Chapter 10: In the Hospital: The Setting, Procedures, and Effects on Patients

A central concern is the impact of cost-containment measures such as the prospective-payment system, which has shortened hospital stays and shifted care to outpatient settings while creating new challenges including increased rates of nosocomial infections. The chapter then explores the patient experience, emphasizing that hospitalization frequently generates anxiety stemming from loss of privacy, increased dependency, and depersonalization—the perception of being treated as a medical condition rather than as a whole person. Healthcare staff experience their own psychological challenges, particularly burnout, which encompasses emotional exhaustion, depersonalization toward patients, and feelings of reduced professional accomplishment. The chapter discusses how patients employ different coping strategies, distinguishing between problem-focused approaches such as requesting pain medication and emotion-focused strategies including denial or social support seeking. A critical factor in patient adjustment is the degree of personal control they perceive, as helplessness correlates with depression and worse health outcomes. Health psychologists enhance coping through three mechanisms: behavioral control by teaching practical techniques like breathing exercises, cognitive control by redirecting attention toward positive procedure outcomes, and informational control through education about what to expect. The effectiveness of these interventions depends on individual coping styles, particularly whether patients are monitors who seek detailed information or blunters who prefer limited details. The chapter addresses special populations, including hospitalized children who experience separation distress and may interpret illness as punishment, and terminally ill patients whose adjustment varies by developmental stage. The chapter concludes by examining Kübler-Ross's five-stage model of adjustment to dying while noting that actual grief responses rarely follow this linear sequence, and describes hospice care as an alternative approach prioritizing quality of life and dignity for the terminally ill.