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DEVELOPING DATA COLLECTION METHODS TO STUDY SUBJECTIVE HOSPITAL EXPERIENCES OF PRE-SCHOOL-AGED CHILDREN Eveliina Viikeri, Anna Axelin & Sanna Salanterä.

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Presentation on theme: "DEVELOPING DATA COLLECTION METHODS TO STUDY SUBJECTIVE HOSPITAL EXPERIENCES OF PRE-SCHOOL-AGED CHILDREN Eveliina Viikeri, Anna Axelin & Sanna Salanterä."— Presentation transcript:

1 DEVELOPING DATA COLLECTION METHODS TO STUDY SUBJECTIVE HOSPITAL EXPERIENCES OF PRE-SCHOOL-AGED CHILDREN Eveliina Viikeri, Anna Axelin & Sanna Salanterä 27th and 29th of July 2011 University of Turku Department of Nursing Science Finland Hoitotieteen laitos / Lääketieteellinen tiedekunta

2 Children´s rights United Nation´s Convention of Children´s rights European Union´s the Charter of fundamental rights European Assosiation for Children in Hospital Charter Constitution of Finland Law of patients´s rights and status (Finland)

3 Studies made of children Before 1980’s children weren´t studied from their point of view (Kirby 2004) Information of children has been collected mainly from their parents (Deatrix & Faux 1991; Kortesluoma et. al. 2003) Methods should be developed to study child’s subjective point of view (Carney et. al. 2003; Pelander et. al. 2006; Pelander et. al. 2009) Only few studies have been made of pre-school-aged children in hospital

4 Purpose and objective of the study Purpose of the study was to compare four different data collection method’s (storytelling, drawing, playing and photograph aided interview) suitability for studying pre-school- aged-children. The objective was to study what kind of information different data collection methods produced of children’s hospital experiences and how did the different data collection methods applied for studying hospitalized pre-school-aged children.

5 Data collection Data was gathered in one University Hospital in Finland between November 2009 to June 2010 Altogether twenty (n= 20) 5 to 6-year-old children participated in the study Four different data collection methods were used Methods were selected based on child’s physical ability and opinion

6 Storytelling By using storytelling child tells a story and the adult writes it down just the way child tells it. After the story is told, it is read to the child. Child can make corrections to the story, if sees it necessary. (Karlsson 1999) Child can also be adviced to tell a story with a beginning, middle-part and an ending (Arad 2004; Bull & Gillies 2007) Children were asked to tell a story of something that had happened or they had experienced in the hospital. They were also asked to tell a story with a beginning, middle-part and an ending.

7 Story of 6-year-old boy ” First they put me into sleep in ICU. I was in a ventilator for two days and asleep for two days. And when I woke up there was all kinds of lines attached to me. And then I talked to my mother. And then I got down here and all kinds of things were done. I went to the playroom with my mother and we played cards. And we also were here. We watched programs. Mother slept in my bed and I watched programs. Today we were out and there was my mother’s cousin Jarno*. And when I went to the elevator with my mother, we went to the wrong floor. And then we went to the right floor. And one day clowns and handcraft lady came. And I have done handcrafts. I played Kimble and Jänisloikka with my mother**.” * Name changed ** Last sentence added afterwards

8 Some of the children had difficulties to start to tell a story, but after they had begun they told the story to the end It took few minutes for the children to tell the story Children acted independently and were concentrated to the given assigment Distractions did not affect to children’s stories One child did not produced a story

9 Playing Children were asked to play with playmobile-hospital, - helicopter and ambulance something that had happened or they had experienced in the hospital There were no time limit placed for the play Children played alone

10 The Playmobil-hospital, helicopter and ambulance

11 Some children wanted playmobile-hospital to include same items than the actual hospital Some of the children just played with the playmobile-hospital and partly ignored what they were asked to do Some children didn’t want to play at all Children did not spoke up very much during the play

12 Drawing Children were asked to draw a picture or pictures of something that had happened or they had experienced in the hospital Children were given 12 crayons and A4 sized paper for the drawing After children had drew the picture they were asked what had they drawn

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14 All of the children drew only one drawing Some of the children had difficulties to tell what they had drawn The drawing included several elements, but usually it was drawn only from one occasion

15 Photograph aided interview Children were asked to take photographs with digital camera of something related to what they had experienced or that had happened in the hospital First children were asked to tell about the things they wanted to photograph Children had 30 minutes time to take the pictures and after that they were interviewed In the interview children were asked what was in the picture and why they took the picture. Sometimes additional questions were asked.

