Social spaces for young children in hospital

'A voice of children: I would like a hospital just for children' - Children's perspectives on hospitalization: A phenomenological study

PURPOSE

This study aimed to explore children's perception of hospital experience and interpretations of hospitalization.

DESIGN AND METHODS

Phenomenological qualitative study design was used. The sample consisted of 18 participants (seven-18 years old) from a general paediatric ward in a university hospital recruited using criterion sampling, a purposive sampling method. Individual semi-structured interviews were conducted face-to-face and were audio recorded. Inductive thematic analysis was used to analyze the data.

RESULTS

The participants talked about the symptoms, limitations and treatments of their diseases, as well as the team communication, lack of activity and physical conditions regarding the hospital. It was seen that the children reported each expression with positive or negative emotions. Finally, they did not neglect to mention their desires regarding the hospital and their daily life. Four main themes emerged "hospital, disease, mood, and desires".

CONCLUSIONS

Health professionals should care about the needs of children during hospitalization and children should be allowed to express themselves.

PRACTICE IMPLICATIONS

Knowing and understanding the needs of hospitalized children can guide the planning and implementation of quality nursing care processes.

Centring children's lived experiences in understanding the importance of play in hospitals

BACKGROUND

Children have a right to participate in matters affecting their lives. With increasing regularity, children's perspectives are being sought regarding their health and health care experiences. Though there is evidence that children find play to be one of the 'best' aspects of hospitalisation, studies rarely focus on children's perspectives on play in hospital.

METHODS

This qualitative study explored children's lived experiences of play during hospitalisation. Over five months, ethnographic observations were conducted on a paediatric oncology ward as well as interviews with 16 children ages 3-13 years.

RESULTS

Using interpretative phenomenological analysis, children's expressions and experiences illuminated three key points: safety and comfort are integral to children feeling able to play in hospital; the value and efficacy of play is decided by children; and that play is a way for patients to be (and be treated as) children first.

CONCLUSION

Hospitals can only be child-friendly if children find them friendly. Listening to and integrating children's perspectives in the discourse around the importance of play in hospital is essential for respecting children's rights and delivering person-centred paediatric healthcare.

Opportunities for play in paediatric healthcare environments: a scoping review

Play spaces are important components of paediatric healthcare environments. They provide children with critical opportunities to experience the social, emotional, and developmental benefits of play while in healthcare settings for appointments or hospitalizations. These spaces can help to mitigate stress, provide a sense of normalcy in unfamiliar environments, and facilitate social engagement for children and their families. Given the benefits of play spaces in paediatric healthcare settings, it is important to understand how these spaces can be designed to enhance children's inclusion and quality of care. The aim of this scoping review was to explore the current understanding of paediatric play space design. Using search terms related to children, health care, and play space, six interdisciplinary databases were searched over a 30-year period. The search found 2,533 records from which eighteen were included for review. Findings suggest that although it is well-documented that play spaces offer valuable social and emotional benefits, little is known about the specific design features that can and should be incorporated to enhance play opportunities and ensure that they benefit all children and families. Further, the literature mostly considers play spaces in the context of designated play or recreational rooms. Scholars are encouraged to consider how play opportunities can be incorporated into the designs of paediatric healthcare environments beyond the boundaries of these rooms. Future studies should also consider the diversity of play space users, including children of varying ages and abilities, to create more accessible and inclusive paediatric play spaces for children and their families. Advancing knowledge on play space design can help to optimize the quality of these important spaces and to ensure their designs meaningfully enhance children's play experiences and quality of care.

A Scoping Review of Pediatric Healthcare Built Environment Experiences and Preferences Among Children With Disabilities and Their Families

BACKGROUND

Some children with disabilities (CWD) frequently visit pediatric healthcare settings for appointments. Their age, disability, and regular visits mean that they have unique experiences in healthcare settings. While previous research has explored the clinical experiences of CWD, little is known about their experiences of pediatric healthcare built environments, even though these environments may play an important role in shaping their perceptions of care. Given the significant time that some CWD and chronic illnesses (e.g., cancer) spend in healthcare environments and the impact that these settings can have on their experiences, the knowledge gap concerning how they view, and experience healthcare built environments demands attention.

OBJECTIVE

To explore how CWD and their families experience pediatric healthcare built environments.

METHODS

A scoping review was conducted by searching five health science and interdisciplinary literature databases using terms related to children, disability, healthcare, and built environment. The search identified 5,397 records that were screened independently by three reviewers.

RESULTS

Nineteen studies met inclusion criteria and were considered in the final review. Findings indicate that CWD and their families value healthcare built environment features that support social engagement, patient privacy, and parental presence. Further, the age of a child was highlighted as an important factor that influences the built environment preferences of CWD.

CONCLUSIONS

CWD and their families prefer certain healthcare built environment features to optimize their experiences in these settings. Healthcare designers can leverage these findings to advance more inclusive pediatric healthcare spaces to improve care and the quality of life for CWD and their families.

Nothing less than a creative triumph: a study of children admitted to hospital for serious somatic illness or injury and their experience of art therapy

Background

Hospitalization can be an extremely distressing experience for seriously ill and injured children. Art therapy has a well-established clinical history, and recent research has begun to demonstrate its effectiveness in somatic pediatric wards. Descriptive and statistical research indicates that art therapy can alleviate anxiety and fear, improve mood, and enhance communication among children, parents, and healthcare professionals. This study aims to enhance our understanding of the specific elements of art therapy that facilitate a connection with the healthier aspects of the self.

