Preparation
of Children
for Hospitalization
in
Acute
Care
Hospitals
in the
United
States
Pat Azarnoff, MEd, and Patricia D. Woody, MA
From the Research Center,
Angeles
Pediatric Projects, Wright Institute Los Angeles, Los
ABSTRACT. To study the prevalence and nature of
psy-chological preparation for pediatric care, children’s hos-pithis and acute care general hospitals were surveyed, and 24 hospitals were visited. Of 1,427 hospitals responding, 468 (33%) provided regular, planned preparation services.
Prior to hospitalization, group tours and group discussion
were the two most frequently used methods. During
hospitalization, children learned informally as events
oc-curred, usually through conversations. Pediatrics
68:361-368, 1981; psychologicaipreparation, preadmission tour, hospitalized child.
In an effort to provide less stressful
hospitaliza-tions for pediatric patients, psychological
prepara-tion of children for admission and for medical and
surgical events is recommended by the American
Academy of Pediatrics,’ and is now offered in a
number of hospitals admitting children.2’2
Re-search evaluating the benefits of specific types of
preparation suggests that preparation results in less
anxious patients whose recovery and postdischarge
adjustment is shorter and less psychologically
trau-matic,2”324 Reviews of studies2’23’25 indicate a wide
interest in psychological preparation; yet, the
na-ture and prevalence of such practices have not been
studied, except for a sample of children’s hospitals.26
Inasmuch as 4.5 mfflion children are hospitalized
annually,2”28 and 90% of them are treated in general
hospitals that may or may not have pediatric units
and specially trained staff, the area of pediatric
mental health appears to be a significant one for
research.
The present research, in addition to studying
preparation practices, was designed to determine
when preparation was given; the issue of timing of
Received for publication Sept 26, 1980; accepted Jan 7, 1981. Reprint requests to (PA.) (Wright Institute Los Angeles, 1100 S Robertson Blvd, Los Angeles, CA 90035.
PEDIATRICS (ISSN 0031 4005). Copyright © 1981 by the
American Academy of Pediatrics.
preparation services has been addressed and advice
given but few studies on it have been found.2’23
METHODS
Questionnaire
To study
the
prevalence
and
nature ofprepara-tion
services in the United States, a surveyques-tionnaire was developed and sent to all children’s
hospitals and general acute care hospitals accepting
pediatric
patients.
Because
no list of such hospitalsexisted, one was generated by this project, using
primarily the American Hospital Association Guide to the Health Care FielcL3#{176}
Additionally, in order to obtain a more
homoge-neous study group, accreditation by the Joint
Com-mission on the Accreditation of Hospitals (JCAH)
was used as the primary selection criterion. It was
believed that the American Hospital Association
Guide,
along
with
the
JCAH
accreditation,pro-vided a standard of classification common to most
hospitals in the United States and assured that the
selected facilities complied with and shared
cur-rently accepted minimal standards of health care.
Specialty hospitals (eg, orthopaedic or eye and
ear; physical rehabilitation facilities; psychiatric
fa-ciities; and pediatric clinics associated with medical
centers) were excluded because of limited time and
financial resources. (The latter groups also have
some unique mental health considerations that
re-quire separate data collection and analysis.)
Addressee/Respondent
One
of the
major considerations in conductingthis study was the individual to whom the
question-naire should be addressed. Based on results from
the pilot study it was decided to address the
ques-tionnaire to the Director of Nursing, with the
thought that this position is common to all or most
individ-ual in this position was most likely to know the
person who would have this information.
Of the individuals completing the questionnaire,
35% were directors of nursing, and 34% were head
nurses. It is therefore likely that the responses in
the questionnaire reflect preparation practices in
the responding hospitals from the nursing
perspec-tive of these situations.
Questionnaire Content
The questionnaire defined preparation services
as
those activities and interactions engaged in by a child and/or parent, on a planned regular basis, before a
hos-pithi or clinic event (e.g., admission, surgery, blood
draw-ing, etc.). The aim of preparation is to psychologically
and emotionally ready (prepare) the child for the
im-pending event and subsequent bodily and emotional changes.
