Hospital care of children in four countries

BACKGROUND: While perceptions of parents and staff about care of hospitalized children have been explored in developed countries, little research has examined these in developing countries. Assumptions about family-centred care are often based on Western values, with little evidence of how cultural constructs affect care delivery in developing nations. AIM: This paper reports a study to provide evidence from which culturally-appropriate hospital care for children can be delivered. METHODS: Using a rigorously devised and trialed questionnaire, attitudes of staff and parents about the way children are cared for in children's hospitals in four countries were examined and subjected to a four way analysis: parents and staff within and between developed and developing countries. RESULTS: There were no questions where all parents and staff in both developed and developing country groups were in complete agreement. However, there was some indication that, while culture plays a major role in paediatric care delivery, basic concepts of family-centred care are similar. CONCLUSIONS: The findings are limited by the sampling strategy. Nevertheless, while differences were found between parents' and staff's expectations of the delivery of care to children in hospitals, similarities existed and the influence of culture cannot be ignored. Education programmes for staff and parents should reflect these influences to ensure the optimum delivery of family-centred care, regardless of where the hospital is situated.     

A descriptive study of the extent to which self-perceived needs of parents are met in paediatric units in Iceland

The purpose of this study was to identify the extent to which parents of 2-12-year-old hospitalized children perceive their needs to be met in paediatric units, what variables influence parents' perception, and whether parents need help from the hospital to meet their needs. Parents perceived that most of their needs were met fully or to some extent. The need to be able to stay with the child 24 h a day was perceived as fully met by all parents. Needs perceived as important but poorly met were as follows: written information about the child's health status, information about financial assistance and follow-up after discharge. Independent variables identified as being related to the extent to which individual needs were met were as follows: parents' age (p < or = 0.05), distance between home and hospital (p < or = 0.05), parents' education (p < or = 0.05), length of hospital stay (p < or = 0.01) and severity of child's illness (p < or = 0.01). Most parents perceived that they needed help from the hospital to meet their needs. These findings call for identification of effective interventions to meet parents' needs.     

家长对"以家庭为中心护理"的认识

目的探讨家长对护理人员提供"以家庭为中心护理"的认识.方法目的抽样选择180例住院患儿的家长,采用美国波士顿儿童医院的"以家庭为中心护理"量表,在患儿出院前1天对其家长进行一对一调查.结果护士提供"以家庭为中心护理"的一致性与家长认为的重要性之间的平均匹配系数为0.59,范围在0.29～0.88.结论我院护士提供的以家庭为中心的护理措施,能满足家长和孩子生理上的需求及孩子和家长在一起的需求,能让孩子感觉受到很好的照顾.在关注孩子及家庭的心理、行为,为家长提供信息和心理支持,以及鼓励家长参与性方面与美国波士顿儿童医院的现况存在一定距离.     

The experience of stress in parents of children hospitalized with long-term disabilities

This paper discusses parents' perceptions of their stress when their children are hospitalized with long-term disabilities. The study used a qualitative method. Data were collected with 40 parents through in-hospital interviews, and were analysed using the method of constant, comparative analysis. Parents' own interpretation of their stress experience is considered in relation to their perception of their role. The data suggest that the hospitalization of a child requires parents to make changes in their usual parenting role. In describing the nature of the changes required, parents identified the need to understand the illness experience; become familiar with the hospital environment; adapt to their changing relationship with the child and other family members; and negotiate with health professionals about their child's care. Verbatim accounts are used in this paper to illustrate parents' interpretations of their hospital experience. Parents perceive their role in their hospitalized child's care differently than health professionals do, and it would appear that much parental stress is attributable to the 'space' between health care workers' understanding of parents' experience, and parents' own comprehension. If nurses understood parents' own perception of their hospital-related stress better, more effective nursing care could be developed. Further research is needed in this important area.     

