EFFECTS OF LONG HOSPITALIZATION ON WELL-BEING AMONG ADULT PATIENTS AGED 18-65 AT

MBAGATHI LEVEL 5 HOSPITAL.

BY:
ITOTO IRINE
D/OT/23013/050

A RESEARCH PROPOSAL SUBMITTED TO THE FACULTY OF REHABILITATIVE SCIENCES OF

OCCUPATIONAL THERAPY AS REQUIREMENT FOR PARTIAL FULFILLMENT OF THE AWARD OF DIPLOMA
IN OCCUPATIONAL THERAPY.

KENYA MEDICAL TRAINING COLLEGE

P.O.BOX 837-90100
MACHAKOS.

DECEMBER 2024

DECLARATION

I declare that this research proposal titled Effects of long hospitalization on

wellbeing among adult patients aged 18-65 years is my original work and has not
been presented for a deploma by any other person in any institution.

Signature---------------------- Date----------------
Name : Itoto Irine
ADM : D/OT/23013/050

SUPERVISOR'S APPROVAL

This proposal has been submitted for view and approved by supervisor:

Name : ----------------------------------
Signature : ----------------- Date : --------------
Mr/Mrs : ------------------------------------------

Name : -------------------------------
Signature: ----------------- Date : -----------------
Mr/Mrs : ---------------------------------------
 DEDICATION

This research proposal is dedicated to the almighty God for strength to complete
this work and my parents and guardians for unwavering love and encouragement
throughout my academic journey. Also to my H.O.D Madam Mercy and the external
lecturer Mr Wakulwa who has guide me and provided unwavering support that has been
crucial.

ACKNOWLEDGEMENT

I am most grateful to God Almighty for wisdom, love, grace and for his protection
throughout this period. I would like to extend my heart felt gratitude to my
supervisors for invaluable guidance and support throughout the research endeavor.

Appreciations also goes to my classmates for their brilliant ideas, comments and
suggestions that has been crucial.

TABLE OF CONTENT

DECLARATION ---------------------------------------------------------------- ¡
SUPERVISOR'S APPROVAL
----------------------------------------------------------------- ¡¡
DEDICATION ---------------------------------------------------------------- ¡¡¡
ACKNOWLEDGEMENT ---------------------------------------------------------- iv
DEFINITION OF TERMS -------------------------- vii
ABBREVIATIONS AND ACRONYMS
-------------------------------------------------------------viii
ABSTRACT -------------------------------------------------------------ix
CHAPTER ONE------------------------------------------------------------- 1
1•0 INTRODUCTION------------------------- 1
1•1 BACKGROUND INFORMATION ------------------- 1
1•2 PROBLEM STATEMENT --------------------- 4
1•3 JUSTIFICATION ------------------------ 5
1•4 OBJECTIVES ------------------ 6
1•4•1 BROAD OBJECTIVE ------------ 6
1•4•2 SPECIFIC OBJECTIVES -------------- 6
1•5 SCOPE OF THE STUDY ---------------- 7
1•6 RESEARCH QUESTIONS --------------- 8
1•7 DELIMITATIONS ----------------------- 9
1•8 STUDY LIMITATIONS ---------------------- 10
CHAPTER TWO -------------------------------------- 11
LITERATURE REVIEW ------------------------------------ 11
2•0 INTRODUCTION ------------------------------------ 11
2•1 PHYSICAL HEALTH CHALLENGES FACED BY UDULT PATIENTS UNDERGOING LONG
HOSPITALIZATION. ----------------- 12
2•2 PSYCHOLOGICAL EFFECTS OF PROLONGED HOSPITAL STAYS ON ADULT PATIENTS
--------------- 13
2•3 THE SOCIO-ECONOMIC EFFECTS OF EXTENDED HOSPITALIZATION ON PATIENTS AND
THEIR FAMILIES --------------- 14
2•4 CONCLUSION ------------------------ 15
CHAPTER THREE ------------------------------- 17
3•0 MATERIALS AND METHODS --------------- 17
3•1 STUDY DESIGN ------------------------- 17
3•2 STUDY AREA ----------------------------- 17
3•3 STUDY POPULATION ----------------------- 17
3•3•1 INCLUSION CRITERIA ------------------ 18
3•3•2 EXCLUSION CRITERIA ----------------- 18
3•4 VARIABLES -------------------------- 18
3•4•1 DEPENDENT ---------------------- 18
3•4•2 INDEPENDENT -------------------- 18
3•5 SAMPLING TECHNIQUES ------------------ 19
3•6 SAMPLE SIZE DETERMINATIONS --------------------- 19
3•7 DEVELOPMENT OF DATA COLLECTION TOOLS ------------------- 20
3•7•1 QUANTITATIVE DATA ---------- 20
3•7•2 QUALITATIVE DATA ------------ 20
3•8 DATA COLLECTION PROCESS -------------------- 21
3•9 PRE-TESTING/ PILOTING ------------------- 21
3•10 VALIDITY -------------------------------- 21
3•11 RELIABILITY ------------------------- 21
3•12 DATA ANALYSIS --------------------- 22
3•13 ETHICAL CONSIDERATION --------------------- 22
REFERENCES ------------------------------------ 23
APPENDIX I : CONSENT FORM -------------------- 25
APPENDIX II : STUDY QUESTIONNAIRE ----------------- 26
APPENDIX III : RESEARCH BUDGET ------------------- 33
APPENDIX IV : WORK PLAN --------------------- 34