Though play is often used to help a child cope with the
stress of health care procedures . .. please note that we are interested in only those activities and interactions specifically designed to prepare the child. In some hos-pithis the term ‘pre-op teaching’ or ‘orientation’ is used instead of ‘preparation.’
The questionnaire was organized into three major
categories. Part I, Hospital Characteristics, covered
general areas such as staffing, age ranges of the
pediatric population, number of beds, and the like.
Part II, Preparation Services, asked whether or not
the hospital provided psychological preparation
ser-vices on a regular basis. Part III, Methods of
Prep-aration, asked about the specific preparation
ma-terial and activities offered by the hospital and
whether or not these items were provided prior to
admission and/or during hospitalization. This
sec-tion concluded with five open-ended questions
about the specific parts of the hospital preparation
services. There were no questions on rooming-in
policies, visiting hours, or play programs.
As part of the total project 24 site visits were
made in six regions of the country, Northeast,
Southeast, North Central, South Central,
North-west and Southwest. Hospitals were selected for
visiting from the questionnaire returns as well as
from reports in the literature. A site-visit
observer-guide and interview questionnaire were developed
as data collection forms. Hospitals were not visited
for comparison purposes, however, but to further
document the preparation process and philosophy
in its various forms.
RESULTS
I. Hospital Characteristics
The following results were obtained from the
analysis of 1,427 questionnaires representing
re-turns from 50 states and the District of
Columbia.27’28 (There are more than 7,000 hospitals
in the United States. Of these, 6,322 are general
acute care hospitals, 2,91 1 of them with pediatric
inpatient units or pediatric care only. The
remain-der of the general acute care hospitals either do not
accept children or mix them with adults. Of the
2,911 hospitals, responses were received from 1,427
or 49%.) The major comparisons within the data
were made by comparing hospital census data, such
as beds and length of stay, and the differences in
these variables between hospitals with and without
preparation services. Additionally, within the group
of hospitals providing preparation, comparisons
fo-cused on the most and least frequently used
prep-aration materials and practices and on the times at
which they were used.
Data analyses were conducted using descriptive
statistics, such as percentages and means, for single
variables, and Yates corrected
x2
and analysis ofvariance for comparisons between hospitals with
and without preparation services.
Staffing: Who Prepares? Of the 13 staff positions
in which people “worked with children in a
psycho-logically supportive role,” nurse and physician were
by far indicated the most frequently, with 1,332
hospitals (96%) and 909 hospitals (65%),
respec-tively, of all reporting hospitals checking these two
positions. (More than one position could be
checked.)
Site visits demonstrated that when preparation
was done, it was most likely the nurse who was
preparing. In addition, the preparation that
physi-cians provided was general, in the form of telling
the parents that the child would be hospitalized,
briefly describing the procedure, and asking the
parent, and sometimes the child, if either had any
questions. It was rare to find in our site visits a
physician who claimed to spend more than a few
minutes to a half hour talking over with the parents
and/or the child what was going to be happening
and ascertaining if the child or parents were
emo-tionally ready to cope with the stressful impact.
Social workers and community volunteers were
reported next most frequently at 547 hospitals (40%)
and 535 hospitals (39%) as being psychologically
supportive.
The least frequently checked staff positions were
preparation therapists, 40 hospitals (2.9%), and
rec-reation therapist, 77 hospitals (5.6%). These two
positions, along with playroom leader, 96 hospitals
(7%), psychologist, 95 hospitals (7%), psychiatrist,
81 hospitaLs (6%), play therapist, 171 hospitals (12.5%), and teacher, 183 hospitals (13.3%), are often
thought to be the most likely sources of
hos-pitals, however, do not employ individuals in these
positions. In our survey when a hospital did have a
preparation therapist, or recreation therapist, it was
also much more likely to offer preparation services,
(recreation therapist
x2
29.25; preparation therapistx2 20.86, both P < .01) The existence of these
positions on a hospital staff is therefore an excellent
indicator that the hospital also provides specific
preparation services; however, the personnel in
these positions may not be the ones to prepare,
when the nurses and, to a lesser extent, physicians
are reported as working with children in a
psycho-logically supportive role.
