solving these problems.
Modern views and methods of preventing allergosis.
Homeostasis. Maintenance Mechanisms
Nursing process for diseases of the digestive system
AFO of the digestive organs in different periods of childhood.
Calculation of a child's fluid needs to maintain water-salt balance. Electrolyte imbalance. Causes. Clinical signs. Regulation of acid-base balance. Causes. Clinical signs of ASR disorders. Changes in the volume of fluid in the body. Causes. Clinical signs. Features of the nursing process in cases of disruption of homeostasis.
1.2 Psychological characteristics of a child with somatic diseases
A sick child, as a rule, differs from a healthy one. his mood changes; he can become depressed, irritable, whiny, anxious, restless and, less often, carelessly - complacent. However, it is not just the emotional state that can be upset. Sometimes thoughts appear and persist about the severity of the disease, about its exclusivity, about the impossibility of a cure, or, on the contrary, about its insignificance and frivolity. In this regard, the attitude towards treatment turns out to be either adequate and even dependent, or dismissive and rejecting the procedure, manipulation and medications. Many children have behavior problems. They stop playing, and direct communication with adults and children is lost. Children do not get joy from playing and having fun together. Sometimes more pronounced disruptions in contacts occur, which leads to the seclusion of sick children who no longer strive for the company of peers and elders. They may be burdened by the restrictions that the disease imposes on them. Often children refuse to follow the regime, do not obey their elders, and become stubborn. The pattern of their behavior is disrupted by pranks, and sometimes by unexpected, inappropriate actions.
The described experiences and behavioral disturbances in sick children are a peculiar manifestation of the child’s personality’s reaction to the emerging illness.
An illness that comes to the house changes not only the established order of life, the attitude of adults, but also changes the child himself. Unfortunately, not everyone manages to correctly and timely note that changes occur not only in the body, but also in internal organs, but also his psyche, mood, behavior. At the same time, many people know that if the mental state of the child depends on the disease of the internal organs, then the latter can also affect the course of recovery. Sick children tolerate their illness differently, but there is not a single child who does not have one reaction or another to it. This reaction, even for a small child, is quite complex. It consists of the assessment and experience of many local, painful sensations, general well-being, self-observation, ideas about one’s illness and its causes. Due to the complexity, this reaction of the patient’s personality to the disease is called the internal picture of the disease. Its formation in children differs from that in adults, the more significantly the younger child. The internal picture of the disease, depending on its content, can act both positively and negatively; it affects the manifestation and course of the disease, relationships in the family, and academic performance. In some cases, it turns out to be the cause of serious illnesses, sometimes leading to the development of neurotic disorders.
As already mentioned, the internal picture of the illness of children is formed differently than that of adults. This depends on a number of features. First of all, the child’s mental abilities influence the assessment and experience of his illness. Understanding what is happening in the body and understanding disease processes depends on the level of development of thinking and therefore, as a rule, is associated with age. The ability to evaluate painful experiences also depends on ideas about one’s body. If something interferes with this, for example, a previous disease of the central nervous system, improper upbringing, then this will serve as an obstacle to the correct assessment of painful sensations. You must be able to systematize and explain your impressions and experiences associated with the disease. The absence or deficiency of such abilities leads to the creation of a distorted internal picture of the disease. Significant willpower is also required. Without them, it is impossible to focus on your experiences, compare them with what you experienced in the past, i.e. give them a rating.
Without knowledge of how the child feels about his health, i.e. Without understanding his internal picture of health, it is impossible to get an idea of the internal picture of the disease. Thus, the need to study health psychology is dictated by the fact that without insight into its essence it is impossible to form an adequate idea of the child’s personality reactions to illness, and therefore it is impossible to provide the patient with the necessary psychotherapeutic support. Assessment of health psychology consists of observing the child’s mood, behavior, reaction to certain changes in the environment and his stories about his well-being. The condition reflects the true state of affairs in the body and its functions. How you feel is subjective, but not always accurate. It expresses the feelings and moods experienced by a person. For a child, health becomes meaningful when he begins to understand its importance for the effective performance of a particular activity in play or study. The entire personality as a whole takes part in creating an internal picture of health. The more complex the psyche, older child, the diverse motives of activity, the more important his physical condition is for the child.
A child’s attitude towards health is part of his self-knowledge or, more precisely, part of his “I” image. The image of oneself consists of the perception of one’s external appearance, one’s behavior, one’s qualities. With age, an ideal image of oneself appears and a desire to become like it appears. The child’s assessment of himself is determined by the degree of his satisfaction with himself and turns out to be significant for behavior and experiences. The measure of satisfaction with oneself and, ultimately, with one’s health turns out to be related to the number of positive and negative assessments of others (parents, adults, older peers). Satisfaction with one's health may be affected by the difference between how a child perceives himself and how he would like to be.
The formation of an attitude towards illness is influenced by the accompanying psychotraumatic circumstances experienced by the child during illness. These include, first of all, referral to the hospital, which is accompanied by separation from parents, peers, educational or other activities, limited mobility, loss of perspective, and experience of disappointment. In children under 11-12 years of age, hospitalization itself, even without experiences associated with the disease and treatment, arouses such fear that it often displaces the preparation received before the disease. The reason for this fear is the separation of the child from the people to whom he is most attached. At the same time, than more independent child, the higher his ability to be alone, away from loved ones. Termination of visit kindergarten or school, disruption of the usual daily routine - all this, together with separation from parents, brothers and sisters, playmates and studies, from usual things and activities, violates the child’s sense of security and confidence in his well-being. The child's reaction to admission to the hospital depends on age, family relationships, duration of hospitalization, the number and nature of previous admissions to the hospital, the nature of the disease, preparation before hospitalization, visits to parents, treatment procedures performed, means used to alleviate the child's anxiety, reaction parents, child's perception of hospitalization.
After discharge, 1/5 of children exhibit adjustment difficulties, behavioral disturbances, irritability, disobedience, sleep disorders, and, less commonly, involuntary urination, emotional explosiveness, appetite disorders, and speech defects.
To reduce mental trauma in connection with hospitalization, in the process of preparing for it, the child should be explained as clearly as possible everything that will happen to him in the hospital, then the internal picture of the illness will be more adequate. Visiting parents and relatives significantly reduces the child’s anxiety in the hospital.
Creating a favorable environment, involving staff, other children, parents in the creation of game programs, play corners, colorful interior design of medical institutions, weakens the anxious anxiety of young patients and thereby creates an adequate attitude towards the disease and treatment, as well as the adaptation of the sick child to his surrounding environment.
Information about the work “The influence of chronic somatic diseases on the mental development of adolescents (features of mental activity)”
The formation of a personally developed individual is delayed and the formation of a socially mature personality is ambiguous. Chapter II. Psychological characteristics of children with mental retardation up to school age Important feature preschoolers with mental retardation is that the earlier the age we consider, the less formed the mental...
This defect, necessary to provide adequate assistance, requires a comprehensive study of the specifics of communication and interpersonal relationships such children in terms of age and in the specific conditions of their life. Unfortunately, there are few experimental studies of the communicative activity of children with mental retardation. At the same time, all these works have a correctional pedagogical and...
(See: Nosov S. D. Deontology in pediatrics. - M.: Medicine, 1977.)
Characteristics of the psyche and behavior of a sick child
The behavior of a sick child differs in many ways from the behavior of a healthy child. For healthy child is a typical state of optimal excitability, i.e. the reaction of the cerebral cortex corresponds to the strength of the stimulus (the baby laughs after hearing something funny; inquisitively tries to figure it out new toy; cries with frustration, but quickly calms down, etc.). The behavior of a sick child is different. Some children are very irritable, cry and scream loudly, call an adult to them, and when they are approached, they push them away from them. Such children refuse toys, their favorite food, become capricious, tired, do not calm down for long, fall asleep, and when they wake up, they cry again. Later, the overexcited state is replaced by depression, indifference, then the child becomes excited again, but to a lesser extent. Gradually he adapts and calms down. Other children, when sick, on the contrary, become very sad, look into the distance with an indifferent gaze or close their eyes, turn away if an adult speaks to them. In both cases, there is a deviation from the state of optimal excitability, i.e., to the same stimulus, the child’s nervous system gives too strong or, conversely, too weak a response.
