Use of the drawing technique in nursing assessment

Children's Drawings With Narratives in the Hospital Setting: Insights Into the Patient Experience

OBJECTIVES

To explore PICU patients' experiences and perceptions through their drawings with explanatory narratives.

METHODS

Single-center prospective study in a 14-bed PICU in a tertiary care, academic-affiliated hospital. Pediatric patients age 6 to 17 years admitted to the PICU were approached to participate within 12 hours of transfer out of the PICU. Patients completed a brief study interview to identify the best and worst things about their PICU experience. Patients were asked to draw a picture of their experiences and then explain their drawings to study staff.

RESULTS

Forty patients (median age 11 [6-17] years) agreed to participate. The median length of PICU stay was 2 days. The best aspects of the PICU stay included staff (25%), entertainment devices (15%), and food (13%). The worst aspects of the PICU stay that were reported were the intravenous line (25%), alarms (10%), and physical discomfort (10%). The most common elements in drawings were self-depictions (88%), monitors (53%), the intravenous line (50%), registered nurses (35%), and television (33%). Patient narratives related to their drawings provided additional insights regarding patient experiences in the PICU and identified various coping mechanisms used by patients to adapt to their experiences.

CONCLUSIONS

Drawing, along with explanation, enables patients admitted to a PICU to disclose additional unique descriptive information about their experiences as patients. Facilitating this mode of communication may increase providers' awareness of positive and negative aspects of a PICU admission and may be used to improve pediatric patients' experiences in the hospital setting.

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.

Investigating Children’s Perception of Nurses Through Their Drawings

Hospitalized children can have various fantasies about hospital, health staff, and related tools and equipment. They need to develop new coping strategies for compliance with hospitalization.This study aimed to investigate the perception of nurses by children with acute and chronic illness through their drawings. The study was carried out using a descriptive research model. “Nurses through the eyes of sick children data collection form” was used in data collection procedure. The instruction “draw a picture of a nurse, please” was used to get the children to draw a picture. The majority of the children portrayed nurses as a smiling face. The children with chronic diseases featured nurses more in their drawings and they mentioned more nurse duties. The most important sign of the progression of nursing is that the mentioning of the modern roles of nursing by the children in their drawings and expressions. As children are influenced by their emotions, thoughts, observations, and experiences while drawing pictures, nurses can determine their thoughts about the disease, hospitals, physicians, and nurses by having sick children draw pictures.

Body experiences, emotional competence, and psychosocial functioning in juvenile idiopathic arthritis

We investigated self-image, psychological functioning, and quality of life in children and adolescents with juvenile idiopathic arthritis (JIA). Thirty-nine children with JIA were compared with 80 healthy peers. We first administered the Human Figure Drawing Test (HFDT) to all subjects; children also completed standardized questionnaires evaluating health-related quality of life (PEDSQL 4.0 Generic Core Scales) and the main aspects of psychological functioning: anxiety (SAFA-A) and depression (CDI). Parents were asked to complete the Child Behaviour Checklist (CBCL) and the PEDSQL 4.0. For each patient with JIA, clinical notes were gathered and a global disease assessment (visual analog scale--VAS) was performed. Compared to healthy peers, patients with JIA reported reduced maturity quotients at HFDT, more depressive traits, greater anxiety, and lower health-related quality of life. Among the subjects with JIA, HFDT revealed that adolescents had a greater impairment in all areas investigated. Furthermore, there was a significant correlation between the physical well-being rated by VAS and the perception of poorer quality of life in patients, mostly in the psychosocial domains. Children and adolescents with JIA exhibit emotional difficulties and a delay of psychological development leading to low self-esteem, a distorted self-image, more anxiety and depression traits, and a worse quality of life, when compared to healthy subjects.

A Comparison of Emotional Indicators and Depressive Symptom Levels of School-Age Children With and Without Cancer

This study aims to compare the emotional indicators and depressive symptom levels of 6- to 12-year-old children with and without cancer. The sample included 20 children with cancer and 20 healthy children of similar ages and gender. Data were collected by using the Child Introduction Form, Children’s Depression Inventory, the Human Figure Drawing test, and children’s drawings. The results showed that the depressive symptom levels of children with cancer were significantly higher than those of healthy children. Impulsivity, mistrust, and anger were observed significantly more in children with cancer ( P < .05). Although anxiety was equal in the two groups, shyness was observed more in the cancer group, though the difference was not significant ( P > .05). The emotional indicators of both groups of children did not have an effect on their depression scores.

Hospitalized children drawing their pain: the contents and cognitive and emotional characteristics of pain drawings

Describing pain is difficult. Children like to draw, and through their drawing they reveal worrying issues. This study aimed to examine how hospitalized children express pain through drawings, and was carried out by examining children's thematic drawings of pain. A comparison was made between hospitalized children and healthy control groups with respect to the thematic contents and cognitive and emotional characteristics of pain drawings. The drawings were sorted in categories on the basis of content, and cognitive competence and emotional disturbances by the Draw-a-Person procedure. The hospitalized children showed a lower level of cognitive capacity than their healthy controls. The control group children revealed a higher level of emotional disturbance than the hospitalized children. The groups differed in the contents of their drawings. The drawings of the hospitalized children frequently depicted medical procedures, whereas the drawings of the healthy controls depicted more consoling human and family relations.