Who owns the child in hospital? A preliminary discussion

Evaluating children's rights in the hospital setting of Afghanistan

PURPOSE

Children's rights must be realized in all children-related settings, such as hospitals. This study aimed to assess children's rights in hospital settings in Afghanistan in 2021.

DESIGN AND METHODS

A cross-sectional survey using the World Health Organization questionnaire was conducted. It was distributed among the randomly selected healthcare providers in the studied hospital. One hundred forty-two hospital managers, physicians, and nurses participated in the study. Descriptive and analytical statistics were used to analyze the results in SPSS.

RESULTS

In this study, 54.2% of participants were men, 59.9% had a bachelor's degree, and most were 20-30 years old (56.7%). The total score of the hospital in fulfilling children's rights was 1.71 ± 0.46. Among different children's rights, "equality and non-discrimination" received the highest score (2.01 ± 0.59), and the lowest was for "play and learning" (1.1 ± 0.46). There was a meaningful relationship between education level, years of work experience, and the scores given to children's rights. Various dimensions of the rights had significant relationships (p < 0.05).

CONCLUSION

The hospital has taken action to fulfill children's rights. The main gaps include the lack of adolescent-friendly health services, opportunities to play and learn, and child protection. Hospital managers, staff, and the public should be educated on children's rights. Moreover, protocols for improving children's rights and a monitoring system are needed.

PRACTICAL IMPLICATIONS

Children's rights should receive special attention in hospitals. Educating children, parents, service providers, health policymakers, and society about children's rights is essential. They should know their responsibilities regarding children.

Pragmatics and Parenting

THEORETICAL PRINCIPLES

Pragmatic Children's Nursing Theory draws on the theory principles of North American Pragmatist including the work of William James, Richard Rorty, and John Dewy and incorporates Margaret Urban Walkers' work on expressive collaborative feminism.

PHENOMENA ADDRESSED

In this discussion paper I explore how the role of parents is framed in Pragmatic Children's Nursing Theory. In setting out Pragmatic Children's Nursing Theory I detailed a rebuttal of Family Centred care. However, working with the theory I have come to realise how the arguments against Family Centred care do not exclude involving parents in children's care. Indeed, Pragmatic Children's Nursing recognises the vital role parents and other carers play in children's access and experience of childhood. Using Walkers expressive collaborative feminism who accepts and who rejects the parenting role for children living with illness is discussed.

RESEARCH LINKAGES

This is an emergent theoretical approach to children's nursing with challenging research evidence. However, I draw on existing children's nursing studies to explore the potential of Pragmatic Children's Nursing Theory to assist children, parents and nurses in negotiating care. Concluding that as childhoods and parenting are continually evolving, in time, in certain physical, cultural and political contexts, that pragmatic theory will evolve to meet these intergenerational contextual challenges.

Empowering Parents of Australian Infants and Children in Hospital: Translation, Cultural Adaptation, and Validation of the EMpowerment of PArents in The Intensive Care-30-AUS Questionnaire

OBJECTIVES

To translate, culturally adapt, and psychometrically test the EMpowerment of PArents in The Intensive Care-30 questionnaire in Australian pediatric critical care, neonatal, and pediatric ward settings.

DESIGN

Cross-sectional, descriptive, multicenter study conducted in two phases; 1) translation and cultural adaptation and 2) validation of the EMpowerment of PArents in The Intensive Care-30 questionnaire.

SETTINGS

Two Western Australian sites, the PICU and two pediatric wards of a children's hospital and the neonatal unit of a women's and newborn hospital.

PARTICIPANTS

Parents whose baby or child was admitted to the participating wards or units with a length of hospital stay greater than 24 hours.

INTERVENTION

None.