Any disease primarily injures the child’s nervous system and this always affects the state of his skills and habits, i.e. conditioned reflexes. In acute illness, newly formed conditioned reflexes may suddenly disappear. For example, Andryusha learned the poem very well - he was preparing to perform at the festival. In the evening, mom, dad and grandma listened to a poem. But in the morning Andryusha fell ill, his temperature rose, and he was not taken to kindergarten. Having called the doctor, the mother tried to calm her son down (he was very upset that he would not go to the holiday) and offered to read the poem he had learned the day before. The child uttered the first words, but then became confused and could not continue reading - he “forgot”; the relatively new, still unstable conditioned reflex was quickly lost.
In another case, a skill may fade away if it is not systematically reinforced during the period of illness. For example, a child stops eating on his own, although he was able to do this before illness, and stops asking to go to the potty. Extinction of the conditioned reflex is more often observed with long-term chronic diseases. A sick child's routine is disrupted, appetite decreases, the state of physical, mental, moral, aesthetic development changes, work skills and play activities change. Neuropsychiatric hospitalism may occur as a consequence of the adverse effects on the child of a long stay in a hospital environment. More often it occurs due to unsatisfactory educational work and manifests itself in the physical and mental retardation of the child, who loses interest in the environment and is absorbed exclusively in the medical manipulations that are about to be experienced.
Changes in motor skills and physical development in a sick child
When the disease occurs, children may experience growth retardation and weight gain, lethargy, and inactivity. Children early age may lose the ability to perform some movements, especially those they have recently mastered. One year old baby who took the first few steps yesterday not only stops walking, but sometimes cannot even stand on his own. Preschoolers often refuse to draw when they are ill.
The coordination of movements also changes, becoming more primitive. For example, a 12-year-old girl, before getting the flu, was good at crocheting clothes for a doll. When a child heat was sleeping, and she asked to give her threads and a hook, it turned out that it was difficult for her to knit, her hands “did not obey,” her hands were wet, the threads were tangled. Many children, trying to eat on their own, spill food and get dirty, although before the illness they knew how to do all this independently and carefully.
When a child is sick for a long time, he develops a desire for repeated simple, monotonous movements. Looking into the distance, with his legs hanging off the bed, the baby dangles them, or sits for a long time in one position, sucking a finger, a corner of a pillow, or a sleeve of clothing, which is a manifestation of hospitalism. This is explained by the fact that children, especially young children, cannot remain stationary for a long time and one of the reasons for overexcitation or depression of the nervous system is the lack of conditions for active activity during illness.
Changes in mental development in a sick child
Often, a sick child does not answer an adult’s questions and it seems as if he “doesn’t want” to talk. In reality, an acute illness, high temperature, and pain not only inhibit the child’s speech, but also impair his memory, and some words are forgotten, especially those he has recently learned. A sick child seems to “get younger” in his mental development - pronunciation is disrupted, and “lisp” appears, typical of younger children.
For example, Sasha, 5 years old, recently learned to pronounce the sound “r” clearly and loudly, but he fell ill, developed a high temperature, and he could not explain to his mother that he had a sore throat - “goylo” came out all the time. Mom joked, “You’ve started talking just like a little one,” and Sasha cried bitterly, “I’m not little, but I can’t think straight.” The distressed child lay and whispered words with the sound “r”, but nothing worked for him. After some time, when the boy felt better, the lost sound was restored.
During the period of illness, some children may develop slurred pronunciation and even stuttering, and speech becomes primitive.
For example, 6-year-old Verochka, when asked “where do you live?” after a long pause he answers “there, in... the alley, well, in the shiny one... I forgot..., oh, in Serebryany!” Children answer many understandable questions with a brief “yes” or “no.” It is difficult for them to retell a familiar fairy tale; many unnecessary words appear in speech, such as “well, what’s his name,” “this is the same,” etc.
Older children do not show interest in new books; they prefer to reread stories they already know, and they are more interested in texts with dialogues than in various descriptions.
How younger age child, the more often during a long-term illness he experiences symptoms of neuropsychic hospitalism and mental development: he can, looking indifferently out the window, repeat some words or just syllables for a long time in a whisper or in a chant. Often this rhythmic repetition in speech is consistent with monotonous movements.
Changes in moral development in a sick child
During the period of illness, children's behavior changes. Many of them become more irritable, others become withdrawn. Wanting to be the center of attention, children try in various ways to arouse pity from adults through fantasy, exaggeration, and sometimes lies. So, 11-year-old Vasya writes a note to his mother that tomorrow he will undergo a very complex manipulation - “a real operation”, and he does not know “whether he will remain alive”, so he asks his mother to bring his favorite candies and “buy a bicycle”, about which he had been dreaming for a long time. In a conversation with the doctor, the worried mother found out that Vasya came up with all this... With the disease, negative habits often arise (thumb sucking, etc.), primitive emotions - suspiciousness, keen interest in medical manipulations, cowardice, whims and even bitterness, harshness, painful perception of jokes, etc. A boy of about 7 years old, after being discharged home, walks with his mother around the hospital grounds. Seeing a free taxi, the mother suggests that her son speed up his pace in order to stop the car, and the child very sedately objects to her: “I can’t walk fast, you know that I have a bad heart!”
Little Marusya has rheumatism, she has been in the hospital for more than a month, she is 9 years old. To the teacher’s friendly question about her well-being, the girl cheerfully replies: “It’s good, my blood has become calmer, the soya (erythrocyte sedimentation rate) is lower, the doctor says that I’ll go home soon!” Twelve-year-old Valya has just been given an injection, she winces and explains: “But they still give cocarboxylase pain” (she clearly pronounces the name of the medicine!). Admitted to the examination room new boy 10 years old, his peers get to know him: “Does your liver hurt? So they will do duodenal intubation, don’t be afraid, you’ll swallow the tube, it’s not scary - I’ve already swallowed,” they teach the “inexperienced” comrade.
Sometimes a child undertakes a rather unpleasant manipulation in a downright heroic manner for his age, while taking a non-bitter “harmless” medicine, on the contrary, causes protest and whims.
Young children do not realize the danger of their illness, the need for treatment, and do not understand that painful manipulations or taking medication improve the condition. The main thing for them is the emotional side of this moment - the fear of the injection, of the unknown. So, Alyonushka, 4 years old, sat in the dentist’s chair for the first time, the doctor asked her to open her mouth just to look at the sore tooth. The girl did not allow anyone to touch her, began to scream, tried to bite the doctor’s hand, although the tooth did not hurt at the moment. The mother could not help and took her daughter out of the office. When Alyonushka calmed down a little, it turned out that she was afraid to open her mouth “because a whole car would fit into her mouth, but how can I close it later?” the little girl complained.
The baby has not yet developed a sense of humor and he can perceive a kind, but incomprehensible joke as an insult or ridicule. In older children, ridicule can even provoke rudeness and insolence in response. Some children, especially those who have been in hospital for a long time, become sullen and grumpy; they start quarrels with friends over trifles, complain about each other, and take away toys.
Often children not only stop developing, but also want to be less years than in reality. Sick Marina, a 3rd grade school student, asks her mother to buy her a pacifier “for a doll” at the pharmacy. Imagine the mother’s surprise when her daughter put the pacifier she brought into her mouth and began sucking, saying: “Mommy, when I was little, did I suck the pacifier like that?” Sometimes children ask: “Rock me like a little girl, wrap me in a blanket with an envelope,” or “Tell me how I was little.” In the evening in the hospital before going to bed, the children become especially sad, they remember their parents, their home, they feel “sorry” for themselves, they often cry. So, 9-year-old Yura cried quietly, covered with a blanket. It turned out that the boy figuratively imagined his mother and father, who were “crying bitterly because they found out that I was sick, sick and died.”
Changes in work skills in a sick child
As a rule, a sick child experiences a loss of work skills due to movement disorders (cannot fasten a button, has difficulty eating independently), memory impairment (forgot to brush his teeth, wash his hands), and changes in behavior (whims, laziness, sloppiness). Most likely, those skills and abilities that the child mastered relatively recently are lost, but has not yet had time to consolidate them or previously performed them with reluctance. It is also difficult for him to control his will, and interest in work activity decreases. The usual “I-myself” in a healthy state is now rarely pronounced. Even schoolchildren lose their activity: “why wash your face - after all, I’m already lying in bed”, “you can eat the second course with a spoon, why use a fork?”, “why comb your hair - anyway, when you lie down, your hair gets shaggy”, etc. The laziness of children with illness is not pedagogical neglect. The child is not a quitter. In this case, refusal to activity should be considered as a consequence of the disease. As they recover, activity returns to the children.
Changes in aesthetic development in a sick child
The aesthetic development of children also changes under the influence of illness. This is reflected in their visual creativity and attitude towards music. Bright color toys or curtains, music and singing can irritate a sick child, so he begins to break beautiful toy, trying to get rid of the brightly colored parts of her, cries during loud music (especially in a low register).
