Unaccompanied hospitalized children: nurses' search for understanding

Exploration of trust between pediatric nurses and children with a medical diagnosis and their caregivers on inpatient care units: A scoping review

PROBLEM

Trust is central to the development of nurse-patient relationships. Pediatric nurses encounter difficulties developing trust with children and their caregivers. The purpose of this scoping review was to identify, examine, and summarize available evidence on the concept of trust among nurses and children/caregivers when admitted to hospital inpatient care units.

ELIGIBILITY CRITERIA

Using the Joanna Briggs Institute (JBI) methodology for conducing and reporting scoping reviews, CINAHL, MEDLINE, PsycINFO, Cochrane DSR, Cochrane Central, and JBI EBP were searched for qualitative, quantitative, mixed methods, and review studies with no time limits published in English. Included studies presented findings on the experiences of developing trust between pediatric nurses and children under 18 years of age and their caregivers within inpatient care units.

RESULTS

A total of 12,269 titles and abstracts were reviewed independently by two reviewers. 366 full-text articles were retrieved, a final of 81 studies were included in the review.

CONCLUSIONS

Trust was bi-directional between nurses and children/caregivers, developed over time during multiple interactions, and foundational to the development of relationships. Distinct facilitators and barriers to the development of trust between nurses and children/caregivers were identified. The development of trust was rewarding and enriching for both nurses and children/caregivers and was the fundamental to the provision of safe and high-quality nursing care.

IMPLICATIONS

Findings provide nurses with direction and strategies on how to develop and maintain trust with children/caregivers on inpatient care units. The development of training programs and interventions geared at equipping nurses with the skills to develop trust with children/caregivers is needed.

The experience of parents in Ronald McDonald houses in France

BACKGROUND

Ronald McDonald houses are located close to children's hospitals. They enable the hospitalized child to benefit from their family's presence, while helping the family to cope better with their child's hospital stay. This study aimed to describe the experience of parents staying in Ronald McDonald houses in France, identify their needs, and study the psychological impact of their child being in hospital.

METHOD

This cross-sectional observational epidemiological study was conducted in 2016, using anonymous self-administered questionnaires offered to parents staying in one of the nine Ronald McDonald houses in France. The questionnaire had two sections: a general section about the hospitalized child, and a 62 questions section to be completed by each parent, including a Hospital Anxiety and Depression Scale (HADS).

RESULTS

The participation rate was 62.9%: 71% of mothers completed the questionnaire (n = 320), and 54.7% of fathers did so (n = 246). They were the parents of 333 children (53.9% boys, 46.1% girls), under 1 year old (44.1%), hospitalized in the following three departments: intensive care (24%), pediatric oncology (23.1%), and neonatal care (20.1%). The mothers on average spent 11 h a day at their child's bedside, while the fathers spent 8 h 47 min. The parents tended to be employees or manual workers, and mostly lived together, with an average 2-h journey to hospital. They reported financial problems in 42.1% of cases, significant sleep deprivation (>90 min) in 73.2% of cases, and anxiety and depressive disorders: anxiety (59%) and depression (26%). There were some significant differences between the experiences of mothers and fathers: mothers lost out on their sleep and lost more appetite, and spent more time at their child's bedside, while the fathers encountered twice as many work-related difficulties (p<0.01). Additionally, their perception of the Ronald McDonald House was similar, as over 90% of them stated that this family accommodation allowed them to feel closer to their child and supported them in their role as parents.

CONCLUSION

The parents of children in hospital were 6-8 times more anxious than the general population, while clinical symptoms of depression were twice as common as in the overall population. Despite this suffering linked to their child's illness, the parents rated highly the support provided by the Ronald McDonald House in helping them cope with their child's time in hospital.

A phenomenological study exploring pediatric hospitalization: The voices of accompanied and unaccompanied hospitalized children

PURPOSE

Most children go through their childhood without being hospitalized. For a child, being hospitalized may be a disturbing and unfamiliar experience. Pediatric institutions promote parental presence and family-centered care, yet not all parents are able to stay with their children. Holding the child's voice central to the phenomenon, the aim of this study was to explore how parental accompaniment and absence shape a child's hospitalization experience.

DESIGN AND METHODS

A phenomenological study was implemented, and children ages 7-11 years old were included if they were in the hospital for at least 24 h with a parent present or 12 h without a parent present. Deriving from the interviews of children, themes were identified to unearth the meaning of children's lived experiences.

RESULTS

Twelve school-age children shared their hospitalization experiences. The findings of this study are organized around the following themes: (a) participating in care; (b) being on the road to recovery; (c) being a kid, still; (d) being accompanied - having a familiar face; and (e) being unaccompanied - yearning but understanding.

CONCLUSIONS

Being in the hospital was not significantly different when parents were absent, but children preferred their parents to stay. Being in the hospital was not a negative experience. Hospitalized children were attentive, independent, understanding, and resilient.

PRACTICE IMPLICATIONS

Children in this study illuminate the need to listen to children's voices. Understanding the experiences of hospitalized children provides pediatric nurses with insight on supporting the patients and families they care for.

Unaccompanied Hospitalized Children: An Integrative Review

PROBLEM

A child's hospitalization is often associated with stress that is exacerbated when the child is left unaccompanied by parents/caregivers. Parental presence, as part of a family-centered approach to care, is a strategy to mitigate the stressors and negative effects of hospitalization. However, due to a variety of circumstances, some children continue to remain unaccompanied in the hospital. This integrative review explored the phenomenon of unaccompanied hospitalized children.

ELIGIBILITY CRITERIA

Relevant articles available in full-text and written in English were identified through electronic searches of CINAHL, PubMed, and PsycINFO and through hand searches of reference lists.

SAMPLE

Eleven studies were included, analyzed, and synthesized into themes. Study quality was assessed using Bowling and Pearson's appraisal checklists.

RESULTS

Distress of hospitalized children is evident when children are unaccompanied in the hospital and left to experience the stressors of hospitalization alone. The compounding effects of hospitalization and separation can cause distress and psychological trauma during and after the hospitalization period. Pediatric nurses strive to provide care to unaccompanied children that lessens these negative effects.

CONCLUSIONS

Unaccompanied hospitalized children represent a vulnerable population. While the literature provides some insight into the experiences, research does not adequately explore the unaccompanied hospitalized child's experience.

IMPLICATIONS

Pediatric nurses hold a position that enable them to support the physical and psychosocial needs of unaccompanied hospitalized children. By recognizing and addressing the stressors and distress unaccompanied children experience, nurses can help alleviate the subsequent effects resulting from separation and hospitalization.