Method

A total of 12 hospitalized children, aged 4-12, participated in an art therapy session led by a certified art therapist. Verbalizations during the sessions were recorded, and subsequent observations were synchronized with verbatim transcriptions of audio recordings. A reflexive thematic analysis was conducted to identify relevant patterns of meaning.

Findings

The study identified four significant dimensions of the children's experiences during art therapy: (1) The child feels safe, (2) The child becomes a competent artist, bursting with creativity, (3) The healthy child emerges, and (4) The child achieves something beyond its limits - a triumph.

Discussion

The active ingredients contributing to effective art therapy include the stimulation of creativity, guided art-making with scaffolding support, task variation, granting children control over the artistic process, encouragement of free expression, and the display of positive regard. This study also delves into the therapeutic alliance, emphasizing its role in facilitating children's learning, self-expression, concentration, and the creation of work they take pride in. Additionally, certain psychotherapy-like interactions, such as control-mastery dynamics, were observed. Nevertheless, more extensive research with larger sample sizes is required to draw broader conclusions.

Translation, cultural adaptation and validation of a patient-reported experience measure for children

BACKGROUND

There is no national, validated, generic patient-reported experience measure (PREM) for children under 15 years of age in Sweden. A recent cross-sectional study found no consensus in how children's voices are heard in paediatric health care, as well as a lack of validated questionnaires.

AIM

The aim of this study is to translate, adapt and validate the six versions of the Children's and Young People's PREM for use in a Swedish health care context.

DESIGN

An exploratory sequential mixed-method design including cognitive interviews and content validity index (CVI) was used. The interviews focused on evaluating children's understanding of the questionnaire, and the CVI was used to further adjust the relevance of the questionnaire.

PARTICIPANTS

A convenience sample of 62 children participated in the cognitive interviews and an additional convenience sample of 42 children was included in the CVI testing. The children, aged 8-16 years, were attending routine visits at paediatric departments in a county hospital and a children's hospital in the mid-Sweden region between October 2020 and June 2022.

RESULTS

The translation, adaptation and validation process identified several issues regarding the understanding of the questionnaire in a Swedish context. Adaptations were made based on issues related to context, wording and the structure of the questions. CVI testing resulted in the removal of 3-10 questions in each of the different versions of the questionnaire.

CONCLUSION

The study has resulted in six face- and content-validated Swedish versions of the questionnaire ready for pilot testing. Although the versions of the original questionnaire were developed in collaboration with children in the United Kingdom, this did not mean that they could automatically be used in a Swedish health care context. This study confirms the importance of a rigorous process of adaptation and validation to ensure quality and applicability to children accessing health care in different countries.

PATIENT OR PUBLIC CONTRIBUTION

Children's views have guided the development of the original instrument and its adaptation to the Swedish health care context. Due to the strong patient involvement in the process of developing the Swedish versions of the questionnaire, the research group made a pragmatic decision to have no other patient contribution in the study.

Hospital classroom experiences of hospitalized school-age pediatric oncology patients: A qualitative study

PURPOSE

In this study, it was aimed to examine the hospital classroom experiences of school-age children who received treatment and care at a pediatric oncology-hematology clinic in Turkey.

METHODS

The study was conducted using the in-depth interview method with the participation of 17 children who were hospitalized in the pediatric oncology-hematology clinic of a research and training hospital in the Ankara province of Turkey. The data were collected using a "Semi-Structured Interview Form". The interviews started with the question "How do you perform the assignments given by your teacher while you are hospitalized?", and the interviews were recorded as audio with the consent of the children and their parents.

RESULTS

As a result of the interviews, three main themes, (1) Learning, (2) Maintaining normalcy, and (3) Expectations, and 9 subthemes (teacher, continuation of learning, learning through play, feeling good, continuation of routines, peer interaction, communication with the school-teacher, basic sport activity, and tablet/internet access) were generated from the data.

CONCLUSIONS

Hospital classrooms had a significant role in increasing the children's adaptation to hospital conditions and ensuring the continuation of school/learning.

PRACTICE IMPLICATIONS

Pediatric nurses can refer children with long and repeated hospitalizations (e.g., pediatric oncology patients and children with chronic diseases) to hospital classrooms. Thus, children can adapt more easily to the procedures performed in the hospital.

Designing Well-Being: A Qualitative Investigation of Young Patients' Perspectives on the Material Hospital Environment

BACKGROUND

Physical surroundings of healthcare facilities are suggested to influence young patients' well-being and hospitalization experiences.

PURPOSE

The current research seeks to understand young patients' views and perspectives of the hospital lobby and inpatient rooms. Thus, a qualitative study was carried out in a social pediatric clinic for young patients with disabilities, developmental delays, behavioral problems, and chronic health conditions, that is undergoing reconstruction.

METHOD

Operating from a critical realist position, the study employed arts-based methods in conjunction with semi-structured interviews. The data were explored by employing thematic analysis.

RESULTS

37 young people between the age of four and 30 years participated in the study. The analysis illustrates that the built environment should contain comforting and joyful elements, while enabling patients' autonomy. The ideal lobby was depicted as open and accessible and an ideal patient room as practical and adapted to personal needs.

CONCLUSION

It is suggested that disabling and medicalized spatial arrangements and features may restrict young people's sense of control and autonomy, while possibly posing a barrier to a health-promoting environment. Large and open spaces with comforting and distracting features are cherished by patients and may be embedded in a comprehensive, yet simple overall design and structural concept.

