CHAPTER ONE

INTRODUCTION

Background To The Study

Prolonged hospitalization among orthopedic patients is a significant concern in modern

healthcare, as it can impact both physical and psychological wellbeing. Orthopedic condition,

such as fractures, joint replacement and spinal injury, often require extended hospital stay due to

surgical interventions, post-operative complications, and rehabilitation requirements (Galea et

at,2020). While hospitalization is necessary for recovery, extended stays may have unintended

negative consequences.

Physically, prolonged immobility can lead to muscle atrophy, joint stiffness, and an increased

risk of complications such as deep vein thrombosis and pressure ulcers (Brown et al, 2018).

Studies suggest that early mobilization and rehabilitation programs are critical in preventing

these adverse effects and improving functional outcomes (Lichtenberger et al, 2021).

Psychologically, extended hospitalization can lead to emotional distress, anxiety, depression and

a perceived loss of independence patients often experience feeling of helplessness and

frustration, particularly if they perceive their recovery as slow or uncertain (salmon et, 2019),

social, prolonged hospitalization or stay can disrupt family dynamics, employment, and financial

stability, further affecting patients quality of life (Smith and Jones, 2022).

Understanding the perceived effects of prolonged hospitalization among orthopedic patients is

crucial for developing effective intervention to minimize negative outcomes. It also plays a

1
crucial role in their overall experience and willingness to engage in rehabilitation. Negative

perceptions including dissatisfaction with hospital care, fear of long-term disability, and

concerns about financial burden, many influence recovery outcomes (Williams et al, 2021).

Beyond [physical challenge prolonged hospitalization can have a profound psychological impact

on orthopaedic patients. Many experience anxiety, depression, and emotional distress due to

feeling of helplessness, isolation and uncertainty about their recovery (Smith and Johnson,

2022). Hospital environment can be stressful, with disruptions in sleep patterns, unfamiliar

surroundings, and limited social interaction contributing to mental health status (deterioration).

Studies have found that patients with extended hospital stays often reports a decline in self-

esteem and confidence, which can further hinder their motivation for rehabilitation (Brown et al,

2020). Addressing their psychological concerns is essential in ensuring a holistic approach to

patient care.

Social and financial burdens are additional concern associated with prolonged hospitalization.

Patients may experience disruptions in their personal and professional lives leading to strained

relationships, loss of income, and difficulties in fulfilling social roles (willingness et al, 2021).

Families and caregivers may also face increased stress and financial hardships due to prolonged

hospital stays, particularly if the patient require ongoing support post discharge. The economic

burden of extended hospitalization extends beyond the individual, imparting health care systems

by increasing hospital costs, resource allocation, and bed shortages (Gibson et al, 2021).

Prolonged illness requires a long stay in the hospital causing delay in the care of hospitalized

patients, may also lead to increase length of stay and cause complications. Long stay in the

hospital can cause certain problem such as pressure sore, infection and depression, other hospital

related problems are caused by being in bed for a long period of time, others may result from

2
being in an unfamiliar surrounding or being given drugs to relieve pain or treat a disorder. When

hospitalized, some people are depressed, confused or undernourished and those that are older

often become less able to take care of themselves, people that cannot adequately care for

themselves are more likely to have a longer stay in the hospital and are often sent to nursing

home after discharge (Brodsky 2020). People that be admitted to the hospital are at risk of

acquiring an infection within the hospital called nosocomial infection about 5% to 10% of people

who are hospitalized get a nosocomial infections and about 10,000 of these people die each year,

the risk for infection is high in infants, older people and people with weak immune system.

These infections may be caused by fungi, bacterial, virus etc. (Griffiths, 2020).

Organisms that are acquired in the hospital are often resistance to common antibiotics; the

frequent use of antibiotics in the hospital encourages resistance strain to develop. Hospital

acquired infection includes conditions in hospital and increase risk of falling particularly for

older people after being in bed for a long period of time, leg muscles can become weak and less

able to squeeze the leg veins and they force blood towards the heart, thus blood pools in the leg.

The institute of rehabilitation and artificial limb centre treat patients with various ailments like

poliomyelitis, cerebral palsy, hemiplegia, various nervous disorders, arthritic conditions,

orthopaedic, traumatic amputation and chest condition, most of these patients suffering from

these conditions requires a long term hospitalization.( Albert 2020)

The prevalence of prolong hospitalization varied from 16%(UK) to 26% ( USA ) and the

numbers of participants reported increase health care expenditures varied from 9.4% ( Urban

South Asia) to 58% ( China ) who were restricted of activities and forced dependence on others

ranged from 45% to 71% , 45% and 50% who emotional, developmental and physical needs

3
were affected. Incidence of prolonged hospitalization was 0.50 times higher as hospitalization

increase. Despite the high prevalence of prolong hospitalization adults and children did not

receive enough professional assistance (Zing 2017)

Adults from 5 different hospital in Mumbai, India total 40% of the adults had pressure sore,

10.2% had infection, about 7000 of this people die each year, 40% of this people could fairly

care for themselves (Karishma P 2018).

The prevalence of prolong hospitalization in France was 55.4% in Malawi 81.7% in Harvard

64.2% and in Sudan 89.10% due to many hospitalization which leads to depression which had a

negative effect on quality of life ( Garfield 2020)

The prevalence of prolong hospitalization in Ghana is 75% in Zambia the prevalence of prolong

hospitalization is 76.1% in Egypt is 50% and in Togo 30.6% in Rwanda has a low prevalence of

20.5% and higher prevalence rate of 95.2% in Mexico also in Sub- Saharan the prevalence is

74.4% in Togo 43.3% and also South America is 84.2% and for the South Korea 54.0% (WHO

2019)

In Nigeria the prevalence of prolong hospitalization has been found to range from 45.5% among

adults in Lagos State and as high as 70.9% in Enugu State which has resulted to socio- economy

problem and also in Kano the prevalence of prolong hospitalization and socio- economy problem

was 73% (Baloch 2020).