The study of the creativity of sick children is of great interest. As a result of many years of studying children's drawings, N. N. Burmistrova (1977) found out that their visual creativity is a subtle indicator of well-being and mood. Changes in the manner of drawing and its subject matter often precede a change in the patient’s somatic condition or the development of complications. The drawings sometimes reflect the state of emotional stress that occurs in a child if he is afraid of some kind of painful medical manipulation.
When a child is ill, his drawing and modeling become more primitive; he tries to depict what he could do before the disease, as if using a stencil to repeat the lines he had studied. If you ask a child to draw something from life, even a schoolchild may refuse to do it. Very often a child uses repetition in a drawing. For example, over the course of 3 days, a doctor, nurse or teacher approached 7-year-old Dima and asked him to draw what he wanted. And every time the child drew the same thing - an airplane, a car, trees. He talked about his drawing in approximately the same way: “A car is driving, and an airplane is flying low over the trees and the sky above it is blue, blue, the weather is good, you can walk.” It was spring and Dima really wanted to go for a walk, but because of his illness they could not allow him to do this. If several sick children are asked to draw and they sit next to each other at the table, then, as a rule, they will borrow plots from each other; even school-age children do this.
Changes in play activities in a sick child
The play activity of a sick child changes both in form and content. A sick child's activity decreases, play becomes contemplative, that is, the child watches the action of an adult with a toy more than he plays himself. If you give a 3-4 year old child a toy, he will very soon return it to the adult with the request “play some more, and I’ll take a look.” Fatigue from playing in sick preschool children occurs faster than they have had enough of playing, so in the hospital you can often see a child dozing off with a toy in his hands, but when he wakes up, he continues to play with it. The play of a sick child is mainly individual, since he is more in bed. However, children who are allowed to walk may be grouped together for short periods of time. Game plots are dominated by the theme of treating a doll, which is mercilessly “given injections,” “put on mustard plasters,” given “bitter medicine,” and then it “quickly gets better.” Children of primary school age love small toys and hide their favorite doll, car or teddy bear under the pillow. Eight-year-old Vadik did not want to go to the treatment room without his Cheburashka, which was lost somewhere; the boy calmed down only when his favorite toy was found. Until he was discharged from the hospital, he did not part with the Cheburashka, and then gave it to the nurse.
During the period of illness, raising children does not stop, since any communication and influence on the child is educational in nature. As for the methods of education, they should change in accordance with the state of health of the child. The pedagogical goal is to achieve the least loss of conditioned reflexes (skills) in the processes of feeding, sleeping, hygienic care and activities of children. It is important not only to preserve the developed habits and skills, but also to continue their development, taking into account the child’s condition, so that after an illness he can fully return to his daily activities in a nursery, kindergarten, or school. All this can be successfully accomplished with knowledge of the basics of medical deontology. Deontology is the doctrine of a person’s duty to people and society as a whole, and medical deontology is the doctrine of the professional duty of a medical worker to a person in his field of activity and to the whole society. Surgeon N.N. Petrov (1956) pointed out that every “little thing” in a medical institution is of significant importance in the overall complex of medical care for patients. Medical deontology teaches medical personnel to treat the patient not as an object of their observations and therapeutic actions, but as an individual with his own spiritual world, his own desires, hopes, concerns, and fears. The same attitude should be towards the child. A combination of knowledge of medicine, psychology and art is required, as well as an understanding of the child’s spiritual life and character. Love, affection, sympathy, that is, empathy with a child for his pain and the ability to optimistically show and explain to the child the prospect of recovery - should be included in all the details of relationships with sick children. When working with them, there should be no extraneous conversations or inappropriate laughter, otherwise the patient (even if he is small and seems to “not understand anything”) will develop hostility towards “these cruel” people in white coats. S. D. Nosov (1977) writes that rudeness especially turns children against themselves, and older children and adolescents are hostile to familiarity (“well, dear, let’s not shed tears”), unceremoniousness, and manifestations of disgust on the part of the doctor.
A positive attitude towards the hospital, clinic, and medical worker should be cultivated when the child is still healthy. It’s no secret that families often scare the child with the hospital and the police - “if you eat an unwashed apple, your tummy will hurt, the doctor will give you bitter medicine, we’ll take you to the hospital and they’ll cut your tummy open or give you terrible injections,” the grandmother admonishes her disobedient grandson. Or: “If you don’t obey, I’ll hand you over to the policeman.”
But if trouble happens - injury or disease - and the medical worker will not only provide first aid, but also give his blood to save the baby; If a child gets lost or runs out onto the pavement, the policeman will be the first to protect him.
Admission of children to the hospital
When admitted to the hospital, a child experiences many difficulties: the severity of the disease, a new environment, separation from parents, unpleasant medical procedures, etc. Everything must be done to mitigate these moments and help the child adapt.
The reception area should not frighten children due to the presence of medical equipment or the strictness of its design. Toys, prints or drawings on glass partitions with fun themes from familiar fairy tales delight children. But drawings shouldn't
be large or too bright. For example, a well-drawn hedgehog with an apple on thorns, 75 cm in size, on the glass partition frightened young children and aroused hostility among elders, and Pinocchio, made in bright fluorescent gouache, was difficult for children to look at - the drawings had to be replaced.
N. N. Burmistrova (1977) recommends for better adaptation of the child to have certain sets of toys for the bath (made of rubber, polystyrene), winding, voiced (but without a sharp sound) toys for the first show. Parents should be persuaded to leave the child I with a toy that he brought with him from home, since with a familiar object it is easier for him to get used to a new environment.
When accepting a child, you need to show maximum attention to him and his parents. If a conversation with the mother I in front of the child is conducted in an inappropriate tone, then this I sets the child against the medical staff, and he acts as a defender of the mother, who is being “scolded.” The manifestation of formalism irritates parents.
The nurse should not be indifferent to the suffering of the child and parents. S. D. Nosov says that if the feeling of compassion disappears, indifference to the sick develops, callousness, moral deafness, then one is lost precious property medical worker - his true humanity. When admitting a child to the emergency department, you need to not only make sure that the child does not cry, but also ask if he wants to drink or go potty, since in a new environment the baby is embarrassed to say so. One of the difficult moments is saying goodbye to your mother. Some children, carried away by toys and affectionate treatment, part with their parents relatively easily, but many cry bitterly. Therefore, you should not focus the child’s attention on the mother’s departure, but it is better to interest him in the upcoming acquaintance with the children, new game etc. and quickly take him out of the reception room. It is reasonable for parents to be advised to bring their child allowed sweets and a toy on the same day. Thus, upon entering the ward, the child will already feel the care of his mother. N. N. Burmistrova (1977) recommends a successful questionnaire for the child’s parents:
| Questions | Parents' answers |
|---|---|
| 1. What is the abbreviated or affectionate name for a child at home? | Shurik |
| 2. What does he like to play most? | Cubes, cars, draw |
| 3. When does he sleep at home? | From 13:00 to 15:00 |
| 4. How do you go to bed and how do you go to sleep? | Tucks in the blanket and falls asleep with a toy in his hand |
| 5. When do you go to bed in the evening? | At 21 o'clock |
| 6. Does he attend a child care facility? | No |
| 7. What food does he not like? | Semolina porridge |
| 8. How to feed (from a spoon, a horn, in the hands) | Eat on your own at the table, wash down the second meal with compote. |
| 9. Is it easy to communicate with children and adults? | With children - yes, with adults - no |
| 10. Does it need to be grown in a pot and how is it planted? | They ask, they are very shy around strangers |
In the department where the child will be treated, he is met by the nurse of the ward where the baby is being assigned. The bed is prepared in advance. There should be a toy on the bed or nightstand. The path from the front door to the bed should be designed so as not to cause fear in the child. Curtains with a familiar pattern, toys, flowers, prints, furniture can remind children of their home; the entire environment must meet aesthetic standards. The nurse needs to have warm hands, literally and figuratively. When meeting each newly admitted child, you need to convince him that he is in a kind, friendly environment. It is known that when children strive for positive contact with people, they bring their toys, show them, and give them to others. This is a kind of “password” - “I want to be friends with you.” If, when receiving a child, a nurse takes a toy out of her pocket and gives it to him, this will have a positive effect on their relationship in the future.