The Best and the Worst Things About the Hospital for Children with Cancer: A Qualitative, Interview-Based Study in a Spanish Hospital

The comprehensive psychosocial assessment of children with cancer requires listening to them and understanding their point of view. The objective of this work was to know what the participating children with cancer thought about the hospital, which they considered to be the best and worst aspects of their experience. We conducted a qualitative study using semi-structured interviews with 27 children with cancer. The interviewer asked the participating children what they considered to be the best thing about the hospital and what they considered to be the worst. These conversations with them were recorded and transcribed, and a thematic analysis of these transcripts was conducted. Among the aspects of the hospital that the children rated most highly was the treatment they received from the health care staff. Among what the children considered the worst aspect of their experience was pain, particularly pain caused by medical procedures such as injections. The obtained results lead us to conclude that children have a complex view of the hospital and are capable of a detailed analysis that must be taken into account.

The social and physical environmental factors associated with the play of children living with life threatening/limiting conditions: A Q methodology study

BACKGROUND

Living with a life threatening/limiting condition changes and challenges children's play. The environment is known to support participation in play, yet there is a lack of evidence highlighting its specific factors contributing to children's play. In this study, we investigated the perspectives of children living with life threatening/limiting conditions with regard to the environmental factors that are related to their engagement in play whilst receiving inpatient healthcare.

METHODS

Twenty-seven children took part in this study. Participants were aged between 5 and 11 years, diagnosed with life threatening/limiting conditions and were receiving care at either a children's hospital or hospice in either Kuwait or the United Kingdom. Children were asked to rank-order a Q set according to their perceived importance. The used Q set composed of social and physical environmental factors. The data were analysed using factor analysis and content analysis.

FINDINGS

Two shared viewpoints were identified, which represented children from both countries. For Factor 1, the children's need for social connectivity guided their answers regarding the environmental factors. For Factor 2, although children considered being surrounded by others important, their selections of the play conditions directed their play. For both factors, children had relatively little concern for outdoor and the type of play to engage in, with the exception of arts and crafts play activities, which were deemed important.

CONCLUSIONS

Play settings are important to support rich, social play experiences and opportunities that match children's play preferences. Children living with life threatening/limiting conditions in Kuwait and the United Kingdom have relatively similar play needs.

Evaluation of an In-Hospital Recreation Room for Hospitalised Children and Their Families

OBJECTIVE

Many children's hospitals have established 'recreation rooms' to help reduce distress among hospitalised children and families. We investigated recreation rooms in two Australian children's hospitals to determine: 1) families' first use of the room (including discovery and delays); 2) characteristics of families accessing the room; 3) parents' positive and negative associations with the room; and 4) parents' most and least valued aspects of the room.

METHOD

Using a concurrent mixed methods design, parents completed questionnaires (Restorative Experiences Tool, Parenting Stress Index-Short Form, Paediatric Quality of Life Inventory) and an optional interview. We analysed data using t-tests and multiple regressions (questionnaires) and content analysis (interviews).

RESULTS

Parents (n = 123) commonly reported delays in accessing the recreation room (n = 74, 60.2%). Parents' distress was positively related to their frequency of room use (r = 0.28, p = .001). Families of hospitalised children with lower physical (r = -0.36, p < .001) and psychosocial (r = -0.31, p = .001) functioning used the room more frequently than families of children with higher functioning. Parents reported more positive than negative associations with the rooms for themselves (t(121) = 20.92, 95% CI = 4.34-5.25), their hospitalised child (t(117) = 23.91, 95% CI = 5.00-5.90), and any siblings (t(79) = 15.76, 95% CI = 4.28-5.52). Thirteen parents completed the interviews. We identified three themes: 1) respite; 2) social support and reduced isolation; and 3) need for greater accessibility (particularly for infants/toddlers).

CONCLUSIONS

Respite and social support provided within the recreation rooms may be particularly important for highly distressed parents and families of children with lower psychosocial and physical functioning. Dedicated areas for different age groups may help to improve accessibility of the recreation rooms.

Visual Arts in Children's Hospitals: Scoping Review

PURPOSE

The purpose of this work was to review scientific publications related to the use of visual arts in pediatric hospitals.

BACKGROUND

Visual arts, particularly painting, have historically played an important role in the design and atmosphere of healthcare spaces, especially hospitals.

METHODS

From 2000 to 2019, 79 publications located in relevant databases and manual searches were identified and analyzed.

RESULTS

Sixty of these publications include empirical studies and 19 theoretical models, comments, or reflections on the use of art in children's hospitals. Their analysis allows us to differentiate four groups of works: (a) "environmental" includes works whose purpose is to know how visual artistic interventions in the hospital can affect the people who see them, mainly pediatric patients, families, and health workers; (b) "participatory" includes studies aimed at knowing the effect of developing visual arts activities in the hospital; (c) "exploratory" includes works whose purpose was to know more about the children's perspective using their artistic expressions; and (d) "diagnostic" includes those that use children's drawings as a tool to diagnose diverse processes related to the pediatric patients' experience.

CONCLUSIONS

Taken together, the works we analyzed in our study support the use of visual arts in hospitals as a resource to enhance the well-being of children and families and their experience in the hospital. We indicate two particularly relevant aspects in this sense: the importance of the visual arts in improving the symbolic quality of hospitalization settings and the communication processes that occur in these environments.

