Qualitative Research Analysis and Critical Appraisal

This assignment requires a critical appraisal of qualitative research studies related to family-centered care and parental experiences in pediatric hospital settings. The analysis involves evaluating the quality and relevance of the studies using established tools such as CASP (Critical Appraisal Skills Programme) and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Specific details include analyzing 10 qualitative research articles, applying thematic analysis to identify common themes and patterns, and critically appraising the studies' methodological quality. The assignment aims to enhance understanding of family-centered care and its implementation in pediatric hospital settings.

RESEARCH
DISSERTATION

Table of Contents
TITLE:.............................................................................................................................................1
CHAPTER 1- INTRODUCTION....................................................................................................1
Overview of the Research......................................................................................................1
Definition of Key Terms........................................................................................................1
Incidence and prevalence / statistics.......................................................................................2
Relevant Policies and Guidance.............................................................................................2
Summary of Existing Literature.............................................................................................3
Rationale of the Research.......................................................................................................3
Development of Research Question.......................................................................................3
Aims and Objectives...............................................................................................................3
CHAPTER 2- METHODOLOGY...................................................................................................4
Search Strategy.......................................................................................................................4
Inclusion and Exclusion Criteria............................................................................................5
Critical Evaluation..................................................................................................................6
Method Of Analysis...............................................................................................................7
PRISMA Flow Chart..............................................................................................................7
CASP Checklist......................................................................................................................8
CHAPTER 3- FINDINGS...............................................................................................................8
Study Characteristics..............................................................................................................9
Article Summary Table..........................................................................................................9
Identification of Themes.......................................................................................................16
Summary...............................................................................................................................19
CHAPTER 4- DISCUSSION........................................................................................................19
Discussion on Themes..........................................................................................................19
Recommendations for research, practice and education......................................................22
Review Limitations..............................................................................................................23
CONCLUSION..............................................................................................................................23
REFERENCES..............................................................................................................................24
APPENDIX- 1...............................................................................................................................25

CASP Qualitative Appraisal Tool........................................................................................25

TITLE:
What are the experiences of parents who have witnessed long term hospitalisation of their
child?
CHAPTER 1- INTRODUCTION
Overview of the Research
This dissertation is based on experiences of parents whose children have been
hospitalised for a very long time. It is quite stressful for parents to witness such an event and
seeing their child in pain enhances feelings of despair, depression and pain. Parents witness a
significant and high level of distress and in some cases, clinically harmful levels of post-
traumatic symptoms. Long-term suffering of their child have a tedious and excruciating impact
on the emotional facet of the parents as well. Such a high levels of nervousness and tension
causes long-term, and sometimes permanent, exasperation. This kind of negative behaviour
amplifies when the child is younger than 5 or 6 years. Hospitalisation of child induces negative
changes in lives of parents and drastic shift in their daily routine. The key aspects in this
dissertation are parents, hospitalisation, diseases, care home, medical treatment, child
professionals, etc.
Definition of Key Terms
The dissertation is based on experiences of parents who have witnessed long term
hospitalisation of their child. There are various key terms which are required to be defined.
These terms are mentioned below: Parents: These individuals brings forth or begets offspring. They nurtures and raise their
children and provide extensive and selfless care to them. It includes people who
biologically reproduce children and those who are given responsibilities to parent a child.
It could include foster and adoptive parents. Diseases: This refers to the condition which induces illness and abnormal and harmful
physical symptoms within an individual's body. These have negative effects on a person's
body and have vile characteristics which requires immediate medical attention. Hospitalisation: This term refers to a condition where individuals suffering form illness
or disease gets admitted to a health care centre or hospital to receive adequate medical
treatment for that illness.
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 Medical Treatment: It means the care and management where medical professional tends
patients to help them combat with a disorder, illness, disease. For parents whose children
suffers from a disease or serious medical condition sometimes are reluctant to go beyond
a certain level of medical treatment seeing risks and cost of the same.
 Care Home: These organisations or institutions are associated with providing effective
care and fulfilment of needs of individuals who are either orphans or somehow have
failed to acquire a shelter for themselves.
Incidence and prevalence / statistics
Hospitalisation of children adversely and negatively impact the parents' emotional and
physical well-being. It is that sort of experience which induces fear and negative levels of
anxiety within an individual. Recent studies reveal that the child hospital stays in England are
rising. From past decade, the admission of infants have increased by more than 50% as compared
to the last decade. There have also been substantial increase in the admission rate of children
aged between one and four to about 25% (Child hospital stays 'keep rising', 2019). In addition to
this, with hospitalisation of children, parents tend to be quite disturbed and distracted in finding
balance between their routine and the issues associated with their child. Another analysis denote
that almost 40% of parents experience high level of anxiety even after 3 months of discharge of
their child (Parental anxiety and stress during children's hospitalisation, 2011). Substantial
stress levels along with anger and pessimism are the impacts on parents experiencing
hospitalisation of their offspring.
Relevant Policies and Guidance
In recent times, there are various guidelines and policies set out for providing effective
child care and support provided to them. With enhancements in awareness in recent times, the
government of the UK is carving out more appropriate and systematic guidelines to ensure better
health of children. In other words, the government and few organisations are taking initiatives
which could contribute in betterment of children's health. For instance, the government of the
UK is paying more attention towards pollution which could cause asthmatic and lung infections
in children. Moreover, food production regulations by the government also indicates various
guidelines which emphasize on quality production of food items provided to children without
added preservatives or food colouring. Such guidance and effective policies would focus on
preventing any sort of condition that could cause serious illness or diseases in children.
2