It is not necessary to introduce a newly admitted child to all the children in the ward, but to name the neighbor’s name, and the neighbor needs the name of the new arrival. When you put your child to bed, you should cover him warmly, since it always seems colder in a “strange” bed. You need to ask the child if he wants to drink or eat, point to the place where the potty is located. All this must be said quietly, taking into account the child’s shyness. If he is very agitated upon admission to the department, then, having done everything necessary, it is better to leave him alone, since further conversation with him will only increase irritability.
Daily regimen of a sick child
For each child, an individual regimen is created, taking into account the state of health, mental and I physical development, but the regimen may not correspond to the patient’s age. The regime is gentle in nature and has its own peculiarity, namely that periods of wakefulness are reduced; Sick children sleep more often and for longer periods of time, and time is allocated for medical examinations and medical procedures. All this should be combined with feeding, hygiene care, games and activities (with children of preschool and school age) and carried out in a quiet and calm environment in the department.
Organization of feeding, sleep, hygiene care
Feeding is carried out in various conditions depending on the child’s condition: in bed, at the table in the ward and in a specially equipped dining room. For feeding, hanging tables are used in the bed, in the ward - tables and chairs, which must correspond to the height of the children (for children of the first year of life - special high tables with sliding chairs), in the dining room the furniture is designed for all ages of children in this department. The dishes should be comfortable and beautiful, and the food should be appetizing. Before feeding; you need to wash the children’s hands (even if they are lying in bed), put their clothes in order, try to create a positive attitude towards the upcoming process, making them want to eat on their own. If a sick child lying in bed eats 1-2 spoons of food on his own, this will support the skill he has developed and give satisfaction. Children should be prepared for feeding calmly in a friendly environment, and the methods should be as close as possible to those used in nurseries and kindergartens.
It is not recommended to sit children on different diets next to each other, as this makes them want to eat the food that the neighbor has, and then conflicts arise. Babies who receive food from a bottle should be fed only in their hands, and not left alone in the Bed with a bottle placed on a rolled up diaper; This is fraught with the risk that children may not only wet themselves, but also choke.
Dream. In the ward or box it is necessary to create the most favorable conditions for the child to sleep peacefully. The room should be ventilated, but it is better if sleep is organized on the walking veranda. Procedures should not be performed while children are sleeping. If an injection is necessary, the child should be woken up first and prepared accordingly. Before bedtime, children are occupied with quiet games, gradually placed on potties, changed clothes, and shaded windows. It is more correct to put to bed first those children who do it calmly and, thus, they will serve as an example for more capricious and excitable children. If there are children in the ward who live according to different regimes, then during the daytime nap the younger children should be occupied with games in the playroom.
Hygienic care. The staff of the medical institution have to constantly deal with hygienic care for children. A child who is neatly dressed, combed, and has a clean nose is usually in a good mood, which will to a certain extent contribute to the success of the treatment. Some children are panicky about changing their pants because they are afraid of injections. To carry out this procedure, you need to warn the child that they are not going to hurt him. Children should be dressed comfortably, without wearing diapers instead of panties or rompers; clothes should be appropriate for their height and be beautiful, but not too bright. In sick children, whenever possible, it is necessary to maintain neatness skills: wash their hands, put them on the potty, comb their hair, brush their teeth.
Organizing games and activities with a sick child
The environment in the hospital must meet all sanitary and hygienic standards, but the emphasized whiteness frightens the child. Washing floors by nurses should not hinder the movements of children who are allowed to walk. The environment should not be sparse and faceless; This is especially difficult for children in boxed units. The chambers should be light, the walls and curtains should have calm tones. It is necessary to allocate space for the play corner, equipping it accordingly. N. N. Burmistrova convincingly writes: “It has been established that different colors have different effects on the nervous system: red color is irritating and tiring, green color is calming. Even temperature sensations can fluctuate depending on the color design of the walls and surrounding furniture” ( Burmistrova N. N. Deontological aspects educational work with sick children. - In the book: S. D. Nosov. Deontology in pediatrics.- M.: Medicine, 1977, p. 141.).
The correct selection of toys is of great importance: they must be hygienic, durable, light and comfortable to hold, and relatively small in size so that it is convenient to play with them in bed. For sick children of early and preschool age, the following toys and materials are recommended: dolls, bears, hares, dogs, cats, chickens, roosters; furniture for dolls, stove and dishes; pyramids, a set of loose cups, boxes; cubes, various plywood pictures for folding; balls, rolling eggs, balls, animal toys (on wheels), vehicles, clowns and characters puppet theater; rubber and wind-up toys without harsh sound; construction material, planar mosaic; nursery rhyme toys (pecking chickens); books; paper and pencils for drawing. Older children can be given a variety of simple Board games and toys for school age. It is very important that the toy matches the child’s hospital regime. For example, Katya, 6 years old, was on strict bed rest in the rheumatology department and dreamed of new doll. Katya’s mother knew that even before her illness the girl wanted to have a large “walking” Marina doll and brought her this gift. But the nurse did the right thing, explaining to the mother that such a doll would only cause grief to the child, since Katya could not walk yet and advised her to bring the toy during the recovery period. Sometimes children ask to bring them a toy from home or buy a new one. This cannot be regarded as spoiling or whims. For example, 12-year-old Marina fell ill with pneumonia, the girl had a high fever, she lay quietly with her eyes closed. I remembered the doll corner in kindergarten 1 and she suddenly wanted so much to have a “naked” doll, which was just like a “little baby.” In older children, the desire to become “small” often manifests itself in games with dolls “to be daughters and mothers,” since they are embarrassed to directly tell their mother “rock me like a little one.” Marina asked to buy her a “naked one,” but dad “overdid it” and brought her a luxurious large doll in beautiful clothes, with long hair. He did not understand why Marina sighed sadly and, as it seemed to him, capriciously: “Eh, dad, I needed a small child, and not such a big girl.” By touchingly caring for the doll, the child thereby shows how he wants adults to treat him this way.
In order to improve the play of a sick child, to calm him down and please him, it is not enough to have only sets of toys or to equip play corners in the wards; it is also necessary to work with children, teach them to play, and find contacts with them through play. Treatment and educational influence on a child are a single process.
Yes, Prof. E. A. Arkin praised the game not only because in it the child creates, expresses himself in it to the greatest fullest, but because it has a beneficial effect on his health.
Activities with sick children need to be planned in such a way that they have a positive effect on physical, mental, moral, labor and aesthetic education. Depending on the patient’s condition, his age and development, the forms of classes can be different: individual classes at the patient’s bedside, small groups in a play corner or at a table in the ward, and frontal classes in a play room with older children.
Since play activity in a sick child is weakly expressed, when individual lessons It is recommended to show the simplest performances with a toy (hide the toy under the pillow and find it, cover the doll with a diaper, and the bear must “look for it”, roll the ball on the bed, etc.). Telling and reading (at an older age) fairy tales and short stories are done without scary plots. Joint games with an adult are gradually introduced: they make a swing from a piece of ribbon on the bed barrier, sit a doll or animal on it and swing it towards the child, then invite him to repeat these movements; make a house, train, furniture for a doll from small building material; play lotto, with planar mosaics, etc.
If there are several children in the ward on bed rest (not in serious condition), then you can conduct simple activities with them: show a performance with characters from a puppet theater or send a wind-up toy across the floor, let bubble, tell or read a fairy tale. When the children are allowed to walk around the ward, you can play with them and rearrange the play corner. If space allows, then medium-sized building material and small cars and carts should be placed near the doll corner. Children love to draw and you can sometimes organize exhibitions of their drawings to show their parents.
Children who are allowed to leave the ward should be dealt with in the playroom, grouping them according to age and development, and playing with them not only calm, but also active games. This is especially important for recovering children, since outdoor games make it possible to fully demonstrate the need for physical activity. But we must not forget that children have not yet fully recovered, that they have increased excitability and fatigue. In the playroom you can show a puppet or shadow theater, a filmstrip, listen to a children's program on the radio or watch it on television. But these spectacular activities should be dosed, and care should be taken to ensure that children do not get tired of prolonged sitting and a complex plot.
The methodology for conducting special classes in medical institutions is basically similar to the methodology for the same classes in nurseries and kindergartens. However, when working with patients, it is not so much the age that is taken into account, but rather the individual development of the child. The main thing is not to teach the child something new, but to strive to preserve the old, already acquired by the child even before the illness, to support his curiosity and desire to study, to distract him from all the troubles associated with manipulation, as well as from homesickness .
