HOSPITALIZATION AS A DIFFICULT SITUATION FOR CHILDREN IN THE OPINION OF PARENTS AND NURSERY PERSONNEL
HOSPITALIZACJA JAKO SYTUACJA TRUDNA DLA DZIECKA
W OPINII JEGO RODZICÓW I PERSONELU PIELĘGNIARSKIEGO
Jolanta Witanowska (0000-0002-5547-214X), Aneta Ilona Warmuz-Wancisiewicz (0000-0001-9003-2425), Alicja Ullman
Department of Paediatric Nursing, School of Health Sciences in Katowice, Medical University of Silesia in Katowice
DOI:
ABSTRACT
Introduction. A child's stay in hospital is not only care for him/her, but also their parent. The
parent present in the ward is an inseparable element of the therapeutic team. The nurse helps in adapting to the new environment through contacts and partner relations with the child. Parents, thanks to their presence, ensure the child's safety and reduce anxiety.
Aim. The aim of the study was to clarify whether the hospitalization process is a difficult
situation for a child in the opinion of his/her parents and medical staff.
Material and methods. The research material was collected using a questionnaire containing
31 questions for parents as well as for nursing staff working in the pediatric ward. The study included 110 parents and 79 nurses.
Results. Almost three-fourths of respondents (71.6%) fully agree with the opinion about the
beneficial impact of the presence of a parent by the child during hospitalization. Most parents claim that nursing staff cares for patients properly (61.6%) and have a high level of professional skills. 57.9% of parents say that nurses provide their children with safety not only physical but also psychological. Over half of the respondents (65.6%) believe that nurses approach a small patient with full respect. In the opinion of nurses surveyed, the presence of a parent by the child is beneficial for the child and the treatment process. 80.7% confirm that the presence of a parent is of special importance in the case of a child with a difficult verbal contact.
Conclusions. 1) The presence of a parent positively influences the acceptance of the environmental change and increases the sense of security during the hospitalization process.
2) The contact with the parent has a significant impact on the further treatment of the child through the exchange of information between the nursing staff and the parent. 3) The nursing staff provides emotional comfort to the child during the procedures. KEYWORDS: hospitalization, opinions of parents, opinions of nurses. STRESZCZENIE
Wstęp. Pobyt dziecka w szpitalu to nie tylko opieka nad nim, ale również nad jego rodzicem.
Rodzic obecny na oddziale to nieodłączny element zespołu terapeutycznego. Pielęgniarka pomaga w adaptacji do nowego środowiska przez kontakt oraz partnerskie relacje z dzieckiem. Zaś rodzice dzięki swojej obecności zapewniają dziecku bezpieczeństwo i zmniejszają lęk.
Cel. Celem pracy było wyjaśnienie, czy proces hospitalizacji jest sytuacja trudną dla dziecka
w opinii jego rodziców i personelu medycznego.
Materiał i metody. Materiał badawczy zebrano przy użyciu kwestionariusza ankiety
obejmującego 31 pytań dla rodziców, jak również dla personelu pielęgniarskiego pracującego na oddziale pediatrycznym. Badaniem objęto 110 rodziców oraz 79 pielęgniarek.
Wyniki. Prawie 3/4 badanych (71,6%) całkowicie zgadza się z opinią o korzystnym wpływie
obecności rodzica przy dziecku w trakcie hospitalizacji. Większość rodziców uważa, że personel pielęgniarski dba o pacjentów (61,6%) oraz cechuje go wysoki poziom umiejętności zawodowych. 57,9% rodziców twierdzi, że pielęgniarki zapewniają ich dzieciom bezpieczeństwo nie tylko fizyczne, ale także psychiczne. Ponad połowa badanych (65,6%) uważa, że pielęgniarki podchodzą do małego pacjenta z pełnym szacunkiem. W opinii badanych pielęgniarek obecność rodzica przy dziecku jest korzystna dla dziecka i procesu leczenia. 80,7% potwierdza, że obecność rodzica ma szczególne znaczenie w przypadku dziecka z utrudnionym kontaktem słownym.
Wnioski. 1) Obecność rodzica wpływa korzystnie na akceptację zmiany środowiska i
zwiększa poczucie bezpieczeństwa podczas procesu hospitalizacji. 2) Kontakt z rodzicem ma duży wpływ na dalsze leczenie dziecka poprzez wymianę informacji między personelem pielęgniarskim a rodzicem. 3) Personel pielęgniarski zapewnia komfort emocjonalny dziecku podczas wykonywanych zabiegów.
