The views of children and their families on being 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.

Instruments to evaluate hospitalised children parents' satisfaction with nursing care: a scoping review

AIM

To identify instruments that allow the evaluation of parent's satisfaction regarding nursing care during their child hospitalisation.

METHODS

A review was performed using Preferred Reporting Items for Scoping Reviews. The study was prospectively registered in Open Science Framework. Research was carried out on EBSCOhost, PubMed, SciELO, Web of Science and ScienceDirect platforms as well as grey literature. Additionally, the references of selected articles were also examined.

RESULTS

A sample of 65 articles allowed the identifications of 38 distinctive instruments to evaluate parents' satisfaction in different hospital settings. Most studies were applied in paediatric wards (n=28), followed by neonatal intensive care units (n=21), paediatric intensive care units (n=9) and emergency departments (n=7). Sample size ranged from 13 to 3354 and 3 studies used mixed methods, 20 were methodological studies of instruments construction or validation and 43 were quantitative studies. 21 different instruments previously existent were found. In 3 studies, adapted instruments were used and, in 14 studies, structured instruments were purposively designed for the study. Instruments had between 1 and 13 domains and total number of items ranged between 13 and 92. Most studies assessed overall satisfaction (n=53) and instrument reliability (n=49) and/or validity (n=37).

CONCLUSION

Most instruments consider nursing care as a domain of satisfaction. Only two instruments focused specifically on nursing care. In most of the studies, there was a concern to evaluate instruments psychometric properties. This review clearly shows that there is still a gap in the literature on the range of aspects that influence satisfaction and a lack of consensus on ideal conditions for instrument use and application.

Promotion Media for Children’s Health: Applicable Study of Management Child Illness

BACKGROUND: Public understanding of immunization problems, pneumonia cases, and nutrition in children is important to improve children’s health status. Provision of attractive and illustrated media is one option to increase public knowledge in supporting the success of government programs in the health sector. AIM: The purpose of this study is as a form of promotion effort to support an increase in the immunization movement in infants, a decrease in cases of malnutrition and malnutrition, and a decrease in pneumonia cases in infants. METHODS: The research method used is qualitative and quantitative study. Researchers analyzed the promoting media and the value of benefits in the community. Qualitative analyze used content analysis to get an assessment of media from cadres and parents of children. Quantitative study used univariable analysis to see understanding of illness prevention effort. Interesting picture books for immunization, pneumonia, and malnutrition are used as the promoting media. The number of samples was 20 cadres and 20 parents of children under five, done by simple random sampling technique. RESULTS: The results showed that the media used for learning nutrition, immunization, and pneumonia material was effective for cadres and the community about easy to understand, completeness, attractive, assistance, easy to use, and practically. This is evidenced by a positive assessment of the media and increased understanding of the material from 50% to 90%. CONCLUSION: Thus, it can be said that it is necessary to provide educational media to increase public knowledge and understanding of cases that often arise in the community as a problem.

Understanding Young People and Their Care Providers' Perceptions and Experiences of Integrated Care Within a Tertiary Paediatric Hospital Setting, Using Interpretive Phenomenological Analysis

Introduction:

Benefits of integrated care include improved health outcomes and more satisfaction with experiences of care for consumers. For children and young people with chronic and complex health conditions, their care may be fragmented due to the multitude of healthcare providers involved. This paper describes the experiences of integrated care in a paediatric tertiary hospital.

Theory and methods:

Using an Interpretive Phenomenological Analysis approach, semi-structured interviews were conducted with children and young people, their parents and healthcare providers to explore stakeholders’ integrated care experiences.

Results:

Nineteen interviews were completed (6 children and young people, 7 parents and 6 healthcare providers) and transcribed verbatim. Two recurrent themes were applicable across the three cohorts: ‘agency and empowerment’ and ‘impact of organisational systems, supports and structures’.

Discussion and conclusion:

Stakeholders’ experiences of integrated care highlighted the need to examine the discrepancies between healthcare strategies, policies and service delivery within a complex, and often inflexible organisational structure. Power imbalance and family agency (including directly with children and young people) needs to be addressed to support the implementation of integrated care.

