Actual implementation of sick children's rights in Italian pediatric units: A descriptive study based on nurses' perceptions
Abstract
Several charters of rights have been issued in Europe to solemnly proclaim the rights of children during their hospital stay. However, notwithstanding such general declarations, the actual implementation of hospitalized children's rights is unclear. The purpose of this study was to understand to which extent such rights, as established by the two main existing charters of rights, are actually implemented and respected in Italian pediatric hospitals and the pediatric units of Italian general hospitals, as perceived by the nurses working in them.
Cross-sectional study. A 12-item online questionnaire was set up and an invitation was sent by email to Italian pediatric nurses using professional mailing lists and social networks. Responders were asked to score to what extent each right is respected in their hospital using a numeric scale from 1 (never) to 5 (always).
536 questionnaires were returned. The best implemented right is the right of children to have their mothers with them (mean score 4.47). The least respected one is the right of children to express their opinion about care (mean 3.01). Other rights considered were the right to play (4.29), the right to be informed (3.95), the right to the respect of privacy (3.75), the right to be hospitalized with peers (3.39), the right not to experience pain ever (3.41), and the right to school (3.07). According to the majority of nurses, the most important is the right to pain relief. Significant differences in the implementation of rights were found between areas of Italy and between pediatric hospitals and pediatric units of general hospitals.
According to the perception of pediatric nurses, the implementation of the rights of hospitalized children in Italian pediatrics units is still limited.
... da criança e é benéfico, pois, juntamente com a equipe de saúde, auxilia na detecção precoce de riscos. (15) Desta forma, o ECA estabelece a obrigação das instituições de saúde em proporcionar condições, para permanência em tempo integral com a criança de um dos pais ou responsável. (2) Pesquisas realizadas na Itália e no Brasil (4,15) A presença da brinquedoteca foi citada pelas profissionais como um direito da criança, pois compreendiam a brincadeira como uma das suas necessidades básicas. ...
... (15) Desta forma, o ECA estabelece a obrigação das instituições de saúde em proporcionar condições, para permanência em tempo integral com a criança de um dos pais ou responsável. (2) Pesquisas realizadas na Itália e no Brasil (4,15) A presença da brinquedoteca foi citada pelas profissionais como um direito da criança, pois compreendiam a brincadeira como uma das suas necessidades básicas. Assim, ressalta-se que as instituições hospitalares devem obrigatoriamente fornecer espaços para que os usuário de menor idade possam "ser criança" e continuar o acompanhamento escolar, uma vez que a hospitalização já é um potencial fator estressor. ...
... Assim, ressalta-se que as instituições hospitalares devem obrigatoriamente fornecer espaços para que os usuário de menor idade possam "ser criança" e continuar o acompanhamento escolar, uma vez que a hospitalização já é um potencial fator estressor. (8,16,17) Pesquisas (15,18) revelaram que a presença de classes escolares era mais frequente dentro de hospitais pediátricos do que em gerais, demonstrando que esse direito ainda encontra-se implementado de forma incipiente. O desconhecimento das profissionais sobre os direitos da criança hospitalizada foi identificado nessa pesquisa assim como em outros estudos. ...
Objetivo: Apreender a percepção da equipe de enfermagem sobre os direitos da criança hospitalizada. Método: Estudo qualitativo exploratório com 13 profissionais de enfermagem em unidade pediátrica de um hospital universitário em Salvador-BA. A coleta de dados ocorreu em novembro de 2018, através de entrevista semi-estruturada. Foi utilizada a análise de conteúdo de Bardin. O estudo foi aprovado pelo Comitê de Ética em Pesquisa. Resultados: As categorias foram: cumprimento das obrigações legais; garantia do cuidado integral e humanizado; Implementação das ações relacionadas ao tratamento e segurança do paciente; desconhecimento dos direitos da criança hospitalizada. Conclusão: Os profissionais conhecem parcialmente ou desconhecem os direitos infantis, sendo necessário empenho para capacitação dos profissionais e gestores.