Summary of Existing Literature
As per the view points of Wray J., and et. al. (2019), parents tend to receive high level of
stress during hospitalisation of their children. In addition, hospital service tend to influence as to
how these parents cope with the condition of their child. Majority of parents experience anxiety
at clinical levels and their condition remains the same even after months of discharge. They tend
to be pessimistic and feel uncertainty regarding the illness. Such characteristics indicate
worsening of physical and emotional condition of parents whose children are hospitalised.
However, there are various interventions are made to increase coping of parents during the
hospitalisation of their child.
Rationale of the Research
The above reviewed literature brings out the experience of parents throughout and even
after the time their children have been hospitalised. This research covers a very wide area of
research where the emphasis would be completely on the experience of parents. Moreover,
diseases will also be highlighted which causes such long-term hospitalisation. This research
would be useful to gather initial warning and symptoms which require immediate medical
attention to reduce the possibility of such long span of hospitalisation. It would also be helpful
for individuals who seek to develop the professional criteria for learner in Health Care.
Development of Research Question
What are the experiences of parents/carers whose child has required long term
hospitalisation?
Aims and Objectives
Research Aims
 To understand parents/carers experiences of their child's long term hospitalisation. To analyse the impact long term hospitalisation has on parents/carers.
Research Objectives
 To improve the experience of long term hospitalisation for parents/carers in future
practice.
 To evaluate the effectiveness of current practice and support networks available to
parents/carers whose child has experienced long term hospitalisation.
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CHAPTER 2- METHODOLOGY
After brief introduction, the next step requires the researchers to identify and determine
the methodologies used throughout the dissertation, its critical evaluation tool as well as method
of analysis.
Search Strategy
Formulation of Key Terms
Each question has several key terms which are required to be identified for gaining a
better understanding of the subject matter. It is imperative that the question is well focused for
researcher to determine appropriate and effective resources as well as search for relevant and
applicable evidence. For this specific issue, the framework that would serve quite appropriately
for the research would be PICO framework. This term stands for: Population, Intervention,
Comparison and Outcome. The framework is utilised to identify evidence-based practice
resources. For the current research question. After identification of each key term, it is also
imperative to find alternative terms for those words which are wild cards and truncations. While
the former is used for alternate spellings, the latter is used for alternate endings.. The PICO
framework is analysed below:
Research Question: What are the experiences of parents who have witnessed long term
hospitalisation of their child?
POPULATION INTERVENTION OUTCOME
Parents
OR
Father
OR
Mother
OR
Carer
OR
Guardian
A
N
D
Long-Term Hospitalisation
OR
Medical Intervention
OR
Rest
OR
Exercise
A
N
D
Experience
OR
Perception
OR
Observation
OR
Understanding
OR
Judgement
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It is crucial to determine Boolean operators within the PICO framework as it helps to
effectively narrow down the research and make it more effective for researcher to gain a better
understanding.
Databases
Databases used for researches provide effective insight to researcher to better perform the
activity with utmost professionalism and ease, gathering only those information which is relevant
and necessary for the research. For the same, EBSCO host platform has been utilised to
determine databases which could help in conducting effective and timely research (Calvert,
2015). CINAHL and Mediline were the two databases that have been taken into consideration to
gain an insight about the experience of parents whose children suffer from long-term