The Child's Voice in Satisfaction with Hospital Care

PURPOSE

Patient satisfaction is a quality improvement indicator used to evaluate care. Ratings of patient satisfaction in pediatrics exclude the child voice. We tested the feasibility and acceptability of a new model that included both child and parent satisfaction ratings.

DESIGN AND METHODS

We executed a randomized, two-arm, unblinded cohort study comparing child (aged 7-17 years) and parent reports (Arm 1) to parent report only (Arm 2) among a convenience sample of inpatients at a single urban pediatric medical center. The primary (feasibility and acceptability) and secondary outcomes were assessed at the time of discharge (T1) and approximately 10 days following discharge (T2) (standard timing).

RESULTS

Of 672 screened families, 89.3% (n = 600) enrolled in the study; 362 children and parents were randomized to Arm 1 and 238 parents to Arm 2. Patients (98.6%) and parents (99.8%) indicated preference for providing satisfaction ratings at the time of discharge. Seventy-five percent of families (n = 488) completed T1 and T2; neither child nor parent ratings differed significantly between T1 and T2 nor did parent ratings differ between the two study arms. Nurse friendliness, courtesy, and feeling well cared for were among the highest rated items at T1 and T2 by both children and parents.

CONCLUSIONS

Children 7 to 17 years of age and their parents are willing and like to provide satisfaction with care ratings prior to hospital discharge.

PRACTICE IMPLICATIONS

This measurement model could yield valid findings representative of hospitalized children and their parents, and could become the basis for a new and needed measurement approach for pediatric satisfaction with hospital care.

The Patient's Voice: Development of an Adolescent Hospital Quality of Care Survey (AHQOCS)

PURPOSE

To develop an adolescent determined hospital quality of care survey.

BACKGROUND

Adolescents do not currently evaluate their quality of hospital care. Hospital satisfaction surveys are mailed following discharge to parents, and parental input may not reflect adolescent perception.

DESIGN AND METHODS

This exploratory, descriptive study utilizing Q-sort methodology, investigated 60 adolescents/young adults' (ages 12-21) perception of hospital care. A comprehensive, peer-reviewed journal search conducted 1998-2017 explored adolescent perception of hospital care. Themes emerging from adolescent's perception of care were developed into 56 statements for relevance sorting.

RESULTS

Excellent content validity of the care domains was established at 0.982 (utilizing the universal agreement). After placement of all 56 cards, items were correlated in order to reveal similarities in perspectives. Items of greatest importance to adolescents included 'able to tell the doctor what was wrong with you', 'having family stay', 'trust in nurse to take care of you', 'able to ask the doctor to explain what they said', 'nurse clearly told you what would happen to you', and 'a clean room'. Little variation in response occurred across the variables of age, gender, length of stay, or diagnosis.

CONCLUSIONS

Given the opportunity to relate autonomously to health services, adolescents are able to determine quality preferences and should be contributory in determining hospital care.

PRACTICE IMPLICATIONS

Based on adolescent preferences demonstrated in this study, satisfaction with pediatric care delivery should be improved with attention tailored to adolescent wishes.

Reminiscing on acute and chronic events in children with cancer and their parents: An exploratory study

BACKGROUND

Children with cancer live through intense emotional experiences that call for coping with stressful events. The narration of these events allows them to construct a detailed memory system, fostering the elaboration and attribution of meaning to the disease experience. In particular, shared memory between the parent and the child about past events (i.e., reminiscing) helps children to deal with negative emotional experiences, encouraging emotional regulation and adaptive coping strategies. The present study aims to investigate reminiscing in parent-child with cancer dyads, focusing on parents' reminiscing habits, parents' reminiscing style about acute and chronic events, and children's well-being, assessed with respect to emotional regulation and coping skills.

METHOD

Fifteen children from ages 4 to 8 years admitted to a paediatric haematology and oncology ward of an Italian hospital, and their parents were engaged in a reminiscing conversation about acute and chronic events related to disease. Moreover, some questionnaires have been proposed to evaluate parents' reminiscing habits and children's emotional regulation and coping skills. Descriptive and quantitative analyses were conducted.

