Children’s experiences as hospital in-patients : voice, competence and work. Messages for nursing from a critical ethnographic study

Livesley, J; Long, AJ

Abstract

Background: There is growing evidence that children’s subjective interpretations of events
may differ significantly from those of adults; yet children’s and young people’s voices and
children’s knowledge regarding hospital care remain relatively unexplored.
Objective: To develop insight into children’s subjective interpretations and knowledge of
being hospital in-patients.
Design: Critical ethnography.
Setting: A nephro-urology ward in a tertiary referral children’s hospital in the north of
England.
Participants: A purposive sample was employed of 15 children over 2 phases: six (9–15
years) at home in a reconnaissance first phase, and nine (5–14 years) in hospital in phase 2.
Methods: A raft of child-friendly, age-appropriate strategies was used to engage children
in phase 1. Phase 2 involved over 100 h of field-work with hospitalised children over 6
months, with observation, interview, play and craft activities as prominent methods. Data
were analysed using constant comparative methods.
Results: The study ward was a place in which children struggled to find a space for their
competence to be recognised and their voice heard. Children’s voice became manifest in
what they said but also through the non-verbal mechanisms of resisting, turning away and
being silent. While all the children shared the experience of being in trouble, recognition of
their competence was fluid and contingent on their relationships with the nurses
alongside other structural and material factors. The children worked hard to maintain
their position as knowledgeable individuals. When they could not do so they relied on
supportive adults, and in the absence of supportive adults they became marooned and
received bare minimum care.

Conclusion: The hospital ward was a place for children in which there was little space for
children’s voices. When their voices were heard, they were often seen as a challenge. Quiet,
sick and shy children who were alone were the most likely to have their needs overlooked
and become subject to standardised nursing care. A more inclusive and participatory
model of nursing practice with children is urgently needed.

Citation

Livesley, J., & Long, A. (2013). Children’s experiences as hospital in-patients : voice, competence and work. Messages for nursing from a critical ethnographic study. International Journal of Nursing Studies, 50(10), 1292-1303. https://doi.org/10.1016/j.ijnurstu.2012.12.005

• Journal Article Type: Article
• Publication Date: Jan 1, 2013
• Deposit Date: Jan 25, 2013
• Journal: International Journal of Nursing Studies
• Print ISSN: 0020-7489
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 50
• Issue: 10
• Pages: 1292-1303
• DOI: https://doi.org/10.1016/j.ijnurstu.2012.12.005
• Keywords: Children and young people; Children in Hospital; Children’s voice; Critical ethnography; Qualitative research; Hospital in-patients; Children and young people’s nursing
• Publisher URL: http://dx.doi.org/10.1016/j.ijnurstu.2012.12.005
• Related Public URLs: http://www.sciencedirect.com/science/article/pii/S0020748912004336