Beds: How Many for C4ildren? Hospitals
with-out preparation services for children and/or their
parents were much more likely to have fewer beds
available for children than hospitals with
prepara-tion (F [1,1228] = 68.66; P < .001). Hospitals with
preparation on the average had 18 more beds for
children than those without preparation services.
The 152 hospitals that indicated a nonspecific or
variable number of beds available on an as-needed
basis for pediatric patients were much more likely
to be hospitals with no preparation for children
and/or parents
(x2
42.28; P < .01). The meannum-ber of beds for pediatric patients in all hospitals
was 28.4; in those hospitals with preparation
ser-vices for children, the mean number of beds
in-creased to 38.8; in hospitals that did not have such
services, the mean number of beds for pediatric
patients was 20.9.
Length of Stay: Long Enough to Prepare?
Hos-pitals providing preparation services for children
hospitalize children for a slightly longer period of
time. These hospitals kept children approximately
one-third to one-half day longer than hospitals
without preparation services. The average length of
stay for all hospitals was 4.1 days. Hospitals
provid-ing preparation averaged 4.3 days and those with
no preparation averaged 3.9 days. Although there
is not quite a half-day’s difference between these
two types of hospitals, the difference was significant
at the 0.001 level (F [1,1333] = 22.03).
Site visits and open-ended questions in the survey
confirmed that whether a longer stay creates more
time in which to offer preparation, or the child is
purposely held longer in order to prepare is
deter-mined on a random, rather than a planned, basis.
In some instances, the child was hospitalized earlier
than medical or surgical procedures required, in
order to prepare the child for what the staff
per-ceived to be a major or life-threatening surgical
procedure. In the site visits it was rare to find a
child hospitalized additional time in order to
pre-pare for what the staff perceived to be a minor
procedure, whether or not the child or parents
perceived it as minor.
TABLE I. Number of Hospitals Reporting Staff
Posi-tion Providing Preparation Services#{176}
Staff Member All
Hos-pitais
Prepa-ration
No Prepa-ration
Most frequent
Nurse 1,332 528 804
Physician 909 384 525
Least frequent
Preparation therapist 40 30 10
Recreation therapist 77 53 24
S Total number of hospitals surveyed was 1,427; more
than one position could be checked.
TABLE 2. Percentage
Preparation
of Patient Groups Receiving
Patient Group All Hos-pitais
Prepa-ration
No Prepa-ration
White 71.4 71.9 71.1
Black 21.4 18.6 23.7
Mexican-American 153 13.0 17.0
Asian-American 4.0 3.9 4.1
Native American 7.5 5.2 9.4
Age Range: Wider Range, More Services?
Hos-pita.l.s with preparation were much more likely to accept children within a wider age range, from
newborns through 16 years 9 months, than hospitals
without preparation, from 2 months 12 days to 15
years 5 months (youngest age F [1,1374] = 6.38 P
< .01; oldest age F [1,1342] = 72.09 P < .001).
All hospitals admitted children aged 4’/2 to 5 years
more frequently than they admitted children of other ages. There was no significant difference in the ages of pediatric patients seen most frequently between hospitals offering (4 years 8 months) or
not offering (4 years 6 months) preparation.
Patient Groups: Who Receives Preparation? Of
the five patient/racial groups asked about in the
questionnaire, the one reported most frequently
was white. White patients comprised 80% (on the
average) of the pediatric patients in hospitals
re-sponding to this item. The two groups least
fre-quently reported were Asian-American and Native
American. That is, in hospitals that reported having
Asian-Americans and Native Americans among
their pediatric patients, each group comprised, on the average, less than 5% and 10%, respectively, of the total pediatric population.