School teachers specially assigned to the hospital work with school-age children. This keeps children in good spirits and confident that they will not fall behind in their studies. Schoolchildren's classes must be supervised by the ward nurse and teacher. Some children are reluctant to study, and here you need to find out the reason for their reluctance to study - often this is due to illness. There are children who, afraid of falling behind in their studies, do too much, which harms their health. Such children need to be restrained and switched to other activities and games. The nurse should separately tell the school teacher about each child, who, taking into account certain circumstances, will approach each child in a special way. Children are very jealous of grades in subjects, so it is better to give them incentives, since a score of “2” can traumatize and overexcite the child. The purpose of school activities is to maintain academic skills, but not to complete the entire school curriculum.
When carrying out various medical procedures, physical therapy or massage, you should always use game elements: joke with the child, give him a toy, distract him, speak in a calm, quiet voice.
Children in general, and especially sick ones, are more nervous before various examinations and manipulations than adults, due to the greater vulnerability and sensitivity of the child’s body, especially the central nervous system, to external influences.
Educational work in boxed departments deserves special attention. The child is alone in the box, so you need to contact him more often, talk kindly, change toys, hiding the boring ones in the nightstand. From the corridor side, through the glass, you can show pictures or toys, alternately bring a decorated Christmas tree to each box on a mobile table, and show a mimic scene with puppet theater characters.
Holidays and preparation for them bring children great joy. They not only improve mood, but also enrich the environment and help establish contact with newly admitted children. The holiday begins with the decoration of the chambers and preparation for it, then there is a matinee (15-20 minutes) and the distribution of gifts. The department room should be decorated slowly, without overloading children with an abundance of impressions, but attracting them to participate as much as possible. At a matinee, it is best to show a puppet theater or a filmstrip. It is important to ensure that children do not become overtired. The distribution of gifts - toys, fruits, some sweets - needs to be thought through and carried out as interestingly as possible. It’s good when children are given toys after the matinee, and after lunch they extend the pleasure and give them sweets or fruits. You can involve Petrushka or another character from the puppet theater who performed at the matinee in distributing gifts to children - this will once again delight the child. At the holiday, adults should not dress up in the costumes of Santa Claus, a bear, etc. - instead of joy, this can cause fear and deterioration in health.
It is very important for recovering children to organize walks. They are prescribed and dosed by a doctor, and carried out by a nurse, a teacher with the help of all department workers and parents. The walking area should be fenced and properly equipped with benches, tables, a sandbox with legs and a side on which it is convenient to place molds and toys.
When inviting parents to walk with their children, the ward nurse must explain to them certain rules. It is prohibited to let children go for a walk with friends or anyone else. While children are walking with their parents, the nurse is not relieved of responsibility for the child’s health.
When discharged from the hospital, optimal excitability of the central nervous system has not yet been restored in children, so they are not able to attend a child care facility on the first day after returning home. Children, especially young children, find it difficult to get used to their home environment; even their parents are mistaken for “strangers.” So, 2-year-old Vovochka, returning after a month and a half stay in the hospital, called his parents “Aunt Mom” and “Uncle Dad” for some time. Therefore, for the first few days, you need to create a particularly calm environment at home, do not invite guests to your children, do not allow them to watch a lot of TV shows, do not excite them with a large number of gifts, etc. After discharge from the hospital, the child is under the supervision of the clinic.
The role of the clinic nurse in monitoring the physical and neuropsychic development of the child
Children under the age of 15 are under the supervision of the district children's clinic. They visit the clinic without much enthusiasm, since this is often associated with unpleasant sensations (examinations, vaccinations), and, nevertheless, in most cases, relationships are established between the doctor, nurse and children. friendly relations. This is probably why younger children often imitate adults, playing “doctor,” giving dressings and “injections” to their “sick” dolls, and in the future they choose a medical profession for themselves.
As soon as a new citizen arrives from maternity hospital home, he is visited by a local nurse. She examines the newborn, gets acquainted with his surroundings: is he conveniently located; crib, how the issue of walking, bathing, feeding is resolved, does the mother know how to swaddle the baby, etc.
The nurse gives advice to the child’s parents, systematically visits the family, and reports all the child’s characteristics to the local pediatrician. Carrying out further monitoring of the development of children, the nurse pays special attention to the timely formation of their movements, speech, play, positive character traits, relevant skills and habits. Each clinic has a room for a healthy child, which practically serves as a methodological center for educating parents in matters of child development and upbringing. If parents are going to send their baby to a nursery, kindergarten or school, then the nurse should take care of taking certain tests from the child and talk with the parents about how to help the child adapt to new conditions. The nurse, together with the pediatrician and parents, strive to implement the basic pedagogical rules of education - consistency of educational techniques, rules of parental behavior, timely activities with children, compliance with the regime, etc. Not all children attend preschool institutions, so it is necessary to help parents properly prepare them for school.
If a nurse comes to the home of a sick child to give injections, she should at the same time talk with the parents not only about the child’s illness, but also about the correct treatment of him, explain some of the features of his behavior during illness, and recommend appropriate games and activities. This will help the mother behave correctly with the patient and strengthen the friendly relationship between mother, child and nurse.
Thus, the medical work of the district nurse must necessarily be combined with educational work, since the main goal of the clinic is to help the family raise a healthy, harmoniously developed child.
Features of raising children in sanatoriums
Children with active and subsiding forms of tuberculosis, convalescents after tuberculous meningitis are placed in children's sanatoriums; patients with rheumatism; children with consequences of polio; with diseases of the gastrointestinal tract; patients with rickets; children with psychoneurological disorders; with musculoskeletal disorders. There are general therapeutic sanatoriums with the goal general health improvement children, and specialized. A sanatorium can be single-disciplinary for the treatment of patients with similar diseases or multi-disciplinary with several specialized departments for the treatment of diseases of various systems. Currently, a network of sanatoriums for mothers with children is actively developing. The duration of treatment is set depending on the profile of the sanatorium: in specialized non-tuberculosis sanatoriums the treatment period is from 45 days to 3 months, in tuberculosis sanatoriums - from 1 to 10 months.
Since a sanatorium is an intermediate link between a hospital and an institution for healthy children, it is natural that educational work should be carried out in a special way. Firstly, with a cyclical system, on the days of arrival at the sanatorium, many children arrive at the sanatorium at the same time, all of them are unfamiliar with each other, with the sanatorium staff, and they need a certain time to adapt. Secondly, the degree of poor health of children varies. Therefore, they require an individual approach taking into account the disease, a gentle regime, as well as a selection of games and activities in accordance, first of all, with their physical level of development. In sanatoriums, children are united in groups, and their living conditions approach those of a nursery or kindergarten.
The form of the regime is the same as in preschool institutions, but while walking or playing, children have the opportunity to rest more often, spend less time in a group, many of them are individually assigned additional sleep. And although a single regime is created for the group, it is built taking into account purely individual characteristics every child.
The nurse, doctor, teacher carefully study the child’s behavior and accordingly assign him the necessary load.
Significant difficulties arise when organizing feeding, sleep, and hygienic care. Children enter the sanatorium with different habits: some are very spoiled by their parents during illness and flatly refuse to eat on their own, others eat on their own, but do it carelessly, some of them have lost a number of cultural and hygienic skills or have developed negative habits. Most children are very picky about food and often have negative behavior. For example, 4-year-old Ninochka does not want to eat soup. The nurse tried to persuade her and try to feed her, but the girl pursed her lips, turned away and closed her eyes. The nurse stepped aside and pretended not to pay attention, then Nina suddenly began to eat quickly herself, but as soon as the nurse praised her, she sharply pushed the plate away again and turned away.
The entire environment in the room where children eat (furniture, type of dishes and food) should help stimulate appetite. Children should be fed slowly so that they can chew their food well. Given the rapid fatigue of children when feeding, short breaks should be taken between meals. It is not recommended to give your child a large portion - he may refuse to eat, it is better to give a little food at first, and then add more and praise him for eating well. For lethargic and passive children, before feeding, you need to try to cheer them up, play with them, establish contact, and during feeding, encourage them with facial expressions and a smile to maintain a cheerful mood. When feeding easily excitable children, a different approach is used: about 10 minutes before meals, stop playing and give them complete rest. If the child is very excited, he should be fed at a separate table. However, feeding a child at a separate dining table should never be used as punishment. Taking into account the characteristics of the child, sometimes mixing homogeneous foods is allowed: for example, a child does not like cottage cheese, but enjoys eating kefir, then a little cottage cheese can be added to the latter. But mixing heterogeneous food is unacceptable.