A rapid review of the impact of quarantine and restricted environments on children's play and the role of play in children's health

Amidst the coronavirus disease 2019 (COVID-19) pandemic, there is uncertainty regarding potential lasting impacts on children's health and educational outcomes. Play, a fundamental part of childhood, may be integral to children's health during crises. We undertook a rapid review of the impact of quarantine, isolation and other restrictive environments on play and whether play mitigates adverse effects of such restrictions. Fifteen peer-reviewed studies were identified, spanning hospitals, juvenile and immigration detention and refugee camps. We found evidence of changes in children's access to play in crises and quarantine. These studies indicated how play might support children enduring isolation but lacked robust investigations of play as an intervention in mitigating impacts of restriction. Studies pertaining to children in isolation due to infectious disease outbreaks were notably absent. It is important that the potential effects of changes to such a crucial aspect of childhood are better understood to support children in this and future crises.

The experience of school-aged children with hospitalisation

AIMS AND OBJECTIVES

This study intended to contribute to the improvement of nursing care for both children and their parents and aimed to identify the best and worst experiences of school-aged children during hospitalisation.

BACKGROUND

Child hospitalisation has traditionally been studied from the parent's perspective, but studies in which the child is the subject are scarce and mainly focus on to the hospitalisation experiences.

DESIGN

A cross-sectional, observational and descriptive exploratory design was used, and STROBE reporting guidelines were followed.

METHODS

A paper survey was applied by the primary researcher within a 3 months period to 252 children. It presented two open-ended statements: 'In my opinion the best thing about the hospital is …' and 'In my opinion the worst thing about the hospital is…'. The study was submitted and approved by the national data protection commission and also by the ethics committees of each of the six institutions where the study was undertaken. Informed consent was also obtained from children and parents.

RESULTS

Answers were analysed through content analysis. Five categories were identified for each of the open-ended statements. Children identified 'people', 'physical environment', 'activities', 'outcomes' and 'food' as best experiences. The worst experiences included: 'feelings', 'activities', 'food', 'environment' and 'outcomes'.

CONCLUSIONS

The results allowed the identification of the children's most valued aspects of hospitalisation.

RELEVANCE TO CLINICAL PRACTICE

The results should be considered by healthcare professionals in order to make the hospitalisation experience more positive from the perspective of the school-aged children.

Distance and acceptance: Identity formation in young adults with chronic health conditions

Health has long been a chief concern of life course researchers, especially in examining early life. Research on chronic conditions and their impact on individual identity often center on biographical disruption or the idea of a bifurcation of "before and after" identities. This research examines identity formation in young adults with chronic health conditions that began in childhood, a population that continues to grow. This study focuses on young adults' narrative identities, both regarding how young adults describe the transition to adulthood and how cultural ideals of young adulthood and actors from institutions influence how they describe themselves. This study uses 22 in-depth qualitative interviews to reveal how young adults distance themselves from their conditions or move to acceptance through the narratives they tell about their health, feelings, and behaviors. This research suggests that identity confirmation by others forms an integral part of the nexus of health and the life course, shaping how adolescents make the transition into young adulthood. Social support from actors in institutions gives room to some young adults with chronic conditions to integrate their conditions into their narrative identities. This study reveals the social nature of young adult identities, and how cultural ideals guide them, precisely because it uses cases of young adults who must transition to adulthood in alternative ways.

Play in Children With Life-Threatening and Life-Limiting Conditions: A Scoping Review

IMPORTANCE

Play is essential to children and provides opportunities to promote their health and well-being. Children living with life-threatening and life-limiting conditions experience deprivation in play.

OBJECTIVE

To conduct a scoping review of studies that examined play of children with a life-threatening or life-limiting condition to explore their play characteristics and possible factors influencing their participation in play.

DATA SOURCES

A search of literature published between 1990 and 2017 was conducted in the health, social care, and built-environment fields. The scoping review included multiple searches in electronic databases, a gray literature search, and manual searches of relevant journals and reference lists of included articles.

STUDY SELECTION AND DATA COLLECTION

Defined criteria were used to select articles describing studies that examined the daily play of children ages 5-11 yr with life-threatening and life-limiting conditions; articles that focused on play as therapy or that used parents' accounts of a service were excluded. The identified articles were critically appraised with the Critical Appraisal Skills Programme and the Joanna Briggs Institute Critical Appraisal Tools.

FINDINGS

Thirteen articles were reviewed. The findings indicate that children's play is influenced by their health conditions and play opportunities and by the limited availability of appropriate play equipment and spaces allowing play and social interaction.

CONCLUSIONS AND RELEVANCE

Available appropriate play opportunities need to be maximized for children living with life-threatening and life-limiting conditions. This goal can be achieved by understanding and considering the needs of these children and by facilitating environmental enablers and limiting barriers.

WHAT THIS ARTICLE ADDS

Promoting the participation in play of children who live with life-threatening and life-limiting conditions is important to their health and well-being and can be achieved by targeting the cultural, social, and physical environmental factors that shape the children's play.

Positive Distractions and Play in the Public Spaces of Pediatric Healthcare Environments: A Literature Review

Background:

A positive distraction is a significant environmental feature that introduces positive feelings by diverting attention from stress or anxious thoughts. Existing research has deemed the application of positive distractions in pediatric environments to be significant. This study investigated the essential positive distractions and the associated health benefits.

Aims:

The aims of this study were to validate and extend evidence on positive distractions and play opportunities in the design of the public spaces in pediatric healthcare environments, translate existing evidence into design suggestions, and identify research gaps in this realm.

Methods:

A four-phased literature review method was employed in the study, including literature search, literature screening and selection, literature appraisal, and thematic analysis and in-depth discussion. Eventually, 27 peer-reviewed publications were reviewed and discussed in detail.