DEFINITION OF TERMS

Long hopitalization: A hospital stay exceeding four weeks or more typically due to
severe, chronic or complex health conditions requiring extended care.
Psychological impact: The effects of prolonged hospitalization on mental health
such as stress, anxiety, depression and feeling of isolation.
Economic burden: The financial impact of long Hospital stays on patients and their
families, including direct medical costs and indirect costs like lost income.
Intervention: strategies or treatments applied to reduce the negative effects of
prolonged hospitalization on Patients.
Physical deconditioning: the decline in physical function due to inactivity and
prolonged bed rest often seen in long stay Patients.
Mental deterioration: a decline in cognitive, emotional and psychological
functioning overtime.

ABBREVIATIONS AND ACRONYMS.

WHO : World Health Organization

HAIs : Hospital-Acquired Infections
LMICs : Low and Middle Income countries.
NHIF : National Hospital Insurance funds.
UHC : Universal health coverage
SHIF : Social health insurance funds
PTSD : Post traumatic stress disorder.

ABSTRACT

Long hospitalization can have profound effects on the physical, emotional and
psychological wellbeing of patients.while the primary goal of extended
hospitalization is to address acute medical conditions, the prolonged nature of
hospital stays often leads to various negative consequences.
Physically, extended hospitalization may result in muscle atropy, weakned immune
system and increase risk of hospital-aquired infections. Psychologically, patients
may experience heightened levels of anxiety, depression, and stress due to
isolation, uncertainty about recovery and the challenges of adapting to a hospital
environment. Socially, prolonged hospital stays can disrupt personal relationship
and lead to feeling of loneliness or frustration.
Additionally, the financial burden of extended hospitalization can exacerbate
stress, further affecting a patient's quality of life. This review examines the
multidimensional effects of long hospitalization on patient's well-being,
highliting the importance of supportive care strategies, early rehabilitation, and
mental health interventions to mitigate this adverse effects and improve outcomes
for hospitalized patients.

CHAPTER ONE
1.0 INTRODUCTION.
This chapter consists of background information, problem statement, justification,
broad objective, specific objectives, scope of the study, research questions,
delimitations and study limitations.

1.1 BACKGROUND INFORMATION

Hospitalization is a crucial part of healthcare providing essential treatment and
support for patients dealing with a range of medical conditions. However when
hospital stays extend over a long period, the consequences can signignificantly
affect patient's physical, psychological and Socio-economic well-being. Long
hospitalization often results from complex medical conditions, recovery
complications or limited healthcare resources, creating a multifaceted challenge
for patients families and healthcare providers alike.

Globally, long hospitalization can significantly affect patients health, quality of

life and overall healthcare costs. According to the World Health Organization (WHO)
prolonged hospitalization often leads to increased risks of hospital-aquired
infections (HAIs) with about 10% of patients in low and middle income countries
(LMICs) and 7% in high income countries experiencing HAIs due to inadequate
infection control and hygiene practices;( WHO 2017). HAIs can complicate recovery,
extend hospital stays and increase mortality risks, particularly among vulnerable
populations like elderly and immunocompromised; ( Magill et al, 2014). Furthermore,
extended hospitalization contribute to global burden of unsafe healthcare
practices, which WHO estimates lead to approximately 134 million adverse events and
2•6 million deaths each year in LMICs. This incidents not only harm patients but
also add significant costs to healthcare systems through resources wastage, such as
unnecessary treatments and repeated procedures and losses in productivity due to
long term disability or death;( European commission, 2020). The economic effects of
prolonged and unsafe hospital stays is notable. In high income countries, safety
failures can account for up to 15% of hospital costs, while LMICs lose around $1•4-
1•6 trillion in productivity each year due to poor quality care. WHO emphasizes the
need for patients centered healthcare to improve outcomes.
In Africa countries, prolonged hospitalization has unique challenges. Limited
hospital resources, including medical supplies and trained healthcare workers
amplify the negative impacts. Patients may experience delays in receiving adequate
care, leading to worsened outcomes and extended recovery periods. African hospitals
often struggle with high patients loads and limited bed space, which can lead to
overcrowded conditions and increased HAIs;( Tumusiime et al, 2021). Mental health
support during prolonged hospital stays is also limited, leaving many patients
without adequate psychological care and support.