The prevalence varies between 30% and 40% in children with anxiety. In Ibadan the impact of

prolong hospitalization is 50.3% among patients (Bob 2019)

4
Other states in Nigeria was 30.7% in Jigawa 30.2% in Cross River in Benue 30.6%. The

prevalence of prolong hospitalization is 90.6% with more than half of the patients depressed and

anxious (Daniel D 2017)

Also in Kaduna State shows that 60.4% of patients experience restrictions from social activities.

The impact of prolong hospitalization has been a topic of interest over the years (ABU teaching

hospital 2018)

Orthopaedic patients may require prolonged hospitalization due to the nature of their injuries,

surgeries, or rehabilitation needs. However, extended hospital stays can have detrimental effects

on their physical, psychological, and social well-being. Previous studies have shown that

prolonged hospitalization can lead to functional decline, muscle weakness, increased risk of

infections, pressure ulcers, anxiety, depression, and reduced quality of life (Abu-Qamar et al.,

2018; Canbaz et al., 2020; Zhao et al., 2019).

Therefore, it is crucial to investigate the perceived effect of prolong hospitalization on

orthopaedic patients to identify potential strategies for minimizing the negative consequences of

hospitalization and improving patient outcomes. This study aims to explore the perceptions of

orthopaedic patients regarding the impact of prolonged hospitalization on their physical,

psychological, and social well-being.

Statement of problem

Prolonged hospitalization among orthopaedic patients presents significant challenges that can

negatively impact physical recovery, psychological wellbeing, and overall quality of life. While

hospitalization is necessary for post-surgical care and medical management, extended stays often

5
result in complication such as muscle deconditioning, joint stiffness and increased susceptibility

to infections and pressure ulcers (Hoyer et al 2019).

Beyond physical health, the psychological and emotional consequences of emotional

consequences of prolonged hospitalization are equally concerning. Many orthopaedic patient

experience heightened levels, anxiety, and depression due to feelings of helplessness, isolation

and uncertainty about their recovery (smith and Johnson, 2022). The restricted hospital

environment, lack of social interaction and dependence on health providers can contribute to the

decline in mental wellbeing, ultimately affecting a patient’s motivation to part9icipate in

rehabilitation programmes. Mental health deterioration can further exacerbate with recovery

process, as patients with psychological distress may be less likely to engage in necessary

physical therapy or follow medical recommendation.

In Nigeria, the problem of prolonged hospitalization among orthopaedic patient is further

complicated by a weak health care system, inadequate funding and a shortage of orthopaedic

specialists. A study published in the Nigerian journal or orthopaedics and trauma found that

prolonged hospitalization was a common experience among orthopaedic patient in Nigeria,

resulting in significant economic burdens and decrease quality of life (Oginni et al 2017). In our

local settings, prolonged hospitalization among orthopaedic patients is a significant concern with

many patients experiencing extended hospital stays due to complications, or inadequate

healthcare service. This has resulted in decreased mobility, increased risk of complication s and

reduced quality of life among orthopaedic patients. It is therefore on this note that research study

aims to investigate perceived effects of prolonged hospitalization on orthopaedic patients in

federal teaching hospital, Lokoja.

6
Objectives of the study

- To assess the social effects of prolonged hospitalization on orthopaedic patients

- To assess the psychological effects of prolonged hospitalization on the affected patients.

- To identify coping mechanisms towards prolonged hospitalization.

Research questions

-What are the social effects are of prolonged hospitalization on orthopaedic patients?

-What are the psychological effects of prolonged hospitalization on orthopaedic patients?

-What are the ways of identifying coping mechanisms towards prolonged hospitalization?

Significance Of The Study

The findings when published will be beneficial to professional workers to have insight on the

impact of prolong hospitalization on patients. The research will help individuals, families and

community to identify the effects of prolong hospitalization.

It will serve as a guide to hospital management to know the ways to alleviate the problems

associated with prolong hospitalization.

Scope of study

This study will focus on the perceived effects of prolonged hospitalization on orthopaedic

patients in federal teaching hospital, Lokoja.

7
Operational Definition Of Terms

Perceived Effects: patients understanding and experience of the impact of long hospital stay in

federal teaching hospital, Lokoja.

Prolonged Hospitalization: Hospital stay lasting longer than expected recovery period for a

given condition in teaching hospital Lokoja

Orthopedic patients: They are individuals suffering from bone, joint or muscle injuries

admitted in orthopedic ward in teaching hospital Lokoja.

8
 CHAPTER TWO

LITERATURE REVIEW

Conceptual Review

Hospitalization is admission in a hospital for a maximum period of 24 consecutive in-patient care

hours except for specified procedure or treatment where such admission could be for a period of

less than 24 consecutive hours (WHO).

Hospitalization can be caused by heart attack, cerebrovascular disease, severe malaria, fracture,

pneumonia (WHO 2023).

Hospitalization can be defined as the period of stay in a hospital (Today Health 2018).

Hospitalization can be defined as an act of being hospitalized (American Medical Association

2020).

It also defines Hospitalization as admittance to the hospital as a patient (Steve O 2017).

There are 4 types of hospitalization which Includes:

Full hospitalization: this type of hospitalization refers to stay of several days in the hospital.

Some surgical procedure requires quite lengthen postoperative monitoring, the patient is

hospitalized the day before the surgery and is discharge once the physician is satisfied that

recovery is on track (WHO 2021).

9
Same-day hospitalization: this type of hospitalization is when the patient is hospitalized the

same day of surgery (OECD, Health at a Glance 2023).

Outpatient hospitalization: this type refers to patient arrive at the hospital and leave the same

day, generally between two and four hours of treatment. This type of hospitalization is very

comfortable for the patient who appreciates being able to return home that evening (NCL 2021).

Day hospitalization: in this type of hospitalization, many treatments can be administered at the

hospital with no need for patient to stay several days. This is often the case of chemotherapy and

radiotherapy (WHO 2021).