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17 Most of the children got very excited of photographing Children did not had any difficulties using the digital camera Some children could not name the things they wanted to photograph inadvance Only one children wanted to take a picture somewhere else in the hospital than the own ward Sometimes children did not remember why they had took the picture

18 Data analysis – inductive content analyses Children’s hospital experiences were analysed with inductive analysis First data of each method were analysed separately Secondly a summary was made of all inductive analyses

19 Versatility of the data based on inductive analyses MethodsMain categoriesSubcategories Storytelling1337 Playing1027 Drawing1021 Photograph aided interview 619

20 CHILDREN’S SUBJECTIVE HOSPITAL EXPERIENCES ENVIRONMENT NEED FOR SUPPORT OF FAMILY AND LOVE ONES FULFILMENT OF AUTONOMY PLAYING DAILY ACTIVITIES ENJOIYING HOSPITALIZATION FULFILMENT OF CARE PROCESS TIME GOING BY PAIN FAMILY’S ADAPTATION TO VARIATION RECOGNIZING HEALTH CARE STAFF RESTRICTIONS POSITVE EMOTIONS HOSPITAL OF CHILDREN’S VOICES COMMUNICATION Summary of inductive analyses.

21 Pre-school-aged children’s hospital experiences Being in the hospital was mostly positive experience, which included the presence and attention of family members, playing, autonomy, positive feelings and daily routines Negative things in hospital were restrictions, pain and lack of self control Children reacted neutrally in hospital procedures (e.g. being in the ventilator, getting an enema) after they were done Nurses were not recognized by the children and mentioned only by one children

22 Data analysis – Typology of study situations Typology was made based on child’s behaviour and ability to follow directions, communicate, be affected of distractions and how the study situation proceeded Three different types of study situations were formed: successful, restless and unsuccessful.

23 Different study situations based on typology STORYTELLING n/% PLAYING n/% DRAWING n/% PHOTOGRAPH AIDED INTERVIEW n/% SUCCESSFUL4/801/202/401/20 RESTLESS_2/403/60 UNSUCCESSFUL1/202/40_1/20 Altogether 5/100 5/100 5/100 5/100

24 Results of study situations In most of the study situations (n = 16) children followed instructions like they were asked or mainly like they were asked In four study situations children did not follow instructions at all or just a little bit

25 Study implemented in the hospital According to feedback asked from the children most of them experienced study situations positively One children said that participation to the study was hard (drawing) and one children said that the given task was difficult (playing) There were a lot of distractions in the hospital (e.g. procedures, parents, noise), that sometimes affected the child during the study situation Also some of the children were still recovering of their illness and had limited resources

26 Validity of study results Only 20 children participated in the study – results can not be generalized There were a lot of distractions in some of the study situations  effect on study results is hard to evaluate Qualitative study includes researcher’s interpretation

27 Conclusions Pre-school-aged children are capable of telling their own experiences when study methods are suitable for them Children produced information about their hospital experiences with each method Storytelling produced most information and most versitile information in this study compared to other methods. There were also most successful study situations when storytelling was used. Data collection methods should be studied more to confirm their suitability and validity for studying pre-school-aged children

28 References Arad, D If Your Mother Were an Animal, What Animal Would She Be? Creating Play-Stories in Family Therapy: The Animal Attribution Story-Telling Technique (AASTT). Family Process. 43 (2). 249 – 263. Bull A. & Gillies M Spiritual needs of children with complex healthcare needs in hospital. Paediatric Nursing. 19 (9). Carney T, Murphy S, McClure J, Bishop E, Kerr C, Parker J, Scott F, Shields C & Wilson L Children’s Views of Hospitalization: An Exploratory Study of Data Collection. Journal of Child Health Care. 7 (1), 27 – 40. Deatrix JA & Faux SA Conducting Qualitative Studies with Children and Adolescents. Qualitative Nursing Research – A Contempory Dialogue. Morse JM. Sage Publications. United States of America. European Assosiation for Children in Hospital (EACH) Charter. Charter with Annotations. annotationshttp://www.each-for-sick-children.org/each-charter/charter-and- annotations European Union’s the Charter of Fundamental rights Karlsson L Saduttamalla lasten kulttuuriin. Verkostotyön tuloksia Kuperkeikka kyydissä. STAKES. Raportteja 241. Saarijärvi: Gummerus Kirjapaino Oy.

29 Kirby P Involving young people in research. The New Handbook of Children’s Rights. Comparative policy and practice Franklin B. Trowbridge, Wiltshire. Great Britain. Kortesluoma RL, Punamäki RL & Nikkonen M Conducting a qualitative child interview: methodological considerations. Journal of Advanced Nursing. 42 (5), 434 – 441. Law of patients rights and status Pelander T, Salanterä S, Nuutila LM & Leino-Kilpi H Lapsi tiedonlähteenä: katsaus Suomessa tehtyihin hoitotieteen opinnäytetöihin. Hoitotiede. 18 (4), 162 – 171. Pelander T, Leino-Kilpi H & Katajisto J The quality of peadiatric nursing care: developing the Child Care Quality at Hospital instrument for children. Journal of Advanced Nursing. 65 (2), 443 – 453. The Constitution of Finland United Nation´s Convention of Children´s rights Viikeri E Developing data collection methods to study hospital experiences of pre-school-aged children. Master thesis. University of Turku. Department of Nursing Science.

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