hospitalisation. Both of these databases have ample amount of medical journals which provide
relevant and effective information on various resources. With such abundance of medical
literature present in these databases, it becomes quite efficient to gather relevant information
regarding the research. The most contributing aspect of these databases is that information are
timely updated for users to find the most recent and reliable information regarding their research
topic.
Additional Search Strategies
Another type of strategy which has been used in this dissertation is Phrase Searching. It is
a quite effective strategy where researcher could search their relevant research topics by using
two or more words as phrases. This method is very crucial in case something specific has to be
researched.
Inclusion and Exclusion Criteria
Within every research, it is of vital importance that only those information be included
which is reliable, relevant and authenticated. A very strong reason for choosing such type of
information is that it helps in keeping a narrow focus and the research does not deviate from its
objectives. Thus, it is necessary for every researcher to segregate criteria that are either to be
included in the research or excluded from the research (Hadi and Closs, 2016). Doing so would
further ease researcher's work of gathering relevant information. These criteria for the research is
mentioned below:
INCLUSION EXCLUSION RATIONALE
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Research emphasised upon
long-term hospitalisation of
children
Research focused upon long-
term hospitalisation of adults.
It would ensure that only
information related to
hospitalisation of children are
taken into consideration.
Published between 2010 to
2017 Published before 2010.
Information beyond 2010 is
more recent and relevant as per
the requirements of research.
Qualitative Information Quantitative Information
Since the research is about
experience of parents whose
children have been long-term
hospitalised, qualitative
research would result better in
covering a broad subjective
area.
Articles in English Articles in other languages
It could be very hectic and
tough for the researcher to
translate the articles into
English which would reduce
the scope of effective
information being gathered for
the research.
Critical Evaluation
Critical Evaluation refers to a process which considers both positive and negative aspects
of research in order to effectively bring out the best material and information forward which is
essential for the research to be reliable, relevant and effective. It requires the researcher to be
analytical and not mere descriptive. Being analytical needs all the strengths and weaknesses of
research effectively evaluated for enhancing its understandability and applicability by completely
removing those weaknesses. There are several critical appraisal tools available which could help
the research to be utmost effective and rightfully applicable. It is crucial for researcher to choose
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the tool which increases scope of the research to be informative and helpful in nature. For the
same, appraisal tool appropriate for this research is Critical Appraisal Skills Programme (CASP),
which would provide a framework for the researcher to enhance the quality of information and
appraise all the relevant and reliable aspects of the overall data. This tool is very effective as it
provides diversified methods to critically evaluate the research such as checklist for the
researcher to conduct a systematic review of their research.
Method Of Analysis
Various methods and aspects are being used in this research to effectively fulfil each
requirement. It is crucial to choose the most appropriate method of analysis in order to
effectively carry out the research in a systematic manner. For the same, thematic analysis is
being used to combine and align the findings for this dissertation. This is because it is an
effective tool to derive a pattern and a flow from research findings (Braun and et. al., 2019).
With a cluster of effective methods, this analysis is very flexible which further enhances its
applicability. Within this analysis, inductive method is being utilised which would allow the
researcher to develop contributing themes from the researched information in ways which could