... Knowing the extent to which the rights of hospitalized children are actually respected by healthcare professionals is essential for the implementation of children's rights and for planning measures to guarantee their psychological and physical health in the hospital. However, Bisogni et al. (2015) reported significant variations regarding the application of children's rights among different regions of Italy, and even among children's hospitals and general hospital pediatric units [14]. Kahriman et al. (2016) studied the thoughts of midwives and nurses who provide health services to the pediatric age group on the rights of children. ...
... Knowing the extent to which the rights of hospitalized children are actually respected by healthcare professionals is essential for the implementation of children's rights and for planning measures to guarantee their psychological and physical health in the hospital. However, Bisogni et al. (2015) reported significant variations regarding the application of children's rights among different regions of Italy, and even among children's hospitals and general hospital pediatric units [14]. Kahriman et al. (2016) studied the thoughts of midwives and nurses who provide health services to the pediatric age group on the rights of children. ...
... In the study, it is seen that midwives and nurses do not agree on the problems encountered in clinical practices regarding children's rights [9]. There are a limited number of studies in the literature that examine healthcare professionals' awareness of children's rights [14][15][16][17][18][19]. For this reason, discussing the thoughts and opinions of children's rights of healthcare personnel, especially on scientific platforms can provide significant contributions. ...
It is important for health professionals working with children to be aware of all aspects of children’s rights. the research was conducted to determine the qualitative analysis of the knowledge of the healthcare professionals working in pediatrics units on children's rights. Twenty health workers in the pediatric units of an obstetric and children’s hospital, nine physicians and eleven nurses, took part in the research. Data were collected with the semi-structured interview technique using an ‘Information Form’ and an ‘Structured Interview Form.’ Data were then subjected to analysis. Two themes were determined as "the views of healthcare professionals on children's rights" and "What can be done to better implement children's rights". In line with these themes; It was determined that healthcare workers mostly focused on children's right to life and development, and other rights were not mentioned much. It was determined that healthcare professionals thought that training should be given to raise awareness on children's rights. It is recommended that in-service training be provided to increase the knowledge and awareness of children’s rights among health workers in pediatric units. Key words: Child; Children’s Rights; Nurse; Physician
... It is thus of considerable importance to assess the level of knowledge of people working in a children's hospital with regard to children's rights and the degree to which these rights are observed. Pertinent data have been published from various countries (Italy, Romania, Iran, and others) in which inadequate possession of relevant knowledge and a lack of observance of children's rights in hospitals have been reported [5,[11][12][13][14][15][16][17]. Analogous data have not, to date, been published from Greece. ...
... The aforementioned message has also been noted in other studies [24,25]. Literature data from other countries also showed inadequacies in following children's rights in hospitals, of variable type and degree, the latter most likely related to variability in the study design or the population involved [5,[11][12][13][14][15][16][17]. Specifically, in the study of Migone et al. concerning a tertiary referral hospital in Dublin, the findings suggest that healthcare professionals shared similar concerns with the participants in our study, including the lack of appropriate facilities in the hospital for play, education, age-appropriate wards, and the lack of privacy. ...
Background and Objectives: In 1989, the United Nations (UN) General Assembly adopted the United Nations Convention on the Rights of the Child (UNCRC), with a considerable number of the Articles of the Convention being related to the health status of children. Therefore, adhering to and assessing the implementation of the rights of children during hospitalization is a very important step towards child protection. Herein, we attempt to highlight the depth of knowledge of employees working in children’s hospitals with regard to children’s rights as well as the degree of adherence to the UNCRC with respect to hospitalized children. Material and Methods: The target group included all healthcare professionals working in the various general pediatric clinics of the three Children’s Hospitals of the Athens metropolitan area in Greece. We conducted a cross-sectional study, with data collection carried out in February and March 2020, using a structured questionnaire consisting of 46 questions which was handed out to all personnel. For the analysis, we used the IBM SPSS 21.0. Results: A total of 251 individuals participated in the study (physicians 20%, nurses 72%, and other employees 8%). A total of 54.5% of health professionals did not know what the UNCRC is, and 59.6% of them were not even aware that their hospital had rules and a bioethical committee related to clinical research involving children. Lack of awareness or trust of health professionals is also observed for other procedures or supervisory measures such as abuse protocols, complaint control, admission control, etc. With regard to the health system, there are shortcomings or weaknesses in (a) procedures followed with regard to respect for gender and privacy, (b) information on basic services provided by pediatric hospitals (such as recreation, education and free meals during hospitalization), (c) the logistical infrastructure (such as recreational facilities and facilities for the disabled), (d) the possibility of recording complaints, and (e) hospitalizations that were not necessary. A difference emerged concerning the nurses’ responses between the three hospitals, with nurses participating in relevant seminars held in one of the hospitals being significantly more informed. Conclusions: The majority of healthcare personnel seem unaware of basic principles with respect to children’s rights during hospitalization as well as relevant procedures and supervisory measures. Moreover, obvious weaknesses of the health system exist with respect to procedures, services, infrastructure, and complaint recording. There is a need for improved education of health professionals with respect to the implementation of children’s rights in pediatric hospitals.