SŁOWA KLUCZOWE: hospitalizacja, opinie rodziców, opinie pielęgniarek.
A child's stay in a hospital is not only care for him/her, but also their parent. The essence of this process is to help the child and support the parents so that the child could recover. The whole process begins when the child is admitted to the pediatric ward. Communication between the nurse and the patient as well as his parents has a very large impact on the cooperation process in the field of care [1-2]. The Act of 30 August 1991 on health care institutions gives the possibility of taking care of a child by a close person. In the past years, the stay of a parent with a child in the ward was impossible [3]. The consequences of long-term hospitalization are reflected in the experiences as well as in the child's development. Unfortunately, sometimes changes can be permanent and disturb the child's development [2,4].
According to data from the Silesian Voivodship Office in Katowice, based on information about hospitalization in the years 2012-2013, the most common reason for hospitalization were respiratory diseases falling within the ICD 10 classification in the range J00-J99. Depending on the age, the reasons for hospitalization are different. The age of patients arriving in the pediatric ward also varied. Most often hospitalized children are under one year of age, followed by patients aged 5-14 years [5].
All reactions that lead to strong emotions in the hospitalized child are caused by separation from parents. The parents present in the ward is an inseparable element of the therapeutic team, and their presence affects the quality of child care [2,6]. The child's environment should be designed, furnished and equipped to meet children's bio-psycho-social needs. The environment should be colorful and not anxious [7-8].
In the process of child hospitalization, the role of a nurse is no less important than the role of a parent. The nurse helps in adapting to the new environment through contact and partner relations with the child. Parents, thanks to their presence, ensure the child's safety and reduce anxiety [8-9]. As much as possible, the parents help in caring for their child and the nurse's task is to explain their role and create appropriate conditions for it. In the case of a 24-hour stay at the child, the parent becomes a member of the therapeutic team and has the full right to be informed and make decisions related to further treatment [10-11].
Aim of the study
The main goal of the study was to analyze the research material and explain whether the hospitalization process is difficult for the child in the opinion of his parents and medical staff.
The research material was collected using a questionnaire prepared by employees of the Pediatric Nursing Department, for the parent of a child hospitalized in the pediatric ward as well as for nursing staff working in the pediatric ward. The questionnaire consisted of 31 closed questions.
Characteristics of the studied groups
After obtaining the consent of the management, the research was conducted among parents who were staying with the children in the Department of Pediatrics in Rydułtowy 26 people (23.6%), in Żory 24 people (21.8%), Sosnowiec and in Bytom -30 people each (27.3%).
Nursing staff working in the hospital in Żory and Rydułtowy, 20 people each (25.3%) and 39 people in Sosnowiec (49.4%) were also examined. The research was carried out at the turn of August and September 2016.
Characteristics of the studied group of parents
The presented research indicates that the majority of the surveyed parents were women, who in total constituted as much as 82.2%, men - only 17.8% of those surveyed.
The age range of the surveyed group of parents indicated that more than half of the respondents were people aged 26 to 39 years old (59.2%). The surveyed parents mostly lived in the city up to 50,000 people (34.6%).
The highest number of respondents had higher education in Rydułtowy 50.0%, in Żory -37.5%, in Bytom and Sosnowiec, the percentage was 36.5%.
Characteristics of the studied group of nursing staff
Most of the nursing staff in the study group working in the pediatric ward were women, only in the Sosnowiec hospital 2.6% of the respondents were men. The largest number of respondents was in the 40-49 age group (44.6%). The highest number of respondents graduated from medical school (37.6%), 30.3% had a bachelor’s degree and 16.8% a master's degree.
Seniority in the largest percentage is 20-29 years (36.2%), then over 30 years (25.2%) and 10-19 years (23.5%).
Most of the respondents worked only in the pediatric ward (58.0%) and were employed full-time (84.1%).
Results
The majority of parents (78%) stays with their child in the ward during his hospitalization 24 hours a day, 14.0% - during the day, 6.0% in the evening hours and only 2.0% of parents stay with the child in the morning.
Almost three-fourths of respondents (71.6%) fully agree with the opinion about the beneficial effect of the presence of a parent at the child during hospitalization.
The majority of parents (65.9%) fully agree with the thesis that their presence in painful treatments allows the child not to feel alone in suffering.
