Managerial guidelines to support parents during the hospitalisation of their children in a private paediatric unit

Correspondence address P rofK Jooste Department o f Nursing University o f Johannesburg PO Box 524 Auckland Park 2 m Abstract: Curationis 32 (3): 47-59 The purpose o f this article is to describe managerial guidelines to support parents with the hospitalisation o f their child in a private paediatric unit. The hospitalisation o f a child is regarded as a m ajor stressor fo r both parents and child. The role o f the fam ily in participating in a child's illness is slowly being recognised (Kibel & Wagstajf, 2001:544), but the South African government p er se has not y e t issued any form al reports on parental participation in the hospitalisation process.


Nursing care personnel have a m edical k n o w ledge an d backgroun d, w h ilst p a ren ts have a com prehensive knowl edge about their child, their environ ment, an dfam ily dynamics, and under sta n d the role that the ch ild p la y s in the fa m ily and the fa m ily 's role in the c h ild 's life. Both types o f knowledge d e sc rib e d ab o ve a re im perative f o r treating the child, and should be view ed as equally important (Strober, 2005:204). Also, parents ' role in participatin g in their child's care is not always clarified. D arbyshire noted in his study that p a r ents w ere often confused an d uncer tain as to exactly what they were al lo w ed an d expected to do during their c h ild 's h o s p ita lis a tio n (B en n er,
.

Parental involvement in the care o f hos pita lised children has been encouraged by the governm ents o f the United King dom, B razil an d A m erica (de Lima, Rocha, Schochi & Callery, 2001:599), with many reports being issued to the effect o f including paren ts in the care o f their children during a hospitalisa tion episode. The role o f the fa m ily in a child's illness is slow ly being recog n is e d in S ou th A fr ic a ( K ib e l & Wagstaff, 2001:544), but this is by indi vidual authors an d the South African governm ent p e r se has not issued any form al reports on parental participation in the hospitalisation process.
A c h ild 's hospitalisation is particularly difficult, and p aren ts who are already sa d and worried about their ch ild 's con dition, are likely to also feelfrig h ten ed an d agita ted when hospitalisation is n eeded (McCollum, 1975:55) (McCollum, 1975:6).Darbyshire (in Benner, 1994:185-209) concluded that the term parental participation seem ed to have a meaning f o r nurses and p a r en ts th a t im p lie d an a rra n g em en t whereby one party, the parents, would be a llo w e d by the o th er p a rty , the nurses, to help with their c h ild 's care.

M cCollum (1975:56) advocates that p aren ts should be encouraged to help care f o r their children, especially by feeding, bathing, changing, dressing and p la yin g with them. P arents how ever, m ay f e e l em otionally torn about visiting. They wish to be with th eir child to comfort and reassure them, and to observe their condition and progress directly, but on the other hand, visiting or living in m ay be difficult and upset ting. Parents ' discom fort m ay be inten sified because they lack the fam iliar, organising influence o f their usual rou tine o f daily work. In order to accom m odate the parents ' n eed to con tin u e p e rfo rm in g th eir parenting tasks, fam ily-cen tred care has been introduced to nursing units o ver a p erio d o f time, and in varying degrees. One aspect im portant to this stu dy is the concept o f paren t p a rtici pation. A narrow definition o f parent participation in hospitalisation is "to include perform ance o f routine p h ysi cal care and extended visiting " (Knafl et al" 1988:109). An extreme form o f paren t participation is the establish ment o f care-by-parent units, wherein nursing personn el are only minimally involved and parents provide all ph ysi cal and em otional care f o r their child (Knafl e ta l, 1988:99).
A cu tely ill children require sp e c ia l equipm ent and sp ecia l nursing care.H owever, as the c h ild 's condition im proves, so the scope o f care that p a r ents can deliver increases, so that by the tim e the ch ild is w ell enough, the parents are able to perform all parenting tasks in totality (Passero, 1988:3-4).(Benner, 1994:109,190).

P atient opinion surveys com pleted by parents in a paediatric unit within a p ri vate hospital (Vereeniging M edi Clinic, 2004) indicated that parents are experi en cin g th eir c h ild 's h o spitalisation negatively. Comments m ade included that "personnel are notfriendly ", "too f e w personn el f o r the number o f p a tients ", "day personn el m ore com pe tent than night -m ore helpful ", and "medication not given as prescribed". No follow -u ps had been done on these comments, and no investigations had been in stig a ted b y m anagem ent, to docum ent paren ts ' lived experiences an d how these can be effectively man ag ed within a p a ed ia tric unit. D issatis faction o f next o f kin with p a tie n t care is on e o f th e f i v e c a te g o r ie s th a t Booyens (ed) (1998:593) recognises as a high-risk area. It w as also noted that nursing p erson n el are in volved in this area
The stu dy raises the fo llo w in g ques tions: •  (Benner, 1994:59).