... Despite the high degree of alignment between the job responsibilities of child life professionals and children's participation, there is a paucity of knowledge on how child life professionals experience these rights in practice. Previous studies have primarily focused on the views of nurses and/ or physicians on children's decision-making (Bisogni et al., 2015;Coyne, 2005;Runeson et al., 2002). Based on central findings from a doctoral study (Matthiesen, 2022), the purpose of this critical qualitative study was to explore child life professionals' perspectives regarding children's participation in decision-making and how children's participation processes are shaped by wider contextual (e.g., organizational and socio-cultural) factors. ...
Objective: Despite a growing trend towards the recognition of children’s participation rights, many children are not provided with adequate opportunities to participate in decision-making regarding their health and healthcare. Child life professionals, as members of the pediatric team, are often poised to promote children’s rights - in particular, the participation rights of hospitalized children. However, a lack of research exists on the role of child life professionals in shaping children’s participation rights. This paper reports on central findings from a qualitative study exploring the experiences of child life professionals with children’s participation in decision-making in pediatric hospitals in the Netherlands.
Method: Semi-structured interviews were conducted with two groups of participants, child life professionals ( n = 12) and hospital directors ( n = 5), and 17 pertinent legal, institutional, and professional documents were analyzed.
Results: The findings shed light on various complexities in shaping children’s participation rights. While child life professionals and directors associated value and importance to children’s participation, children’s involvement in decision-making were shaped by adult-dominated and (age-based) developmental discourses.
Conclusion: Implications for the field of child life and broader pediatric healthcare policy developments are discussed.
Disclosure Statement: No potential conflict of interest was reported by the author(s).
Funding Statement: No funding sources were provided by the author(s).
... Children's views about their treatment and care are often not listened to [9]; play empowers children and gives them a voice [29] improving, at least in the short term, their well-being and reducing long term adverse outcomes [68]. Playfulness and humour when interacting with Clown Doctors improves positive outlook in oncological patients [3]. ...
... Other research studies in Transylvania and Italy confirm the existence of other types of infringements and reveal that hospitalized children do not have their rights fully guaranteed during the hospitalization period. The main violations cited were treatments based on obsolete medical practice principles, disrespect for the rights of agreement or disagreement in their treatment and disrespect for the right to continue school monitoring, as well as the right not to feel pain (7,8). ...
Objective: To understand the perception of the Nursing team about institutional violence against hospitalized children. Materials and method: A qualitative, descriptive and exploratory study, performed at a large-size public hospital in Salvador, Bahia, Brazil, with 17 Nursing professionals working in the Pediatrics unit, to whom semi-structured interviews were applied between March and May 2019. The collected data were categorized in the NVIVO12 software and submitted for content analysis. Results: The results are presented in four categories: The professionals’ lack of knowledge about institutional violence against hospitalized children; Recognition of institutional violence related to problems in the hospital infrastructure, Recognition of institutional violence in interpersonal relationships and Recognition of institutional violence in the care practices. Conclusions: It becomes necessary to apply policies to confront institutional violence, ranging from training the professionals to adapting the spaces and care practices to favor the children’s hospitalization environment.