At the end of feeding, after praising children who ate well, one should not be angry with those who ate poorly. It is better to express the hope that next time they will eat well. The children will be grateful that they are not angry with them, and in the future they will try to please the kind nurse. When stimulating children to eat, one should not promise that if they eat well, then mother will come or they will go home earlier, since memories of home cause melancholy, and the child generally refuses to eat.
Properly organized sleep is very important. In the hospital, the child could sleep as much as he wanted, since he was on bed rest. In the sanatorium, the duration of sleep changes, approaching the sleep norms of a healthy child. But in the first days and weeks of children’s stay in the sanatorium, at the first signs of fatigue, the child should be offered to sleep or lie down for a while. It is recommended to put the most weakened children to bed earlier than others, and wake them up later than others when they wake up. When assigning children to sleeping places, the most excitable ones should be placed so that they do not disturb others. You should not disturb the child’s sleep with morning manipulations, since those who are recovering need rest, and they should wake up at good mood- this can be the key to good appetite and wakefulness. When preparing excitable children for bed, it is necessary to eliminate irritants such as toys, bright lights, noise, loud conversation, and harsh remarks. If a child undresses incorrectly, he should be helped rather than insisted on carrying out this process independently.
As prescribed by a doctor, some children are given additional sleep in the air. During the walk, it is recommended to have several beds in the area in case any of the children want to lie down for a while. In most cases, small children are reluctant to go to bed in the evening due to overexcitation of the nervous system, which is still fragile after an illness, which manifests itself in homesickness. At the same time, the younger ones are capricious, some cry loudly, and the older ones are sad. Therefore, putting children to bed in the evening is quite a difficult job, and the nurse should show maximum tact, care for children and patience.
Some children, due to the loss of neatness skills during illness and due to weakness, are indifferent to neatness, do not want to comb their hair, change clothes, or tie their shoelaces. It is necessary to monitor the cleanliness of children, but when dressing, do not forget about an individual approach to them: do not wrap sweating children, but dress them warmer than those who are cold.
In order to restore lost skills, special games and activities are conducted with children. Considering the increased fatigue of the child, the optimal state of the body systems should be restored gradually. When organizing any activities, it is necessary to alternate rest with movement. For example, when showing a puppet theater performance, children cannot sit for a long time, then you can invite them to stand up and move around or clap their hands while standing. If children draw birds during drawing lessons, let them wave their hands like birds do with their wings. When reading books, you need to ensure that children do not sit in the same position for a long time.
In independent play, it is necessary to diversify the plots, distracting them from hospital topics ("treating dolls", "injections"), help them play collectively, but make sure that the children do not get overtired. The appearance of irritability in children, arguments and quarrels are signals to stop playing.
In the playroom, the environment should allow the child to be alone for a while, sit on the sofa, look out the window. The methodology for conducting classes can be borrowed from nurseries and kindergartens, but this should be approached taking into account the state of health, development, and then the age of the child.
The joy of recovery is the main goal of educational work in the sanatorium. The experience in this regard of the Leningrad sanatorium "Solnyshko" is interesting ( Kalmykova K. Solnechnoye.- Health, 1979, No. 4, p. 24.). It houses 1,000 children aged 2 to 7 years at a time. The multidisciplinary sanatorium is equipped with a complex of diagnostic and treatment services: an X-ray room, a clinical and biochemical laboratory, an electric light and mud bath, an inhalation room, an aerosol therapy room, and oxygen therapy. The design of the entire sanatorium reflects a children's theme; health and educational tasks are solved using modern aesthetics. The park has play complexes and even a small zoo.
A procedure such as inhalation usually frightens young children; they breathe shallowly and the therapeutic effect of aerosols is reduced. The sanatorium has an inhalator based on the fairy tale "Thumbelina". In the depths of a large, beautiful “flower” device sits a fairy-tale baby, and when children are asked to “smell” the flower, they do it calmly. In this game version, most procedures are performed. Children also enjoy getting to know the plants in the greenhouse and walk to the artificial bay where there are ships, a lighthouse and a fortress with real old cannons.
In our country, vouchers to the sanatorium are given to children free of charge, and the state allocates 2 million rubles annually for the maintenance of the Solnyshko sanatorium alone. In 1979, there were 164,000 places in children's sanatoriums in the USSR, and their network is expanding every year.
In hospitals and sanatoriums, children are equally cared for medical workers and teachers, therefore nurses should be familiar with some issues of pedagogy and psychology of children, and teachers should be familiar with the characteristics of diseases. Greater explanatory work needs to be carried out with nurses and other medical personnel, since only through joint efforts can the issue of restoring the health and development of a sick child be qualitatively resolved.
Lecture 12
12.1 Children’s reaction to hospitalization and adaptation to a medical institution
All children under seven years of age suffer from deprivation parental care and supervision. This is especially difficult for children in the first three years of life, most noticeably between the ages of 6 months and 2 years. In the first three months, the baby reacts poorly to a change in environment if the regime of care and feeding does not change. The last remark is explained by the fact that at this age (up to three months) the child is not able to notice any changes outside of his immediate contacts. On the contrary, in the subsequent period of development the child reacts sensitively to disruption of habitual contacts with surrounding people and objects.
There are three phases of a child’s adaptation to a hospital or childcare facility:
1. “Protest” phase: the child experiences a severe shock, calls his mother crying, experiences signs of panic, does not let his mother go when she comes, and sees him off crying.
2. The “despair” phase sets in after a few days. The child plunges into himself, becomes withdrawn, sleep, appetite, etc. may be disturbed. Pathological habitual behaviors, such as finger sucking, may appear.
3. “Alienation” phase: The child may lose interest in his parents and become indifferent to whether they visit him or not.
Naturally, not all children exhibit such phasic reactions. How the child adapts to new conditions depends on the adequacy of attachment to the mother, experience of visiting other people's houses, etc. These phases can be most clearly distinguished in children from 6 months to 4 years. All children show signs of a stress reaction, and in 2/3 stress is accompanied by an anxiety reaction, and in 1/3 by anger. As the indicative reaction fades, negative emotional manifestations intensify, and speech activity is disrupted. Poorly adapted children experience psychosomatic reactions - tachycardia, tachypnea, weight loss.
Similar changes can be observed when the child enters the nursery. preschool. Failure of adaptation to the nursery, for example, manifests itself on average on the 4th day in the form of various diseases or pre-neurotic reactions. Favorable adaptation is completed between the 11th and 24th days after admission to a children's institution.
Admission of a child to a hospital is the same separation from the family as admission to a children's institution, however, there are significant differences: the child becomes the object of painful manipulations and procedures, he is limited in communication and movement. In addition, a sick child initially has fewer reserves for adaptation than a healthy child.
The child's reaction to hospitalization depends on the following factors:
· Child's age
Duration of hospitalization
· Number and nature of previous hospital admissions
Nature of the disease
· Preparation before admission to the hospital
· Visiting parents
· Treatment procedures performed
· Parents' reactions to the fact of their child's hospitalization
Child's perception of hospitalization
Burmistrova N.I. identified three groups of children according to their reaction to hospitalization:
1. Children with a negative reaction to hospitalization who react with agitation, crying, sleep disturbance, and refusal of toys.
2. Children with a sluggish, inhibited reaction, calmly reacting to admission to the hospital.
3. Balanced children who respond adequately to hospitalization.
Langmeyer et al. described three stages of a child’s adaptation to the hospital:
1. Stage of “protest”, “primary despair” or pronounced primary maladjustment. It is a manifestation of a stress reaction that occurs in a child in response to a break from his usual environment. It can last from several hours to several days and weeks.
2. Stage of unstable adaptation. It is characterized by a significant decrease in the degree of psycho-emotional stress, which is supported only by the child’s strong desire to return home. This stage lasts several days or more, and can continue throughout the entire period of the child's stay in the hospital.
3. Stable adaptation is a favorable outcome of adaptation, a continuation of the stage of unstable adaptation. Characterized by the disappearance of emotional distress due to hospitalization.
The dependence of the duration of the adaptation period on the child’s age is shown. Thus, children in the first two years of life experience the most painful hospitalization, when the average adaptation period is 9-10 days. At the 3-4th year of life, this figure decreases to 4-5 days and gradually decreases, reaching 1-2 days by 15 years.
The success of adaptation to the hospital depends on children’s understanding of the disease. With age, there is a gradual evolution of the child's views on the causes of the disease. Thus, normally, up to 7 years of age, a child’s illness is associated with supernatural forces; between 7 and 10 years, children begin to realize that the disease is inside the body (internalization of ideas about the disease); Starting from the age of 11, children develop an idea of the multiplicity of causes of diseases and the different predispositions of people to them. Between the ages of 4 and 16, 2/3 of children view illness as a punishment for bad behavior or the result of neglecting some rules. Children have difficulty distinguishing between pain caused by illness and pain associated with treatment, which is often also perceived as punishment for wrongdoing.