Social effect of prolong hospitalization on orthopaedic patient

Prolonged hospitalization of orthopedic patients can have significant socioeconomic effects on

both the patient and their family. Here are some of the potential effects:

Financial burden: Prolonged hospitalization can result in increased medical bills and expenses,

which can cause financial strain on the patient and their family. The cost of orthopedic treatment

can be particularly high, with costs including surgery, medications, and rehabilitation (National

institute of Health 2020).

Loss of income: Patients who are hospitalized for an extended period may be unable to work,

resulting in a loss of income. This can be particularly challenging for those who have jobs that

require physical labour or manual work. (American public health 2020).

Emotional impact: Extended hospitalization can also have emotional effects on the patient and

their family. Patients may experience depression, anxiety, and other emotional challenges as a

10
result of being away from their home and routine for an extended period American Psychological

Association (apa.org)

Reduced quality of life: Prolonged hospitalization can also result in a reduced quality of life for

the patient. They may experience pain, discomfort, and a lack of mobility, which can limit their

ability to participate in their usual activities. (Aritolli, et al 2018)

Delayed recovery: Patients who are hospitalized for an extended period may experience a delay

in their recovery. This can result in the need for additional medical care and rehabilitation,

further increasing the financial burden on the patient and their family (zheng et al 2020).

Psychological effect of prolong hospitalization on orthopedic patient.

Prolonged hospitalization can have significant psychological effects on orthopedic patients.

Patients may experience anxiety, depression, and other psychological issues due to social

isolation, loss of independence, and uncertainty about their recovery (Smith et al., 2018).

According to a study by (Bonanno et al 2018), prolonged hospitalization can lead to decreased

quality of life, which can impact patients' mental health.

Another study by (Oluwaseyi et al 2018) found that patients who experienced prolonged

hospitalization reported feeling frustrated and hopeless about their recovery. Patients may also

experience fear and anxiety about the possibility of developing complications or not recovering

fully (Smith et al., 2018).

Anxiety: Prolonged hospitalization can lead to feelings of anxiety, which can be exacerbated by

the uncertainty of the patients' condition, unfamiliar surroundings, and medical procedures.

Anxiety can negatively impact a patient's physical recovery and well-being. (lette,,et al.2019).

11
Depression: Prolonged hospitalization can lead to depression, which can be caused by the loss

of control, isolation, and loss of independence. Depression can also negatively impact a patient's

physical recovery and well-being. (Adeyanjo B 2019).

Post-traumatic stress disorder (PTSD): Prolonged hospitalization can lead to PTSD in some

patients, especially if they have undergone traumatic procedures or experienced significant pain

or discomfort. Symptoms of PTSD include flashbacks, nightmares, and intrusive thoughts.

( Reidy,et al.2018).

Insomnia: Prolonged hospitalization can lead to insomnia, which can be caused by noise,

discomfort, and changes in sleep routines. Insomnia can negatively impact a patient's physical

recovery and well-being. (Dohme J 2021).

Delirium: Prolonged hospitalization can lead to delirium, which is a state of confusion and

disorientation. Delirium can be caused by medication, infection, and other factors, and can

negatively impact a patient's recovery and well-being. (Jeevamanondal 2020).

Loss of identity: Prolonged hospitalization can lead to a loss of identity, as patients may feel

that their life has been taken over by their illness or injury. This can negatively impact a patient's

mental health and sense of self-worth. (Aritolli, et al. 2014).

Identifying coping mechanism toward prolong hospitalization.

Developing a routine: Patients can create a daily routine to help establish a sense of normalcy

and structure during their hospital stay. This can include activities such as exercise, reading, or

socializing with others.

12
Seeking social support: Patients can seek support from family, friends, or hospital staff to help

manage their stress and cope with their illness or injury. Talking to others can help patients feel

less isolated and provide a sense of comfortable (Mayo clinic 2019).

Engaging in relaxation techniques: Patients can use relaxation techniques such as deep

breathing, meditation, or guided imagery to help manage their stress and promote relaxation.

(Institute for Patient- and Family-Centred Care, 2017).

Staying connected: Patients can stay connected with loved ones and friends outside the hospital

by using technology such as video calls or social media. This can help patients feel less isolated

and maintain a sense of social support (Lette,et al. 2019).

Focusing on the positive: Patients can focus on the positive aspects of their hospitalization, such

as the care they are receiving, progress in their recovery, or the opportunity to rest and relax

(Othroinfo 2020).

Staying informed: Patients can stay informed about their condition and treatment plan to help

reduce feelings of uncertainty and anxiety. This can involve asking questions of their healthcare

providers and reading relevant educational materials (Jeevamanondal 2020).

Finding purpose: Patients can find a sense of purpose during their hospitalization by engaging

in activities such as reading, writing, or learning new skills. This can help patients feel

productive and maintain a sense of accomplishment. (Salsman et al., 2016 )

Setting goals: Patients can set small, achievable goals for themselves during their

hospitalization. This can help patients feel a sense of progress and achievement, which can boost

their mood and motivation (Aritolli et al. 2014).

13
Using humour: Patients can use humour to help cope with the stress of hospitalization.

Laughing or joking can help patients feel more positive and can reduce feelings of anxiety or

depression. (OrthoInfo, 2020).

Seeking professional support: Patients can seek support from mental health professionals, such

as psychologists or social workers, to help manage their stress and emotions during prolonged

hospitalization (National Alliance on Mental Illness (NAMI) 2022).

Engaging in spiritual practices: Patients who find meaning and comfort in spiritual or

religious practices can continue to engage in these activities during their hospitalization. This can

provide a sense of comfort and support during a challenging time. (Puchalski, Lunsford, &

Harris, 2014).

Advocating for themselves: Patients can advocate for their own needs and preferences during

hospitalization. This can involve speaking up about their care preferences, asking questions of

their healthcare providers, and participating in their own care decisions. These coping

mechanisms can help patients manage the stress and emotional challenges of prolonged

hospitalization. However, it's important to note that coping strategies may vary depending on

individual patient needs and preferences (Reidy, et al.2018).