Kenya faces similar challenges with limited healthcare infrastructure that makes
long hospitalizations particularly challenging. Overcrowding in public hospitals is
a significant issue, which can lead to the spread of infections and a lack of
adequate care for each patient. Financial burdens are pronounced in Kenya where
many individuals lack health insurance funds (NHIF), social health insurance funds
(SHIF) and pilot programs under universal health coverage (UHC), out of pocket
costs for treatment and transportation remain high especially for rural
populations, hence leading to dept or impoverishment for entire families
(Njuguna et al; 2020, Barasa et al;2017). In addition the healthcare system faces
a shortage of specialists so patients requiring specific treatments may experience
delays contributing to longer stays, (Wangai et al;2021).

Nairobi a city in central Kenya, faces particular healthcare challenges given its
location and population. Mbagathi the major referral hospital in Nairobi, often
serves patients from surrounding counties as well. Deu to limited resources and
high demand, prolonged hospitalizations can be common,( Kimani et al; 2019). The
hospital faces challenges such as inadequate facilities, high patients loads and
limited staffing, especially in specialized fields. Overwhelming is common which
can impact the quality of care and leads to delays in treatment. Mental health
services in the region are limited so the patients may suffer emotional distress
without access to psychological support.( Mwangi et al; 2018). Additionally long
hospital stays disrupt patients roles within their families and communities leading
to strained relationships and reduce social interaction,( Otieno & Nyamari; 2021).

In villages around Mbagathi level 5 hospital, long hospitalization has significant

impact on their well-being in adult patients particularly in resources constrain
and household. Prolonged stays often disrupt family dynamics as patients are
separate from their roles as caregivers or breadwinners leaving families
economically vulnerable,( Mwangi & Kimani; 2018). Families often rely daily
earnings and a prolonged hospital stay for one member can impact the family's
finances and well-being. Studies indicate that the local communities still
encounters challenges even with UHC pilot programs. Travel to and from Mbagathi for
hospital visits can be costly and time consuming affecting both emotional and
financial support system,( Odhiambo et al; 2018). The burden on caregivers is
particularly high in rural area where access to healthcare is limited.

In summary, while efforts like UHC, SHIF and NHIF aim to reduce the financial
burden of healthcare in Kenya, prolonged hospital stays continue to have a
substantial impact, especially in ender resoused settings. Addressing these
challenges requires improvement in health infrastructures, increased insurance
coverage and better social support system to alleviate the economic and health
impacts on patients.

1•2 PROBLEM STATEMENT

Long hospitalization among adult patients has emerged as a significant global
health concerns with profound physical, psychological and socioeconomic
consequences. According to WHO, extended hospital stays are associated with various
adverse outcomes, including physical deconditioning, psychological stress and
social isolation. Despite the improvement in healthcare delivery and treatment
options, long hospital stays continue to be a challenge. Patients often experience
a decline in their function independence, which can impede their ability to return
to their previous quality of life after discharge. Furthermore, the economic impact
on both the patients and the healthcare system can be significant with increased
costs associated with extended hospital care and subsequent rehabilitation.

This study aims to examine the impact of long hospitalization on patients

identifying the key factors that contribute to negative outcomes and exploring
possible interventions to mitigate these effects. Undergoing the problem from
multiple perspectives is essential to developing holistic patient- centered care
practices that enhance recovery and quality of life.

1•3 JUSTIFICATION.
Long hospitalization significantly impacts in various ways often leading to
complex, interrelated consequences that extend beyond physical health. The
justification for studying these effects especially at kisumu county referral
hospital is rooted in the need to understand the unique challenges and health
outcomes within the kisumu region, where healthcare resources are often stretched
and the social and economic context differ from more developed areas. To sum up,
investigating the impacts of prolonged hospitalization on patients well-being at
kisumu county referral hospital is essential to improve patients outcomes and
ensure healthcare interventions address the multifaceted needs of this population.

1•4 OBJECTIVES
1•4•1 BROAD OBJECTIVE
To determine the effects of long hospitalization on wellbeing among adult patients
aged 18-65 years at Mbagathi level 5 hospital.

1•4•2 SPECIFIC OBJECTIVES

¡) To assess the physical health challenges faced by adult patients undergoing long
hospitalization at Mbagathi level 5 hospital.
¡¡) To evaluate the psychological effects of prolonged hospital stays on adults
patients at Mbagathi level 5 hospital.
¡¡¡) To analyze the the Socio-economic effects of extended hospitalization on
patients and their families.

1•5 SCOPE OF THE STUDY.

