"Children Draw-And-Tell About Stress in the Hospital"
Background: Over 3 million children are hospitalized every year and over 40% of these children are 7 years of age and older (1). Hospitalization of children is reserved for increasingly complex care where acute hospital stays in specialized children’s hospitals, and produces $10 billion of annual hospital costs for children (1,2). Since the 1960’s, it has been well known that hospitalization can be a traumatic experience for children (2,3). This experience elicits feelings of fear, uncertainty, pain and discomfort that can affect a child’s healing, behavior and health outcomes (4,5). Although the psychosocial impact of hospitalization is evident, it has not been fully explored from a child’s perspective.
Methods: Thirty child participants were interviewed in a large Midwest children’s hospital through a ‘draw and tell’ technique (6) to elicit their perceptions of stress in the context of hospitalization. Interpretive description framework was applied (7) to explore stress through a child’s lens. An interpreted child drawing is recognized as a powerful communication tool that promotes rapport building, emotional expression and empowerment of the child (8). Constant vigilance of children’s rights was conducted through human subjects reviews, pictorial child assent, and child empowerment during data collection. A clinical expert group was engaged to validate interpretive themes and propose transferable information to practice.
Results: The analysis of children’s words, behaviors and drawings revealed five interpretive thematic conceptual messages from children communicated to professional caregivers in the hospital. The messages include: a) children express their stress through fear, worry, discomfort but primarily sadness; b) children ask us to talk to them and not just their parents, as they have something important to say; c) Children want to know what you are going to do to them and why; and what you expect them to do during their hospital stay; d) the ultimate relief of stress for children in the hospital is going home and children want to know what they need to do to go home; and e) children identify simple things health care providers can do to comfort them during hospitalization such as like hold their hand, give them a hug, talk nicely to them, give them a band-aid, and give them their favorite food and drink. These new insights from a child’s view direct congruent comfort care for a child in the hospital.
Implications: The themes are the initial building blocks for a conceptualized framework of a child's view of stress and remedies to comfort for the hospitalized child. Application of ‘evidence’ to practice is prompting a child-designed creation of a home-going ‘Star’ chart for children, identifying the main things they need to do to go home on a calendar time-line. Future research to explore child satisfaction, improved health outcomes and expedited discharge is warranted.