Child and parental surveys about pre-hospitalization information provision

Having a heart-to-heart: Parents' experiences preparing their child for a cardiac procedure

Cardiac procedures can be overwhelming for children and parents, with a lack of literature surrounding how healthcare professionals can assist parents in preparing young children for such procedures. This exploratory descriptive qualitative study sought to understand experiences of parents preparing and supporting their child with congenital heart disease, for an upcoming cardiac procedure. Parents of children, aged between three and eight years old, who had undergone a cardiac procedure at a tertiary paediatric hospital in Australia were invited to participate in an interview. Seven parents were interviewed, with recordings transcribed and analysed using reflexive thematic analysis. Four major themes identified were (1) evolving information needs; (2) anticipating anxiety; (3) honesty when delivering information; and (4) equipping parents with resources. Findings from this study emphasised that support for children prior to cardiac procedures must include empowering parents, as they know their child best. A key component of procedural preparation is helping parents navigate how to translate procedural information into explanations which are relatable and appropriate for their child. The development of interactive, relatable resources would allow parents to continue their child's preparation beyond the preadmission visit.

An Intelligent Customer-Driven Digital Solution to Improve Perioperative Health Outcomes Among Children Undergoing Circumcision and Their Parents: Development and Evaluation

BACKGROUND

Circumcision as a common elective pediatric surgery worldwide is a stressful and anxiety-inducing experience for parents and children. Although current perioperative interventions proved effective, such as reducing preoperative anxiety, there are limited holistic solutions using mobile apps.

OBJECTIVE

This paper aims to describe the development and primary evaluation of an intelligent customer-driven smartphone-based app program (ICory-Circumcision) to enhance health outcomes among children undergoing circumcision and their family caregivers.

METHODS

Based on the review of the literature and previous studies, Bandura's self-efficacy theory was adopted as the conceptual framework. A multidisciplinary team was built to identify the content and develop the apps. Semistructured interviews were conducted to evaluate the ICory-Circumcision.

RESULTS

The ICory-Circumcision study was carried out from March 2019 to January 2020 and comprised 2 mobile apps, BuddyCare app and Triumf Health mobile game app. The former provides a day-by-day perioperative guide for parents whose children are undergoing circumcision, while the latter provides emotional support and distraction to children. In total, 6 participants were recruited to use the apps and interviewed to evaluate the program. In total, 4 main categories and 10 subcategories were generated from content analysis.

CONCLUSIONS

ICory-Circumcision seemed to lean toward being useful. Revisions to ICory-Circumcision are necessary to enhance its contents and features before advancing to the randomized controlled trial.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04174404; https://clinicaltrials.gov/ct2/show/NCT04174404.

Strategies to optimize the information provision for parents of children with developmental dysplasia of the hip

Aims

The aim of this study was to identify the information topics that should be addressed according to the parents of children with developmental dysplasia of the hip (DDH) in the diagnostic and treatment phase during the first year of life. Second, we explored parental recommendations to further optimize the information provision in DDH care.

Methods

A qualitative study with semi-structured interviews was conducted between September and December 2020. A purposive sample of parents of children aged younger than one year, who were treated for DDH with a Pavlik harness, were interviewed until data saturation was achieved. A total of 20 interviews with 22 parents were conducted. Interviews were audio recorded, transcribed verbatim, independently reviewed, and coded into categories and themes.

Results

Interviews revealed four fundamental information topics that should be addressed in the different phases of the DDH healthcare trajectory: general information (screening phase), patient-specific information (diagnostic and treatment phase), practical information (treatment phase), and future perspectives (treatment and follow-up phase). To further optimize the information provision in DDH care, parents wished for more accessible and trustworthy general information prior to the first hospital visit to be better prepared for the diagnosis. Furthermore, parents wanted more personalized and visually supported information for a better understanding of the nature of the disease and the reason for treatment.