This study focuses on adult patients who have experienced hospital stays longer
than four weeks due to chronic illnesses, severe injuries or complex medical
conditions. The research examines the effects of long hospitalization from a
multidimensional perspectives including physical, psychological and Socio-economic
aspects. Data will be collected through surveys, interviews, questionnaire and
medical records with participants drawn from hospitals in urban and suburban
settings.

1•6 RESEARCH QUESTIONS

¡) What are the physical health challenges that adult patients face during long
hospital stays at Mbagathi level 5 hospital?
¡¡) How does prolonged hospitalization affect the mental health and psychological
wellbeing of adult patients?
¡¡¡) What are Socio-economic effects of extended hospitalization on patients and
their families?
 1•7 DELIMITATIONS
a) The study will focus specifically on adult patients aged 18 years and above.
b) The study will explore physical, psychological, and Socio-economic well-being,
focusing on factors like mobility, mental health, and Socio-economic support.
c) The study will consider adult patients hospitalized within four weeks or more
to ensure recent data and experience are analyzed.

1•8 STUDY LIMITATIONS

Language and communication barriers where some patients may not speak the primary
language used in the study, potentially leading to misunderstandings or
misinterpretation of questions.

Some patients may experience emotional distress discussing their well-being,

particularly if the hospitalization period has had a traumatic effects. This can
affect the courage of their response.

Privacy regulations might limit access to certain healthcare records, which could
constrain a comprehensive analysis of hospitalization effects.

CHAPTER TWO
2•0 LITERATURE REVIEW
INTRODUCTION
The effects of prolonged hospitalization on adult patients well-being has been
widely studied, revealing significant physical, psychological, social and economic
consequences. Globally, long term hospitalization often results in complications
such as physical deconditioning, increased risks of infections and psychological
effects, including depression and anxiety.( Stuck et al; 2002, Corvinsky et al;
2003). These effects are particularly concerning in lower resource settings, where
hospitals may lack comprehensive rehabilitative services and psychological support.
Studies in sub- Saharan Africa for example, emphasizes that extended hospital
stays, strain limited healthcare resources and increase the risk of negative health
outcomes due to overwhelming and understaffing. (Harries et al; 2016).

In Kenya, specifically, the prolonged hospitalization of adult patients contributes

to social and economic strain on both patients and their families, who often face
challenges such as lost income and high out-of-poket experiences for travel, care
and essential needs. (Kisia et al; 2018, Wachira et al; 2019). For patients at
Mbagathi level 5 hospital, this burden are compounded by the urban nature of many
patients home communities, where family responsibilities and income generating
activities are disrupted often leading to deeper economic hardship.( Omondi et al;
2020). Additionally, separation from social support networks within their
communities affects patients mental well-being, with some studies noting the
importance of social support for successful recovery.( Muthoni et al; 2018).

Given this complexities, further research is needed to understand the unique

impacts of long hospital stays on adult patients at Mbagathi level 5 hospital where
local Socio-economic and cultural contexts play critical roles in shaping patient
experiences and outcomes.
 2•1 PHYSICAL HEALTH CHALLENGES FACED BY UDULT PATIENTS UNDERGOING LONG
HOSPITALIZATION.
Long-term hospitalization poses significant physical health challenges for adult
patients, affecting various aspects of their well-being. One of the most common
issues is muscle atrophy due to prolonged immobility. When patients are confined to
bed or have limited movement, their muscles weakens, leading to reduced physical
strength and impaired functionality a phenomenon well documented in clinical
studies. (Rafferty et al; 2020).

Immobility can also results in pressure ulcers or bed sores which are caused by
sustained pressure on the skin and underlying tissues particularly in bedridden
patients. The risks of infections increases as well, particularly respiratory and
urinary tract infections due to the body's compromised immune response over time
and limited movement.( Bailey et al; 2019).

Additionally, long hospitalization is associated with poor nutritional status, as

some patients may experience loss of appetite or inadequate dietary intake, leading
to malnutrition. Malnutrition further exacerbate weakens and increases
susceptibility to other complications (Rattanachaiwong et al; 2021). Prolonged
hospital stays can also adversely affect cardiovascular efficiency, increasing the
risk of blood clots and deep vein thrombosis ( Castro et al; 2022). Together, this
physical challenges highlight the urgent need for effective care practices to
support long term hospitalized patients and mitigate these health risks.

2•2 PSYCHOLOGICAL EFFECTS OF PROLONGED HOSPITAL STAYS ON ADULT PATIENTS.

Prolonged hospital stays can lead to significant psychological impacts on adult
patients, often results in increased levels of stress, anxiety and depression.
Being confined to a hospital environment disrupts daily routine, restricts freedom
and can create feeling of isolation from family, friends and familial settings,
which are critical to mental well-being. This isolation is compounded by lack of
control over one's life which can lead to heightened stress and anxiety. Studies
have shown that long-term hospitalization can also negatively affect Cognitive
functioning and increase the likelihood of developing post traumatic stress
disorder ( PTSD) in certain individuals ( Jackson et al; 2007).