Theoretical Framework

Maslow’s theory developed a theory based on the hierarchical nature of human needs. The

theorized needs experienced by individual primarily influence the person’s behaviour. The

motivated behaviour is as a result of pleasant and unpleasant experience of the individual. The

individual behaves in a manner that would facilitate reduction of tension caused by the needs and

this leads to satisfaction. It stands to reason therefore that only unsatisfied needs are prime

14
sources of motivation. All human needs are placed under seven categories. The progress through

the categories of needs is seen as a ladder where by the person must have held firmly to the

lower rung before progressing to a higher rung. The inability or difficulty in fulfilment of a lower

need may result in the individuals holding onto inactive behaviours, thus when a patient

manifests ineffective breathing pattern and care giver concentrate on how to improve the

effectiveness of the respiration until this has been achieved to a reasonable life supporting

extend.

KEY COMPONENTS OF MASLOWS THEORY

This theory Describe five (5) major needs(constructs) as follows:

Physiological needs: these are the most basic human survival needs which include Air, food,

water, sleep, shelter, clothing, elimination (e.g toilet use), physical movement.

Safety needs: These level involves personal security and protection from harm. These include;

physical safety, health and well-being, financial security, stability and routine.

Love and belongingness needs: They are social needs that relate to forming relationships and

being part of a community. They include; friendship, family connections, intimacy and social

interaction.

Esteem needs: These refers to a person’s need to feel respected, valued, and independent. They

include; self-esteem, confidence, achievement, recognition from. others and autonomy.

Self-actualization needs; This is the highest level of Maslow’s hierarchy. It involves the desire

to become the most one can be. It involves; personal growth, creativity, problem solving,

realizing personal potential, fulfilment and purpose.

15
APPLICATION OF THEORY TO THE STUDY

Physiological needs: Orthopaedic patients often rely on nurses and caregivers for help with

feeding, toileting and mobility dude to pain, fractures, or immobility; when the needs are not met

independently, patients may feel discomfort, frustration and loss of control.

Safety needs: Hospitalized orthopaedic patients may experience fear of complications, surgical

failure or infections, concerns about job loss, financial strain, or permanent disability may also

threaten their psychological sense of safety and disability.

Love and belongingness needs: Prolonged hospital stays often separate patients from loved

ones, leading to feelings of loneliness and social isolation. Limited interaction with family and

friends may negatively affect emotional well-being.

Esteem needs: Prolonged dependency on others for personal care may result in a loss of self-

esteem. Patients may feel helpless, embarrassed, or less valuable due to their inability to perform

basic task or engage in productive activities.

Self-Actualization needs: Prolonged hospitalization can delay patients ability to pursue life

goals, careers, or personal interests. As a result, patients may feel that life progress is stalled,

which can lead to frustration or loss of purpose.

16
 MASLOWS THEORY

Self actualization.

Self actualization need to be self

fulfilled, learn, create, understand and
experience on potential
self esteem.

Needs to be well thought by oneself or others

Love and belonging.

Need for affection, feeling of belonging and meaningful relationship

with others

Safety and security.

Need for shelter and freedom from harm and danger.

Physiological needs

Need for oxygen, food, water, rest and elimination need for sex and for survival of
mankind

(A Systematic diagram Maslow’s Hierarchy model, Parson, G. 2023).

17
Empirical Review

Several studies have investigated the effects of prolonged hospitalization on orthopaedic patients,

particularly focusing on psychological, physical and social dimensions. These empirical studies

provide a strong basis for understanding the scope and depth of the problem. Smith and lee

(2020) conducted a study in the united states titled ‘Psychological Effects of long term

Hospitalization on post- operative Orthopaedic patients.’ The study involves 120 orthopaedic

patients who had been hospitalized for more than three weeks. The results indicated that

approximately 65% of the participants experience moderate to severe symptoms of depression,

anxiety, and emotional fatigue. The researchers concluded that prolonged immobility, isolation

from family and friends, and uncertainty about recovery contributed significantly to patients’

mental health challenges.

In Nigeria, Okafor (2019) investigated the ‘perceived impact of Extended Hospital Stay on

Recovery Outcomes in Orthopaedic Units.’ This study was carried out in a tertiary healthcare

facility with a sample size of 85 patients. The findings revealed that patients who remained

hospitalized for more than 14 days reported a slower physical recovery rate and increased

dependency on Nursing Staff. About 73% of the respondents also experienced emotional

distress, with a noticeable decline in motivation and morale during their hospital stay.

18
Kumar et al.(2021), in their study titled ‘Social and psychological Effects of long-term

Hospitalization among Elderly patients. The researchers found that 78% of the patients

experienced feelings of loneliness and emotional isolation, while 64% reported a decrease in

self-esteem due to their prolonged hospital admission. The study emphasized the need for

structured psychosocial support systems to address these emotional and social challenges in

hospital settings.

Similarly, Garcia and Mendes (2022) conducted a study in Brazil on ‘Length of Hospital Stay

and its impact on Quality of Life in orthopedic patients.’ Using a sample of 90 patients, the

researchers discovered that prolonged hospital stay had a negative impact on patients’ emotional

well-being and overall quality of life. About 68% of participants reported reduced satisfaction

with care, increased irritability, and a lack of interest in social interaction during their

hospitalization.

Lastly, Abdullahi and Binta (2018) in Nigeria explored ‘Nursing Interventions and psychological

coping Among Orthopedic patients with prolonged Hospitalization.’ Involving 75 patients, this

study assessed the role of nursing-led interventions in improving patients’ psychological

resilience. The results indicated that patients who received regular counselling, emotional

support, and social engagement activities demonstrated significantly better coping mechanisms

and emotional stability compared to those who did not receive such interventions.

