Helen Rushforth

Practitioner Review: Communicating with Hospitalised Children: Review and Application of Research Pertaining to Children's Understanding of Health and Illness

There is growing recognition amongst child health care practitioners of childrens rights to be informed about their condition and treatment, and to be actively involved in decisions pertaining to their care. In order to facilitate such understanding, there is a need to explore the ways in which such concepts can best be communicated, in particular to younger children whose conceptual ability may be regarded as limited. Consideration of the literature on how childrens conceptualisation of health and illness develops reveals diverse perspectives, with seminal work heavily influenced by the work of Piaget (1929), and a belief that the understanding of younger children may be minimal. However, more contemporary theorists refute such beliefs, suggesting that children may have far more potential to understand complex illness concepts than they have previously been given credit for. The work of Carey (1985) and Vygotsky (1962) offers alternative developmental theories congruent with this perspective, which might more appropriately underpin current practice. A variety of clinical situations are then explored in the light of this debate, including preparation of children for hospitalisation, their competence to consent, their views of pain and death, and approaches to child health promotion. Guidelines are offered to practitioners throughout, with the aim of enhancing childrens understanding of their conditions, and their active participation in care, which in turn has the potential to optimise care delivery.

Commentary on Mantzoukas S & Watkinson S (2007) Advanced nursing practice: reviewing the international literature and developing the generic features. Journal of Clinical Nursing 16, 28–37

patient and the weight increase – these may be linked by greater food intake but the stimulus for greater food intake may be an improved mental state or the increased food intake may lead to weight increase and improved mental state. This could be amenable to longitudinal study using cross-lagged panels and structural equation modelling as demonstrated by Watson and Deary (1996). There is also the possibility of a confounding factor here in that changing the meal environment and routine may have an effect on staff which is conveyed to patients and this may be the link between the intervention and the effect. These points are not meant to be negatively critical; they demonstrate the difficulties of conducting research in this area and on this topic. For example, the possibility of blinding people to interventions is almost negligible. The problems in this area of study deter many from making a start and I am just pleased that some, such as the present authors, are persevering. References