Results/Conclusions:

The gathered materials were grouped into six themes of positive distractions: (1) art and environmental aesthetics, (2) spatial arrangement and atrium, (3) considerations of socialization patterns, (4) play and interactive technologies, (5) sound and lighting interventions, and (6) access to nature. The research indicated that positive distractions in the pediatric healthcare environment provide a series of health benefits for patients, including improved behavioral and emotional well-being, reduced stress and anxiety, enhanced healthcare experience and satisfaction, and facilitated medical procedures and recovery. Yet significant research gaps emerged between positive distractions and play in garden spaces and spatial design to accommodate interactive technology and socialization in the public areas of pediatric healthcare environments. This study organized the understanding on the components of supportive environments and its outcomes for pediatric healthcare design.

User-provider experiences of the implementation of KidzAlive-driven child-friendly spaces in KwaZulu-Natal, South Africa

BACKGROUND

KidzAlive is a child-centred intervention aimed at improving the quality of HIV care for children in South Africa. Through this intervention, 10 child-friendly spaces were created in 10 primary healthcare centres (PHCs) in KwaZulu-Natal to enhance child-centred HIV care. However, the user-provider experiences of these child-friendly spaces in these facilities have not been explored. This paper addresses this gap.

METHODS

We conducted qualitative interviews with children (n = 30), their primary caregivers (PCGs) (n = 30), and KidzAlive trained healthcare workers (HCWs) (n = 20) using and providing child-friendly spaces, respectively. Data were generated, using a semi-structured interview guide printed in both English and IsiZulu. The interviews were audio-recorded transcribed and translated to English by a research team member competent in both languages. Data were imported to NVivo 10 for thematic analysis. The COREQ checklist was used to ensure that the study adheres to quality standards for reporting qualitative research.

RESULTS

Child-friendly spaces contributed to the centredness of care for children in PHCs. This was evidenced by the increased involvement and participation of children, increased PCGs' participation in the care of their children and a positive transformation of the PHC to a therapeutic environment for children. Several barriers impeding the success of child-friendly spaces were reported including space challenges; clashing health facility priorities; inadequate management support; inadequate training on how to maximise the child-friendly spaces and lastly the inappropriateness of existing child-friendly spaces for much older children.

CONCLUSION

Child-friendly spaces promote HIV positive children's right to participation and agency in accessing care. However, more rigorous quantitative evaluation is required to determine their impact on children's HIV-related health outcomes.

Ideal physical features of environmental design in children’s hospital

Purpose

During hospitalization, children are faced with physical disorders and many psychological challenges. One important factor affecting children is the environmental design of the hospital. The inappropriate design of hospitals may contribute to an increase in fear, anxiety and behavioral disorders. The purpose of this study is to use children’s perspectives to evaluate the importance and impact of effective environmental factors to generate children’s hospital design guidelines.

Design/methodology/approach

In this study, children’s desired atmosphere during treatment was examined via 16 drawings and 24 interviews from children at a children’s hospital in Iran.

Findings

The encoding of information extracted environmental components such as window view, color, hobby, playing, decorations, family presence, structure of hospital, presence of nurse, furniture, water features, light and green space. The results indicate that children prefer a hospital environment that provides entertainment facilities while also offering design features such as the presence of light, colorful decorations, the existence of green spaces and conditions suitable for their families to be present.

Research limitations/implications

Depending on the location and their living conditions, the children’s prioritization can be different in any society. In addition, the data of this research was descriptive; thus, the conclusions must be considered tentative.

Originality/value

A number of studies focus on the needs of populations in developed countries. This topic has not been investigated in a major way via professionals in non-western countries such as Iran. Thus, the context of this study and present findings can be deemed unique.

Adaptation and Validation of the Instrument ‘Children Care Quality at Hospital’ for Portuguese

Objective: adapt and validate the instrument Children Care Quality at Hospital (CCQH) to assess the quality of nursing care of hospitalized children for the Portuguese language of Portugal. Materials and Methods: content, language, and conceptual validity methodological study, with translation, feedback, and reflection. A non-probabilistic simple was used of 252 children between 7 and 11 years of age, hospitalized due to acute disease in nine services of six Portuguese hospitals. The reliability and validity of the results were determined to measure the psychometric properties of the instrument. Construct validity was calculated through exploratory factor analysis of main components with Varimax rotation and the internal consistency by determining the Cronbach’s alpha coefficient. Results: the internal consistency has adequate psychometric characteristics suitable for the Portuguese population (Cronbach’s alpha values between 0.66 and 0.82). The instrument maintained 49 items grouped into three categories: characteristics, activities, and environment. The psychometric characteristics of the CCQH, adapted and validated for Portuguese, guarantees its reliability and validity to measure satisfaction with the quality of nursing care from the perspective of school-aged children. Conclusions: the instrument could be used to assess children’s satisfaction with the quality of nursing care during their hospitalization.

A scoping review: The utility of participatory research approaches in psychology

Consistent with community psychology's focus on addressing societal problems by accurately and comprehensively capturing individuals' relationships in broader contexts, participatory research approaches aim to incorporate individuals' voices and knowledge into understanding, and responding to challenges and opportunities facing them and their communities. Although investigators in psychology have engaged in participatory research, overall, these approaches have been underutilized. The purpose of this review was to examine areas of research focus that have included participatory research methods and, in turn, highlight the strengths and ways that such methods could be better used by researchers. Nearly 750 articles about research with Indigenous Peoples, children/adolescents, forensic populations, people with HIV/AIDS, older adults, and in the area of industrial-organizational psychology were coded for their use of participatory research principles across all research stages (i.e., research design, participant recruitment and data collection, analysis and interpretation of results, and dissemination). Although we found few examples of studies that were fully committed to participatory approaches to research, and notable challenges with applying and reporting on this type of work, many investigators have developed creative ways to engage respectfully and reciprocally with participants. Based on our findings, recommendations and suggestions for researchers are discussed.

