Development and validation of the needs of children questionnaire: An instrument to measure children's self-reported needs in hospital

Parents' experiences of their child's best interests during a hospital stay in Australia

Determining the child's best interests in a hospital setting will ideally involve the combined views of children, parents, and healthcare professionals. However, few studies have explored parents' experiences of their child's best interests when they engage with the healthcare system. Therefore, this study aimed to explore parents' experiences of their child's best interests during hospitalisation. A descriptive qualitative inductive design using face-to-face parent-child combined interviews, analysed by latent content analysis, was used. Sixteen parents recruited from a tertiary hospital in Western Australia were interviewed. Collaboration, development of trustworthy relationships, and effective communication were essential in shaping parents' experiences of their child's best interests during hospitalisation.

Nurses' beliefs and perceptions regarding family-centered care services in acute pediatric healthcare settings

OBJECTIVES

To describe pediatrics nurses' beliefs about family-centered services (FCS) as a model of providing healthcare to children in acute care settings in Jordan.

DESIGN AND METHODS

This is a cross-sectional descriptive study. Nurses who provide direct acute care to children (n = 246) completed the 'Measure of Beliefs about Participation in Family-Centered Service' questionnaire. Descriptive statistics were used to describe nurses' beliefs about participation, practical feasibility, implementation self-efficacy, principles, and potential adverse outcomes of FCS.

RESULTS

Many nurses feel confident (70%) about their ability to work with others in providing FCS and perceive having the ability to operate according to family-centered care (FCC) principles (68%). Many (75%) nurses believed parents should be encouraged to decide how much they want to be involved in the child's care. However, only 46% of the nurses valued attending to family priorities if the health decisions made by the family differed from the healthcare providers' priorities. Many nurses (70%) believed that healthcare professionals' competencies and capacities to work utilizing FCC are more important than their personal preferences and opinion.

CONCLUSIONS

The findings of this study clearly indicate that nurses positively viewed providing children's care within a FCS. This supports the efforts to reasonably integrate FCC as an operating model in the pediatric healthcare settings in Jordan.

PRACTICE IMPLICATIONS

FCS is a complex task requiring integrating multidisciplinary effort and healthcare providers' positive attitudes toward families as care partners. Steps should help maximize the organizational resources to facilitate family presence and create opportunities for professional-families partnerships for children's care.

Perceptions and Expectations of Youth Regarding the Respect for Their Rights in the Hospital

Information obtained from children themselves regarding the characteristics of the ideal hospital that ensure well-being during a hospital stay is scarce. Here, we report the opinions, perceptions, and expectations of 700 children and adolescents about their experiences, assessed through a mixed-method research approach with age-appropriate questionnaires, three open-ended questions, and an analysis of optional pictorial and textual narratives. Most children indicated that, while they acknowledged the expertise of hospital staff, they also noted several shortcomings, e.g., insufficiently understandable medical information as well as emotional and cognitive support. The continuity of schooling and the right to suffer as little as possible were also critical issues. Adolescents valued in particular the quality of care and services provided, the hospital's adherence to equality and non-discrimination rights, and protection systems but negatively perceived several aspects related to play and participation. Significant differences in the co-occurrences of the most frequently used text terms with the keywords "hospital" and "child/adolescent" between age groups highlight variations in the way patients perceive and articulate their experiences within the hospital setting depending on the cognitive processes linked to age. In drawings, prevailing attention was placed on the physical context of the hospital room, with figures expressing mostly negative emotions. Specifically, in this regard, the main emotion in children was sadness, and, in adolescents, it was fear. Overall, these insights are pivotal in the context of our research objectives as they shed light on the nuanced preferences, needs, and perspectives of children and adolescents during their hospital stays. Recognizing the identified shortcomings, we propose recommendations emphasizing the improvement of medical communication clarity, enhancement of emotional and cognitive support, and the improvement of programs to avoid instructional gaps during hospital stays. Addressing these specific needs is critical for a more comprehensive approach to pediatric healthcare provision.

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.

Reliability and validity of the Chinese version of the Early-Onset Scoliosis Self-Report Questionnaire in children aged 8 to 18 years with early-onset scoliosis

Background

The Early-Onset Scoliosis Self-Report Questionnaire (EOSQ-SELF) is a novel self-report instrument to evaluate the health-related quality of life (HRQoL) of early onset scoliosis (EOS) patients, as a complementary HRQoL assessment tool for the proxy-repot 24-item Early-Onset Scoliosis Questionnaire (EOSQ-24). This study aimed to translate and adapt the EOSQ-SELF into a Chinese version and evaluate its reliability and validity in EOS patients.