RESULTS

The data showed that parents frequently practise reminiscing in everyday life, focusing on directive and socioemotional functions. In reminiscing conversations about acute and chronic events concerning their child's illness, they use an elaborative reminiscing style and an emotional reminiscing style mainly concerning chronic events. A positive correlation between this reminiscing style and children's adaptive coping strategies was found mainly in acute events. A negative correlation emerged between parents' emotional terms (emotional reminiscing) and children's difficulties in emotional regulation.

CONCLUSION

This study underlines the benefits of elaborative and emotional reminiscing conversation, in order to help children with cancer and their families to cope with acute and chronic stressful events. Reminiscing can be a useful methodology for health professionals with a view to collecting information on patients' memories of illness.

Hospitalized children's representations of their relationship with nurses and doctors

This article reports an explorative study which aims to investigate hospitalized children's views of their relationships with nurses and doctors. Twenty-seven school-aged children and adolescents from 6 to 15 years old in the paediatric haematology and oncology ward of an Italian hospital participated in the study. Each participant was asked to draw him or herself with a doctor or nurse from the ward while they were doing something. The drawings were analysed using Pictorial Assessment of Interpersonal Relationships (PAIR) and a qualitative analysis. The results showed that the participants viewed their relationships with health professionals positively, in particular with the nurses. This relationship was perceived as close, intimate, cohesive and without conflict. In some cases it became an emotional bond. Finally, this relationship helped the patients to cope with painful and uncomfortable medical procedures, which gradually became familiar and accepted. The clinical implications of this study are discussed.

Children's experiences as hospital in-patients: voice, competence and work. Messages for nursing from a critical ethnographic study

BACKGROUND

There is growing evidence that children's subjective interpretations of events may differ significantly from those of adults; yet children's and young people's voices and children's knowledge regarding hospital care remain relatively unexplored.

OBJECTIVE

To develop insight into children's subjective interpretations and knowledge of being hospital in-patients.

DESIGN

Critical ethnography.

SETTING

A nephro-urology ward in a tertiary referral children's hospital in the north of England.

PARTICIPANTS

A purposive sample was employed of 15 children over 2 phases: six (9-15 years) at home in a reconnaissance first phase, and nine (5-14 years) in hospital in phase 2.

METHODS

A raft of child-friendly, age-appropriate strategies was used to engage children in phase 1. Phase 2 involved over 100 h of field-work with hospitalised children over 6 months, with observation, interview, play and craft activities as prominent methods. Data were analysed using constant comparative methods.

RESULTS

The study ward was a place in which children struggled to find a space for their competence to be recognised and their voice heard. Children's voice became manifest in what they said but also through the non-verbal mechanisms of resisting, turning away and being silent. While all the children shared the experience of being in trouble, recognition of their competence was fluid and contingent on their relationships with the nurses alongside other structural and material factors. The children worked hard to maintain their position as knowledgeable individuals. When they could not do so they relied on supportive adults, and in the absence of supportive adults they became marooned and received bare minimum care.

CONCLUSION

The hospital ward was a place for children in which there was little space for children's voices. When their voices were heard, they were often seen as a challenge. Quiet, sick and shy children who were alone were the most likely to have their needs overlooked and become subject to standardised nursing care. A more inclusive and participatory model of nursing practice with children is urgently needed.

Children's experience regarding the quality of their hospital stay: the development of an assessment questionnaire for children

A questionnaire assessing the satisfaction of children with their hospital stay has been developed and tested with 136 children (aged 6-12 years) at 2 Swiss hospital sites. Three out of 4 children were satisfied overall with their hospital stay. Their relationships with the professional medical staff, explanations they received, games they played, and environment, all received positive evaluations. The most critical points were pain, fear, and the absence of relatives. Ninety percent of the children appreciated that their opinions were sought. These results reinforce the importance of having questionnaires available for the children to consider their opinions to enhance the quality of care.

Children's best and worst experiences during hospitalisation

THE STUDY RATIONALE: In earlier research on paediatric nursing care, children's views have received only scant attention. As a rule, it is the parents' opinions that are solicited, but these are not necessarily accurate representations of what children think.