When hospitals with and without preparation
were compared according to the racial/ethnic
com-position of their pediatric patient population,
sig-nificant differences were found for Native Ameri-cans, blacks, and Mexican-Americans. Although the number of these groups seen in United States hos-pitals is small in comparison to white patients, those
hospitals without preparation are significantly more
than hospitals with preparation. (Native Americans
F [1,314] = 5.64 P < .02; Mexican-Americans F
[1,637] = 6.83 P < .01; blacks F [1,930] = 12.49 P
< .001.) It is clear that when Mexican-American,
black, or Native American children are hospitalized
in acute care facilities they are very likely to be in
a hospital without preparation. When white and
Asian-American children are hospitalized, however,
they are as likely to be in a hospital with
prepara-tion as one without.
These findings do not necessarily indicate a
causal relation between racial groups and
psycho-social preparation, but do indicate clearly that
hos-pitals without preparation are also likely to have a
higher percentage of black, Mexican-American, and
Native American pediatric patients than hospitals
with preparation services.
II. Preparation Services
Of the 1,427 hospitals responding, only 468 (33%)
indicated they provided regular preparation
ser-vices: they checked “yes” to the question, “Does
your hospital currently provide psychological
prep-aration services on a regular (not occasional)
basis?”; 664 (47%) indicated they did not offer such
services. Another 282 (20%) were classified as
Un-sure; they also checked “yes” to this question but
went on to answer an open-ended question that
asked for reasons why their hospital did not offer
preparation. Because of this contradictory response,
these 282 hospitals were not included in the results
reported in part III.
No Preparation. When respondents indicated
that the hospital did not provide preparation
ser-vices they were asked on the questionnaire to share
some possible reasons for the absence of such
ser-vices; 912 of the “no” and “unsure” groups did, and
usually one or two reasons were given. The most
frequently given reason was low census (336
re-sponses), that is, not enough pediatric patients to
warrant a program. The second most frequently
given reason was not enough staff (281 responses).
Hospitals seem to need an ideal minimal number of
children and staff before a preparation program is
begun. Site visits confirmed that in planning
prep-aration, hospitals try to reach as many children as
possible with as few staff in the shortest reasonable
time. When hospitals that did not have preparation
reported being in the process of planning such
ser-vices, they were almost always planning group,
rather than individual, preparation services.
Funding. Those hospitals offering preparation
services were asked the source of funding. Hospital
funds were the most frequently reported, with a few indicating federal research grants, foundation
ser-vice grants, department budgets, and combinations
of these. The source of funding remains an
unre-solved issue, although many respondents indicated
their belief that preparation is not an additional
service but an integral part of quality care.
III. Methods of Preparation
One of the major purposes of this study was to
learn which methods of preparation were being
used in the survey hospitals and at what point in
the child’s hospitalization these methods were used; therefore, the second half of the questionnaire was
directed at the issues of method and timing.
Re-spondents were asked to indicate how many of 23
items listed were used in their hospital’s preparation
programs and “to think only of the items your
hospital uses regularly, not occasionally.” In
check-ing an item, respondents were asked to indicate
whether it was used “prior to” and/or “during”
hospitalization. Again, only those 468 who clearly
indicated that such services existed at their
hospi-tals are discussed below. The choices given
in-cluded: (1) printed material, such as coloring books,
written instructions, and information booklets; (2)
audiovisual materials, such as slides, film strips, and
videotapes; (3) models and miniatures, such as dolls,
puppets, and medical/nursing supplies; (4) verbal communication, such as conversation, phone calls, and group discussion; and (5) activities, such as
tours, parties, and play groups.
Overall, none of the items appeared to be used
equally often in both time periods; most items were used either prior to or during hospitalization.
Prior to admission, tours were by far the most
frequently used item, reported by 283 hospitals
(64%). No other activity is reported as often; group
discussion was the second most frequently used
item, reported by 123 hospitals (26.3%). Because
tours are often combined with group discussions it
may be that the reported group discussion is in
combination with the tours, although, had this been
TABLE 3. Number of Hospitals Reporting U se of Preparation Materials and Activities5
Prior to Hospitalization During Hospitalization Prior to and During Hospitalization
Most used
Least used
Tours 283
Group discussion 123
Home visit 5
Storybooklet 16
Learn as events occur Conversation
Home visit
Films, tapes, each
419
409
30 55
Conversation
Medical/nursing supplies
Home visit
122
106
3
the case, a larger number of hospitals would have
reported group discussion.
