Impact of long term hospitalization on the patients and the families

Patients with chronic critical illness—those who exhibit metabolic, endocrine, physiologic,
and immunologic abnormalities that result in profound debilitation and often ongoing
respiratory failure—frequently need hospital level care for relatively extended periods.

Affects the normal functioning of family as the bread winner is admitted. It disrupts the
normal functioning of the family.

Psychological effect of hospitalization:

Medical and surgical hospital patients were asked to perceived Stressfulness . From this
results it can be seen that some of the most stressful events :

Involved lack of communication factor:

1. Unfamiliarity of the surrounding.

2. Loss of independence.

3. Separation from spouse.

4. Financial problem.

5. Isolation from other people.

6. Lack of information.

7. Threat of severe illness.

8. Separation from family.

9. Problem with medication.

STRESS EVENTS:

1. Unfamiliarity of the surrounding: -having strangers sleep with you in the same room,
having to sleep in a strange bed, being aware of unusual smells around you, being in a room
that is too cold or too hot, having to eat cold or tasteless food.

2. Loss of independence: -having to eat at different times than you usually do, having to
wear a hospital gown, having to be assisted with bathing, not being able to get newspaper
radio or TV when you want to, having to be assisted with a bed pan, being fed through tubes
thinking you may lose your weight.
3. Separation from spouse : worry about your spouse, being away from you.

4. Financial problem: -thinking about losing income because of your illness, not having
enough insurance to pay for your hospitalization, cannot afford to pay for family upkeep etc.

5. Isolation from people: having room mate who is seriously ill or cannot talk with you,
having room mate who is not friendly, not being able to call family or friend on the phone as
you like.

6. Lack of information: thinking you might have pain because of surgery or test procedure,
not knowing when to expect thing will be done to you, having nurses or doctors talk too fast
or using un-understanding words, not knowing the results or reasons for your treatment, not
being told what your diagnosis is.

7. Threat of severe illness: thinking your appearance might be changed after your
hospitalization being put in hospital of an accident.

8. Separation from family: Being in the hospital during holidays special family occasions
not having family visit you, being hospitalized faraway from homes.

9. Problem with medication: having medications cause you discomfort, feeling you are
getting dependent on medications, not getting relief from painful medications.

Attitudes to sickness:

Some people regard illness as a challenge. Their efforts to overcome illness and weakness
may lead to greater achievements then would otherwise have been possible. The term
“compensation " is sometimes used to indicate the mechanism of overcoming a weakness
suffering helps many people to find a new faith in religion to discover their purpose in life .
Illness can be turned into an advantage helping the development of most desirable
characteristics.

Regression: Under stress people often revert to earlier patterns of behaviour they "regress”.
Sickness often causes change in behaviour which are quite irrational . The patient cannot help
himself because he is reacting unconsciously and some of his troubles lie in the past rather
than in the current illness.

The stigma of illness: Some illness still bear stigma. People suffering from mental disorders
epilepsy, tuberculosis or venereal diseases are still occasionally treated as outcasts of society.
Ill health is often looked upon as a punishment in many cultures it is regarded as shameful
and wicked. Looking upon illness as if it were blameworthy causes sick people to behave
with resentment. This watermark does not appear in the registered version.
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Guilt feelings about illness:

Often people believe that illness is a punishment for some misdeed . Some patients who feel
guilty look upon the illness as a punishment they are unjustly treated for wonder what they
have done to deserve suffering. Unfortunately there is a tendency to regard any illness as a
punishment even when it is unavoidable and in no way attributable to individual negligence
or wickedness . When patients or relatives adopt the attitude that the illness must be regarded
as punishment and to find the guilt for which the punishment has fallen upon them they adopt
an outlook which is not conductive to recovery . Some patients who look at illness as a form
of punishment react to it by becoming resentful, angry, rebellious others by becoming
submissive, apologetic or passive .

The need for attention: during illness patient may use behaviour pattern quite unconsciously
such as cry, complain, and display their suffering other appear to be able to tolerate a great
deal of discomfort without complaint. Sometimes they succeed in gaining special
consideration just as they did in childhood . Often the behaviour appear misplaced and fails to
fulfil its purpose. Crying and complaining may result only in irritating the nurse or in
discouraging visitors, remaining too silent may result in being ignoring by a busy staff , but
childhood patterns of behaviour may persist even when they turn out be of no practical use .
It is helpful to assume that any patient who seek attention really needs it, proved otherwise.
Often when it is freely given and when it is given before the patient has had to ask for it . The
"attention seeking" behaviour decrease dramatically. If need for attention is understood
childish attitude can more easily give way to more adult forms of adaptation.

Chronic sickness and disability: accepting disablement: illness is regarded as a temporary

When the patient first realize that he cannot get completely well he may become depressed.
He may feel that in such circumstances life is not worth living . He may lose interest in
himself, his treatment and the conditions surrounding him. When the patient in this
psychological state it is very difficult to nurse him ,as he himself does nothing to help . He
may refuse to take sufficient nourishment , neglect his personal hygiene , lose all interest in
any activity. All doctors and nurses know that the will to live is essential for recovery and
they must help the patient to see that in spite of his handicap he is needed by those who love
him and that he can still be useful to the community

Stigma: Often the patient who realizes that he is permanently disabled becomes furiously
angry with himself and with everyone whom he feels he can blame for his disability. He may
express his feeling in the criticism of the treatment and care he is receiving in the hospital
possibly even in litigation against the hospital or those he thinks are responsible for his
condition or he may accuse his family or people in general of being hard – hearted disliking
him because he is burden to them and looking down on invalids. At some stage of the illness
most disabled people project their anger on to other people. They refuse to meet people refuse
to be seen or to go out .this phase of self – consciousness increases the difficulties because
while originally people may not have harboured any of the feelings ascribed to them the
patient's attitude creates in them embarrassment , discomfort and eventually rejection .

Difficulty in communication: it is inevitable that a disabled person must lose some of his
former friends . If he can no longer work he loses interest in discussion about his former job .
After an initial attempt to keep in touch he become increasingly isolated from all those whose
interests he can no longer share.

The greatest isolation occurs in those who lose sight ,hearing or speech . We rely in our social
contact and communication by speech and we keep informed about our environment mainly
by sight and hearing . It must be remembered that deaf people are suspicious. Partially deaf
people may be even more handicapped because they may be less conscious of defective
hearing and more inclined to blame other or failing to themselves clear.

People who have become partially sighted or blind need constant interpretation of their
environment while they are learning to use their other senses . The total isolation of those
who cannot see may lead to period of confusion . Disorientation and terrifying feeling of
being lost which may result in uncontrolled , sometimes aggressive behaviour. It is
sometimes difficult to know how soon the patient should be confronted with the fact the
prognosis is not too good. But this information is not mentioned to him for a long time . By
then the patient has already begun to realized that all is not well and , sensing other people’s
reluctance to face fact . He keep his worry to himself and begin to see himself as an object of
pity and despair it may be much wiser to encourage talk of the future as early as possible .
And to help the patient to get to know himself as a different but in no way inferior , person to
the one he used to be .

Rehabilitation: this can best be done by emphasizing what the patient do rather than what is
no longer possible for him . If he has lost the power of his legs he can work with his hands,
he can paint or learn a new craft . The creation of new interest , new skill in no way
connected with the disabled part of the body give a positive purpose or direction to life.
Many patients are able first to accept the fact that they may be useful to other sufferers of
their own kind. Association for sufferers from poliomyelitis, paraplegia or epilepsy may
contribute a lot for giving a meaning and direction for a new life.