Social and psychological care before and during hospitalisation

Hospitalisation is a stressful experience, especially for children. While maternal separation has been as a major cause of distress among younger children, a broader perspective is required to understand the links between the individual, familial, professional, institutional and structural levels of hospital care affecting children. This can be seen in the changing attitudes in hospitals to parents as visitors, and the gradual introduction of open visiting. A model of discontinuity is proposed to analyse the experiences of children, parents, and professional staff in the ward. A variety of ameliorative techniques are discussed, in terms of their implications for change to hospitalised children or to hospital organisation. Studies in the development of children's concepts of illness show the need for providing information relevant to their developmental level. It is suggested that more should be done to involve parents in the care of their children in hospital, and to offer them support during this time. The effects on nursing and other staff are considered. The introduction of play schemes has benefits for children, but may lead to organisational complications if the priorities between therapy and welfare are not reassessed. More attention should be given to the psychological risks of treatment in assessing effects of medical intervention. A move towards more child centred care should in particular involve a change in the role assigned to the family within the medical sphere, and a reduction in the insularity of hospitals and fragmentation of treatment derived from existing medical and nursing practices.