Tangibot: A collaborative multiplayer game for pediatric patients

BACKGROUND

Previous research has studied the effects of games in pediatric wards, but none of it has focused on the impact of the hospital's school staff on the psychosocial state of the children nor on the gameplay itself.

OBJECTIVES

To present the Tangibot application and evaluate its impact on the children's psychosocial state in the short term and the impact of the teacher on their psychosocial state, communications and coordination during the activity.

METHODS

A study was conducted in a hospital classroom with 20 participants, who participated twice in the game: one with the teacher playing along and another without her. An observational scale was used by two evaluators in order to assess the impact on the children.

RESULTS AND CONCLUSIONS

The study revealed that the teacher has an impact on the children's communication and coordination procedures but has no impact on the psychosocial state of the participants. The teacher's impact was found to be positive about communications. Dialogue management significantly improves when the communication includes the teacher, which means speaking turns are observed more consistently. Information pooling also improves, and the participants ask the teacher more questions. Consensus is also reached more often and more easily, but this does not reflect on the performance, as the time management is evidently worse when the teacher is present, as is also the joint task orientation. On the other hand, it was found that the teacher does not have an impact on the psychosocial state of the participants during the game, and that it is the game itself which changes their state over time. In the case of affection, which reflects the participants' emotions of joy or boredom, their state improved significantly after a few minutes of play. The same thing occurred for physical activity, interest in the activity and interaction between peers, which increased in value in the first part of the game, although physical activity and interaction were reduced towards the end. No changes were found throughout the game in the number of complaints, nervousness or satisfied comments, which remained very low for all these aspects, showing that the game distracted them from their various symptoms. Based on these results, future work will explore the effects of gamification on the overall hospitalization perception, with special focus on the social opportunities during the hospital stay, to provide ways for the children to meet others during their treatment, to make the experience less painful and reduce their feelings of isolation. Some game strategies should also be evaluated to determine the ones that provide the best opportunities to improve the children's hospital experience.

Understanding children's spatiality in cancer care environments: Untangling everyday practices around an IV-stand in a paediatric day-care ward

Since the turn of the 21st century we see a renewed interest in the impact of hospital environments on children's well-being. In this article, we study the spatiality of children affected by cancer, i.e., their encounters with the day-care ward they are situated in. First we elaborate on these encounters through Schatzki's practice theory and Gibson's theory of affordances. Then we clarify our thinking in a case study and turn as empirical focus to a 'thing', an intravenous-pump and stand (IV-stand). The data used are field notes and videos shot by two children in a day-care ward, tinged with examples from literature and coincidental encounters with the IV-stand. Through carefully untangling everyday practices around the IV-stand, we show their complexity and offer a more nuanced understanding of child-friendly environments.

Identifying areas for improvement in paediatric inpatient care using the Child HCAHPS survey

The Child-Hospital Consumer Assessment of Healthcare Providers and Systems (Child-HCAHPS) survey is a validated measure of paediatric inpatient experience. The study objective was to determine which survey questions were most correlated with respondents' overall rating of care. Knowing which questions are most important may provide valuable insights for developing targeted quality improvement initiatives.

Methods

Within 6 weeks of discharge, 3,389 telephone surveys were completed by parents/guardians of children who were hospitalized for at least 24 hours. The survey was comprised of 66 questions, with responses based on Likert-scales. One survey question asked respondents to rate the overall care that their child received on a scale from 0 (worst care) to 10 (best care). The correlation between the overall rating of care and each survey measure and question was then examined using Spearman correlation coefficients. All survey questions were normalized to a 100-point score (0=worst, 100=best).

Results

Questions on provider coordination and nursing care were most correlated with overall experience. Quietness of hospital room (r=0.19, P<0.001), and keeping families informed in the emergency room (r=0.12, P<0.001) showed poor correlation. Correlation with overall experience was strongest for the 'communication with nurses' domain (r=0.46, P<0.001).

Conclusions

To our knowledge, this is the first study which examines the correlation of individual questions of the Child-HCAHPS to overall rating of care within a Canadian context. Our results suggest that our large health care organization may attain initial inpatient experience improvements by focusing upon personnel-based initiatives, rather than physical attributes of our hospitals.

Researching and Designing Health Care Environments: A Systematized Review of Creative Research Methods

In research and design, Creative Research Methods (CRMs) are useful to gain insight into user perspectives. Reviews suggest that CRMs offer potential to engage people, yet little detail is available regarding their use in relation to built health care environments. Consider environments for cancer care, where patients are confronted with particular physical and emotional challenges. This review aims to synthesize what is known from existing literature about CRMs exploring user experience when researching and designing (cancer) care environments. Based on 16 items, we evaluate the potential of CRMs, offering insight into why, how, where, and when they are employed. Generally little consideration is shown for participants' abilities and limitations. Our analysis further emphasizes the importance of reflecting on visual methods, and the need to report research approaches transparently including where CRMs are used. A sophisticated research approach can leverage CRMs' potential to study experience and carry artifacts forward to inform design(ers).

Home to Hospital Live Streaming With Virtual Reality Goggles: A Qualitative Study Exploring the Experiences of Hospitalized Children

BACKGROUND

Being separated from home and relatives is a major stressor for children and adolescents when hospitalized. Children long for a manner to be distracted, pleasured, and socially connected during hospitalization. Different technological devices have been applied in health care to answer those needs. Both virtual reality (VR) and videoconferencing have proven their value in hospital wards and pediatrics. VisitU combines these 2 technologies innovatively. VisitU is a recently launched VR product enabling users to be virtually at home during hospitalization.