Parents whose ch ild was a t that stage being hospitalised in a p riva te pa ed ia t ric unit were u sed fo r the data gath er ing ph a se o f the research. The study was conducted in one o f the p riva te hospitals in the Vaal Triangle region o f Gauteng, South Africa. Criterion-based purposeful sam pling was conducted. Purposive sam pling chooses subjects who are ju d g e d to be typ ica l o f the population in question, o r who are p a r ticularly know ledgeable about the is su e under stu d y (P o lit & H ungler, 1997:229). Thoughtful planning was requiredfor appropriate participant se lection. Purposive sam pling was used to achieve saturation o f data and seven parents w ere interview ed and fifteen parents com pleted narrative diaries. The criteria f o r p a r e n ts ' selection were as follow s:
• Parents able to communicate in English or Afrikaans;

Biological parents (mother or father), adoptive parents, single parents o r step-parents;
•

The p a ren ts'ch ild was form ally adm itted in a paediatric unit within a p riva te hospital;
•

The hospitalised child was a g ed between six weeks and 12 yea rs o f age;
•

Ethical clearance was obtained from the ethical committee o f the residential uni versity where the researcher was reg istered f o r the postgradu ate stu dy as w ell as the p riv a te hospital authority. Parents also sign ed a letter o f consent before being in terview ed or com plet ing the narrative diary. The parents were given a covering letter, explaining the re a so n s an d im p o rta n ce o f the re search. C on fiden tiality w as assu red a n d the re sp o n d e n ts c o u ld ch o o se whether to participate or withdraw dur ing the study. The respondents were also a ssu red o f anonym ity. The re search er respected the individual p a r e n t's right to privacy, confidentiality an d anonym ity b y not allow in g any fo rm o f identification on the transcrip tio n s o r n a rra tiv e d ia ries. The re search er plan n ed and executed the re search in such a w ay that it was to the parents ' benefit, and that there were no harmful, ph ysica l o r psych ological ex perien ces f o r the paren t or child. Inter view s w ere held at a tim e convenient f o r the parents, during their child's ad mission. The ch ild w as ca red f o r by nursing person n el f o r the duration o f the interview. The research er m ain ta in ed the h igh est sta n d a rd s o f re search planning, implementing and re
porting.

Interpretation of data
The  1).

Table 2 only indicates exam ples o f raw data that was in terpreted and lea d to certain findings. The raw data given by paren ts that lea d to the interpretation o f certain categories rela ted to their lived experiences o f the hospitalization o f their ch ild is outlined in table 1. The sam e p ro cess was fo llo w e d f o r inter pretation o f a ll the raw data tow ards identifying guidelines to su pport p a r ents with the hospitalization o f their
child in a pediatric unit in a private hos pital..

P arents described the fo llo w in g expe riences with the hospitalisation o f their child in a pediatric unit in a private hos p ita l (tra n scrib ed ra w d a ta fro m the in dividual interview s an d narratives given by participan ts in table 3):
From the em pirical data and the litera ture study, the fo llo w in g gu idelines w ere fo rm u la ted to su p p o rt p a ren ts during their c h ild 's hospitalisation in a private paediatric unit.

G uidelines can be im plem ented to ef fe c tiv e ly su pport parents during their child's hospitalisation in a p riva te p a e diatric unit. Possible managerial actions that cou ld be taken are b v no means lim ited to the selection below.
Guidelines related to the interactive processes in the private paediatric unit

Subtheme: Em powerm ent o f parents to p a r ticipate in certain aspects o f care
Theme: Barriers on the extent and intensity o f parental participation in their child's care

It is important to clarify paren tal and nursing roles, thus en
suring that no m isunderstand ings occur which will impact the quality o f care received by the child.This could also be done Table 3: Experiences described by parents related to the interactive processes and the environment of the pediatric unit in the pediatric unit

A ll resources an d services im pacting on the p riv a te pa ed ia tric unit should be optim ally organ ised to prom ote p a tie n t satisfa ctio n . The unit m an ger cou ld im plem ent the fo llo w in g mana
geria l actions to prom ote organised re sources: •

Service contracts should be drawn up between the p riva te paed ia tric unit and the p h a r macy, as w ell as other depart ments that are in interaction with
the unit (pharmacy, technical department, kitchen, house keeping services, etc.) to ensure that the patien ts receive tim ely treatm ent an d quality care.
• Nursing care should be evalu a ted continuously to ensure quality p a tien t care a t all times.