Conclusion

This study offers novel insights to optimize the information provision in DDH care. The main finding is the shift in information need from general information in the screening phase to patient-specific information in the diagnostic and treatment phase of DDH. Parents prefer visually-supported information, provided in a timely fashion, and tailored to their child's situation. These recommendations potentially decrease parental anxiety, insecurity, confusion, and increase parental empowerment and treatment adherence throughout the diagnostic and treatment phase of DDH.

Mothers' Involvement in Pediatric Postoperative Pain Care in a Tertiary Healthcare Setting in Saudi Arabia

Background Many children feel moderate to intense pain in the hospital following surgery. Untreated pain can have deleterious physical and psychological effects. Mothers' involvement in child pain care and management postoperatively has been shown to be important in improving the outcomes and experiences of children, mothers, and health professionals. Aims To explore mothers' involvement in postoperative pain care and management of their children during hospitalization and following discharge and identify approaches to improve management and participation activities. Methods We used a qualitative single case study design with thematic analysis. The analysis included 20 mother-child dyads and 21 nurses, involving observation of participants and semi-structured interviews of mothers and nurses. The analysis also incorporated a review of documents from the pediatric surgical department (hospital policies and forms).  Findings The following main themes and sub-themes were generated from the data: (i) provision of pain information (expected type, frequency, and duration of pain after surgery, pain intensity score, pain relief medication, and pain management methods), (ii) communication deficiency (language barrier and breakdown in communication between health professionals), (iii) emotional and physical support (family support, environmental comfort, and sleep and meal requirements), (iv) social and cultural influences (patriarchal society, cultural and religious beliefs, and work status), and (v) hospital facilities, provisions, and services (entertainment, follow-up programs, education courses on pain management for nurses, and materials and services). Conclusions The study examined mothers' participation in postoperative pain care and management in a cohort of children admitted to a tertiary care setting in Saudi Arabia, highlighting key factors that influence involvement and suggesting approaches for improving participation.

'We should have been told what would happen': Children's and parents' procedural knowledge levels and information-seeking behaviours when coming to hospital for a planned procedure

Children continue to be poorly prepared and informed about clinical procedures, despite increased evidence of the worth of preparation and the availability of information resources. This study used a concurrent mixed-methods approach to explore the information accessed by children and their parents before attending hospital for a procedure. Information was collected separately from 40 children (aged between 8 and 12 years) and their parents using a paper booklet to examine self-reported perceived procedural knowledge and information-seeking behaviours. Data were analysed using descriptive statistics and content analysis techniques. The findings indicate that many children (70%, n = 28) and their parents (65%, n = 26) have low procedural knowledge levels. The majority of children (85%, n = 36) reported not receiving or seeking information about their procedure, despite identifying a desire and preference for more information. This study shows a mismatch between the current provision of procedural information and children and parents' expectations that information will be provided directly to them by health professionals. In order for this 'information hole' to be filled, there needs to be a concerted effort to develop and systematically use meaningful information materials and for children and their parents to have the opportunity to discuss their procedural knowledge with health professionals.

How are children's best interests expressed during their hospital visit?-An observational study

AIMS AND OBJECTIVES

To describe ways in which children's best interests were observed to be expressed in paediatric settings during their hospital visit.

BACKGROUND

The best interests of the child are embodied in national and international legal systems, although the definition remains problematic. The child's limited autonomy mandates duty bearers to have both a child perspective and the child's perspective when considering what the best interest of the child entails in care situations.

DESIGN

A qualitative descriptive study with overt, non-participant observations fulfilling the COREQ criteria.

METHODS

Thirty-two observations of interactions between children aged 2 to 17 years with both acute and chronic conditions, their parents and healthcare professionals were conducted at three paediatric hospitals in Sweden. Inductive and abductive reasoning were used in the content analysis of data, which followed the identification, coding, categorising and abstraction of observed patterns of the best interest of the child.

RESULTS

Findings reveal facilitating and obstructing factors for the child's best interests to be safeguarded in healthcare situations. Children were guided in or hindered from exercising their competence. The observations showed a variation in actions taken by both parents and healthcare professionals to safeguard the best interests of the child.