The effects on mental health can vary depending on factors such as pre-existing
psychological confirmations, age and social support system. Patients who have
limited social connections or support are more vulnerable to adverse psychological
effects. Furthermore, the hospital environment itself, with constant noise,
frequent disruptions from medical staff and lack of privacy, can exacerbate sleep
disturbance, leading to further Cognitive decline and irritability (Davydow et al;
2008). In low resource settings, such as parts of Africa, these challenges can be
intensified by limited mental health support within hospitals, further worsening
the psychological toll of extended hospital stays (Gureje & Alem; 2000).

Promoting patient- entered care and improving social support networks in healthcare
facilities can help mitigate some of this psychological effects. Regular
communication with family members and access to mental health support can
significantly reduce feelings of isolation and improve the mental resilience of
patients enduring prolonged hospitalization ( McKinley et al; 2019).

2•3 THE SOCIO-ECONOMIC EFFECTS OF EXTENDED HOSPITALIZATION ON PATIENTS AND THEIR

FAMILIES.
Extended hospitalization can have significant Socio-economic effects on patients
and their families, often leading to financial strain and emotional distress. The
cost of prolonged medical care is a major burden, as many families are forced to
divert funds from other essential areas of their lives, such as housing, education,
and food, to cover medical expenses (Kowalski et al; 2019). In some cases, patients
may also face the loss of income due to their inability to work during prolonged
recovery periods, exacerbating financial difficulties. For families, the emotional
toll is equally profound, as the stress of managing medical costs, coupled with
concerns for the patient's health, can lead to mental health challenges such as
anxiety and depression (Baird et al; 2020). Additionally, caregivers often takes on
the responsibility of providing support, which can lead to their own physical and
emotional exhaustion, further reducing their ability to earn an income.

Furthermore, patients and their families may experience social isolation due to the
time and energy spent managing healthcare needs, which can erode social support
networks. In regions with limited access to healthcare resources like part of
Africa, the effects are even more pronounced. Limited infrastructure and the need
to travel long distance for treatment add extra costs and logistical difficulties (
Akinyemi et al; 2019). This factors contribute to a cycle of poverty and poor
health outcomes, as individuals and families face continuous struggles to regain
financial and emotional well-being.

Studies have shown that the Socio-economic effects of extended hospitalization are
not limited to the immediate family but can affect the broader community. With many
families unable to cover medical expenses, they may have to rely on informal
financial support networks, such as borrowing relatives or taking loans. This can
results in long-term indebtedness, Wich has ripple effects on community resources (
Cheng et al; 2021). Furthermore, in areas with limited access to Social support
structures, the effects can extend in generations, affecting education outcomes and
social mobility ( Adebayo et al; 2019).

2•4 CONCLUSION

In reviewing the literature on the physical, psychological and Socio-economic

effects of long hospitalization on wellbeing of adult patients, it is clear that
extend stays in hospitals can results in significant consequences that affect
patients holistically.

Prolonged hospitalization often leads to a range of physical challenges that hinder

recovery. Extended bed rest and reduced physical activity are major contributors of
muscle atrophy, joint stiffness and physical deconditioning, all of which
complicate recovery process (Tontodonati et al; 2018). Additionally, patients face
increased risks of hospital-acquired infections including pneumonia, urinary tract
infections and pressure ulcers, all of which can have lasting effects on their
overall health ( Mylotte; 2019). The physical effects of prolonged hospitalization
can also limit a patient's ability to regain independence, particularly for those
who are already suffering from chronic or critical condition.

The psychological toll of long hospitalization is well documented, with significant

evidence linking extended hospital stays to mental health challenges such as
depression, anxiety and emotional distress. Social isolation, disrupted routines
and the uncertainty of prolonged illnesses contribute to these conditions, with
many patients reporting feeling of helplessness and frustration ( Kisely et al;
2015). The prolonged exposure to medical procedures, unfamiliar environment and
lack of normal life engagement often exacerbates these psychological burden.
Importantly, the psychological effects can extend beyond the individual, affecting
families and caregivers who may also experience stress and burnout from the long-
term caregiving responsibilities (Boyer et al; 2018).

Long term hospitalization also have significant Socio-economic effects on patients

and their families. The direct financial costs associated with extended hospital
stays such as hospitalization fees, treatment and medications can place a heavy
financial burden on patients, especially in low resource settings where access to
health insurance and financial assistance may be limited ( Hussey et al; 2020).
Moreover, the indirect costs such as the loss of income from inability to work and
the economic strain placed on family providing care, further complicate the
economic situation of patients. This economic stress can often lead to further
complications as patients may delay or forgo necessary treatment due to financial
constraints ( Murtinez et al; 2020).