MEASUREMENTS AND MAIN RESULTS

Phase 1: A structured 10-step translation process adhered to international principles of good practice for translation and cultural adaptation of patient-reported outcomes. Thirty parents participated in cognitive debriefing. Phase 2: A total of 328 parents responded to the EMpowerment of PArents in The Intensive Care-30-AUS questionnaire. Reliability was sufficient (Cronbach α at domain level 0.70 -0.82, for each clinical area 0.56-0.86). Congruent validity was adequate between the domains and three general satisfaction items (rs 0.38-0.69). Nondifferential validity showed no significant effect size between three patient or parent demographic characteristics and the domains (Cohen's d < 0.36). Between the different clinical areas, significant differences in responses were found in all domains.

CONCLUSIONS

The translated and culturally adapted EMpowerment of PArents in The Intensive Care-30-AUS is a reliable and valid questionnaire to measure parent-reported outcomes in pediatric critical care, pediatric ward, and neonatal hospital settings. Using this questionnaire can provide a framework for a standardized quality improvement approach and identification of best practices across specialties, hospital services and for benchmarking similar health services worldwide.

Decision Making in Paediatric Care: an overview with reference to nursing care

The purpose of this overview of published articles on decision making in paediatric care was to identify important aspects of its possible use in clinical practice and to obtain a base for future research. A literature review was undertaken utilizing snowball sampling to identify articles because of the diversity present within the area of decision making in paediatric care. The databases PubMed and CINAHL were used. The search was limited to articles published in English during the period 1994-2004. The analysis entailed a series of comparisons across articles, focusing on major areas of enquiry and patterns of results. Various levels of decision making are described because these seem to form a basis for how decisions are made. Concepts found to be of importance for decision making are described under the following headings: competence, the child’s best interests, knowledge, values and attitudes, roles and partnership, power, and economy. Further research is suggested.

A web-based programme for person-centred learning and support designed for preschool children with long-term illness: a pilot study of a new intervention

For children living with long-term illness, school age is a risk period with regard to psychosocial ill health and poor compliance with treatment. There is a need for methods to promote health, well-being, and self-esteem. This study describes a new concept for supporting children, person-centred web-based learning and support, which has been tested in 12 preschool children and incorporates learning about feelings, relationships, and the right to integrity. SKYPE was used for conversations between the child and the web teacher. Methods. The programme was developed and tested in two steps. The conversations were tape-recorded and analysed using phenomenography. The questions addressed concerned the quality of the intervention process: accessibility of intervention, learning content and support, and identification of measurable items and patterns. Findings. The children found it interesting to communicate with their web teacher using SKYPE. The story about Max and Sara served as a good basis for discussion, and development was found in the learning process. The children were able to talk about relations and feelings and developed an understanding for use in new situations in their daily lives. Items and patterns that are useful for research and documentation were identified, for example, well-being, resources, needs, and wishes.

How children's rights are constructed in family-centred care: a review of the literature

It appears that the acceptance of children's rights within the acute care setting is treated as a given but such a given requires a more systematic analysis. This has been undertaken here in the form of a review of the literature. The purpose of the review is to explore how children's rights, defined by the United Nations Convention on the Rights of the Child (UNCRC) are recognized in family-centred care in the acute care paediatric setting as reported in the literature. Reports that were available from 1989 to 2010 were reviewed. Children's rights are not mentioned frequently in the literature of interest to children's nurses. What is revealed are the ethical tensions in the challenge to act at all times in children's best interests (in the spirit of Article 3) while giving due weight to their views (in the spirit of Article 12) (OHCHR, 1989). The continuing failure to address these tensions undermines the spirit and practice of family-centred care.

The importance of including both a child perspective and the child's perspective within health care settings to provide truly child-centred care

The UN Convention on the Rights of the Child (1989) asserts the right of every child to self-determination, dignity, respect, non-interference, and the right to make informed decisions. The provision of quality care in health services tailored to children's preferences means that health professionals have a responsibility to ensure children's rights, and that the child is encouraged and enabled to make his or her view known on issues that affect them. This paper will help illuminate and differentiate between a child perspective and the child's perspective in health care settings. The issues are supported with research which illustrates the different perspectives. Both perspectives are required to perceive and encounter children as equal human beings in child-centred health care settings.