Qualitative analysis of the care of children in hospital in four countries-Part 2

As part of a large study of the care of children in Australian, British, Indonesian, and Thai hospitals, qualitative methods were used to examine differences influenced by culture. Two groups were surveyed: parents of hospitalized children, and staff caring for them. Vignettes were used to invoke discussion, and content analysis was used to examine the data. Subjects were interviewed singly, or in focus groups. These interviews were audiotaped and transcribed for analysis. This article is the second of a two-part series, and includes results of the staff's interviews and discussion. The parents' results and discussion were published in Part 1 (Shields & King, 2001). Staff in all the countries considered communication with parents to be an important part of care of the hospitalized child, and this was consistent with the parents' responses. Staff were mindful of safe practices, though more so in Australia and Britain than Indonesia and Thailand. Cost of treatment for the parents was an important consideration for staff in Indonesia and Thailand when they were planning care for the child. Cultural constructions were more likely to be considered by the Australian and British staff than the Indonesian and Thai staff, and this may have been influenced by the prevailing culture of medical dominance in those countries.     

Perceived Importance of Needs Expressed by Parents of Hospitalized Two- to Six-Year-Olds

The study describes the needs of 34 parents, 12 fathers and 22 mothers, of hospitalized 2–6 year-olds in a Pediatric Hospital in Iceland. Subjects responded to 43 statements of possible needs during a child's hospitalization on a Likert-type scale based on their perception of the importance of items. The reliability coefficient was over 0.91 for all three parts of the instrument. Parents' perception of importance was significantly and positively correlated with their perception of how their needs were being met and with their request for help from the hospital to fulfil them. None of the statements were perceived to be unimportant. Items related to parents' need to trust nurses and doctors were consistently rated as very important. Items related to the need for information and needs related to other family members were consistently rated as lying between important and very important. Needs related to human and physical resources, and the need for support and guidance were in general rated lowest. Items related to the need to be trusted had a mean importance significantly (p < 0.01) lower for fathers. Although not exhaustive, the statements presented were found to be representative of the needs and concerns of parents during the hospitalization of their children.     

Impact of a hospital palliative care service: perspective of the hospital staff

The first New Zealand hospital palliative care support service was established in 1985. Different service models have now been adopted by various major hospitals. In 1998, a palliative care service, funded by Mary Potter Hospice, was piloted at Wellington Public Hospital. Twelve months post-implementation, the hospital staff's views of the service were evaluated. It was found that referrals to palliative care from hospital specialities outside the Cancer Centre increased. While most doctors, nurses and social workers strongly agreed or agreed that the service positively influenced patients' care and effectively addressed their symptom management needs, spiritual needs were less often met. Over 90 percent of each discipline strongly agreed or agreed that the service had assisted them in caring for patients, but, only about a half agreed that useful discharge planning advice and staff support was provided. Significant differences in responses were found between different disciplines and specialities. One fifth of the staff identified palliative care education needs. Recommendations are made concerning the development of a future hospital palliative care service.     

Caring for parents of hospitalized children: a hidden area of nursing work

Children are the recognized patients when admitted to hospital but their parents can also present demands for care by nurses. Involvement in care can be stressful for parents, particularly when children are required to undergo unpleasant procedures. Parents turn to their families for support in the first instance but some also look for care from nurses. Consequently parents can present a need for care of themselves to nurses whose primary patients are children. In this paper the experiences of a group of parents who became co-clients of nurses are considered along with the views of nurses working on the same ward. The discussion arises out of a larger study of the experiences of the parents of children admitted to a surgical ward in a children's hospital. The principal purpose of the study was to examine parents' and nurses' perceptions of their participation in the care of hospitalized children. The work of caring for parents is found to be ad hoc and unpredictable. The implications of the study for practice and policy are considered.     

Parental perceptions of the preschool obese child

Childhood obesity is a serious public health problem today with many potential complications and adverse outcomes for children. How parents view their children's weight is an important consideration for nurses. The purpose of this study was to increase staff understanding of parents' views so that interventions could be developed to achieve improved outcomes in attenuating the rate of weight gain in obese children. A questionnaire was administered to 200 parents, mostly Hispanic, of obese children to determine the parents' perceptions of their child's obesity. The study revealed that 35% of parents did not believe their obese child was overweight and 53% had no problem controlling what their child eats. However, 78% of parents expressed concern about heart disease as a consequence of childhood obesity. The study demonstrated that parents acknowledge some health risks of obesity but that interventions in treating childhood obesity need to begin with the understanding of parents' perceptions of their own child's obesity.     