Methods

A cross-sectional study was performed from July 2022 to September 2022. Patients aged 8 to 18 years with EOS were recruited. Forwards-backwards translation and cross-cultural adaptation of the original EOSQ-SELF were performed. The Chinese EOSQ-SELF was administered and collected twice through social media, with a 2 weeks interval. Reliability was evaluated by using internal consistency, and test-retest reliability was assessed by the intraclass correlation coefficient (ICC) of data between the two time points. A Delphi survey in the expert committee was used to investigate the content validity. SRS-22r, PedsQL4.0, and EQ-5D-Y scales were used to assess the criterion-related validity. Nonparametric tests and multiple linear regression were performed to evaluate the discriminative ability.

Results

A total of 101 valid responses from EOS patients were received. The mean age was 12.08±2.19 years, and 53.47% were female. The mean Cobb angle was 60.56°±19.48°. Floor effects of 0.00% to 7.92% and ceiling effects of 0.00% to 52.48% were observed. Excellent internal consistency and test-retest reliability of the Chinese EOSQ-SELF was observed, with a Cronbach's α coefficient of 0.942, McDonald's ω coefficient of 0.940, and ICC of 0.930. All domains of the Chinese EOSQ-SELF were significantly correlated with SRS-22r (0.709 to 0.878), PedsQL4.0 (0.568 to 0.718), and EQ-5D-Y (-0.598 to -0.625), depicting excellent criterion-related validity. Discriminative ability was validated in aetiology (P<0.001), severity of spinal deformity (P<0.001), treatment status (P<0.001), and ambulatory ability (P<0.001).

Conclusions

The Chinese EOSQ-SELF is a reliable and valid tool for the assessment of self-report HRQoL in patients aged 8 to 18 years with EOS. It can be easily applied in clinical settings and for research purposes, as a complementary tool for the proxy-report EOSQ-24.

Children's voices on their participation and best interests during a hospital stay in Australia

PURPOSE

To explore school-aged children's experiences about their best interests and participation in care during a hospital admission.

DESIGN AND METHODS

A descriptive qualitative design involving in-depth, iterative inductive review of child responses to generate key words that led to identification of categories and themes. The study was guided by the United Nations Convention on the Rights of the Child's definition of the best interests of the child, Bronfenbrenner's bioecological model and a child centred care approach.

RESULTS

Nine school-aged children (5-15 years old) from one children's ward in Australia participated. Analysis yielded thirteen categories, six sub-themes, and three themes: 1) Relationships with parents were positive when they met their children's physical and emotional needs and advocated for them; 2) Relationships with staff were positive when staff created opportunities for children to have a say in their healthcare, and checked in on the children and 3) Seeking familiarity away from home was facilitated when the environment children found themselves in provided them their own space and various forms of entertainment.

CONCLUSION

School-aged children were able to verbalize what their best interests were and how participation in care could be facilitated in the hospital setting. The inter-relationships of the children with their parents, healthcare professionals, and the immediate environment reflected interactions both within, and between systems.

RESEARCH AND PRACTICE IMPLICATIONS

Children in hospital need to be provided with age-appropriate opportunities to participate in shared decision making to support their best interests. Studies that model and evaluate such opportunities are needed.

Development and validation of the Health Education Adherence Scale for Stroke Patients: a cross-sectional study

Background

Due to the lack of health education adherence assessment tools for stroke patients, the assessment of health education adherence in this population is insufficient, which hinders the prevention and rehabilitation of stroke. This study aims to develop and validate a Health Education Adherence Scale for Stroke Patients (HEAS-SP).

Methods

A cross-sectional design with a purposive sampling method was used for this study. Six hundred and fifty-four eligible participants completed the demographic questionnaire and the HEAS-SP. The data collection lasted for 7 months, from March 1stto September 30th in 2019. Item analysis and exploratory and confirmatory factor analysis were employed to develop and validate the HEAS-SP.

Results

The item analysis, exploratory and confirmatory factor analysis resulted in a 20-item HEAS-SP with 4 domains: medication adherence, diet adherence, rehabilitation exercise adherence, and healthy lifestyle adherence. The four-domain model demonstrated acceptable model fit indexes and the 20-item HEAS-SP demonstrated acceptable reliability and validity.

Conclusion

The 20-item HEAS-SP was shown to have acceptable reliability and validity for assessing health education adherence with respect to diet, medication, rehabilitation exercise and healthy lifestyle in stroke patients, making it a potential basis for developing targeted interventions for stroke patients.

How paediatric departments in Sweden facilitate giving children a voice on their experiences of healthcare: A cross-sectional study

Background

In January 2020, the United Nations Convention on the Rights of the Child was incorporated into Swedish law. According to Swedish regulations, patients are to be given the opportunity to participate in quality improvement. Sometimes, the patients are children who have the right to be heard on matters concerning them, such as their experience of a hospital visit.