CONCLUSIONS

Determining the best interest of the child requires a case-by-case basis, as it is context-dependent, situational, flexible and dependent on all actors involved and actual decisions made.

RELEVANCE TO CLINICAL PRACTICE

Healthcare professionals' actions can facilitate or obstruct observed expressions of the child's best interest. It is essential to enhance healthcare professionals' communication skills, knowledge awareness and continuing education about the rights of children receiving healthcare services. Reflections and discussions on how to protect the best interests of children may help healthcare professionals to uphold children's best interest in daily clinical practice.

Parent-Child Reminiscing about Past Pain as a Preparatory Technique in the Context of Children's Pain: A Narrative Review and Call for Future Research

Pain permeates childhood and remains inadequately and/or inconsistently managed. Existing research and clinical practice guidelines have largely focused on factors influencing the immediate experience of pain. The need for and benefits of preparing children for future pain (e.g., painful procedures) has been well established. Despite being a robust predictor of future pain and distress, memories of past painful experiences remain overlooked in pediatric pain management. Just as autobiographical memories prepare us for the future, children’s memories for past pain can be harnessed to prepare children for future painful experiences. Children’s pain memories are malleable and can be reframed to be less distressing, thus reducing anticipatory distress and promoting self-efficacy. Parents are powerful agents of change in the context of pediatric pain and valuable historians of children’s past painful experiences. They can alter children’s pain memories to be less distressing simply by talking, or reminiscing, about past pain. This narrative review summarizes existing research on parent–child reminiscing in the context of acute and chronic pediatric pain and argues for incorporation of parent–child reminiscing elements into preparatory interventions for painful procedures.

'If I knew what was going to happen, it wouldn't worry me so much': Children's, parents' and health professionals' perspectives on information for children undergoing a procedure

Children undergoing procedures such as blood tests and X-rays experience less anxiety and upset if they are well prepared and informed. Currently the provision of information about procedures can be ad hoc and there are barriers to children understanding this information. This study explored the perspectives of 32 children undergoing procedures (aged between 8 and 12 years), 27 parents and 19 health professionals on the provision of preparatory information to children. Qualitative interviews, prompted by visual images, were thematically analysed. The three themes, 'accessing information', 'understanding information' and 'using information', resonated with the central tenets of health literacy. Children reported mainly accessing information second-hand through their parents and demonstrated misconceptions about their procedure. Children identified that procedural information would help them to know what was going to happen and enable them to feel less worried and scared about their procedure. This study highlights that children can have low levels of health literacy in relation to a planned procedure. Their health literacy in this context is heavily influenced by the adults (parents and health professionals) around them. There needs to be further work conducted, informed directly by children, to improve the health literacy of children attending hospital for planned procedures.

The information needs of children having clinical procedures in hospital: Will it hurt? Will I feel scared? What can I do to stay calm?

BACKGROUND

Children often have unmet information needs when attending hospital, and this can cause them anxiety and uncertainty. If children are prepared and informed about what will happen during a procedure, they tend to have a better experience. Finding out what children want to know before they attend hospital for procedures could provide significant benefits for children, their families, and healthcare professionals. This study set out to investigate children's perspectives of what information is important and valuable to know before attending hospital for a planned procedure.

METHODS

A "write and tell" activity sheet underpinned a semistructured qualitative interview with children attending hospital for a planned procedure. The interview focussed on the information children thought was important to know before a procedure. Data were analysed using content analysis techniques.

RESULTS

One hundred six children aged between 8 and 12 years old participated in the interviews. The children identified 616 pieces of information they thought would be of value to children attending hospital for procedures. These were inductively coded into three types of information: procedural, sensory, and self-regulation. Children want to know detailed procedural and sensory information to actively construct a script of a procedure and then build on this with information about specific strategies to help them cope with and self-regulate the situation.

CONCLUSION

This study has identified three types of information children recognize as important in preprocedural preparation. Children construct an understanding of a planned procedure through actively scaffolding procedural, sensory, and self-regulation information.