Parental consent for neuroimaging in paediatric research

BACKGROUND

Functional magnetic resonance imaging (fMRI) is increasingly applied in paediatric research. Parents typically provide research consent for their children; yet, no study has examined the rates of consent, nor factors influencing parental decision making for consent. The present study aimed to determine the proportion of parents that would consent to their child undergoing an fMRI study, and to elicit the reasons, motivators and detractors affecting their decision.

METHODS

Ninety parents of children aged 6 years were invited to participate in a postal survey study.

RESULTS

Fifty-three parents (59%) responded and one-third (34%, 18/53) reported that they would consent. The main reason for consent was that participation could benefit children in the future (89%, 16/18). Common reasons for not consenting included that fMRI may be anxiety-provoking (54%), or was an unnecessary medical procedure (23%).

CONCLUSIONS

Our preliminary data suggest that researchers may have to approach three times the number of participants required in order to recruit a suitable number of healthy children to fMRI studies. Further research examining the influence of recruitment approaches (e.g. phone vs. postal) and the various factors influencing decision making regarding consent is required. For example, careful examination of the language used in describing the procedure could facilitate parental understanding about fMRI and alleviate anxiety associated with the procedure. This is an important consideration for recruitment to future fMRI studies given that anxiety was a key factor influencing parental non-consent.

Reviewing the process of preparing children for MRI

BACKGROUND

MRI is a common medical imaging investigation. Patients, including young children, can be required to keep still for up to 60 min for the study to be completed successfully. Children often find the confined space, noise, need to lie still and possibility of intravenous administration of contrast agent anxiety-provoking and sometimes so distressing that they are unable to cope and require general anaesthesia.

OBJECTIVE

A practice MRI intervention was introduced at the Royal Children's Hospital in Melbourne, Australia. The program is conducted by educational play therapists in conjunction with the Department of Medical Imaging. This study explored the effectiveness of this intervention.

MATERIALS AND METHODS

The intervention was conducted in a practice MRI unit devoid of magnets. Data were collected as a clinical audit with respect to age, gender, times of scans, position in bore, diagnostic scans and movement artefact. Epidata and Stata were used to analyze the data.

RESULTS

A total of 291 children were included; their ages ranged from 3 years 7 months to 17 years (mean 7.9 years), and 48.8% were male. Of the 291 children, 218 (74.9%) were considered a pass at practice, 35 (12 %) were considered borderline pass, and diagnostic images were obtained from 218 (96%) of those children who went onto a clinical MRI.

CONCLUSION

We conclude that practice MRI intervention facilitated by educational play therapists is a useful intervention in supporting children to cope with MRI without general anaesthesia.

Children who refuse anesthesia or sedation: a survey of anesthesiologists

BACKGROUND

Few articles have addressed the issue of the child who refuses anesthesia or sedation for surgery. A survey of members of the Society for Pediatric Anesthesia in the USA was conducted regarding their experience with pediatric refusal and assent for surgery.

METHODS

Structured response and open-end questions were used in a confidential postal survey to assess the following: details of cancellations, the use of, and attitudes to, physical restraint at induction, premedication, the management of a hypothetical case of child refusal and individual techniques used for uncooperative children.

RESULTS

Surveys were received from 453/852 anesthesiologists for a 57% response rate. Nine percent and 45% of respondents had cancelled one or more cases for child refusal in the past year and during their entire career respectively. Forty-four percent of respondents used restraint in the majority of children<1 year of age, whereas only 2% did so in children>11 years. Respondents were more uncomfortable with restraint in older children and less likely to proceed with induction. Twelve years was the median age when respondents would respect the child's refusal to proceed.

CONCLUSIONS

Cancellation of planned surgery because of child refusal is not uncommon. It is important to recognize the potentially uncooperative child, particularly older children with developmental delay or a lack of understanding. Discussion with child and parents, selective use of premedication and different induction agents, distraction, play techniques, gentle restraint and the option of cancellation and review should all be considered.