The examined parents have divided opinions about the role of the caregiver during the procedures. Nearly 1/3 of respondents think that a child who has painful treatments can be sorry for a parent that he/she accepted this pain.
Most parents surveyed believe that despite the child's preparation for surgery, the presence of a parent is important for the child’s well-being (62.3%).
A good relationship between the nursing staff and the child's carers is very important, helps at work and works in the patient's favor by exchanging information about the child. Almost half of the respondents (48.4%) think that conversations between a nurse and a parent can have an impact on changing the attitudes towards taking care of the child's health. According to the parents surveyed, the nurses explain all doubts connected with their child's health situation (53.9%).
The opinion on the cooperation between a parent and a nurse for the recovery of a child in the examined hospitals varies, however, most parents believe that nursing staff cares for patients (61.6%).
The vast majority of parents (92%) believe that nurses are characterized by a high level of professional skills.
The research carried out indicates that the majority of parents (57.9%) believe that nurses ensure not only physical safety of their children, but also psychological one. Over half of the respondents (65.6%) believe that nurses approach a small patient with full respect.
The opinions of parents of children hospitalized in pediatric wards in the area of professional activities of nursing staff were also analyzed (Figure1).
Assesment of the work of nursing staff in the ward
completely agree rather agree no opinion rather disagree completely disagree
Figure 1. The work of nursing staff in the opinion of the respondents (n = 110) Source: author’s own research
In the opinion of the nurses surveyed, the presence of a parent at the child is beneficial for the child and the treatment process (Figure 2).
Continuous presence of a parent / guardian during hospitalization is beneficial for the child and the course of treatment?0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0% 45.0% 50.0%
The role of parents during the child's hopitalization
completely disagree rather disagree no opinion rather agree comletely agree
Figure 2. The opinion of the surveyed nursing staff regarding the role of parents during the child's hospitalization (n = 79)
Most respondents believe that in the case of a child with difficult verbal contact, the presence of a parent is of special importance (80.7%) (Figure 3).
0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0%
In your opinion, the presence of a parent at a child in a hospital is of special importance:
completely disagree rather disagree no opinion rather agree comletely agree
Figure 3. The pinion of the nurses surveyed on the importance of the presence of a parent at the child (n = 79)
Source: author’s own research
Discussion
The vast majority of parents surveyed stay with the child in the ward. The literature on the subject states that the parent is an inseparable element in the therapeutic team. His continuous presence in the ward affects the quality of childcare. The 24-hour presence of a parent with a child is most common in the case of the youngest patients [6]. In our own research it has been shown that the parents' attitude to staying with the child in the
positive effect on the course of the child’s treatment. The nursing staff also think that the presence of a loved one has a positive effect on the treatment. According to John Bowlby, the stay of a parent with a child causes mental strain [7, 12]. The fear for the child's life and health and constant stress contribute to this. And the child gives a sense of security during all care and treatment activities. According to Kirschnick, the closeness of the closest person soothes pain and suffering [7, 12].
The European Charter on the Rights of the Child says that the parent can stay with the child around the clock, which is used by most caregivers. However, the fact of staying with the child during the treatment activities raises a dilemma. According to literature, most parents, hearing the crying of their child, do not remain in the treatment room [13].
One of the nurses' tasks is to help them accept the new environment and strengthen the relationship with the child. The nurse's work requires empathy and devotion to the child staying in the ward. By reducing the tension as a result of play and dedicating time, the child does not associate hospitalization with a traumatic situation [9,14].
Our own studies have shown that hospitalization has a major impact not only on the well-being of the child, but also on their parents.
Conclusions
The research carried out gives the following conclusions:
1. The presence of a parent positively influences the acceptance of environmental change and increases the sense of security during the hospitalization process.
2. Contact with the parent has a significant impact on the further treatment of the child through the exchange of information between the nursing staff and the parent.
3. The nursing staff provides emotional comfort to the child during the procedures.
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The manuscript accepted for editing: 09.10.2018. The manuscript accepted for publication: 02.01.2019. Funding Sources: The study was not supported.
Conflict of interest: The authors have no conflict of interest to declare.
Address for correspondence:
Jolanta Witanowska Batorego 15
41-902 Bytom phone: 32 7861498
e-mail: jwitanowska@sum.edu.pl
Department of Paediatric Nursing, School of Health Sciences in Katowice, Medical University of Silesia in Katowice