... Es gibt bereits verschiedene Untersuchungen zu Kinderrechten in Krankenhäusern, die alle zumindest teilweise Mängel in der Umsetzung von Kinderrechten aufzeigen [1,15,16,21,22,25]. In Deutschland gibt es seit 2018 die Initiative "Kranke Kinder haben Rechte", um Bewusstsein zu Kinderrechten im medizinischen Bereich und zu der Besonderheit von Kindermedizin zu schaffen [22]. ...
Background
Various studies show that it is important for children and adolescents (as well as their parents) to be involved and have a say in decisions regarding treatment. Nevertheless, it seems that participation processes are not necessarily implemented into hospital routines everywhere. So far, no study has been conducted on the implementation of children’s rights or participation in Austrian hospitals.Objective
Our study aimed at investigating the extent to which children’s rights (especially the right to participation) and the European Association of Children in Hospital (EACH) Charter are known in Austrian hospitals, how they are implemented, and which facilitating and hindering factors can be identified.MethodsA questionnaire survey was conducted among the chief medical and nursing staff on wards where children and adolescents are treated (n = 133), and qualitative interviews were conducted with experts on children’s rights, medical and nursing staff, parents and one adolescent girl (n = 15). The results and recommendations for action that were derived from the data were discussed and validated in an expert workshop.ResultsThe medical and nursing staff in Austrian children’s and adolescents’ wards are already doing a lot to implement and uphold children’s rights. There is awareness of the need for child-centered treatment and the need to allow children and adolescents to participate during their hospital stay. Nevertheless, the interviews with parents show that there are large differences between hospitals and that there is still a lot to be done.Conclusion
Based on the results, three areas for recommendations for action were identified: 1) anchoring children’s rights, both legally and in the training of medical and nursing staff, 2) strengthening the team and feedback culture, e.g., through more staff resources for good teamwork and 3) good health information and good conversation quality. This means that health information for children and adolescents should be quality assured, comprehensible, evidence-based and on aspects relevant to them. Conversations between health professionals and patients and their relatives, should be patient-centered, which can be promoted through training, introduction of quality standards and guidelines.
... The United Nations children's convention from 1989 confirmed the rights of children to be supported, protected and respected, and for them to participate with their dignity recognised. Although these obligations are clearly stated, an Italian study of paediatric nurses' responses found that hospitalized children's rights are still not implemented fully [33]. Another study has also pointed out that the organization must recognise that extra time and a high level of clinical competence and resources are needed for advanced paediatric care [16]. ...
Background
Nurses play an active role in supporting the children with the blood sampling experience. Unfortunately, the blood sampling collection procedure is often affected by pre-analytical errors, leading to consequences such as delayed diagnosis as well as repeated sampling. Moreover, children state that needle procedures are the worst experience of their hospital stay. The nurses’ experiences of errors occurring during blood sample collection is unknown. Therefore, the aim of this study therefore was to describe paediatric nurses’ experiences of blood sampling collections from children.
Method
We used a qualitative study design with a (reflexive) thematic analysis (TA) method described by Braun and Clarke. Three focus group interviews were conducted, with 19 nurses collected by purposeful sampling from Sweden working at two different paediatric hospitals, focusing on their experiences of the blood sample collection procedure.
Results
From the three focus group interviews we analysed patterns and meanings of the following main theme Paediatric blood sampling is a challenge for the nurses and the four subthemes Nurses’ feelings of frustration with unsuccessful samplings , Nurses believe in team work , Venous blood sampling was experienced as the best option , and Nurses’ thoughts and needs regarding skills development in paediatric blood sampling .
Conclusion
The narrative results of this study illustrate that nurses working in paediatric hospital care face a big challenge in blood sampling collection from children. The nurses felt frustrated due to unsuccessful blood samplings and frequently could not understand why pre-analytical errors occurred. Nevertheless, they felt strengthened by colleagues in their team and shared feelings of responsibility to help each other with this complex procedure. The implications of this study are that paediatric hospital care needs to focus on improving guidelines for and increasing competence in blood sampling children and helping nurses to understand why samplings may be unsuccessful and how this can be avoided.