During the hospitalization period, the two most
frequently reported items were the two most
infor-mal and occasional methods respondents could
se-lect. They were “child learns as events occur,”
reported by 419 hospitals (89.3%), and
“conversa-tion,” reported by 409 hospitals (87.2%). The third
most frequently used method was coloring books,
reported by 374 hospitals (80%). (As part of this
project 150 coloring books were reviewed; most
offered specific, brief information about the
hospi-tal, although not necessarily the child’s experiences
there, or named the medical instruments depicted
and rarely commented on feelings about being in
the hospital.)
Home visit was consistently the least used
method reported: it was used by five hospitals (1%)
prior to admission, 30 hospitals (6%) during
hospi-talization, and three hospitals (less than 1%) both
prior to and during hospitalization. The next least
used items prior to admission were story booklets,
16 hospitals (3%) and television/videotapes, 15
hos-pitals (3%). During hospitalization, the least used
items (after home visits) were films and tape
re-cordings, each reported by 55 hospitals (12%) and
slides, 47 hospitals (10%).
Data were also analyzed by looking at the items
that respondents indicated were used both prior to
and during hospitalization. Overall, few hospitals
checked both categories for any one item; when one
item was checked for both time periods, again it
was usually conversation, reported by 122 hospitals
(26.9%). The second preparation item most
fre-quently used both prior to and during
hospitaliza-tion was the use of medical/nursing supplies,
re-ported by 106 hospitals (22.6%).
SUMMARY
In summary, the characteristics of those acute
care general hospitals reporting that they provide
preparation to children include: (1) staff trained in
psychosocial care, although they are not necessarily
the ones who prepare children; (2) more than 35
beds for pediatric patients; (3) longer than average
hospital stay; (4) age range of patients from
new-born through adolescence; (5) primarily white
pa-tients; (6) activities that include tours, informal
conversation, and materials to read; and (7) the
most likely preadmission event, a tour of some areas
of the hospital.
During hospitalization, informal conversation as
some events occur is the most likely means used by
hospitals that profess to prepare children. The next
most likely means of preparation is coloring books
and the play exploration of medical/nursing
sup-plies.
DISCUSSION AND RECOMMENDATIONS
In many instances the preparation of children for
hospitalization and medical procedures, when it is
offered at all, is random, occasional, and
insuffi-cient. When preparation is not offered, the most
frequently given reason appears to be that there are
not enough pediatric patients to warrant instituting
such a service. The unanswerable question is: How
many patients are needed to warrant the regular
provision of planned emotional support and
infor-mation? There are some hospitals, with less than
20 beds, that give such service without increasing
the number of staff. They seem to manage it through attitude, the belief that preparation is
es-sential for the well-being of the family and that
supportive care can be incorporated along with
physical care, and through training and education
of the existing and new staff.
When preparation is offered, who can or should prepare children? Inasmuch as there are a greater number of nurses and doctors than of other staff,
and because nurses and doctors give direct care, it
seems reasonable to expect them to prepare the
child, at least for procedures they themselves will
do, but the preparation of children can be a
contin-uous effort, begun at home, continued at school,
influenced by the community and peers and even
can include service after hospitalization. When a
child is about to be hospitalized, it would also seem
reasonable that a staff member primarily responsi-ble for psychosocial support of patients and families contact them and continue in a dependable sup-portive role through discharge and follow-up.
Prior to hospitalization, materials can be mailed
and phone calls or home visits can provide
reassur-ing human interaction. Preparation at
prehospital-ization clinic visits or when presurgical tests are
given can become routine. During hospitalization,
preparation can be offered before any procedure or change in routine, personnel, or relationship. When
staff unknown to the child will do a physically
intrusive treatment, for example, it is important that the child be prepared for the change in
care-giver as well as for the physical experience.
In speculating about the finding that hospitals
with preparation services are more likely to admit
newborns and older patients, it may be that
hospi-tals with newborns also have maternity services,
where prenatal classes and tours of the hospital
may have been offered for some time. The natural
the hospital or ask the staff to answer questions
and respond to their concerns. Also, parents of older
patients who are chronically ill are more
experi-enced parents and may therefore be more assertive
about their needs.
