Talk Time for hospitalized children

40 The modern hospital, particularly ing. In addition, he is separated from an urban university hospital, is not a his entire normal way of life. He misses long-term institution. It sees patients brothers and sisters, friends, and class in the acute phase of their illness, treats mates. He may have waited months them, and discharges them. Even so, for his dog to have puppies, only to in reviewing studies of the effect of be away on the crucial day. His daily hospitalization on children admitted routine will be changed. He may be for tonsillectomy (a short and minor expected to be at once more dependent operation), Cooke concluded that and more independent than he is at from 20 to 60 percent of the children home. His clothing is supplied by the showed signs of difficulty in adjusthospital and may be of regulation de ment during or after hospitalization.1 sign. On the other hand, this may be There is evidence that older children the first time that he is away from are more able to withstand the experihome all night, is served certain foods, ence, but certainly in cases when the or is in contact with members of other illness is either acute or of long duraraces. tion, children react more strongly The child's illness will have an effect than adults.2 This being true, they will on his physical self-image. He may have often need help in coping with a hosto have a part of his body removed by pital experience. surgery, or disease may change the In response to this need, in Februway in which he sees himself. A child ary 1972 the departments of nursing who is diagnosed as diabetic during and child psychiatry of the University hospitalization, whose leg is ampu of Illinois Hospital in Chicago inititated, or who has an implanted pace ated a program called "Talk Time" for maker is an altered child when he pediatric patients. Although the projleaves the hospital. The hospital per eci was seen originally as a means of sonnel and equipment, the teams of working with children who demonphysicians, and the strange terminol strated low self-esteem—a frequent acogy are all threatening. Whereas adults companiment to chronic illness—it have developed the ability to ration soon became apparent that the proalize medical procedures, children see gram served a range of goals for chilthem as a brutal invasion. These dren and staff alike. The social worker threats are in constant interaction with assigned to the inpatient pediatric serthe child's period of development and vice became active in the group at the with his fantasies about illness. Chil end of its first year and receives dren bring with them to the hospital backup support from other members their life experiences that may include of the department. This article will atbeliefs that children get sick because tempt to discuss, from the viewpoint of they are bad and playground talk the social work profession, the theoabout "needles five feet long." retical basis and practical applications During crisis even a normal, well of Talk Time. functioning adult will regress to earlier patterns of behavior and recall past experiences of similar loss. This is even more true of hospitalized chil dren, for whom regression may be the Hospitalization can be viewed as a rule. The experience of entering a hos crisis situation.3 The reaction to crisis, pital and suffering separation and new however, must not be seen as a reflecthreats frequently comes at a time tion of underlying pathology—alwhen a child's ability to cope is already though it may interact with it—but as strained by physical discomfort and a response to a threatening situation. lowered self-esteem. The child expe Separation and loss, which are partieriences pain and must undergo seem ularly difficult for the hospitalized ingly meaningless medical procedures, child, are major elements of crisis. The He has fantasies about what is wrong separation from parents is usually the with him and why. For example, chil most difficult and may engender anger dren often believe they have caused in himself that the child finds threatentheir own illness or that their parents CRISIS SITUATION