OBJECTIVE

This study aims to explore the experiences of hospitalized patients with the VR intervention of VisitU in addition to standard care.

METHODS

Over a 3-month period, a purposive sample of 10 patients hospitalized in the Radboudumc Amalia Children's Hospital was included in this qualitative study. Semistructured interviews were performed, one before and one after the use of the VR device. Patients were asked open-ended questions concerning their experiences with VisitU on practical, cognitive, emotional, and social domains. The interviews were audiorecorded and transcribed verbatim. Atlas.ti was used to support the qualitative analysis. Furthermore, the inductive thematic analysis was done according to the 6-step procedure described by Braun and Clarke.

RESULTS

The following 6 main themes were the result of the qualitative analysis: "Being hospitalized," "Expectations of VisitU," "VisitU in use," "VisitU, the benefits," "The impact of VisitU," and "Barriers when using VisitU." The way VisitU was used by patients varied. The main benefits of VisitU were being somewhere else, being at home, and facilitating social connection. Limitations were experienced on the technical abilities, physical side effects, and complexity of use. Despite that, patients were positive about VisitU and unanimous in the view that they would like to use it again and advise other patients to use it.

CONCLUSIONS

This study shows the positive experiences of pediatric patients with VR live streaming. VisitU brings together the needs of patients and possibilities of VR and videoconferencing; it offers patients a way out of the hospital. Nevertheless, practical and technical obstacles must be overcome and side effects are an area of further research.

Attractions to Fuel the Imagination: Reframing Understandings of the Role of Distraction Relative to Well-Being in the Pediatric Hospital

OBJECTIVE

Ulrich's (1991) definition of "positive distraction" includes that which "elicits positive feelings and holds attention," implying that the capacity of an environmental feature to hold attention is a necessary component. This article examines whether, in the context of a pediatric hospital, a distraction needs to "hold attention" to secure positive benefits for patient well-being.

BACKGROUND

Data collected from 246 patients at Melbourne's Royal Children's Hospital (Australia) revealed a discrepancy between what children and young people told us they did, and valued, within the hospital, relative to the time they spent engaging in, or paying attention to, these same features. This motivated a closer interrogation of the relationship between well-being, distraction, and socialization within the pediatric context.

METHOD

Data were collected using a mixed-methods approach that included 178 surveys, 43 drawings contributed by patients/siblings within the outpatient waiting room, 25 photo-elicitation interviews with patients, and 100 hr of spatial observations within public and waiting room spaces. This was supplemented by interviews with architects and hospital staff.

CONCLUSIONS

The mechanism by which we have understood positive distraction to contribute to well-being within the pediatric hospital environment is more complex than existing models accept. Within this context, environmental features that can positively transform expectations of visiting the hospital-that can ignite the imagination and incite a desire to return-can offer significant benefits to well-being. This is particularly relevant in the context of absenteeism from outpatient appointments and in reducing patient resistance to future, or ongoing, treatments.

The Role of Hospital Design in Reducing Anxiety for Pediatric Patients

Objectives:

To study the impact of hospital design on patient and family experiences during and after hospitalization.

Background:

Hospitalization can be psychologically traumatic for children. Few research studies have studied the role of the design of the hospital environment in mitigating that traumatic experience.

Methods:

The study employs a two-group posttest and follow-up design to compare the impact of hospitalization on child anxiety and parent stress. It compares the experiences of children (ages 3–17) hospitalized at a new facility designed to support child-centered care and with family-friendly features with an older facility that did not have these features. The new facility was a replacement of the old one, so that many challenges to comparison are addressed.

Results:

Controlling for the facts of hospitalization, patient demographics, and the child’s typical anxiety level, children in the new facility experienced less anxiety than in the old facility. The study does not provide evidence that the hospital design reduced the psychological sequelae of hospitalization. Parents and children found different features of the hospital to be restorative.

Conclusions:

The study supports the use of Ulrich’s theory of supportive design to children’s healthcare environments, though what is experienced as supportive design will vary by the developmental stage of the child.

Hospitalized Adolescents’ Use of Mobile Technologies for Learning, Communication, and Well-Being

Hospitalized adolescents experience significant needs beyond medical treatment. They require emotional support for anxiety and stress, educational support for learning, and social support to reduce isolation. This qualitative study explored the use of mobile technologies to connect students to their schools, classmates, and families in an effort to reduce their isolation and disrupted schooling experiences. We conducted in-depth interviews with 18 hospitalized adolescents aged 12 to 18, 29 teachers, and four parents about the affordances of mobile technologies. We found that mobile technology use in a hospital school was critical to engage adolescents in learning and keep them up-to-date with schoolwork. Mobile technologies should be available and accessible in hospital for adolescent patients for the purpose of meeting their learning, communication, and well-being needs. In particular, mobile technology should be used as a therapeutic tool to overcome hospitalized adolescents’ social isolation and improve their well-being.