A Qualitative Analysis of the Information Needs of Parents of Children with Cystic Fibrosis prior to First Admission

PURPOSE

Hospitalization can be stressful for patients and their families. Pre-hospitalization information is crucial in establishing a good basis for patient satisfaction. In order to develop better preparatory material for parents, this qualitative study explored whether parents of children with cystic fibrosis, admitted to a UK Children's Hospital, felt adequately prepared for their child's admission.

DESIGN AND METHODS

Data were collected from twelve parents whose children had been admitted within the last two years for routine intravenous antibiotics. Semi-structured interviews were analyzed using thematic analysis.

RESULTS

Four themes emerged from the analysis: (1) preparing for admission, (2) the ward as a challenging environment, (3) changes in the parent-professional relationship and (4) the parental role in medical care.

CONCLUSION

Provision of adequate preparatory information is essential in reducing parental stress, influencing how future experiences are appraised and managed. Effective parent-professional communication and opportunities to participate in care are likely to improve parental satisfaction.

PRACTICE IMPLICATIONS

Preparatory information prior to hospital admission greatly assists parents in making informed decisions and working as joint advocates in their child's inpatient care.

Experience and nursing needs of school-age children undergoing lumbar puncture during the treatment of acute lymphoblastic leukaemia: a descriptive and qualitative study

AIMS AND OBJECTIVES

To describe experiences and nursing needs of school-age Chinese children undergoing lumbar puncture for the treatment of acute lymphoblastic leukaemia.

BACKGROUND

Lumbar puncture is an invasive procedure, causing psychological changes and physical discomfort in patients. In a previous study, it was proved that distraction intervention, such as music therapy, relieves pain and anxiety. There is limited evidence regarding the experience and needs of school-age children during lumbar puncture after being diagnosed with acute lymphoblastic leukaemia. To minimise their anxiety and pain during the procedure, it is important to collect information directly from these children.

DESIGN

A descriptive qualitative research.

METHODS

Twenty-one school-age children with acute lymphoblastic leukaemia participated in semi-structured interviews at a Children's Hospital in China. Data were collected by an experienced and trained interviewer. Qualitative content analysis was chosen to describe experiences of children undergoing lumbar puncture.

RESULTS

While undergoing lumbar puncture for the treatment of acute lymphoblastic leukaemia, school-age Chinese children experienced complex psychological feelings (fear, tension, helplessness, sadness and anxiety). They also experienced physical discomfort. They had multipolar needs, such as information, communication, respect, self-actualisation, environment and equipment.

CONCLUSIONS

This study identified important areas that must be closely monitored by healthcare staff, performing lumbar puncture on acute lymphoblastic leukaemia children. Thus, a successful and smooth procedure can be performed on these patients, and their quality of life can be improved.

RELEVANCE TO CLINICAL PRACTICE

The experiences described in this study contribute to a better understanding of the needs of acute lymphoblastic leukaemia children undergoing lumbar puncture. They also provide valuable information to professional medical care staff that develops future nursing assessments.

Effects of pre-consultation lists on the communicative behavior of children with cancer and their caregivers

Abstract This cross-sectional study present effects of pre-consultation lists on caregivers' and children's communicative behavior. Thirty-two dyads caregiver-child took part in this research, divided in three groups concerning the study design: Baseline 1, Intervention phase, and Baseline 2. Children and caregivers were individually interviewed before consultations on pediatric cancer treatment, in order to list doubts, expectations, and estimated issues to the medical visit. These themes were written down on a sheet of paper, attached to the child´s medical record cover, and would then be used as a memo in the following consultation. Results show that pre-consultation lists produced no effects on children's behavior, however the procedure was associated to specific doubts discussed by caregivers regarding dietary recommendations, coping with side effects, child development, biological aspects of cancer, and school activities. This study presents a low cost procedure that may contribute to tailor communication in pediatric settings.