Consent and nothing but consent? The organ retention scandal

The organ retention scandal arose in the UK in the autumn of 1999 when knowledge of the practice of organ and tissue retention after post-mortem for subsequent diagnostic, teaching, audit and research purposes fully entered the public domain. Many families were shocked and distressed to realise that by allowing a post-mortem on their relative or child they were also deemed to have agreed to the long-term retention of organs and tissues and thus had buried or cremated, as they perceived it, not a 'whole' body but an 'empty shell'. Subsequently, informed consent was placed at the centre of recommendations for reform, now given expression in the Human Tissue Act (2004). Through a discourse analysis of the documentary evidence produced in the wake of the organ retention scandal, I argue that the emphasis on informed consent masks concerns about body wholeness. In addition, whilst informed consent is posited as key in 'balancing' the rights of the individual over the needs of medical science, this position is tempered by the concurrent presence of notions of the gift relationship and post-mortem citizenship. Incorporating these notions alongside the discourse of consent also renders concerns about the commodification of the body less acute.

Negotiation of parental roles within family-centred care: a review of the research

AIMS AND OBJECTIVES

To review research published in the past 15 years about how children's nurses' negotiate with parents in relation to family-centred care.

BACKGROUND

Family-centred care is a basic tenet of children's nursing and requires a process of negotiation between health professionals and the family, which results in shared decision-making about what the child's care will be and who will provide this. The literature highlights inconsistencies in the degree to which nurses are willing to negotiate with parents and allow them to participate in decisions regarding care of their child. There is need to explore further the extent to which nurses communicate and negotiate shared care with children and their parents.

CONCLUSIONS

Three themes emerged from this review of the literature relating to whether role negotiation occurred in practice, parental expectations of participation in their child's care and issues relating to power and control. Parents wanted to be involved in their child's care but found that nurses' lack of communication and limited negotiation meant that this did not always occur. Nurses appeared to have clear ideas about what nursing care parents could be involved with and did not routinely negotiate with parents in this context.

RELEVANCE TO CLINICAL PRACTICE

For family-centred care to be a reality nurses need to negotiate and communicate with children and their families effectively. Parents need to be able to negotiate with health staff what this participation will involve and to negotiate new roles for themselves in sharing care of their sick child. Parents should be involved in the decision-making process. However, research suggests that a lack of effective communication, professional expectations and issues of power and control often inhibit open and mutual negotiation between families and nurses.

Paradigm shifts in inpatient psychiatric care of children: approaching child- and family-centered care

TOPIC

This article describes the components of child- and family-centered care, including a review of the literature about the delivery of family-centered care and the barriers that often prevent the provision of such care. The article describes an inpatient child psychiatric unit that has implemented an approach to care that embraces these principles. The changes in structures and policies that the unit adopted are described, with specific examples cited as illustrations of the components of this care.

PURPOSE

To describe the elements of child- and family-centered care and the ways in which this model of care may be implemented on inpatient child psychiatric units.

SOURCES USED

Literature review including journal reports and articles and books.

CONCLUSIONS

Preliminary outcomes are encouraging in the decrease in use of practices such as restraint and seclusion, and physical holds. Further research examining parents' satisfaction is warranted in determining the success of such endeavors.

Nurses' moral agency in negotiating parental participation in care

The purpose of this study was to investigate the issues for nurses in facilitating parental participation in the care of the hospitalized child. A qualitative study informed by grounded theory was undertaken. Nine nurses were recruited from an acute, high-dependency, 23-bed paediatric cardiac/renal unit in Melbourne, Australia. Data collection involved individual semistructured interviews, hospital policies related to family-centred care and a focus group interview. Constant comparative analysis was undertaken to develop an understanding of the data collected in the context of the nurses' experiences and the environment in which they work. Moral agency was identified as the central phenomenon of the study. Causal conditions related to this included the child's best interests, disputes about care and nurses' expectations. These causal conditions were seen to potentially lead to moral distress for the nurses. The coping mechanisms and strategies that affected moral agency have been identified.