Hospitalisation and stressful medical procedures
7 important questions on Hospitalisation and stressful medical procedures
Hospitalisation; most frequently reported stressors
- separated from one's home and/or family
- worries about family
- lack of control/loss of autonomy
- communication difficulties staff/patient (often lack of information)
- uncertainty regarding treatment and treatment effects
Hospitalisation; additional concerns in pediatric populations
- repeated and long-lasting hospitalisations may be experienced as a traumatic experience and can interfere with normal cognitive and socio-emotional development
- separation anxiety and homesickness
- palliative care should be given
Stressfull medical procedures
* upper gastrointestinal endoscopy (lower and upper)
* magnetic resonance imaging (MRI)
- oncology
* chemotherapy
* bone marrow transplantation
- gyneacology
* in vitro fertilisation (IVF)
* fear of childbirth
- critical care unit
* PTSD
- Higher grades + faster learning
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Reducing stressin hospitalised patients
* wide variety of psychological interventions available to help patients' coping with stressful medical procedures
* relative effect of different strategies difficult to determine --> 'treatment packages'
* wide variation in outcome measures --> evidence is often fragmentary
* interventions can be categorised based on coping skills from 'crisis theory'
- children are an especially vulnerable group
* developmental stage and maturing cognitive skills may prevent them from understanding necessity and objectives of hospitalisation
Reducing stress in hospitalised patients: providing information, social support, and skills training
- best evaluated techniques
- procedural information (objective information about procedures)
- sensory information (sensations that patients may experience before, during, after procedure; in paediatric care -> use cartoons, videos etc.)
- modelling; this implies the provision of information by patient models (especially in paediatric care)
- social learning (especially in paediatric care)
A randomised controlled trial of intervention in fear of childbirth
- intensive therapy: psycho-education, cognitive therapy, visits to midwife and obstetric care for practical information (e.g. about pain relief) and information in writing (pro's and con's of vaginal delivery versus caesarean delivery)
- conventional therapy: standard information, routine check-ups, information in writing
CONCLUSION
- both intensive and conventional therapy reduced unnecessary cesareans; and resulted in nulliparous and well-motivated women
- intensive therapy reduced pregnancy- and birth-related anxiety and concerns and labors were shorter
Patient control and optimizing patients' comfort
Patient-controlled analgesia (PCA), were patients can self-administer opioids intravenously by means of a specially designed programmable pump.
- patients may tend to use somewhat higher doses of pain medication
- however, better pain control and patients satisfaction as compared with conventional methods
- example: after hip or knee surger replacement
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