Doing the rounds

One of the greatest figures in the history of British hospitalsin the twentieth century was not a doctor, but a former steelworkerfrom Glasgow who later became a social worker and then a filmmaker. His name was James Robertson. Robertson started his researches into paediatric wards in Britainin 1948. At that time, sick children were routinely separatedfrom their parents for long periods of time. Having parentsin hospital was regarded as disruptive, and staff were upsetto hear how children cried when mothers arrived or left. Visitswere restricted and in some cases forbidden. Here,     

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.     

Impact of chronic illness in children on parental living conditions. A population-based study in a Swedish primary care district.

In a geographically defined child population aged 0-15, every twelfth child suffered from chronic illness. Their parents and randomly selected control children's parents were asked about their living conditions using questionnaires. Non-responders (30%) had the same sociodemographic profile as responders. The socioeconomic level in index families (n = 95) was lower than in control families (n = 166). Both parents worked fewer hours in index than in control families. Index mothers had more health problems and sick days than control mothers. The parents' social relations were most hampered by having children with allergic disorders or mental retardation. Despite reduced hours, more absence from work to care for sick children, and reduced leisure activities, two thirds of the parents of moderately/severely disabled children found it difficult to cater adequately to the needs of their child. A family approach is recommended to provide comprehensive care of children with chronic illness, in which both specialized and primary care are needed.     

Separation and psychological trauma: a paradox examined

This paper explores the separation of children from their parents that took place in British hospitals in the middle years of the 20th century (Bradley 2001). It is widely believed that this child-parent separation was the product of a failure to understand the child's psychological and social needs (Bowlby et al 1939, Brain and Maclay 1968, Branstetter 1966, Editorial 1957). Paediatric nurses have been blamed for this ignorance and the resulting failure of care (Bowlby et al 1939). However, evidence suggests that such accusations are flawed in logic and in fact: paediatric nurses of the time were fully conversant with the prevailing understanding of child psychology and practised that psychology. In this article it is argued that the cause of child-parent separation lies elsewhere. Data are drawn from a study concerning the social history of paediatric nursing between 1920 and 1970 (Jolley 2004). Oral history data were collected from past nurses of children and from people who had been in hospital as children within this period. Oral history data from 30 participants were recorded, content analysed and validated by the participants.     

Alternate child care, history of hospitalization, and preschool child behavior

BACKGROUND: With more single mothers entering the workforce due to welfare reform efforts, more hospitalized children from single-parent families will have experienced alternate child care arrangements where routine care is provided by adults other than the child's mother. OBJECTIVES: To investigate with secondary analysis of data whether experience with alternate child care has a moderating effect on the relationship between hospitalization and behavior of preschool children living in female-headed single-parent families. METHOD: A sample of 60 preterm and 61 full-term children who were 3, 4, or 5 years old was recruited for the larger longitudinal study. Behavior problems were measured with the Child Behavior Checklist. History of hospitalization and alternate child care arrangements were measured with the Life History Calendar. RESULTS: Preschool children who experienced hospitalization without alternate child care experience had more somatic complaints, but those with both hospital and alternate child care experience had fewer aggressive behaviors than other children. For children with a history of hospitalization, aggressive behaviors decreased as the proportion of the child's life in alternate child care increased. CONCLUSIONS: Experience with alternate child care may ameliorate some of the negative effects of hospitalization, and potentially other novel and negative experiences, for preschool children. This could be due to child care providing positive experiences with separation from the mother, a peer group with which to talk about the novel experience, or actual instruction about the novel experience.     

"Airplanes crash, spaceships stay in orbit" : the separation experience of a child "in care"

There are few empirical studies of the subjective experience of separation from living parents in children who are removed from their families following abuse or neglect. The author presents the case of a child who spent most of his childhood in foster homes and treatment residences, including 7 years in which he had no contact with his natural family. The fate of his primary attachments and its influence on his capacity to form new ones are discussed, using material drawn from 6 years of individual therapy while he was "in care" and during the time that contact with his mother was renewed. Separation, loss, and attachment in a child welfare context and relevant clinical interventions are discussed.     

Time use of mothers with school-age children: a continuing impact of a child's disability.