Hospital staff perceptions of parental involvement in paediatric hospital care

AIM: This paper reports a study of hospital staff perceptions of parental involvement in children's hospital care. BACKGROUND: Previous research has shown that parents are expected and encouraged by hospital staff to be actively involved in the care of their hospitalized children. At the same time, parents have expressed a need for improved communication with paediatric hospital staff to clarify both parental and staff expectations and preferences about this involvement. Few studies, however, have studied hospital staff perceptions of parental involvement in the care of hospitalized children and their implications for clinical work. METHODS: A cross-sectional questionnaire study was conducted among paediatric hospital staff in October of 2003. Questionnaires were distributed to a total of 338 staff, including all physicians, Registered Nurses and nursing auxiliaries working on oncology, surgery and neurology units in three university children's hospitals in Sweden. RESULTS: A total of 207 questionnaires were returned, yielding a response rate of 61%. Exploratory and confirmatory factor analyses of the 26-item questionnaire resulted in the creation of two indices, Work Routines and Work Strain. Oncology staff reported having better work routines for involving parents in their children's care and they experienced less strain from parental demands compared with staff on other paediatric units. Staff perceptions and workplace routines regarding parental involvement did not differ statistically significantly by profession or by length of work experience. CONCLUSION: Staff perceptions of parental involvement may be related to clinical specialty. Oncology units may find it easier to establish routines for parental involvement, thereby experiencing less work strain in their interactions with parents. There is a need to further study staff perceptions of parental involvement and their implications for the staff work situation in both Sweden and other countries.     

对护理人员综合素质期望的差异性研究

目的了解医院患者、护士和医生对护理人员综合素质期望的差异性,以便于针对性的提高护理人员各方面素质。方法采用自行设计问卷调查某三级甲等医院的患者、护士和医生共260名,了解其对护理人员综合素质的期望状况。结果医院患者、护士和医生对护理人员各方面素质总体期望存在差异,且差异有统计学意义（F分别为19．720、3．377、26．054、10．076、7．322,P〈0．05）。结论医院患者、护士和医生对护理人员综合素质期望存在差异,应以患者的需求为出发点,患者的满意为目标,提高护理人员综合素质,最大程度的满足患者的需求。     

A review of the literature from developed and developing countries relating to the effects of hospitalization on children and parents

There is a literature base about the care of children in hospital in developed nations, but little from, or about, developing countries. The aim of this review was to critically examine publications relating to the effect of hospitalization on children and their parents. 'Parents', in this context, were considered as the child's natural or adoptive parents, step-parents or any other context of parent-child relationship, in other words, the primary care-giver to the child. Most of the work reviewed from developed countries was sourced from the nursing literature, while in developing countries, the available literature was largely from medicine. Conclusions from developed countries indicated that parents should be allowed to stay in hospital with their child, and that care must be developmental-stage appropriate. Furthermore, staff need to be educated about special needs of children, children should be prepared for hospital admission (if possible) and parents' needs met. In developing countries, the meagre literature available suggested that recognition of the important role parents play in a child's hospitalization is starting to become recognized.     

Nurses' perceptions of parental involvement in hospital care

Parental involvement is an essential element of quality of care for children in hospital. However, there is often confusion in role perception between parents and nurses which may be affected by nurses' attitudes, their ability to provide information, their communication and interpersonal skills and willingness to relinquish control. AIM: This study examined nurses' perceptions of parental involvement and communication with parents of children in hospital and explored differences in perceptions of recent graduate nurses and more experienced nurses. METHOD: Two focus groups were carried out at a university paediatric hospital in Sweden, one with experienced paediatric nurses (n = 7) and one with recent nursing graduates (n = 6). FINDINGS: Analysis of the discussions identified five themes: clarifying roles, information, work environment, support and clinical competence. These nurses confirmed the belief that involving parents in the child's care is an important part of nursing in paediatric care and suggested that the nurses should play the role of being the communicator with the parents. CONCLUSION: Nurses need to be aware of the impact their communication has on parents and help them to clarify their role as parents in hospital.     