The negative emotional reaction of parents to the upcoming hospitalization of the child also affects the adaptation process and correlates with emotional difficulties in children admitted to the hospital. The presence of a chronically ill person in the family also negatively affects the child’s adaptation to hospitalization.
According to some data, 25% of children have an ergopathic and sensitive type of attitude towards the disease, 16% have a harmonious type, and 10% have an anxious type. Anosognosic and hyponosognosic reactions often occur, but in 25% a hypernosognosic reaction occurs.
The inability to attend school during hospitalization can also negatively affect the child’s condition, due to separation from peers, the danger of social isolation and disruption of the usual pattern of life.
In addition to all of the above, the child’s reaction to admission to the hospital depends on his personal characteristics and relationships with the doctor and nursing staff, relationships with the peer group that the child encounters in the hospital.
Ways to mitigate a child's reaction to hospitalization:
1. Visiting children by parents and other relatives. Although there may also be Negative consequences(children may become more stressed and miss home even more), many studies have shown that free parental visits to children has a beneficial effect on adaptation to the hospital.
2. Creation of semi-permanent care. This form of treatment organization allows you to maintain maximum contact with your family and reduce the negative emotional consequences associated with treatment.
3. Adequately informing the child about the upcoming examination and treatment. The child must be prepared not only for painful manipulations, but also for trivial procedures. This helps reduce the child’s level of anxiety, which is sometimes associated with a misconception about the upcoming diagnostic or treatment procedure. In addition, it is useful to carry out explanatory work with parents, which can also have a beneficial effect on the child’s reactions.
12.2 Features of the internal picture of the disease in children
According to Isaev D.N. (2000), the main components of the internal picture of illness (IPD) in children are:
1. Level of intellectual functioning. This component of the VKB determines how adequately the child perceives his physical “I”, how much the child is able to correctly interpret and systematize the symptoms that arise in him: general discomfort, pain, dysfunction of organs, etc. Poor intellectual functioning (eg, in young children or the mentally retarded) can lead to both anosognosia and hypernosognosia.
2. Knowledge about health, internal organs, illness, treatment. Without the concept of health, it is difficult to construct an idea of illness. Children 4-9 years old consider health simply the absence of illness, while older children describe health as a pleasant state - “feeling great.” Stable ideas about the likelihood of disease in children arise by the age of 7 years. Interestingly, girls and older children are more afraid of health problems than boys and younger children. When assessing health, children aged 9-11 years are more focused on somatic well-being, adolescents aged 12-14 years – on social activity.
Children's knowledge of internal organs is important for the formation of ICD. Children think that the number of organs varies between children: children 4-6 years old believe that there are at least three, 15-16 year olds name up to 13. Half of the children mention bones, heart, blood vessels and blood. The degree of importance of various organs is also assessed differently: children put the heart first, then (from 9-10 years old) the brain and, finally, the stomach. 1/7 of children consider the lungs, nose, throat and mouth to be vital. If older children judged the importance of organs by their participation in the life of the body, then the younger ones - by the time required to care for them - for example, legs were named in connection with the constant obligation to wash them. Up to 60% of children 4-6 years old relatively correctly determine the location of the heart; this is rarely possible with respect to other organs.
Children's ideas about diseases are important for the formation of ICD. Few patients aged 8-12 years understand the variety of causes of diseases; they cannot yet take into account either the state of the body or the quality of the pathogen. As mentioned above, many children consider illness as a punishment for misdeeds and mistakes.
3. Children's understanding of the universality and irreversibility of death. The formation of an adequate VKB requires an understanding that death is the final end of life. Half of preschoolers use words such as “death” or “dead” in their speech. Some preschoolers do not react in any way to the spoken word “death,” others do not know its meaning, and still others have a very limited understanding of death. Children, when confronted with the death of animals or insects, ignore it or show unusual reactions, avoiding contact or rejoicing at the death of a small creature. Children of this age do not have the concept of death as the final cessation of life; they understand it as a long departure or sleep. 20% of preschoolers aged 5-6 years believe that the death of animals is reversible, and about 30% of children of this age assume the presence of consciousness in animals after their death. The preschooler interprets the death of a parent due to magical thinking as the result of his desires, which often leads to feelings of guilt. For a preschooler, the death of parents is not only separation from protective, emotionally significant figures, but also abandonment by them. The variety of reactions of a preschooler who comes into contact with death depends on previous experiences, the religiosity and culture of the family, the child’s attachment to the deceased family member and the child’s level of development.
Children aged 5-9 years tend to personify death or identify it with a deceased person or animal. They think that death is invisible, strives to be unnoticed, hides in the cemetery - that is, the traits of an animate being are attributed to death. The characteristics of a child’s reaction to death are determined by culture, religious upbringing and style of psychological defense.
Students have a more realistic understanding of death and recognize that death can happen at any time. They cite specific exposures as the cause of death: knives, guns, cancer, heart attacks, age. However, schoolchildren do not fully understand death, especially when faced with their own serious illness. The state of severe anxiety does not allow them to comprehend what is happening. Their true experiences associated with death are best conveyed by their fantasies, games, and drawings.
Teenagers who already have abstract thinking already accept the idea of their own death. To overcome the anxiety caused by this knowledge of reality, they actually ignore death, provoking life-threatening situations - racing motorcycles, experimenting with drugs, refusing doctor's prescriptions for serious illnesses, etc. 20% of teenagers believe in the preservation of consciousness after death, 60% - in the existence of the soul, and another 20% - in death as the cessation of physical and spiritual life. Teenagers react to death differently: they are aware, reject, curious, despise, despair.
4. Experience of life and past illnesses. All acquired experience, especially previous illnesses, is involved in the construction of the VKB. A child’s life path is short; it is more difficult for him than for an adult to compare the current situation with previously experienced circumstances. Therefore, what a child has recently experienced can leave a serious imprint on VKB. Exacerbations of severe diseases observed by the child in relatives living together can play a negative role in the formation of ICD. Own illnesses suffered in early childhood do not leave a significant imprint on the experience of the current disorder, while recent illnesses perceived as a threat have a significant impact. The formation of a child’s ICD can be influenced by the atmosphere of anxiety and anxiety that reigns in the family due to the suspected or developed disease.
Children can receive information about the disease from various sources - from parents, peers, teachers, and the media. For a child, the most significant information is that he receives from his parents. Exaggerated concern about the child, shown by anxious parents, can lead to an inadequate pessimistic assessment of the disease. For children with severe chronic disease The doctor is of particular importance; in these cases, information from parents is less significant. Therefore, health workers need to take into account that any judgment they make about the disease can be taken on faith by the child and become integral part VKB.
5. Features of emotional response. In children, both premorbid and those developing during the course of the disease, anxious, hysterical and other personality traits, with emotional lability or explosiveness, certain predominant emotions, motivations and orientation of interests are formed that determine ICD. An emotional attitude can determine one of three types of ICD - hyponosognosic (with underestimation of symptoms and excessive positive expectations from treatment), hypernosognosic (with exaggeration of the severity of the disorder and disbelief in the success of treatment) and normosognosic (pragmatic - with a real assessment of the disease and its prognosis, good contact with a doctor and compliance).
6. Gender. The dependence of the formation of VKB on gender has been proven in children suffering from diabetes mellitus, bronchial asthma, leukemia and other diseases. It turned out that self-esteem and conflict in boys with bronchial asthma are lower than in girls with a similar diagnosis. Girls are more likely than boys to repress the idea of illness. Girls with leukemia adapt more quickly to the life changes associated with a severe disorder, and more often experience fears for their future.
7. Associated psychotraumatic circumstances. Hospitalization of a child is accompanied by separation from parents, educational and other activities, and an experience of disappointment due to the inability to continue usual activities. In children under 11 years of age, the mere placement in a hospital, even without the troubles associated with treatment, provokes such fear that it often displaces the preparation received before the hospital. Schoolchildren's understanding of the benefits of treatment does not change their negative attitude towards the hospital, which may distort the VKB. The child’s reaction to hospitalization depends on age, family relationships, duration of hospitalization, the nature of the disease, visits from parents and their reactions, procedures, and anxiety-relieving agents.
8. Parents' attitude towards hospitalization. Parents may experience a feeling of guilt for the development of the disease, indignation due to the child’s behavior that led to the disease, despair due to the poor prognosis, indifference to the disease and its denial. The experiences of parents often evoke similar feelings in the child, which form the basis of VKB.