In summary, the reviewed studies consistently show that prolonged hospitalization negatively

affects orthopaedic patients across psychological, physical, and social domains. The findings also

highlight the importance of holistic nursing care, including emotional and social support, to

improve patient outcomes during extended hospital stays.

19
 CHAPTER THREE

METHODOLOGY

Research Design

This study adopted a descriptive survey research design to assess the perceived effect of prolong

hospitalization on orthopedic patient.

Research Setting

This study will be conducted at Federal Teaching Hospital, Lokoja, kogi state which has

implemented electronic health records (ERHs) system. The federal teaching hospital (FTH),

popularly known as the Federal Medical Centre (FMC) Lokoja, was established by the federal

government of Nigeria on November 9th, 1999 after an understanding with the kogi state

government. On 7th May, 2023, the hospital acquired the status of a teaching hospital and

renamed as Federal Teaching Hospital (FTH) Lokoja. The hospital is located at NO 1 Salihu

Ibrahim road, Lokoja, Kogi state, and the fence and other buildings are painted with milk colour.

20
The hospital is equipped with various equipment and modern teaching facilities designed to

improve healthcare, including well-equipped standard wards and medical laboratory.

The largest department in FHT, Lokoja is the department of nursing sciences, which create

favourable environment for nursing staff to provide effective nursing care to patients and their

families. The hospital has four (4) medical-surgical wards, three (3) paediatric units, two (2) out-

patient department, three (3) main theatres, and thirteen (13) specialty units. Presently, the

hospital has 313 registered nurses (RNs) in its nursing services department. Nurses at the

hospital access the HER system through computers (laptops) in the nursing stations.

Target Population

The target population used for this research is 69 patients admitted in orthopaedic ward, at

federal teaching hospital Lokoja, kogi state.

Sample size

The sample size of 69 patients will be selected in federal teaching hospital. The research used

Taro Yamane’s formula for calculating the sample size of the research study. The statistical

formula decided by Taro Yamane states as follows

N
n= 2
1+ N (e)

in the formula above

n is the required sample size from the population under the study

21
N is the whole population that is under stud, e is the precision or sampling error which is usually

0.10, 0.05 or 0.01

Using the Taro Yamane’s statistical formula to determine the adequate sample sise of the

respondent under this study. This would hence be

69
n= 2
1+69 (0.05)

69
n= ❑
1+69 (0.0025)

69
n=
1.1725

n= 59

The attrition rate= 10% of the sample size

=5.9

10/100 X 59  5.9 copies

Sample size + attrition rate 59+6=65 copies of questionnaire

Sampling Technique

The sampling technique adopted in this study is convenient sampling technique.

Instrument for data collection

The instrument used was structured questionnaire. The questionnaire will be divided into (4)

sections consisting 22 items. Section A (1-6) aimed at collecting the demographic characteristics

of respondents, section B (7-11) consist the social effect of prolong hospitalization on orthopedic

22
patients. Section C (12-17) consist of psychological effects of prolong hospitalization on

orthopedic patients. Section D (18-23) focus on the coping mechanism towards prolong

hospitalization on orthopedic patients.

Validity of instruments

The research questions was structured and given to the supervisor who will ensure face and

content validity. However, items were compared with the stated objectives and all necessary

corrections were effected before administering the instrument to the respondents.

Reliability of instrument

A pilot study was carried out using test and re-test method. 10% of the sample size (6 copies of

questionnaires) was distributed among patients outside the target population to ascertain the

consistency of the instrument.

Method of data collection

Data was collected using questionnaire from respondents. The purpose of the research was

explained to each respondent in a friendly manner, assuring them of confidentiality after which

the questionnaires was distributed and collected as fast as possible to minimize loss of

instruments.

Method of data analysis

Data collected from the respondents was organized and analyzed using descriptive statistics.

Data was presented in illustrative graphs, frequency table and percentage.

23
Ethical consideration

An introductory letter was be obtained by the researcher via the office of the college registrar for

ethical clearance to carry out the study at the hospital. Permission will be obtained from the

hospital management to carry out the research. The respondent will be assured of confidentiality

of the information provided, as well as of their anonymity will be excluded. The respondents will

be equally informed that their participation will not attract any remuneration jut as much as their

refusal to participate attracted nil punishment, and also that they were free at any point to resign

from study.

CHAPTER FOUR

DATA ANALYSIS AND PRESENTATION OF FINDING

SECTION A:

Table 4.1: showing the socio – demographical data of respondents N= 59

S/N VARIABLES FREQUENCY PERCENTAGE

1 Age range

20 – 25 16 27.2%

26 – 30 10 16.9%

31 – 35 13 22.1%

36 – 40 8 13.5%

24
 41 - 45 3 5.0%

46 – 50 9 15.3%

2 Gender

Male 28 47.5%

Female 31 52.5%

3 Occupation

Student 10 16.9%

Farmer 7 11.8%

Civil servant 12 20.4%

Doctor 4 6.7%

Nurse 14 23.8%

Trader 12 20.4%

4 Marital status

Single 20 33.9%

Married 34 57.7%

Widow 5 8.4%

5 Education

Formal 7 11.8%

Primary 5 8.5%

Secondary 12 20.4%

Tertiary 35 59.3%

6 Duration of hospitalization

Less than 1 month 25 42.3%

25
 1 – 3 month 13 22.1%

4 – 6 month 8 13.5%

Over 6 month 13 22.1%

The table above shows the demographic data of the respondents. From the table, 16 (27.1%)

respondents fall within the range of 20–25 years of age, 10 (16.9%) respondents fall within the

range of 26–30 years of age, 13 (22.1%) respondents fall in the range of 31–35 years of age, 8

(13.6%) respondents fall within the range of 36–40 years of age, 3 (5.0%) respondents fall into

the range of 41–45 years and 9 (15.3%) fall into the range of 46–50+ years of age respectively.