OBJECTIVE: The purpose of this study was to compare the time use of mothers of children with disabilities with the time use of mothers of children without disabilities. METHOD: Sixty mothers with children 3 to 14 years of age (30 mothers with children with disabilities and 30 mothers with children without disabilities) completed time diaries over seven 24-hour days. RESULTS: Significant differences were found between the two groups when comparing mean hours spent per week by mothers in occupations involving child-care activities and recreational activities. Mothers of children with disabilities spent significantly more time in child-care activities and significantly less time in recreational activities. In addition, mothers of children with disabilities reported fewer typical days and rated the quality of days as poorer. As children got older, the gap between the time mothers devoted to child care increased between the two groups. CONCLUSION: The type of occupations a mother participates in varies significantly dependent upon whether a child in the family has a disability and the age of the child. Professionals need to work collaboratively with families to assist parents to meet the family's daily needs particularly in light of the time demands of the mother.     

Correlates of mothers who prefer control over their hospitalized children's care.

The purpose of this study was to profile mothers who prefer control over their hospitalized children's care. The subjects were 100 mothers in a private community hospital pediatric unit and 284 mothers in a children's hospital. The findings showed significant correlations in both groups between the desire for control and four of the six variables studied: age of the mother, age of the child, number of children in the family, and amount of time the mother spent in the hospital. The other two variables, ethnic background and prior experience with a hospitalized child, were each significant in only one of the two samples. The study provided guidelines for the pediatric nurse to use in assessing mothers' preferences for control over their hospitalized children's care.     

Parents' experiences of participation in the care of hospitalised children: a qualitative study

BACKGROUND: The introduction of unrestricted visiting hours has led to the encouragement of parents to stay with and participate in the care of their hospitalised child. In order to stay with the hospitalised child, parents have to be away from home or work, which in turn impacts on their personal and family life. However, no published study on parents' experiences of childcare participation during paediatric hospitalisation has been found for a Chinese population. OBJECTIVES: This study explored Chinese parents' experiences of their participation in taking care of their hospitalised child. DESIGN: A qualitative exploratory design was adopted to capture parents' experiences of participation. SETTINGS: The study was conducted in four paediatric wards of a regional acute general hospital in the New Territories, a major geographical region of Hong Kong. PARTICIPANTS: Nineteen parents (16 mothers and three fathers) who had a child hospitalised for more than 48 h and identified themselves as staying comparatively longer with the child than their counterpart were recruited. METHODS: Data were collection by tape-recorded semi-structured interview. RESULTS: Four major categories that illustrated parents' experiences of participation in childcare were identified: reasons for staying with the child, rescheduling of family's routine, expectations of nurses, and comments on facility provisions. The findings highlight parents' desire for participation in caring for their hospitalised child, their unexpressed needs for communication and concern about the non-monetary costs of participation. CONCLUSIONS: Most parents viewed accompanying their hospitalised child as an unconditional aspect of being a parent and had a strong desire for participation. Parents' need for communication and emotional support during their participation of childcare in paediatric unit are universal. As Chinese parents are passive in seeking help, nurses should take the initiative in assessing their needs and offering them support accordingly.     

Strategies for feeling secure influence parents' participation in care

This study investigates what makes parents of hospitalized children feel secure and factors influencing their level of participation. It also studies, whether the degree to which parents participate affects their child's pain and sleep during hospitalization. Questionnaires were distributed to a series of parents whose children were discharged from two paediatric surgical wards and one paediatric medical-surgical ward at two university hospitals in Sweden. Parental security is almost equally distributed among three given alternatives: security derived from trusting that professionals know how to take care of the child; security derived from having control over what is happening to the child; and security derived from being the one who knows the child best. Depending upon the strategy chosen, parents want to participate at different levels in their child's care. The results indicate a relationship between parental participation and their estimation of their child's pain. The study confirms a pattern, developed in a previous study, in how parents adopt different strategies affecting their participation during their child's hospitalization. Some parents who wanted to participate in more aspects of their child's care seemed to think that their child had less pain than parents who preferred more limited participation.     

The effect of child care proximity on maternal reports of separation anxiety in employed nurses.

PURPOSE: To determine whether employed nurses with young children, aged 6 months to 4 years, experienced differences in maternal separation anxiety related to proximity of child care. METHOD: A comparative design was used to survey 29 nurses who were mothers of young children and were employed at two work sites: one with on-site child care services and one without child care services of any kind. The Maternal Separation Anxiety Scale and The Child Care Satisfaction Instrument were the data collection tools. Scores were compared by t-test. FINDINGS: There were no significant differences in maternal separation anxiety between the two groups nor in the level of satisfaction with the child care arrangement. CONCLUSIONS: Future research should address questions of who most benefits and in what ways from differing types of child care services. This research should include larger samples, part-time and full-time employed mothers, low income families, single mothers, mothers with infants, mothers of children in need of after school services, and mothers who work evening and night shifts.     