In conclusion, the literature highlights that the physical, psychological and

Socio-economic effects of long hospitalization are deeply interrelated affecting
patients in multifaceted ways. While the primary concern in healthcare settings is
often the medical recovery of patients. It is evident that addressing the full
spectrum of consequences including physical rehabilitation, mental health support
and economic relief is essential for improving patients outcomes. Mitigating the
physical deconditioning, psychological distress and financial strain caused by long
hospital stays are critical in promoting holistic patients well-being. Future
research should continue to explore strategies for improving the overall experience
of patients during prolonged hospitalizations and identify ways to better support
them in their recovery and reintegration into normal life.

CHAPTER THREE
3•0 MATERIALS AND METHODS
3•1 STUDY DESIGN.
This will be a productive cohort study which will utilize both qualitative and
quantitative technics.

3•2 STUDY AREA

The study will be carried out at Mbagathi level 5 hospital located along Mbagathi
way, adjacent to Kenyatta National Hospital in Nairobi. It is a level 5 ministry of
health established in 1950 providing medical services to a broad segment of the
city's population. It originally served as an infectious disease Hospital but has
since evolved into a comprehensive medical institution offering a wide range of
healthcare services. The hospital is approximately 5 kilometers ( about 15 minutes
drive) from Nairobi's central business district. It has a capacity of around 300
beds and offers services 24 hours a day providing both inpatient and outpatient
care to patients at Nairobi and surrounding areas with NHIF covers.

3•3 STUDY POPULATION

The targeted population will be adult patients aged 18-65 years admitted for more
than 28 days regardless of diagnosis.

3•3•1 INCLUSION CRITERIA

Adult patients aged 18-65 years admitted to Mbagathi Hospital for medical
conditions requiring inpatient care and are willing to participate in the study and
able to give informed consent.

3•3•2 EXCLUSION CRITERIA

• Patients discharged within 21days.

• Patients who have pre-existing severe cognitive impairments, those who cannot
consent due to language barriers or severe health conditions and pregnant women.

3•4 VARIABLES
3•4•1 DEPENDENT
• Well-being of adult patients aged 18-65.

3•3•2 INDEPENDENT
•Duration of hospitalization
•Social support
• Economic impacts.

3•5 SAMPLING TECHNIQUES

Stratified random sampling will be used to ensure that Patients of different age
groups, gender and Socio-economic statuses are represented. At least 30 Patients
will be surveyed and 10-20 interviews will be conducted.

3•6 SAMPLING SIZE DETERMINATIONS

This will display the number of people to be interviewed in the study using
Fischer's formula confidence level 95% and margin 5%.

n= Z^2p(1–p)
e^2
Where:
n: desired sample size
Z: Z-score ( e.g 1.96 for a 95% confidence level.)
P: proportion of the target population with the characteristics of interest (e.g
0.5 if unknown)
e: margin of error (e.g 0.05 for 5% error.)

For small populations (N), the formula is adjusted using the finite population
correction.

nf= n
1+(n–1)
N
nf: final sample size
N: population size

Given data:
N= 20
Z= 1.96 (95% confidence level)
P= 0.5 (50% as the population proportion is unknown).
e: 0.05 (5% margin of error).

STEP 1: Calculate n (initial sample size).

n= (1.96)^2 . 0.5(1–0.5)
(0.05)^2
n= 3.8416 . 0.5 .0.5
0.0025
n= 0.9604
0.0025
n= 384.16

STEP 2: Adjust for the finite population size (N=20)

nf= 384.16
1+(384.16–1)
20
nf= 384.16
1+(383.16)
20
nf= 384.16
1+19.158
nf= 384.16
20.158
= 19.06
nf= 19

3.7 DEVELOPMENT OF DATA COLLECTION TOOLS

This study will use a mixed methods approach combining qualitative and quantitative
techniques.
3.7.1 QUALITATIVE DATA
In-depth inderviews and focus group discussion will be conducted with patients
family members and healthcare providers. This will explore personal narratives
regarding the experience of long hospitalization, emotional challenges and the
support structures available.

3.7.2 QUANTITATIVE DATA

Structured surveys and questionnaires will be distributed to a sample of adult
patients who have been hospitalized for over 28 days. The survey will assess mental
health, quality of life, physical recovery and social well-being. Standardized
scales such as the Hospital Anxiety and Depression Scale (HADS) and the EQ-5D will
be used for measuring well-being.

3.8 DATA COLLECTION PROCESS

The process will begin after permission from all relevant authorities i.e consent
form the department and Management of Mbagathi level 5 hospital and also consent
form participants to issue questionnaire.