Objective

This study aimed to describe how Swedish paediatric departments facilitate children's voices on their healthcare experiences and how their perspectives are taken into account in quality improvement work.

Methods

This study has a descriptive cross‐sectional design. Data were collected using a study‐specific survey sent by e‐mail to all the heads of the paediatric departments in Sweden, with both inpatient and outpatient care. The response rate was 74% (28 of 38 departments).

Results

The results demonstrated a variation in questionnaires used and to whom they were targeted; less than half of the participating departments reported having had questionnaires aimed at children. The results also indicated a major variation in other working methods used to allow children to voice their experiences in Swedish paediatric departments. The results indicate that the national co‐ordination in facilitating the children's rights to be heard on their experiences in healthcare organisations can be improved.

Conclusion

Further research is required to ascertain which method is the most practically effective in paediatric departments, in what way children prefer to be heard regarding their experience of and perspectives on healthcare, and what questions need to be asked. A validated national patient‐reported experience measure developed with and aimed at children could provide them with equal opportunities to voice their experiences in healthcare, regardless of their diagnoses or which paediatric department they visit.

Questionnaires to Measure Process and Structure of Quality Indicators for Pediatric Nursing

The quality of nursing care has a significant impact on the outcomes of care. The specific needs of children requiring hospital care make it essential to monitor and compare data not only on the medically oriented outcome measure but also on nursing care, structure, and process, requiring perspectives from registered nurses (RNs) and nurse managers (NMs). Thus, this project aimed to evaluate the structure and process of nursing quality indicators in pediatric hospital care with questionnaires distributed to RN and NM.

A Scoping Review of Nursing Research Priorities in Pediatric Care

PROBLEM

Priority setting for pediatric nursing is important to plan, coordinate and direct future research. The aim of this scoping review was to systematically identify and synthesise the nature, range and extent of published pediatric nursing research priorities.

ELIGIBILITY CRITERIA

English language full text publications focusing generic nursing research priorities for the child or adolescent, indexed in CINAHL, EMBASE, The Cochrane Database of Systematic Reviews, AMED, MEDLINE and PsycINFO and published from 2008 to 2019.

SAMPLE

A total of 789 citations were identified, 44 full text articles were retrieved and assessed for eligibility and eight studies were finally reviewed, quality assessed (CREDES) and synthesised.

RESULTS

All eight studies used a consensus building method to identify research priorities reported by nurses. Six used Delphi technique, one Nominal Group Technique (NGT) and one consensus workshop. CREDES score range was 10-14 of a possible 16. Synthesis of the 234 nursing research priorities generated four themes; evidenced-based practice, pediatric context, child and family-centered care; pediatric nursing, with 14 subthemes.

CONCLUSION

The nursing research priorities reported appear to be still current and important to nurses. There was a focus on acute care, with fewer priorities reflecting areas of child-, school-, or mental- health. Consumer and community priorities have not been reported.

IMPLICATIONS

These nursing research priorities can be used to inform the national or local research agenda, although there is a need to establish priorities from the perspective of all stakeholders and in particular, identify what is important to consumers.

Development and validation of the needs of children questionnaire: An instrument to measure children's self-reported needs in hospital

Aim

To develop and psychometrically test the needs of children questionnaire (NCQ), a new instrument to measure school‐aged children's self‐reported psychosocial physical and emotional needs in paediatric wards.

Design

This is an instrument development study based on recommendations for developing a reliable and valid questionnaire.

Method

The NCQ was developed over three phases between February 2013–April 2017 and included item generation; content adequacy assessment; questionnaire administration; factor analysis; internal consistency assessment and construct validity. Psychometric properties were assessed after 193 school‐aged children completed the needs of children's questionnaire in four paediatric areas in Australia and New Zealand.

Results

The development and validation of the NCQ over two countries resulted in a 16‐item, four‐category tool to measure the self‐reported importance and fulfilment of school‐aged children's needs in hospital. Cronbach's alpha for the combined samples was 0.93.

Conclusion

The NCQ bridges a gap to measure the level of importance and fulfilment of school‐aged children's self‐reported needs in hospital. Future testing and validation is needed in other paediatric areas and countries.

Impact

The 16‐item NCQ is a valid measure to evaluate if the quality of care delivered and received in hospital is in line with what children self‐report as important and required and to date indicates good usability and utility. Child self‐reports are essential to inform healthcare delivery, policy, research and theory development from a child and family‐centred care lens that honours the United Nations Convention on the Rights of the Child and the best interests of the child.