28 (47.5%) of the respondents are males while 31 (52.5%) of the respondents are females. The

students are 10 (16.9%) in numbers, 7 (11.8%) of the respondents are farmers, 12 (20.4%) of the

respondents are civil servants, 4 (6.7%) respondents are doctors, 14 (23.8%) are nurses while 12

(20.4%) of the respondents are traders. The table also shows 20 (33.9%) respondents who are

single, 34 (57.7%) respondents are married and 5 (8.4%) respondents are widows. 7 (11.8%)

respondents had formal education 5 (8.5%) has primary education, 12 (20.4%) has secondary

education and 35 (59.3%) has tertiary education. Out of the 59 respondents that answered the

questionnaires, 25 (42.3%) spent less than 1 month, 13 (22.1%) spent 1–3 months, 8 (13.5%)

spent 4–6 months and 13 (22.1%) spent over 6 months.

26
S/N VARIABLES FREQUENCY PERCENTAGE

7 Prolong hospitalization result to 33 55.9%

weaken relationship with family and

friends.

8 Prolong hospitalization result to 42 71.1%

inability to participate important social

or community activities.

9 Prolong hospitalization reduce 46 77.9%

27
 significant social engagement.

10 I worried about how people perceived 42 71.1%

me due to my condition.

11 The relationship with my spouse has 30 50.8%

been negatively affected.

From the table above, 33 (55.9%) of the respondents indicated weakened relationship with

family and friends. 40 (67.1%) reported inability to participate in important social & community

activities. 46 (77.9%) has reduced significant social engagement. 46 (77.9%) worry about how

people perceive them due to the condition. 30 (50.8%) testified relationship has been negatively

affected as the social effects of prolonged hospitalization on orthopaedic patients.

28
 keys
50

77.9% prolong hospitalization results to weakened

relationship with family and frieds
45
71.1% 71.2%

40 prolong hospitalization result to inability to

participate important social or community
activities

35
55.9%
prolong hospitalization reduce significant
50.8% social engagement
30

25 I worry about how people percieved me due

to my condition

20
the relationship with my spouse has been
negetively affected
15

10

29
Section c:

Table 4.3: showing the psychological effects of prolonged hospitalization on orthopaedic

patients

N= 59

S/N VARIABLES FREQUENCY PERCENTAGE

12 Prolong hospitalization has 46 77.9%

caused increase stress and anxiety

13 Limited mobility and 35 59.3%

independence during my

hospitalization has been

frustrating

14 I have felt depressed or hopeless 37 62.7%

about my condition and recovery

15 I experience mood swings and 26 44.0%

emotional frustration during my

hospital stay.

16 I felt isolated and lonely during 40 67.7%

hospital stay.

17 My long period of hospitalization 36 61.0%

has increase more worries on my

family.

30
From the table above, 46 (79.9%) respondents reported increased stress and anxiety. 35 (59.3%)

limited (reduced) family functioning. Some respondents about 40 (67.8%) said increased

financial burden was contributing to care. 26 (44.0%) of the respondents reported that they feel

isolated and lonely during the hospital stay. Out of the 59 respondents, 36 (61.0%) reported an

increase in worry on their family.

31
50 keys
77.9%
45 prolong hospitalization has caused increase
stress and anxiety

69.7%
40 limited mobility and independent during my
62.9% hospitalization has been frustrating
61.0%
59.3%
35
I have felt depressed or hopeless about my
condition and recovery

30
DI experienced mood swings and emotional frus-
44.0% tration during my hospital stay.
25
I felt isolated and lonely during hospital stay.

20
my long period of hospitalization has increase
more worries on my family
15

10

32
Section d:

Table 4.4: showing the coping mechanism towards prolonged hospitalization.

S/N ITEMS FREQUENCY PERCENTAGE

18 I rely on my religious or spiritual 58 98.3%

beliefs for comfort

19 I prefer to be alone to deal with my 31 52.5%

feelings

20 I was offer or sought psychological 40 67.7%

support or counselling service

during my hospitalization.

21 I am able to maintain a sense of 49 83.0%

hope for the future.

22 I am able to connect with others 39 66.1%

who are also going through a

prolong hospitalization.

23 I am to cope because I shear my 48 81.3%

worries and concern with close

family members.

From the table above, 58 (98.3%) of respondents rely on religion or spiritual belief for comfort,

31 (52.5%) prefer to be alone to deal with their feelings, 40 (67.9%) sought psychological

support or counseling services during hospitalization, 40 (67.9%) respondents were able to

33
maintain sense of hope for the future, 39 (66.1%) connect with others who are also going through

a prolonged hospitalization, and 48 (81.3%) reported sharing worries and concerns with close

family members as coping mechanisms towards prolonged hospitalizations.

34
 CHAPTER FIVE

DISCUSSION OF FINDINGS

Key Findings:

Majority of the respondents, 46 (79.9%), mostly experience significant social engagement. 42

(71.2%) identified inability to participate in important social or community activities and 39

(66.1%) much worry about how people perceive me due to the condition as the social effects of

prolonged hospitalization on orthopedic patients.

Majority of the respondents identified 46 (79.9%) increased stress and anxiety, 26 (44.0%)

isolated and lonely during hospital stay, and 39 (66.1%) feeling depressed or hopeless about my

condition and recovery as the psychological effects of prolonged hospitalization on orthopedic

patients.

Majority of the respondents 58 (98.3%) identified relying on religious or spiritual belief for

comfort, 40 (67.9%) were able to maintain a sense of hope for the future, and 48 (81.3%)

identified sharing worries and concerns with close family members as coping mechanisms

towards prolonged hospitalizations.

Social Effects of Prolonged Hospitalization on Orthopedic Patients

The findings from the research revealed that reduction in significant social engagement, inability

to participate in important community activities, and much worry about how people perceive

them due to the condition are major social effects of prolonged hospitalization on orthopedic

patients in federal teaching hospitals. Looking at the effects, are patients’ significant health

35
issues. Orthopedic conditions come with frequent pain, immobility, and independence loss, all of

which are causes for defects in social participation. This finding is in line with the findings of

Smith et al (2021), who noted that immobility in orthopedic patients leads to reduced social

functioning.