Organizational differences in early child health care -- mothers' and nurses' experiences of the services

Scand J Caring Sci; 2012; 26; 161–168 Organizational differences in early child health care – Mothers’ and nurses’ experiences of the services Aim: The aim of this study was to evaluate parents’ and nurses’ perceptions of the child health services (CHS) in relation to whether the nurse worked exclusively with children (focused‐child health centre, CHC) vs. with people of all ages (mixed‐CHC). Method: Information about parents’ perceptions about the CHS was acquired by a questionnaire intended for the mothers of 18‐month‐old children. One thousand thirty‐nine answered in the baseline 2002–2003 and 996 in the follow‐up 2004–2005. The nurses answered a special questionnaire aimed to obtain knowledge about their satisfaction with their work. Eighteen CHCs were chosen from the county of Uppsala and eighteen from other Swedish counties. The CHCs were chosen from areas with poor psycho‐social status. The data were collected by questionnaires to mothers and nurses, and the analysis used the chi‐square test, t‐test and logistic regression. The study was approved by the Research Ethics Committees of the universities involved. Results: Mothers were more satisfied, and the nurses found their work tasks easier, at CHCs where the child health nurse worked exclusively with children, compared with mothers and nurses belonging to CHCs where the nurses provided care to people of all ages. Conclusion: The findings indicated that nurses working exclusively with children, being able to concentrate their time and knowledge on a specialized field, develop a more solid child health competence. There are strong reasons to consider introducing ‘exclusive’ CHCs in psycho‐socially vulnerable areas, which would probably make the services more effective. However, intensified education may modify the drawbacks of mixed‐CHCs.     

Involvement and fragmentation: a study of parental care of hospitalized children in Brazil

Parental involvement in the care of children who are hospitalized has been encouraged by the government in Brazil, as it has in the United Kingdom (UK). In this paper, key aspects of the UK, North American, and Latin American literature concerning parental participation are discussed, and implications for hospital care of children in Brazil are considered. A study of the division of work between nurses and the mothers (or other relatives) of 10 children hospitalized with chronic illnesses is reported. Data were collected by participant observation of child care in a Brazilian hospital. The results highlight some of the difficulties that arise in the integration of the work of mothers and nurses in hospital care of children and the fragmentation of care into "manual" and "intellectual" work. The results are considered within the theoretical framework of the model of technologic organization of work (Gon?alves, 1979, 1994). Implications for the organization of child care in the hospital are discussed.     

Animal-Assisted Activity at A. Meyer Children's Hospital: A Pilot Study

The authors systematically studied the introduction of animal-assisted activity into a children's hospital in Italy. This pilot study examined the reactions of children, their parents and the hospital staff and the hospital-wide infection rate before and after the introduction of animals. The SAM (self-assessment manikin), three behavioral scales, analysis of children's graphic productions, a parent questionnaire and a staff questionnaire were used to evaluate the effectiveness of the intervention. The children's participation was calculated. The analysis of the hospital infection rate was completed independently by the Hospital Infections Committee. The authors found that the presence of infections in the wards did not increase and the number of children at the meetings with pets in the wards was high (138 children). The study also found that the presence of animals produced some beneficial effects on children: a better perception of the environment and a good interaction with dogs. All parents were in favor of pets in the hospital, and 94% thought that this activity could benefit the child, as did the medical staff, although the staff needed more information about safety. The introduction of pets into the pediatric wards in an Italian children's hospital was a positive event because of the participation of hospitalized patients, the satisfaction expressed by both parents and medical staff, and the fact that the hospital infection rate did not change and no new infections developed after the introduction of dogs.     

A study of parental involvement in pediatric hospital care: implications for clinical practice

BACKGROUND: Although it has become common practice for parents to stay with their sick child in hospital, most hospitals lack routines and staff guidelines for involving parents in care processes and decisions. AIM: To gain a deeper understanding of factors that influence parental involvement and to clarify the parental role in the hospital care of chronically ill children. METHODS: Semistructured interviews with 14 parents of chronically ill children. RESULTS: Four themes were identified: support, professionalism, work environment, and responsibility. These themes describe the experience and perceptions of parents who regularly spend time in the hospital with their children. CONCLUSIONS: Clinical practices regarding parental involvement need to be established to optimize the hospital care of chronically ill children.