The unit m anager o f the p riva te p a e d i atric ward should promote interpersonal relationships in the paediatric unit, with specia l em phasis on fo sterin g a trust ing, caring parent-nursing care profes sion al relationship that prom otes the communication o f information by us ing a communication network that en sures parents receive adequate infor mation.
Interpersonal relationships should form p a rt o f continuous personn el develop ment.This could be fa cilita ted through the fo llo w in g actions:

Only seven p a re n ts took p a r t in the study, which m ay be too sm all a group to obtain accurate information. Parents who declin ed to take p a r t in the study cited anxiety and concern f o r their child
as their overriding reasons.

D espite paren ts fulfillin g the selection requirements, they w ere a t tim es un able to "grasp " the intended meaning o f the term 'experience ' an d w ere thus unable to g iv e dense descriptions o f th eir liv e d ex p e rie n c e du rin g th eir child's hospitalisation in a private p a e diatric unit.
The stu dy was conducted in a private paediatric unit, therefore generalisation outside o f this environm ent m ay be dif fic u lt to justify.

Recommendations
Recom m endationsfor nursing practice, education and research w ill now be set out.

Research on p a ren ta l participation in their child's nursing care is very lim ited in South
's care; • The parents were willing to re fle c t fre e ly on their lived nur sing care experiences and con vey it to the researcher (using the questioning m ethod o f their choice, i.e. interview and/or nar rative diary).
C r e ssw e ll (1994:155), the transcribed interviews, narrative diaries and the resea rch er's fie ld notes during the individual inter view w ere analysed.The inclusion o f the researcher's fie ld notes was im por tant f o r the enrichment o f the data.Steps included in this m ethod were: reading through it, jo ttin g down ideas in the m ar gin s on the transcript as they come to mind and answering the fo llo w in g questions: "What is it about " and "What is the un derlying meaning?"; • repeating the previo u s step f o r all transcripts, and then making a list o f a ll topics listed in the margins, clustering sim ilar ones together, and then draw ing up three columns m arked 1) m ajor topics, 2) unique topics an d 3the existing data.The fo u r main underlying p ro cesses identified during the em pirical data, which led to the form ulation o f g u ide lines, were: ensure trustw orthiness were applied.Guba's (Guba & Lincoln, 1985:290-327) strategies o f credibility, tra n sfe ra b ility , d e p e n d a b ility a n d confirmability were implemented.Credibility/truth-value P rolonged engagement o f at least three days, during which the ch ild w as hos pitalised, allow ed the respondents (par ents) to becom e used to and fa m ilia r w ith the re sea rch er.When the r e search er had p ro lo n g ed engagem ent with p a rticip a n ts, it a llo w ed the re search er to identify inconsistencies in the respondents ' responses (Bum s & Grove, 2001:41).These inaccurate re sponses could be b a sed on so cia l ex p ectation s rather than on p erso n a l ex perience.
fin din gs regarding p a r e n ts ' expe riences o f their ch ild's hospitalisation rela ted to two main categories namely 1) experiences related to various inter a ctive p ro c e sse s in the p ediatric unitand 2) experiences related to the environm entw ithin the p ed ia tric unit.F ou r su b ca teg o ries w ere identified.Three subcategories rela ted to the in teractive p ro c esse s in the p a ed ia tric unit are p a re n ta lp a rtic ip a tio n in the care o f their child, unit m anagem ent dim ensions in the p a ed ia tric unit and com m unication between paren ts and n u rsin g c a r e p e r s o n n e l.The one subcategory related to the environment o f the p a e d ia tric unit is to cre a te a th erapeu tic environm ent f o r pa ren ts (Table Africa and the fo llo w in g cou ld be fu tu re research topics: Naturalistic Inquiry.London: Sage.H A L L ST R Ò M , I 2004: Parents and c h ild r e n 's in volvem en t in d ecisio n making during hospitalisation.The qualitative re search interview; A phenom enological and hermeneutical mode o f understand ing.Journal o f Phenom enological P sy chology.14:171 -196.M A C K E N Z IE , J 1998: Ward man a g e m e n t in p r a c tic e .E d in b u rg h and Clinic.40(2):116-119.POLIT, DF, & HUNGLER, BP 1997: Essentials o f Nursing Research-Meth ods; appraisal; and utilization.Philadel phia: JB Lippincott Company.TH OM PSON, D (ed) 1996: The pocket O xford dictionary o f current English.Oxford: Claredon Press VEREENIGING MEDI-CLINIC, 2004: P atient opinion survey.Unpublished.