From the review of 150 coloring books surveyed
during this project it was unusual to find
informa-tion written in languages other than English, or
during site visits to find staff who spoke fluently in
any other language. This may account, in part, for
the lack of preparation in hospitals that primarily
serve Hispanic patients who do not speak or read
English. Another factor may be that most medical
and nursing professionals are white, and they may
unknowingly be choosing not to deal with the
con-cerns of nonwhite children and families.
When preparation services are planned, it must
first be decided what constitutes “preparation.”
Does it include giving written instructions without
seeing that the patient and/or family read them or
without knowing what their interpretation was?
Does it include giving spoken information without
observing the response to it? Does it include
archi-tectural tours of the hospital, which some call
“ori-entation”? No, ideally, preparation would include
methods that actively incorporate the children’s
and parents’ responses into the specific preparation
activities, and do not simply point out or describe
without adequate feedback from those who are
being prepared.
When preparation is offered, it is usually given to
groups of children, rather than individually, or in
written form to parents. Feelings can be explored
better through personal contact, but hospital staff
does not usually see families prior to hospitalization.
Therefore, they do not have opportunities to
ob-serve behavior until the family enters the hospital.
Then an effort is made, although not emphasized,
to provide some conversation and written materials.
This may be too little, too late, and in a learning
form that does not take feelings or age level into
account as much as facts. Also this approach does
not enable staff to learn about their patients’ coping
styles or previous encounters with health care.
Fi-nally, it does not leave time or opportunity to
respond to individual emotional needs.
What methods are used to prepare children
be-fore they enter the hospital are not used once the
children are there. This situation offers children
little consistency and continuity at a time when
familiarity and certainty would be two important
stabilizing factors.
Tours are likely to be less helpful when they
emphasize telling children and parents what the
staff wishes them to know rather than hearing what
the children and parents want to discuss. Perhaps
individual or small-group tours could be done, with
emphasis on observation of behavioral responses,
and follow-up for those children seen to be
partic-ularly stressed by contact with the hospital.
Because 41/2 to 5 years is the age most frequently
reported for hospitalized children, it would seem
that more play materials are needed. They can be
used in the presence of a staff person who would
monitor the child’s response. Less reading material
and more real items for this age group would also
be helpful.
Talking with children only when time permits
and then only as events occur does not give them
sufficient time to integrate the concept of
impend-ing stress and to ready themselves to participate or
to respond with healthy protest. It also does not
constitute a program of regular, planned, consistent,
supportive care. Although personal care such as home visits or phone calls uses expensive staff time,
these methods can be effective in bringing
infor-mation to the family about the expected course of
events and engage their motivation to participate in, rather than to resist, treatment. Such contacts can be equally important to the hospital staff by providing information to them about the child’s home environment and support systems outside the
hospital setting.
Some methods can be provocative, such as
show-ing films and videotapes to younger children, when
the media were designed for older children or adults
and when reaction is not observed or no discussion
of response is provided. In the same way, coloring
books may be fun and somewhat informative or, on
the other hand, they can distort the proportionate
size of medical instruments or show treatments a
particular child is not scheduled to have, and may
therefore not be useful. The coloring book serves
also as one of the first efforts at control, by
sug-gesting through its format that children conform to
the lines drawn. If there is to be drawing involved
in preparation, it may be more useful for children
to draw on blank paper to show a staff person or
the parents what the child believes wifi happen or
has happened.
The benefit of storybooks is that the child and
family can see the words and pictures repeatedly.
For many children, however, materials are needed
in Spanish and other languages, and pictorial
ma-terials are needed for all nonreaders. When printed
or pictorial methods are used, perhaps there could
also be human interaction, inasmuch as it is not
known to what extent the effects of these materials
benefit or alarm certain children.
More preparation is needed in hospitals that
serve minority groups. When preparation is more
style, and ethnic beliefs are taken into account, it is
likely to be more helpful to children.