[Children's attitudes regarding health care and perception of pain: the mediating role of medical fears]

This study sought to contribute to a better understanding of children's attitudes and opinions regarding health care, mainly in terms of medical procedures, institutions and the efficacy of health professionals. The sample included 381 children, recruited from different schools in Lisbon. The more negative attitudes were attributed to institutions, while positive attitudes were related to the efficacy of health professionals. Medical procedures were considered less painful compared to potential day-to-day accidents. Higher levels of pain were reported by children of the female sex and by children during the primary education phase. Medical fears mediated the relationship between the perception of pain and children's attitudes with respect to health care. Higher levels of pain perception were seen to be related to more negative attitudes regarding health care. However, this relationship was diminished when children's fears about medical issues were contemplated. In conclusion, a translated instrument to assess children's attitudes regarding health care is needed, as it may even contribute to the development of intervention programs within the scope of the promotion of attitudes towards health care.

Parents' experiences when their child is undergoing an elective colonoscopy

PURPOSE

The purpose was to illuminate parents' experiences when their children are undergoing an elective colonoscopy performed using polyethylene glycol-based regimes for bowel preparation.

DESIGN AND METHODS

Individual interviews with 12 parents were performed and analysed using content analysis.

RESULTS

The parents' experiences were structured into one theme: "Charged with conflicting emotions" with three categories: "Being forced to force," "Losing one's sense of being a parent" and "Standing without guidance."

PRACTICE IMPLICATIONS

Understanding parents' experiences can help healthcare staff guide parents in helping their children undergo a colonoscopy.

Meeting the information needs of children in hospital

The provision of information is an individual entitlement and a prerequisite to enabling children to understand their illness, make choices about their health care and be involved in decision-making processes around these choices. However, limited evidence exists on children's perspectives of information provision while an inpatient in hospital. The aim of this paper is to describe the process of information exchange between health professionals and children in hospital. Informed by an ethnographic design, data were collected using multiple methods, including semi-participant observations, interviews and participatory activities. Forty-nine children aged six to 16 years, with a variety of medical and surgical conditions, admitted to one children's ward at one children's hospital participated in the research. Findings revealed that children encountered a variety of information management experiences. The key message for health professionals is that there is a need to develop child- and family-focussed strategies for assessing children's information needs in order to determine their preferences for information (amount, format, from whom, etc.), to develop a method for gaining an appreciation of parents' and health professionals' beliefs about the optimal amount and type of information to relay to children, and to achieve consensus about who is best placed to transmit this information to children.

Children's pain perspectives

BACKGROUND

Previous studies on children's pain perspectives remain limited to English-speaking populations.

METHODS

An exploratory cross-sectional descriptive design was used to investigate the developmental progression of children's pain perspectives, including their pain experience, its definition and attributes, causality and coping. The Children's Pain Perspectives Inventory was applied to 180 healthy Spanish children. A coding system was developed following the content analysis method. Three age groups were compared: 4-6 years, corresponding to the Piagetian pre-operational stage of cognitive development; 7-11 years, corresponding to stage of concrete operations; and 12-14 years, corresponding to the period of early formal operations.

RESULTS

In children between 4 and 6, the predominant narratives related to physical injuries, the notion of causality and the definition of pain. In children between 7 and 11, the predominant narratives were those in which pain was described as a sensation in one part of the body. The view of pain as having an emotional basis significantly increased with age and was more frequent in adolescents. In contrast, children between 4-6 and 7-11 indicated that pain occurs spontaneously. The denial of any positive aspects of pain significantly decreased with age; some children between 7 and 11 referred to the 'possibility of relief', while the view that pain is a 'learning experience' was significantly more frequent among adolescents aged between 12 and 14 years. The use of cognitive strategies to control pain significantly increased with age. Between 12 and 14 years of age, adolescents communicate pain by non-verbal behaviour and reported that they do not express demands for relief.

CONCLUSIONS

There was a progression from concrete to more complex notions of pain as age increased. These results may be of use to health professionals and parents to understand how children at various developmental stages express and cope with pain and to develop tools that effectively assess and manage pain in children.