The Role of Environmental Design in Cancer Prevention, Diagnosis, Treatment, and Survivorship: A Systematic Literature Review

The purpose of this literature review is to provide a better understanding of the impact that environmental design can have on the process of cancer prevention, diagnosis, treatment, and survivorship. Cancer is considered a chronic disease in the United States, and more than 1.6 million new cases are diagnosed annually. New strategies of cancer care propose patient-centered services to achieve the best outcome, and researchers have found that environmental design can be an important part of improving this care. Searches were conducted in the PubMed and Google Scholar databases as well as in specific healthcare design journals such as Health Environments Research & Design, Environmental Psychology, and Environment and Behavior. The criteria for articles included in the review were (a) English-language articles related to facility design, which addressed (b) the topics of built environment in relation to cancer diagnosis, treatment, and survivorship, and were (c) published in peer-reviewed journals between 2000 and 2017. Finally, 10 articles were selected, and the contents were analyzed. The selected articles demonstrate that environmental design is one of the critical factors for success throughout the whole continuum of cancer care from diagnosis to end-of-treatment. Some of the specific conclusions from the review are that "neighborhood-oriented" design strategies can be beneficial (by providing accessibility to all facilities along the patient's path), that access to nature for patients, staff, and visitors alike is associated with better outcomes, and that provisions for natural lighting and noise reduction are associated with cancer patients' well-being.

Psychosocially Supportive Design: The Case for Greater Attention to Social Space Within the Pediatric Hospital

Objective:

Models of patient and family-centered care advocate catering to psychosocial needs when designing healthcare facilities yet there is little evidence available to determine how the built environment can cater to psychosocial needs. This article highlights the obstacles to overcoming this knowledge deficit in the pursuit of evidence-based guidelines to inform social provisions within the pediatric hospital setting. It will propose a working definition for psychosocial space and identify new research directions to enhance understandings of the relationship between social space and well-being.

Background:

While traditional multibed ward configurations afforded opportunities for peer support relationships to develop, both for patients and caregivers, the contemporary preference for single-occupancy rooms intensifies the need to critically examine social spaces within the pediatric hospital.

Methods:

Research suggests a correlation between social support and well-being. This article reviews the research underpinning contemporary understandings of this relationship; it positions literature from sociology, environmental psychology, and evidence-based design to highlight the limitations of this knowledge and identify where additional research is required to inform evidence-based design guidelines for psychosocially supportive spaces within pediatric healthcare settings.

Conclusions:

Evidence regarding the therapeutic value of social support within the pediatric hospital is not sufficiently sophisticated or conclusive to inform guidelines for the provision of social space with pediatric hospitals. There is an urgent need for targeted research to inform evidence-based design guidelines; this will demand a broad disciplinary approach.

A study of the provision of hospital based dental general anaesthetic services for children in the northwest of England: part 1--a comparison of service delivery between six hospitals

BACKGROUND

Extensive caries in children can result in a referral for tooth extraction under General Anaesthesia (GA). While there are guidelines for the use of GA within paediatric dentistry this process is ultimately dependent upon the decision making of the treating dentist. This decision can be influenced locally by the availability of services and their waiting list. GA services for paediatric extractions (DGA) have developed from different historical positions, including community dental services, maxillofacial services and paediatric led specialist services.

METHODS

This article explores the differences between DGA services provided by 6 randomly selected hospitals across the North West of England. 456 patients who attended a routine DGA appointment in each hospital over a period of two months from 2012 to 2013 gave consent to allow access to their clinical notes and completed a questionnaire (93% consent rate). Data were entered onto SPSS and appropriate statistical tests undertaken.

RESULTS

Differences between hospitals included the clinic structure, patient characteristics and the treatment provided. There was a significant difference in the number of previous child DGAs experienced within the family, ranging from 33% to 59% across hospitals. Hospital 1 attendees differed in a number of ways to other areas but notably in the stability of life time residency with 20% of patients having previously lived in another area and with just 58% of parents stating their child regularly attended the dentist (compared to an average of 9% and 81% respectively across other hospitals).

CONCLUSION

Findings suggest services throughout the region face different obstacles in providing support and treatment for young children referred for DGA. There are, however common practices such as preventative treatment, which could impact on caries experience and subsequent DGA referral, a particular issue given the high DGA repeat rate observed. For many children a DGA may be their first dental experience. It is therefore vital to engage with both child and family at this stage, attempt to initiate a pattern of dental attendance and to ensure this experience does not create an on-going cycle of poor dental behaviour and health.

A study of the provision of hospital based dental General Anaesthetic services for children in the North West of England: Part 2--the views and experience of families and dentists regarding service needs, treatment and prevention

BACKGROUND

Patterns of service delivery and the organisation of Dental General Anaesthesia (DGA) have been found to differ across hospitals. This paper reports on qualitative research aimed to understand the impact of such variation by exploring views and experiences of families receiving care in different hospital sites, as well as dentists involved in referral and delivery of care.

METHOD

Qualitative semi-structured interviews were conducted with 26 people comprising parents (n = 15), dentists working in primary care (n = 6) and operating dentists (n = 5) in relation to DGA. Participants were recruited from areas across the North West of England to ensure a variety referral and treatment experiences were captured. Field notes were made during visits to all settings included in the study and explored alongside interview transcripts to elicit key themes.

RESULTS

A variety of positive and negative impacts on children and parents throughout the referral process and operation day were apparent. Key themes established were clustered around three key topics: 1. Organisational and professional concerns regarding referrals, delivery of treatment and prevention. 2. The role of hospital environment and routine on the emotional experiences of children. 3. The influence of the wider social context on dental health.

CONCLUSION

These findings suggest the need and perceived value of: tailored services for children (such as play specialists) and improved information, such as clear guidance regarding wait times and what is to be expected on the day of the procedure. These features were viewed to be helpful in alleviating the stress and anxiety often associated with DGA. While some elements will always be restricted in part to the hospital setting in which they occur, there are several aspects where best practice could be shared amongst hospitals and, where issues such as wait times have been acknowledged, alternative pathways can be explored in order to address areas which can impact negatively on children.