AIM

To describe school-age children's best and worst experiences during hospitalisation.

METHODOLOGICAL DESIGN AND JUSTIFICATION

Data were collected by using sentence completion. Using the method of content analysis, the answers were coded and main and subcategories identified. A total of 388 Finnish children aged 7-11 years from all Finnish university hospitals (n = 5) who stayed at least overnight at paediatric or surgical wards (n = 23) were included in the study.

RESULTS

Children's best experiences were related to people, their characteristics, activities, environment and outcomes. Especially entertainment activities and objects were mentioned among best experiences. The worst experiences were related to people, feelings, activities and environment. As patients, children felt symptoms of illness and separation in an environment where someone conducted physical care and treatment activities, especially procedures perceived as unpleasant.

CONCLUSIONS

Paediatric care should be improved especially by taking into account children's best experiences and by utilising them to minimise or eliminate worst experiences. Children's own views should be used in strategic planning, purchasing, space design and other key initiatives. Children are more likely to be less stressed if their views are taken into consideration and they are allowed to take part in their health care in accordance with their rights.

"What we want": chronically ill adolescents' preferences and priorities for improving health care

BACKGROUND

As important users of health care, adolescents with chronic conditions deserve to be consulted about their experiences and expectations. This study aimed to explore chronically ill adolescents' preferences regarding providers' qualities, and outpatient and inpatient care. Furthermore, suggestions for improvement of service delivery were collected.

METHODS

This research was a sequential mixed methods study in adolescents aged 12-19 years with various chronic conditions treated in a university children's hospital. Methods comprised 31 face-to-face interviews at home, a hospital-based peer research project in which nine adolescents interviewed 34 fellow patients, and a web-based questionnaire (n = 990). Emerging qualitative themes were transformed into questionnaire items.

RESULTS

Having "a feeling of trust" and "voice and choice" in the hospital were central to these adolescents. Regarding providers' qualities, "being an expert" and "being trustworthy and honest" were ranked highest, followed by "being caring and understanding", "listening and showing respect", and "being focused on me". Regarding outpatient consultations, preferences were ranked as follows: "answering all questions"; "attending to my and my parents' needs"; and "clear communication", while "limited waiting times" and "attractive outpatient surroundings" scored lowest. Regarding hospitalization, adolescents most preferred to "avoid pain and discomfort", "keep in touch with home", and "be entertained", while "being hospitalized with peers" and "being heard" were least important. Regarding priorities for improvement, 52% of the respondents felt that more attention should be paid to older children, followed by enabling more contact with family and friends (45%), shorter waiting times (43%), and more activities to meet fellow patients (35%).

CONCLUSION

Adolescents prefer technically competent providers, who are honest and trustworthy, and attend to their needs. As they gradually grow out of the pediatric environment, they desire staff attitudes to become less childish and more age-appropriate, and welcome being treated as an equal partner in care. Health care professionals should inquire into preferences and adjust their communication style accordingly.

Exciting but exhausting: experiences with participatory research with chronically ill adolescents

BACKGROUND

Adolescents with chronic conditions are major users of paediatric hospitals, but seldom participate in the evaluation of services or in research. Little is known about the usefulness of the participatory approach in adolescent health research.

OBJECTIVE

To evaluate the feasibility, benefits and limitations of a participatory research (PR) project involving chronically ill adolescents as co-researchers.

DESIGN SETTING AND PARTICIPANTS

Nine adolescents, aged 15-17 years, acted as co-researchers in a hospital-based PR project. They co-developed an interview protocol and during a disco party held for this purpose interviewed each other and 25 fellow patients (12-19 years). They provided advice on the draft report and participated in the dissemination of the results, but were not involved in the design of the project or analysis of results.

RESULTS

Involving adolescents in participatory health research was feasible and appreciated by researchers and youth alike, but had its drawbacks too. The peer-research attracted few participants, the interviews lacked depth and did not yield substantial new insights. Maintaining a high level of participation of the chronically ill co-researchers also proved difficult.