3.9 PRE-TESTING/ PILOTING

Pre-testing will be carried out at Machakos level 5 hospital where by 19 prolonged
hospitalized patients or caregivers will be given questionnaires as a method of
data collection.

3.10 VALIDITY
The data collection during the pre-testing will determine the validity of the
questionnaires developed.

3.11 RELIABILITY

Pilot survey will be marked as the main survey hence it will help the researcher
find out any mistake of the data collection tool, therefore ensuring that there
will be suitable measuring instruments through pre-testing.

3.12 DATA ANALYSIS

Data collected will be analyzed manually by use of scientific calculator and

relevant computer packages. This results will be presented using table, charts and
graphs.

3.13 ETHICAL CONSIDERATION

Informed consent will be obtained from all participants. They will be assured of
confidentiality and the voluntary nature of their participation. Ethical approval
will be sought from the relevant health and research ethics committees.

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associated functional decline. The role of hospitalization process beyond
individual risk factors. Journal of America Geriatrics sociaty, 63(1), 55-62.

APPENDIX I: CONSENT FORM

I Itoto Irine an occupational therapy student at KMTC Machakos, am carrying out the
research on the effects of long hospitalization on wellbeing. The questionnaire had
been designed for data collection to be used for learning. You have been selected
as a respondet and all information will be treated with confidentiality. If you
agree kindly append your initials and sign.
Initial ---------------------------
Sign ------------------------------
Date ------------------------------

APPENDIX II: STUDY QUESTIONNAIRE

I Itoto Irine an occupational therapy student at KMTC Machakos, am carrying out a

research on the effects of long hospitalization on wellbeing. The questionnaire has
been designed for data collection to be used for learning. You have been selected
as a respondet and all information will be treated with confidentiality.

Instructions
1.Do not write your name or the name of the patient on the questionnaire.
2. Answer in the spaces provided.
3. Use a tick where necessary.

SECTION A: BIO-DATA
1. What is your age?
18-40. ( )
40-65. ( )
65 and above( )
2. What is your gender?
Male ( )
Female ( )
Others ( )
3. Where is your residence?
Town ( )
Village ( )
4. What is your religion?
Christian ( )
Hindu ( )
Muslim ( )
5. What is your marital status?
Married ( )
Divorced ( )
Single ( )
Widow/ widower ( )
6. Length of current hospitalization
7-14 days ( )
14-21 day ( )
21 and mores ( )
7. What is the reason for hospitalization?
Surgery ( )
Chronic illness ( )
Accident ( )
8. Do you have any existing chronic conditions?
Yes ( )
No ( )
If yes, please specify; ---------------------------
SECTION B: TO ASSESS THE PHYSICAL HEALTH CHALLENGES FACED BY UDULT PATIENTS
UNDERGOING LONG HOSPITALIZATION.

1. How frequent have you experienced physical pain or discomfort during your
hospitalization?
Never ( )
Occasionally ( )
Frequently ( )
Constantly ( )
2. Please rate the intensity of your pain or discomfort.
Mild ( )
Moderate ( )
Severe ( )
3. What area of your baby are most affected by pain or discomfort?
Back ( ) Muscle ( )
Joint ( ) Head ( )
Others ( ) (specify) -----------------------------

Mobility and muscle strength

1. Have you experienced difficulty with movement or mobility since your
hospitalization?
Yes ( ) No ( )
2. If yes how severe is the difficult?
Mild ( ) Moderate ( ) Severe ( )
3. Have you noticed a decrease in muscle strength?
Not at all ( ) Significantly ( )
A little ( ) Completely unable ( )

Skin health
1. Have you experienced skin issues during your hospitalization e.g bedsores,
rashes?
Yes ( ) No ( )
2. If yes what type of issues?
Bedsores ( )
Rashes ( )
Others (specify) ( ) ----------------------------
3. How would you rate the severity of this skin issues?
Mild ( )
Moderate ( )
Severe ( )

Nutrition and weight change

1. Have you experienced any weight changes during your hospital stays?
No ( )
Gained weight ( )
Loss weight ( )
2. Do you feel your current diet meets your nutritional needs?
Yes ( )
No ( )
Unsure ( )
3. How often do you feel fatigued or low in energy?
Never ( )
Sometimes ( )
Often ( )
Always ( )
Respiratory and cardiovascular health.
1. Have you experienced any new respiratory issues ( e.g shortness of breath,
coughing) since being hospitalized?
Yes ( ) No ( )
2. Have you noticed any change in your heart rate or blood pressure since being
hospitalized?
Yes ( ) No ( )
3. If yes, how has this affected your daily functioning?
No impact ( )
Minor impact ( )
Significant impact ( )