... A survey carried out in Italy revealed that professionals confirmed that the right to continue school education is one of the least respected in pediatric units, being more often guaranteed in pediatric hospitals than in general hospitals. In Austria, it was found that this same right is established in almost all child psychiatric inpatient units (20)(21) . In Brazil, there is also evidence of problems related to the absence of a hospital class and difficulty in acquiring materials to keep the toy library functioning, which demonstrates that the education of hospitalized children has not been valued in health services (10) . ...
Objectives:
to analyze the hospital structure elements that demarcate (in)visibilities of institutional violence in hospitalized children.
Methods:
this is a descriptive-exploratory qualitative study that used approaches with Foucault's thinking. Ten companions and 39 healthcare professionals from a university hospital in Salvador, Bahia participated. Data collection took place from November 2018 to June 2019 through semi-structured interviews. The discourse analysis method was used. The study was approved by the Institutional Review Board.
Results:
institutional violence was understood in the violations and invisibilities of the structure of health services through the problems: in infrastructure (physical structure, lack of human and material resources, scrapping of equipment); administrative and management; pilgrimage.
Final considerations:
it is necessary to realize the invisibilities of the infrastructure to act in confronting institutional violence to hospitalized children.
Background
The United Nations Convention on the Rights of the Child (UN CRC) plays an important role in the healthcare system, especially for pediatric medicine. Nevertheless, so far the rights of sick children have not been adequately taken into account in German healthcare policies. In particular, attention to the participative rights necessitates a high degree of creativity and engagement in the clinical routine and is in no way taken for granted.Objective
Practical implementation of children’s rights in pediatric medicine.Material and methodsAnalysis of empirical data from German children’s hospitals, presentation of various case examples and discussion of healthcare policy framework conditions.ResultsVarious approaches for an improved implementation of children’s rights are emerging in German children’s hospitals; however, awareness of children’s rights in pediatric medicine needs to be strengthened further. The rights of sick children and the importance of pediatric medicine for the whole of society are not the focus of the decision-making process in healthcare policy.Conclusion
To adequately implement children’s rights in the German healthcare system it is imperative to create more awareness for the principles of the UN CRC. This can be achieved primarily by creating appropriate healthcare policy framework conditions as well as specific training and education of medical and nursing personnel.
Schooling is known to influence a wide range of economic, social and psychological aspects of people’s life, but children with medical needs are subject to school failure more often than their healthy peers. The aim of this paper is to review different school options available to the paediatrics community for the education of children with medical needs. Hospital school, home tuition and mainstream school re-entry are examined. Critical aspects for each type of solution are discussed. The provision and stability of adequate educational opportunities for children with medical needs represents an important area of collaboration between doctors, educators and parents for the prevention of long-term consequences of illnesses and therapies.
The present study was designed to evaluate the nature of the immediate reactions and modes of adaptation of children and parents to the impact of hospitalization on a medical ward in a children’s hospital, the incidence and character of long-range emotional reactions of children and families to the experience of hospitalization and the degree of modifiability of such reactions with the use of an experimental program of ward management. Two groups of 100 children each were selected for study, one designated as the control and the other, the experimental group. In addition to age, sex and level of psychosexual development, a number of variables appear to operate to determine the degree and nature of traumata deriving from the hospitalization experience. The study of emotional reactions to hospitalization appears to answer certain questions and to pose others for further investigation. All children in the series showed some observable reaction to the experience of hospitalization and treatment for illness, as distinct from the effect of the illness itself. The majority of children exposed to the traditional program of hospital management exhibited reactions calling for special and at times strenuous modes of adaptation, relatively self-limited in character but often persisting for a number of weeks or months following discharge. Such reactions were apparently more severe and persistent in children of preschool age, where separation from the parents seemed to play a major role, and in children with previously limited capacities for adaptation. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
The Issue. Disparities and inequities characterize the health and social well-being of children in the United States and the United Kingdom. Children’s rights and the United Nations Convention on the Rights of the Child are among the most powerful tools available to respond to and increase the relevance of pediatrics to contemporary disparities and determinants of child health outcomes. The articles of the convention establish the framework for a redefinition of what constitutes child health. The convention establishes a template for child advocacy, a matrix for establishing new approaches to health services, a curriculum for professional education, and a set of challenges for future child health outcomes and health systems research.