Concepts of pain in preschoolers and children of early school age and their parents after painful interventions during hospitalization

Subject of the present study are individual pain concepts of preschoolers and children of early school age. Their parents' concepts of pain were considered as well. In a qualitative study interviews were performed with 9 children and their parents in a children's hospital to investigate their individual concepts of pain, their methods of pain assessment, and self-initiated strategies of pain alleviation. Already 4-6 year old children are able to remember painful experiences and to communicate about pain. Strategies of pain alleviation used by children are distraction methods as well as methods of physical relief. The child's parents play an important role concerning pain assessment and coping. The parents' presence is also very important to communicate the child's needs to nurses. Parents want nurses to consider physiological as well as behavioral aspects in the assessment of the child's pain. Besides, they expect nurses to have competences concerning prevention, assessment and alleviation of pain. To perform a trustful relationship to children and parents, more intensified counselling by nurses seems necessary.     

哮喘患儿家长的哮喘相关知识调查

目的了解已确诊哮喘的患儿家长对哮喘相关知识的认知情况,为哮喘专科医生与护士对哮喘患儿家长进行健康教育提供依据。方法采用自行设计的哮喘相关知识调查问卷对71名哮喘患儿家长进行问卷调查。结果患儿家长对哮喘相关知识回答正确率在32．39％～45．07％,认知程度处于中低水平;患儿家长主要通过医护人员获得哮喘相关知识和用药方法。结论哮喘患儿家长的哮喘相关知识有待提高,需要医护人员扩充、改进健康教育方法,提高哮喘患儿在院外的自我管理,有效控制哮喘发作。     

Patients’ Perceptions of What Makes a Good Doctor and Nurse in an Israeli Mental Health Hospital

The aim of this study was to identify inpatients’ expectations of their doctors and nurses in a mental health hospital setting. Individual interviews were conducted with 72 inpatients of a large mental health hospital in northern Israel. Our study produced three major results. First, most patients, whatever their emotional status, share similar expectations of staff, of which the most conspicuous is that they be respected as whole persons and that staff not treat them merely as cases of illness. Second, they expect to be involved in making decisions about their treatment, including being informed of reports and records referring to them. Third, patients expect all hospital staff, particularly nurses, to provide them with emotional support. The findings of this study can be used to facilitate improved care of mental health inpatients by both doctors and nurses. Structured and methodical examinations of inpatients’ expectations at the time they are hospitalized can help adjust not only the professional aspect of health care but also the therapeutic communication approach to patients’ individual needs.     

门诊输液患儿家属的需求调查分析及对策

目的了解门诊输液患儿家属的需求,为患儿输液实施全方位服务提供理论依据。方法随机选择门诊输液患儿家属300例进行问卷调查。结果患儿家属渴望了解药物疗效和药物安全知识,了解患儿疾病的诊断、病程、预后和预防保健知识;在护理服务方面把对技术水平的需求放于首位,同时认为经常巡视、与患儿交谈消除患儿恐惧感,二者同样重要;提供适合儿童心理特点的治疗环境,完善环境设施。结论护士应了解患儿及其家属的需求,采取相应的对策,提供全方位的服务。     

Revision of a parent satisfaction survey based on the parent perspective

Parent surveys typically ask about aspects of care nurses think are important. The Parent Satisfaction Survey at a 250-bed children's hospital was revised based on what parents thought was most important for a nurse to do for themselves and their children. This report is based on a retrospective review of 1,405 self-reported parent surveys collected as a performance improvement activity over a 12-month time period. Surveys were distributed to parents of hospitalized children and were returned anonymously to mailboxes on the units. Using content analysis, a group of pediatric nurses reviewed the parents' comments to determine major themes. The themes were caring, communication, safety, environment, and appreciation. The parent survey was revised to include the themes parents identified as important.