As this is apparently the first study of preparation
practices in acute care general hospitals nationwide,
it would be informative to repeat the study to see
the continuing trends. Having more detail by
re-gions would also be of interest. Data were analyzed
in this study on a regional basis but are stifi being
discussed for a future publication. Preparation of
parents was also surveyed but not reported here as
it was beyond the scope of this presentation.
Inas-much as parents’ influence on children’s attitudes
and anxiety are well known, it would be useful to
have studies on the effectiveness of varied parent
preparation methods. Studying those facilities
which had to be excluded from this survey, such as
specialty hospitals, rehabilitation units, and
pedi-atric clinics, would enlarge and enrich the data.
Although studies have been done on some
meth-ods to prepare, such as a tour, a booklet, videotapes,
films, information, expression of feelings and
pup-petry, there remains the need for replicative studies
as well as new ones on other, yet untested, methods.
Inasmuch as it is unusual to find that the method
chosen by a hospital has been evaluated, other than
by asking parents if they liked the tour or ifim,
in-hospital studies need to be done on those services
already in progress.
Certain diagnostic categories appear to have
more preparation, such as cardiology, hematology,
and endocrinology; a look at preparation by
diag-nostic categories may confirm or deny this
obser-vation. Obtaining responses to the same questions,
but from respondents other than in nursing, would
also be of interest, to see if perceptions of other
staff members concerning services offered are
sim-ilar to those of nurses in administrative or
supervi-sory positions.
Education about preparation in needed for staff,
both pre-service and in-service, and for parents so
that both expect to be emotionally supportive of
child patients. If practitioners and families were
more aware of the demonstrated effectiveness of
preparation in reducing fear, confusion, anxiety,
and the trauma of unsupported hospitalization,
then perhaps implementation of preparation
ser-vices could become the usual practice rather than
the exception.
ACKNOWLEDGMENTS
This study was supported by grant MH31404 from the National Institute of Mental Health to Wright Institute Los Angeles, Pat Azarnoff, Project Director.
The authors wish to thank Virginia Lewis and Anita King for their assistance; we also thank Mary Donnelly
and Drs Morris Green and John Schowalter for their
consultation.
REFERENCES
1. Committee on Hospital Care: Care ofChildren in Hospitals. Evanston, IL, American Academy of Pediatrics, 1970, pp 52, 82-83, 87
2. Azarnoff P, Bourque LB, Green JA, et al: Preparation of Children for Hospitalization: A Final Report to NIMH. Los Angeles, UCLA Department of Pediatrics, 1975
3. Azamoff P, Flegal S: A Pediatric Play Program. Springfield, IL, Charles C Thomas Publisher, 1979
4. Eckhardt LO, Prugh DG: Preparing children psychologically for painful medical and surgical procedures, in Gellert E (ed): Psychosocial Aspects of Pediatric Care. New York, Grune & Stratton, 1978
5. Petrillo M, Saner 5: Emotional Care ofHospitalized Chil-dren, ed 2. Philadelphia, JB Lippincott Co., 1980
6. Prugh DG, Jordan K: Physical illness or injury: The hospital as a source of emotional disturbance in children and family, in Berlin IN (ed): Advocacy for Child Mental Health. New York, Brunner/Mazel, Inc., 1975
7. Plank E: Working With Children in Hospitals, ed 2. Chi-cago, Year Book Medical Publishers, Inc, 1971
8. Sauer J: Preadmission orientation: Effect on patient man-ageabiity. Hosp Top 46:79, 1968
9. Schowalter J, Lord B: Utilization of patient meetings on an adolescent ward. Psychiatr Med 1:197, 1970
10. Wolinsky FG: Materials to prepare children for hospital experiences. Except Child 37:527, 1971
11. Brown MJ: Preadmission orientation for children and par-ents. Can Nurse 67:29, 1971
12. Hunnisett FW, Knowles DJ: Orientin prospective patients. Hospitals 44:51, 1970
13. Cassell 5, Paul M: The role of puppet therapy on the emotional response of children hospitalized for cardiac cath-eterization. J Pediatr 71:233, 1967
14. Ferguson BF: Preparing young children for hospitalization: A comparison of two methods. Pediatrics 64:656, 1979 15. Heffernan M, Azarnoff P: Factors in reducing children’s
anxiety about clinic visits HSMHA Health Rep 86:1 131, 1971 16. Melamed BC, Meyer R, Gee C, et al: The influence of time
and type of presentation on children’s adjustment to hospi-talization. J Pediatr Psychol 5:31, 1976