Additional comments
1. What would you say has been the most challenging physical health issue during
your hospitalization? ----------------------------------------
2. Do you feel your physical health needs are being met during your
hospitalization?
Yes ( ) No ( )
If no please explain -----------------------------
Any additional comments or suggestions? ----------------------------------------

SECTION B: TO EVALUATE THE PSYCHOLOGICAL IMPACT OF PROLONGED HOSPITAL STAYS ON

ADULT PATIENTS

Emotional well-being
1. How frequent have you ever felt stressed or anxious during your hospitalization?
Never ( ) Often ( )
Occasionally ( ) Constantly ( )
2. If you have experienced stress or anxiety, how would you describe the intensity?
Mild ( ) Moderate ( ) Severe ( )
3. How often do you feel sad or down since being hospitalized?
Rarely ( ) Often ( )
Sometimes ( ) Always ( )
4. How would you rate your level of loneliness during your hospital stays?
Not at all lonely ( )
A little lonely ( )
Moderate lonely ( )
Very lonely ( )
5. Have you experienced any feeling of hopelessness during your hospitalization?
Yes ( ) No ( )

Cognitive and sleep changes

1. Have you experienced any difficulty with concentration or focus since your
hospitalization?
Yes ( ). No ( )
2. If yes, how much has this impacted your ability to engage in daily activities?
Not at all ( ). A little ( )
Moderate ( ) Significantly ( )
3. How has your sleep been affected by your hospital stays?
No impact ( )
Slight disturbance ( )
Moderate disturbance ( )
Severe disturbance ( )
4. If you have sleep disturbance, what is the main issue?
Difficulty falling a sleep ( )
Waking frequent ( )
Nightmares or distressing dreams ( )
Others ( ) ( specify) ---------------------------

Copying mechanisms
1. What activities help you feel more positive or relieve stress while
Hospitalized?
Talk with families/ friends ( )
Reading or other hobbies ( )
Spiritual practices ( )
Watching TV/ movies ( )
Others ( ) ( specify) ---------------------------
2. How often do you get the opportunity to engage in these activities?
Daily ( ) Once a week ( )
Several times a week ( ) Rarely ( )
3. Do you feel you have sufficient support from hospital staff for your emotional
needs?
Yes ( ). No ( ). Unsure ( )
4. If no, what type of support would be helpful to you?
-----------------------------

Patients perspectives
1. In your opinion, what has been the most difficult psychological challenges of
your prolonged Hospital stay? -------------------------------------------------
2. Do you feel your mental health needs are being met during your hospital stays?
Yes ( ). No ( ). Unsure ( )

Any additional comments on how prolonged hospitalization has affected your mental
and emotional well-being?
-------------------------------------------------------------------

SECTION C: TO ANALYZE THE SOCIO-ECONOMIC EFFECTS OF EXTENDED HOSPITALIZATION ON

PATIENTS AND THEIR FAMILIES

Employment and income

1. Has your hospitalization affected your employment status?
No impact ( )
Reduced working hours ( )
Temporary leave ( )
Jobless ( )
2. Has anyone in your family had to take time off work to support you during
Hospitalization?
Yes ( ). No ( )
3. If yes, how many family members had to take time off?
One ( ). Two ( ). More than two ( )
4. How has your Hospitalization affected your household income?
No change ( )
Slight decrease ( )
Moderate decrease ( )
Significant decrease ( )
5. Are you current facing difficulties meeting regular household expenses (e.g
rent, utilities, food) ?
Yes ( ). No ( )
6. Have you incurred any experiences due to your hospitalization ( e.g
transportation, special equipment, in hospital purchases) ?
Yes ( ). No ( )

Financial assistance and healthcare costs

1. Do you have health insurance coverage for your current Hospitalization?

Yes ( ). No ( ). Partial coverage ( )
2. How have you managed the additional healthcare costs related to your
hospitalization?
Personal saving ( )
Family/ friends support ( )
Loans ( )
Government aid ( )
Others ( ) (specify) ---------------------------
3. Have you received any financial assistance for government or charitable
organization to help with these costs?
Yes ( ). No ( )
4. If no, would you be interested in information about available assistance
programs?
Yes ( ). No ( )

Social impacts
1. Has your extended hospital stays impacted your relationships with families and
friends?
No impact ( )
Somewhat impacted ( )
Significantly impacted ( )
2. Has your family's daily routine or caregiving responsibilities changed as a
result of your Hospitalization?
Yes ( ). No ( )
3. If yes what has changed?
Increased childcare responsibilities ( )
Change to daily routine ( )
Reduced time spent with family ( )
Others ( ) (specify) -----------------------------
4. Do you feel you or your family have faced social isolation or a lack of support
due to your hospitalization?
Yes ( ). No ( ).

THANK YOU.

APPENDIX III: RESEARCH BUDGETS