Socially, participants described a sense of disconnection from family and friends, especially

when hospitalization lingered over time. The social isolation exacerbated financial burdens due

to lost income or treatment cost fear, another major theme, echoing findings by Long and Lee

(2020) on the socioeconomic challenges faced by long-term patients. Some participants noted

feeling stigmatized, especially those reliant on mobility aids or who acquired physical

deformities post-surgery. They said being treated differently or excluded from social circles once

discharged. A study by Thomas et al. (2019) on post-hospitalization social reintegration found

that orthopedic patients often experience changes in how they are perceived socially, particularly

when recovery is slow or incomplete.

Psychological effects of prolonged hospitalizations on orthopedic patients

The result from this research revealed that the psychological effects of prolonged hospitalization

include increased stress and anxiety, feeling isolated and lonely during hospital stays, and feeling

depressed or hopeless when the condition slows the recovery. This finding is in line with

McWilliams et al. (2019), who reported a high prevalence of depressive symptoms among

orthopedic patients, especially those recovering from surgeries like fractures or joint

replacement. Prolonged immobility and uncertain recovery timelines were key contributors to

depressive mood. Participants frequently expressed fear of delayed recovery, re-injury, or

surgical failure. Some also reported anticipatory anxiety regarding life after discharge,

particularly concerning mobility and independence. Lozano et al. (2019) noted that prolonged

36
hospitalization can exacerbate health-related anxiety, particularly in orthopedic patients facing

long-term rehabilitation or multiple surgical procedures.

Coping Mechanisms towards Prolonged Hospitalization

Findings from the research work suggest that among many respondents, faith and belief systems

play a central role in coping with pain and uncertainty throughout extended recovery times.

Many confide in spiritual or scripture readings and were visited by religious leaders. Krumrei

(2016) found that spiritual coping is linked to lower depression and improved quality of life

among hospitalized patients. Some patients from the study reported actively engaging with their

rehabilitation process, including walking, trauma cooperatively with physiotherapists, and taking

their recovery seriously. Engaging cognitive approach helps patients feel more in control, which

improves psychological resilience (Connor et al., 2018). Some patients also adopted a mindset of

hopefulness and positive thinking, viewing the hospital stay as a necessary part of healing.

The use of positive cognitive reframe has been shown to improve mood and reduce anxiety

(Borman and Markowitz). Patients with flexible gratitude kept a journal were better able to

emotionally regulate.

Implication of findings to Nursing Practice

As discovered from the findings of this research, nurses play a critical role in educating patients

about their condition, treatment plans, and expected outcomes. This reduces fear and increasing a

sense of control. Encouraging patient participation in their own care also fosters empowerment

and psychological resilience.

37
Nurses should involve family members in the care process and facilitate virtual communication

for when physical visits are limited.

Nurses also play critical roles in guiding patients toward positive coping strategies such as

relaxation techniques, journaling, and light recreational activities. Organizing group sessions or

providing access to support services can enhance there effort.

Limitations of the Study

The research is limited because it is confined to a relatively small sample size, which may limit

the generalizability of the findings at large. A more diverse range of participants would have

enhanced the strength of the results and allowed for broader application

Summary

The study was designed to know the perceived effect of prolonged hospitalization on orthopedic

patients at Federal Teaching Hospital Lokoja, Kogi State. The research was carried through the

use of 59 questionnaires, obtained directly from the patients in the school, and then analyzed

using a table of frequencies, percentages, and charts. According to the analysis from the

questionnaires, it was discovered that patients faced physical, social and emotional effects of

prolonged hospitalization such as reduction in significant social connections, worries about how

people perceive them, and increased reality of weak support from family and friends, increased

stress and anxiety, loss of income and loneliness during hospital stay, limited mobility, and

independence.

38
Finally, it was discovered that relying on religion or spiritual belief, maintaining a sense of hope

for the future, sharing unknown worries and concerns with close family members are some of the

coping mechanisms towards prolonged hospitalization.

Conclusion:

The study explored the perceived effects of prolonged hospitalization on orthopedic patients,

focusing on the social, psychological, and coping dimensions of their hospital experience. The

findings revealed that extended hospital stays can significantly impact patients’ mental and

emotional well-being, contributing to feelings of depression, anxiety, isolation, frustration, and

loss of autonomy. Despite the difficulties, patients developed personal coping mechanisms, both

(as practices) through positive thinking, seeking social support, and maladaptive (e.g.

withdrawal, anger).

This study highlights the vital role of nurses in identifying emotional distress early, providing

continuous support and promoting strategies that help patients adapt better to the challenges of

prolonged hospitalization. Understanding the lived experiences of orthopedic patients during

prolonged hospital stays is crucial for improving clinical practices, enhancing patients'

satisfaction, and promoting comprehensive healing.

39
Recommendations:

Based on the findings of the study on the perceived effects of prolonged hospitalization on

orthopedic patients, several recommendations are proposed to enhance nursing practice, improve

patient outcomes and promote holistic care.

It is crucial to integrate psychological support into routine nursing care. The study revealed that

many orthopedic patients experience emotional disturbances such as anxiety, depression,

frustration, and a sense of helplessness during prolonged hospital stays. As frontline caregivers,

nurses are well positioned to identify early signs of psychological distress. Therefore, hospitals

should implement routine psychological screening for patients, particularly those with extended

stays.

In addition, nurses should be trained in basic mental health first aid and be encouraged to

collaborate with psychologists or counselors to ensure timely and appropriate interventions.