17. Melamed BC, Siegel U: Reduction of anxiety in children facing hospitalization and surgery by use offilmed modelling.
J Consult Clin Psychol 43:51 1, 1975
18. Mellish RW: Preparation of a child for hospitalization and surgery. Pediatr Clin North Am 16:543, 1969
19. Prugh D: Investigations dealing with the reactions of chil-then to hospitalization and illness, in Caplan G (ed): Emo-tional Problems of Early Childhood. New York, Basic Books, Inc., 1955
20. Skipper JK, Leonard RC: Children, stress and hospitaliza-tion: A field experiment. J Health Soc Behav 9:275, 1968 21. Vernon DTA: Use of modelling to modify children’s
re-sponses to a natural potentially stressful situation. J Appl Psychol 58:351,1973
22. Vernon DTA, Bailey W: The use of motion pictures in the psychological preparation of children for induction of anes-thesia. Anesthesiology 40:68, 1974
23. Vernon DTA, Foley JM, Sipowicz RR, et al.: The Psycho-logical Responses of Children to Hospitalization and Ill-ness: A Review of the Literature. Springfield, IL, Charles C Thomas Publisher, 1965, pp 8-24
24. Visintainer MA, Wolfer JA: Psychological preparation for surgical pediatric patients: The effect on children’s and par-ents’ stress responses and adjustment. Pediatrics 56:187, 1975
1976
26. Peterson L, Ridley-Johnson R: Pediatric hospital response to survey on prehospital preparation for children. J Pediatr Psychol5:1, 1980
27. Hospital Statistics, American Hospital Association 1978 Annual Survey, 1979 ed. Chicago, American Hospital Asso-ciation, 1979
28. Statistical Abstract of the United States, ed 100.
Washing-ton, DC, US Government Printing Office, 1979 29. Association for the Care of Children’s Health: Humanizing
health care for children and their families, in Azarnoff P, Hardgrove C (eds): The Family in Child Health Care. New York, John Wiley & Sons, mc, 1981, pp 243-247
30. Schechter DS (ed): American Hospital Association Guide to the Health Care Field. Chicago, American Hospital As-sociation, 1976
THE HEALTHIEST COUPLE
They brush and they floss with care every day, But not before breakfast of both curds and whey.
He jogs for his heart she bikes for her nerves; They assert themselves daily with appropriate verve.
He is loving and tender and caring and kind,
Not one chauvinist thought is allowed in his mind.
They are slim and attractive well-dressed and just fun. They are strong and well-immunized against everything under the sun.
They are sparkling and lively and having a ball.
Their diet? High fiber and low cholesterol.
Cocktails are avoided in favor of juice; Cigarettes are shunned
as one would the noose;
They drive their car safely with belts well in place; at home not one hazard ever will they face.
1.2 children they raise, both sharing the job. One is named Betty, .2 is named Bob.
And when at the age of two hundred and three they jog from this life to one still more free,
They’ll pass through those portals to claim their reward
and St. Peter will stop them “just for a word.”
“What Ho” he will say, “You cannot go in. This place is reserved
for those without sin.”
“But we’ve followed the rules” she’ll say with a fright.
“We’re healthy”-“Near perfect”-“And incredibly bright.”
“But that’s it” will say Peter, drawing himself tall
“You’ve missed the point of living By thinking so small.”
“Life is more than health habits, Though useful they be, It is purpose and meaning, the grand mystery.”
“You’ve discovered a part of what makes humans whole
and mistaken that part
for the shape of the soul.”
“You are fitter than fiddles and sound as a bell, Self-righteous, intolerant and boring as hell.”
-William Carlyon