CONCLUSIONS

Adolescents with chronic conditions like to have a say in the design and evaluation of hospital services. But their participation as co-researchers demands ample resources from all parties involved without automatically improving research quality. PR does not seem the most effective and efficient way to make services more responsive. We therefore recommend further exploration of other creative and sustainable ways for involving youth in health-care service development and innovation.

Is children's choice in health care rhetoric or reality? A scoping review

AIM

This paper is a report of a scoping review examining children and young people's health services with respect to choice in order to inform future development of choice initiatives.

BACKGROUND

The importance of including children and young people in the choice agenda reflects the increasing acknowledgement that, individually and collectively, they are important consumers of health care in their own right. Data sources. A scoping review of all major health and medical research databases was undertaken using current guidelines to identify original relevant research papers and grey literature sources from 1990 to 2006.

REVIEW METHODS

Reference Manager software was used to collate, summarize, categorize, store and retrieve the search results. Papers meeting the inclusion criteria were read in full and descriptively summarized using a data extraction sheet. Each paper was repeatedly selected using a snowballing approach until saturation was reached. Results. Children and young people want more say in the planning and development of appropriate hospital and community health services. However, little evaluative research was found about whether these choices are acted upon and lead to more responsive services.

CONCLUSION

Choice for children and young people is viewed as a positive development in health care and many innovative examples of their involvement in decision-making were found. These illustrated that, given the opportunity, children and young people are willing and able to make decisions about their healthcare services. However, there is a long way to go before the rhetoric of the choice agenda is realized.

Children's experiences of hospitalization

This article reports on children's experiences of hospitalization. Data were collected via semi-structured interviews with 11 children aged between seven and 14 years from four paediatric units in England. The children identified a range of fears and concerns, which included: separation from parents and family; unfamiliar environment; investigations and treatments; and loss of self-determination. The children's loss of self-determination over personal needs exacerbated their fears and concerns. It needs to be recognized that compliance with hospital routines is a variable, which influences children's reaction to hospitalization. The findings clearly indicate that children need adequate information tailored to their needs, that their views are sought in the planning and delivery of their care and that hospital environments need to be made more child-centred. Interventions designed to reduce children's stress during hospitalization are not only likely to decrease their stress at the time, but also likely to influence how future experiences are appraised and managed.

Capturing children's voices for quality improvement

PURPOSE

To query children about the perceptions of their inpatient healthcare experiences in order to improve care to make it more developmentally appropriate and responsive to children's needs and desires.

STUDY DESIGN AND METHODS

Children (n = 120) were interviewed and their comments were recorded as they described the best and worst things about their hospitalization and made recommendations for change. They were approached at the time of discharge from a tertiary care unit. Content analysis was used to compare their responses within their developmental levels. Themes were developed, and data were co-coded for trustworthiness of findings. Quotes were extracted that illustrated the themes.

RESULTS

Children provided insightful and specific data regarding the perceptions of their hospital experiences. Pain and discomfort were cited most frequently as the worst aspects of hospitalization and the areas most needing improvement. Play activities were valued by children of all ages. Their positive relationships with hospital staff were described frequently. The developmental stage of children determined the specificity and diversity of their comments.

CLINICAL IMPLICATIONS

Children's unique perspectives should be sought regularly and their data included in ongoing programs of quality assessment. When only parents are queried, important and insightful perspectives of children are missed that could improve care quality.

Supporting parents in managing drugs for children with cystic fibrosis

A semi-structured interview guide was used to interview 17 parents of children with cystic fibrosis identified through a shared care patient database at a London hospital to examine parents' medication-related roles and problems. Parents described their responsibilities in the home and the problems experienced, including adherence to regiments, involvement in decision-making, and relationships with the hospital teams and other healthcare professionals. The findings confirmed medication management as an integral part of the informal caring role. Many practical problems of ensuring the availability and administration of medication on a regular basis were described. Information gaps and problems with medication adherence increased the stress of providing effective care. The involvement of healthcare professionals across primary, secondary and tertiary care sectors in supporting parents in all aspects of medication management, including the development of strategies for transferring the responsibility for medication to their children, must be improved.