There is need to enhance nurse communication effective communication fosters trust, reduces

anxiety, and increases patient participation in their care. Nurses should be equipped with

therapeutic communication skills that encourage empathy, active listening, and consistent

information sharing. When patients are fully informed about their condition, treatment options,

and recovery expectations, they tend to feel more in control and better equipped to cope with

hospitalization. The involvement of family members and social support systems should be

encouraged. Prolonged hospitalization often leads to social isolation issues, even where

psychiatric symptoms may not be severe. Caregivers should create flexible visitation policies and

utilize technology such as phone and video calls to keep patients connected with loved ones.

40
Nurses should also consider including families in care plans and therapeutic activities, which

may help alleviate patients' emotional burdens and foster a sense of connectedness.

Furthermore, it is recommended that nurses actively promote the use of adaptive coping

strategies among orthopedic patients. The study found that while some patients used positive

coping mechanisms like prayer and positive thinking, others engaged in maladaptive behaviors,

such as withdrawal or anger. Nursing staff can play a vital role in guiding patients toward

healthier coping techniques including relaxation exercises, journaling, religious or spiritual

counseling. Designing group-based interventions or recreational therapy can also provide

psychological relief and promote interaction.

Suggestions for further study

Similar study should be carried out in other larger and more diverse sample of orthopedic

patients across multiple hospitals or geographical regions in order to improve the generalizability

of findings and comparisons across different healthcare settings.

The researchers suggest further studies to explore the effect of prolonged hospitalization across

specific age categories (e.g., adolescents, elderly, or working-age adults), to understand how age-

related factors influence psychological, social, and emotional experiences.

41
 REFERENCES

Abu-Qamar, M., Al-Qahtani, S., & Al-Nasser, A. (2018). The impact of prolonged

hospitalization

American Medical Association. (2020). What is hospitalization? Retrievedfrom,

https://policysearch.amaassn.org on 5 Agust 2023

Aritollli, M., et al. (2014). The impact of prolonged hospitalization on quality of life in

orthopedic patients. Journal of Orthopedic Surgery, 22(1), 15-20.

American Psychological Association. (2023). The emotional impact of prolonged

hospitalization Retrieved from https://pubmed.ncbi.nlm.nih.gov no 5 Agust 2023

Adeyanjo, B. (2019). The psychological effects of prolonged hospitalization on orthopedic

patients. Journal of Orthopedic Surgery, 27(1), 12-18.

Aritolli, M., et al. (2014). The impact of prolonged hospitalization on quality of life in orthopedic

patients. Journal of Orthopedic Surgery, 22(1), 15-20.

Bonanno, G. A., et al. (2018). Prolonged hospitalization and quality of life: A systematic review.

Journal of the American Medical Association, 319(14), 1465-1474.

Bob, A. (2019). The impact of prolonged hospitalization on the quality of life of orthopedic

patients in Ibadan, Nigeria. _Journal of Rehabilitation Medicine, 51(12), 1083-1089.

Canbaz, E. O., Ozer, H. T., & Yilmaz, S. (2020). The impact of prolonged hospitalization on the

risk of hospital-acquired infections in orthopedic patients. Journal of Hospital Infection,

106(3), 489-494.

42
Daniel, D. (2017). The prevalence of prolonged hospitalization and its impact on the mental

health of orthopedic patients in Nigeria. _Journal of Clinical Psychology in Medical

Settings, 24(10), 842-850.

Dohme, J. (2021). Insomnia in hospitalized patients: Prevalence, causes, and consequences.

Sleep Medicine Reviews, 60, 101830.

Garfield, A. (2020). The prevalence of prolonged hospitalization and its effect on the quality of

life of orthopedic patients in different countries. World Journal of Orthopedics_,

11(12), 113

Grafiths, J. (2020). Hospital-acquired infections in orthopedic patients. _British Medical

Journal, 368, m3585

Jeevamanondal, C. (2020). Delirium in hospitalized patients: Risk factors, prevention, and

treatment. Journal of Clinical Medicine, 9(12), 3839..

Karishma, P. (2018). The prevalence of prolonged hospitalization and its associated

complications in orthopedic patients in Mumbai, India. _Indian Journal of

Orthopedics, 52(1), 21-26.

Lette, M., et al. (2019). Anxiety in hospitalized patients: Assessment, management, and

prevention. Deutsches Ärzteblatt International, 116(27-28), 488-496.

Mayoclinic(2023).Orthopedicsurgery.,Retrievedfromhttps://www.mayoclinic.org/

departmentscenters/orthopedic surgery/home/orc-20126749

Oluwaseyi, A. K., et al. (2018). The psychological effects of prolonged hospitalization on

orthopedic patients in Nigeria. Journal of Orthopedic Surgery, 26(1), 7-13.

43
Rob, B. (2019). The impact of prolonged hospitalization on the emotional, developmental,

and physical needs of orthopedic patients. Journal of Pediatric Nursing_, 47, 85-90.

Reidy, P., et al. (2018). Post-traumatic stress disorder in hospitalized patients: A systematic

review. Journal of the American Medical Association, 319(13), 1361-1372.

Smith, T. C., et al. (2018). The psychological effects of prolonged hospitalization: A systematic

review. Journal of Clinical Psychology, 74(7), 1173-1202.

TodayHealth.(2018).Whatishospitalization?.Retrievedfrom

https://www.eonline.com/news/hospitalized on June 25, 2023

Tronchlich, G. (2017). The psychological impact of hospitalization on children and adults.

_Current Opinion in Pediatrics_, 29(5), 645-650.

World Health Organization. (2019). _Global report on the prevalence of prolonged

hospitalization. WHO.

Zhao, J., Zhang, L., & Wang, X. (2019). The impact of prolonged hospitalization on the quality

of life of orthopedic patients in China. _Quality of Life Research_, 28(1),223-230.

Zing, L. (2017). The prevalence of prolonged hospitalization and its impact on the health care

expenditures of orthopedic patients in different countries. International Journal of

Healthcare Economics and Policy_, 27(8), 819-830.

Zheng, et al. (2020). Delayed recovery in hospitalized orthopedic patients: A systematic review.

Journal of Bone and Joint Surgery, 102(2), 150-158.

44