Disparities and inequities characterize the health and social well-being of children in the United States and the United Kingdom. Children's rights and the United Nations Convention on the Rights of the Child are among the most powerful tools available to respond to and increase the relevance of pediatrics to contemporary disparities and determinants of child health outcomes. The articles of the convention establish the framework for a redefinition of what constitutes child health. The convention establishes a template for child advocacy, a matrix for establishing new approaches to health services, a curriculum for professional education, and a set of challenges for future child health outcomes and health systems research.
Questo libro nasce dall'esperienza di un gruppo di persone che sono impegnate da anni nel campo della tutela del bambino malato e della sua famiglia. Gli argomenti analizzati sono: il concetto di malattia nel bambino, e gli atteggiamenti tipici di fronte al ricovero in ospedale; il lavoro in équipe nel reparto pediatrico; l'organizzazione della scuola e del gioco in ospedale; l'uso delle tecnologie didattiche; la gestione della relazione tra familiari e operatori e la prevenzione del burnout; la storia dello sviluppo delle attività ludiche ed educative rivolte ai bambini in ospedale. Al giorno d'oggi, grazie agli importanti progressi compiuti dalla medicina, malattie un tempo "incurabili" registrano tassi di guarigione relativamente elevati. Dal punto di vista della "salute fisica", le possibilità di ricevere cure adeguate, anche nel caso dei bambini, migliorano di anno in anno. Tuttavia, la "macchina terapeutica" degli ospedali rischia di rimanere insensibile al disagio psicologico dei pazienti, soprattutto se questi sono bambini, che si trovano - in una fase della vita delicata, come è l'età evolutiva - a vivere il trauma emotivo che si accompagna alla ospedalizzazione. L'opera è rivolta principalmente a chi lavora nell'ambito dell'assistenza pediatrica (medici, insegnanti, infermieri, psicologi, ecc.); a chi opera nel campo della formazione (dato l'ampio materiale didattico-operativo che esso fornisce); a chi, infine, si accosta all'argomento per la prima volta, e incontrerà una traccia chiara ed esaustiva dei principali aspetti della tutela dei bambini in ospedale. Ogni capitolo è corredato da preziose indicazioni operative, sotto forma di esercitazioni e questionari; completa il volume un'appendice che raccoglie una serie di "idee per giocare e studiare in ospedale", da una parte, e le più importanti normative emanate in materia, dall'altra.
The European Association for Children in Hospital (EACH) Charter, adopted in 1988 in Leiden, Netherlands, is a list of the rights of all children before, during, and after a hospital stay. The rights mentioned in the charter apply to all sick children regardless of their illness, age, or disability, their origin or social or cultural background, or any possible reason for treatment, whether as inpatients or outpatients.
All rights mentioned in the charter and all measures derived from it must, in the first place, be in the best interests of children and enhance their well-being.
The rights/needs of children in hospital include accommodation for parents, support for parents and children, informed participation in the decision-making process, and care in pediatric units by staff who are adequately trained.
The EACH Charter is in line with corresponding and binding rights stipulated at the United Nations Convention on the Rights of the Child and refers to children as being aged 0 to 18 years.
Some of the goals of the EACH Charter are still unachieved, such as:
Submitted by Giulianna Brandazzi Filippazzi
In Italy the regulatory framework of the nursing professions presents critical aspects. While a Children Nurse cannot provide care to an adult, a newly graduated General Nurse can legally be assigned to a Neonatal Intensive Care Unit without having ever touched a newborn before. Italian general hospitals with pediatric departments almost always prefer to hire General Nurses rather than Children Nurses, because the former, albeit insufficiently prepared, make staff management easier for nursing directors. Italian Children Nurses are not only penalized by this situation, but also by the public's lack of interest in the specific wellbeing and health needs of children. In addition, they must defend themselves from a part of the Italian nursing leadership, which periodically tries to eliminate the pediatric nursing profession. In an environment that is essentially hostile to Children Nurses, the young who decide nonetheless to take up this profession have very strong and enduring motivations.