May 8 2013
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Do We Know What Kids in the Hospital Think of Their Care? Check.

Nancy Ryan-Wenger, PhD, RN, CPNP, FAAN, is the director of nursing research and an investigator at the Center for Innovation in Pediatric Practice at Nationwide Children’s Hospital in Columbus, Ohio. As a grantee of the Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative (INQRI), she was a lead investigator of the first-ever study to systematically elicit the views of hospitalized children and adolescents on the quality of their nursing care, and also the first to evaluate children’s perceptions of nurses’ behavior for evidence of any disparities across demographic groups. This is part of a series of posts for National Nurses Week, highlighting how nurses are driving quality and innovation in patient care.

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Have we asked the children?

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That became a pressing question for me when I retired from academia after 30 years and joined the staff of Nationwide Children’s Hospital. I became aware of things that are highly important to hospitals, such as opinions of the quality of care. Yet when I saw the patient surveys at Nationwide, they were almost always completed by parents, and 80 percent of the questions were geared toward parents: Were they kept informed of their child’s condition? Did they have a comfortable place to sleep? Was their child treated kindly by staff member?

Those are important questions, certainly, but if you’re doing a patient survey, don’t you want to know what the patient thinks?

Have we asked the children?

The INQRI study included 496 children and youth, ages 6 to 21. We knew that nurses were with them 24 hours a day, so we asked them two questions about their care: 1) “What do you like most about your nurses and what they do for you, and how does that make you feel?”; 2) “What don’t you like about your nurses and what they do for you, and how does that make you feel?” Their responses were sorted into 18 categories of nurse behaviors. Many of the 12 that were regarded as positive behaviors—such as “gives me what I need when I need it,” “checks on me often,” “talks and listens to me,” and “is nice and friendly to me”—were important for us to know, and they were things that parents never mentioned. These positive behaviors made the children feel cared about, safe, and happy. Six categories were regarded as negative, such as “wakes me up” and “doesn’t give me what I need when I need it.”

Overall, children felt that their nurses cared about them, regardless of how many behaviors they did or did not like. Keep in mind that approximately 3 million children and adolescents are hospitalized every year, and their experiences in the hospital can influence their attitudes toward health care—receiving it, and even pursuing it as a career—for the rest of their lives. Children can accurately report their feelings about quality of care, and the study findings strongly suggested that their perspectives on their care in hospitals should be elicited and considered when evaluating nursing practices and procedures.

We’ve turned the results into a clinical trial with a 10-item checklist that’s used for daily interviews with kids and daily evaluations for nurses—not to reward or penalize them, but simply to guide them. It’s the right thing to do. Nurses who work with children do so because they love children and they want them to have the best care.

The hospital administration has been very supportive, and I’ve met with Nationwide’s survey vendor, who is interested in marketing a new survey for children. We’re also expanding the clinical trial to a second site, Advocate Children’s Hospital in Oakbrook, Illinois. The support of the Robert Wood Johnson Foundation through INQRI has allowed us to answer “Have we asked the children?” with a resounding “yes,” and that’s been a really good thing to do.

Tags: Adolescents (11-18 years), Children (6-10 years), Evaluation, Human Capital, Interdisciplinary Nursing Quality Research Initiative, National Nurses Week 2013, Nurses, Nursing, Quality of care, Research & Analysis, Voices from the Field