9. Influence of medical personnel. The doctor, examining and preparing for hospitalization and operations, has a psychological impact on the child. His friendliness, clear explanations, use necessary funds, reducing the pain of manipulation, have a positive effect on VKB. Underestimation of children's ideas about the disease and treatment can lead to the formation of inadequate ICD.
10. Perception of symptoms of illness and ideas about it allows the doctor to understand what burdens the child most, what he suffers from. It is especially important to know what the child’s ideas about the disease are, since this knowledge can be used for psychocorrection. In children, VKB is formed mainly at the emotional-sensual level (unconscious), and not at the logical (conscious) level. By correctly diagnosing ICD, the doctor is able to make a certain correction, which allows reducing the child’s emotional discomfort in connection with diagnostic and therapeutic procedures, as well as formulating adequate ideas for the child about his disease.
LITERATURE:
1. Isaev, D.N. Child medical psychology. D.N. Isaev. - St. Petersburg: Rech, 2004
2. Carson, R. Abnormal psychology. R. Carson, S. Mineka. - St. Petersburg: Peter, 2004. - 1168 p.
3. Comer, R. Pathopsychology of behavior. Mental disorders and pathologies. R. Comer. – Prime-Eurosign, 2007.- 640 p.
4. Lakosina, V.M. Clinical psychology. V.M. Lakosina. – M.: Rech, 2005.- 412 p.
5. Mash, E. Children's pathopsychology. Child mental disorders. E. Mash, D. Wolf. – Prime-Eurosign, 2007.- 512 p.
6. Perret, M. Clinical psychology. M. Perret, W. Baumann. – St. Petersburg: Peter, 2002.- 1312 p.
7. Sidorov, P.I. Clinical psychology. P.I. Sidorov, A.V. Parnyakov. - M., 2002
Knowledge of the patient’s psychology, his personal characteristics and capabilities, of course, can and should increase the effectiveness of medical care. Advances in the treatment of tumors in children have somewhat changed the tasks of psychologists, teachers, social workers and those previously involved in working with these patients, as well as the supervision of these patients by child psychiatrists.
This is due to the fact that previously all these specialists more often accompanied children during their debilitating illness or were involved periodically during the terminal period of the disease. In modern conditions, the main task of all those involved in servicing these patients is
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nyh, is to maintain the highest quality standard of living in conditions of illness with a relatively unfavorable prognosis [Gerasimenko V.N., Paikin M.D., 1988; Mazzin M.J., Holland J.C, 1984]. In this regard, demands are increasingly being made to increase the role of mental adaptation, readaptation and rehabilitation in the complex treatment of tumors in children.
To solve these problems, in our opinion, it is necessary to constantly monitor these children by qualified specialists, specially trained psychologists and often child psychiatrists. Such observation provides very valuable information about the psychological characteristics of patients and members of their families, without which therapeutic work and rehabilitation of families with a sick child are impossible.
It is known that the reaction to hospitalization depends on many factors, the main of which are: the child’s age, personal characteristics, level of intellectual functioning, parental behavior, and a sharp change in life pattern. Patients report that upon admission to the hospital “they were scared,” “sad,” and “wanted to cry.” Children under 10 years old do not differentiate their attitude towards hospitalization, they simply say that “they really, really want to go home.” It should be noted that negative emotions in patients intensify with each subsequent hospitalization, and the trauma associated with repeated admissions to the hospital is deeper and longer lasting. Most children understand that the purpose of hospitalization is treatment, but if they feel well, older children believe that they can be treated at home. Thus, in the first stages of the disease, hospitalization in the vast majority of cases is a serious mental trauma for children.
As the length of the illness increases, all children consider themselves sick, and this is also a psychologically traumatic situation. Children's assessment of the disease can be sharply negative. As the duration of the disease increases, children get used to the status of patients, but in everyday life, repressing the fact of the disease from consciousness plays an increasingly important role in the mechanisms of psychological defense, although they never feel themselves recovering.
Despite this, all patients who have pronounced manifestations of the disease note the seriousness and danger of the disease (“it’s not to be trifled with,” “it takes a long time to be treated,” etc.). During more favorable periods of illness, children, without denying the seriousness of their condition, emphasize the impossibility of continuing a full life (“you can’t play sports,” “go to school,” “go to the pool”). Determining the place of their disease among others, patients note its peculiarity. At the same time, children with a short history of the disease (up to a year) define the disease as “rare, bad and difficult among others.” Children with a longer duration of the disease are characterized by
178 PART I. General issues of pediatric oncology
They call it “the most important”, “the most negative among all diseases”. Sooner or later they raise a question of life and death. And the older the child, the more realistically the seriousness of the disease, the possibility of death is experienced and fear about this is expressed. This is due to numerous visits to the hospital, painful procedures, depression from parents, as well as explanations from some friends or even “stupid” adults. Many studies show that, despite attempts to protect children with cancer from knowledge of the possible poor prognosis of their disease, the anxiety of knowledgeable adults is transmitted to children as a result of the changing emotional climate around them. Often children are interested in purely physiological issues of death: they show interest in corpses, funerals, cemeteries, etc. You need to talk about these topics with children in such a way that they find support in these words. Under no circumstances should a conversation on this topic be avoided if it is initiated by the child himself. Such a conversation should be conducted by a well-trained specialist (psychologist, oncologist, teacher) or a parent instructed on this issue. But more often the fear of death is not revealed in ordinary conversation, it reveals itself in games and drawings; at its core it is a fear of isolation.
In addition, intensive and long-term treatment required for cancer is also a serious psychologically traumatic factor for children. Suffering from manifestations of their illness that are diverse in form and severity, children attach greater, and often primary, importance to the unpleasant sensations and pains arising from the use of various diagnostic and therapeutic procedures (sternal and lumbar punctures, injections), as well as changes in appearance as a result of treatment. Older children, 13-17 years old, consider the worst aspects of their illness to be the emergence of obstacles to satisfying their cognitive needs, separation from peers (inability to attend discos, “parties”), and other restrictions.
One of the important factors in a child’s socialization is school. Patients with cancer often experience school problems due to frequent hospitalizations, long courses of therapy, asthenia, and various restrictions. The most important are:
1. Inability to attend school or frequent absences.
2. Decreased academic performance, difficulties in mastering the material.
3. Misunderstanding on the part of classmates.
In this regard, school for the sick is a very important symbol of health and a fulfilling life. Comparing sick and healthy schoolchildren, it was revealed that sick people evaluate school more positively than healthy ones, and school occupies a significant place in the sick person’s idea of the future, which cannot be said about healthy children.
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The idea of the future in sick children is associated with the prognosis of the disease, and it is no coincidence that they assess the future worse than healthy children. For older children, the future seems worse and more uncertain. This is especially noticeable when analyzing the results of studies of patients with different lengths of illness: on the one hand, patients assume that “the disease will go away in the future,” and on the other hand, patients are not sure that they will be healthy in the “future.” Both trends increase with increasing disease duration. Most children believe that “there will be recovery in the future,” imagining the future as “good, healthy,” while their answers can also be traced to concerns about the outcome of the disease. Children 7-12 years old think that recovery is necessary in order to “rest, grow, go to school” in the future. Children over 12 years old imagine that recovery will provide the opportunity to become strong, work, be needed, and live well. Some children do not assess the disease as a threat to their lives, but believe that it will ruin their future and they have no prospects for a full life. Children's ideas about their parents' experiences of their illness are quite varied: from “my parents are worried” to “there is grief in my family.” Long-term observation of children shows the emergence of rather complex relationships during illness between the child and his family. Despite the fact that children believe that their parents and the entire family treat their situation with compassion, it is obvious that patients in many ways oppose themselves and their family and consider themselves abandoned. This is manifested in the rather polar behavior of children. Where illness is perceived by children as punishment or punishment for previous sins and disobedience, patients are afraid of being “bad” children. Therefore, with the onset of the disease, the behavior of such children improves - they become obedient, self-controlled, and scrupulously fulfill all requests and orders. This is observed both during hospitalization and at home. Other children, with the onset of the disease, become aggressive, irritable, and demonstratively refuse to obey adults. Sometimes their behavior pattern becomes regressive (they behave like small children). Older children and adolescents aged 13-17 years show emancipation reactions early: they stay out late, start smoking, drinking alcohol, and have early sexual intercourse. They are constantly rude to loved ones in the presence of others, even using obscene words. According to our observations, the following relationships with parents are established in children with cancer.