contribute in conduction of appropriate research.
PRISMA Flow Chart
This flow chart clearly describes the stages through which information is gathered and
analysed effectively. It describes each stage of collecting information from identification of
crucial information to its induction. PRISMA flow chart enables researcher to describe the flow
in which each article is read, screened and deemed eligible.
For this research, the PRISMA Flow Chart is described below:
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Illustration 1: PRISMA Flow Chart
CASP Checklist
Refer to Appendix- 1
CHAPTER 3- FINDINGS
Within any research, it is quite imperative to determine the most relevant information that
could satisfy the research aims and objective and helps in including the most appropriate type of
information necessary to carry out the research as per the pre set requirements (Noble and Smith,
2015). For experiences of parents during long-term hospitalisation of their children, more than
350 articles were screened throughout the information gathering process from which each article
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was rightfully screened, some of which were able to provide the most appropriate information.
Ultimately, their eligibility was judged and only those articles are used which effectively
provides information related to the research topic. Choosing appropriate information for the
research effectively helped in performing in-depth analysis which could appropriately fulfil its
agenda.
Study Characteristics
These characteristic enables appropriate and systematic segregation of the information
gathered and methods used to collect them. It is an imperative practice which is crucial for the
researcher to present relatable and relevant information which could be used to determine
various aspects related to this research.
While most of the identified articles used qualitative methods like structured interview
and synthesis, one article used numeric and quantitative approach to effectively give accurate
and statistical information about the research study. It is crucial to conduct effective research
which could satisfy research criteria and could be used systematically to use this for future
studies.
Article Summary Table
Authors
and Study
Title
Date and
Country Objectives Methods Sample Findings
Strengths
and
Limitations
Franck,
L.S., and et.
al., 2015.
Predictors
of parent
post-
traumatic
stress
symptoms
after child
hospitalizati
2015,
San
Francisco
, United
States;
London,
United
Kingdom
The aim of this
study was to
identify the
predictors or
factors which
induces post-
traumatic
stress
symptoms
followed after
child
Standard
questionnaire
s have been
used to
determine
and identify
the distress
levels
following
hospitalisatio
n of their
Parents
whose
children
were
admitted in
paediatric
ward were
chosen as
sample.
107 parents
filled up
Several
parents were
experiencin
g Post-
Traumatic
Stress
Symptoms.
While there
were some
too who
elevated
While the
study is
effective
enough to
identify the
predictors of
post
traumatic
stress
symptoms
and their
9

on on
general
paediatric
wards: a
prospective
cohort
study.
Internationa
l journal of
nursing
studies.
52(1).
pp.10-21.
hospitalisation children. In
addition,
correlation
as well as
multiple
regression
have been
utilised to
identify as to
whether
distress of
parents and
coping
strategies as
well as
resources
predicted
PTS
symptoms
after 3
months of
discharge of
their
children.
questionnai
res during
hospitalisat
ion as well
as 3 months
after their
discharge.
from any
such
symptoms.
Moreover,
various
factors like
self-blame,
denial and
other
negative
coping
strategies
along with
uncertainty
and anxiety
were found
as
prominent
factors
which
enhanced
such
symptoms.
hospital
experience.
However,
the study
limits the
methods
through
which
further
support
could be
given to the
parents
while
hospitalisati
on of their
children.
Wigert, H.,
Berg, M.
and
Hellström,
A.L., 2010.
Parental
presence
2010,
Sweden,
Europe
The objective
of this research
was to
determine
factors which
either
facilitated or
Structured
interview
was
undertaken
by the
researchers
parents of
67 parents
of 42
children
were
interviewed
for this
research
Presence of
parents at
the NICU's
were
completely
dependant
upon the
The study
effectively
reveals that
there is a
dire need for
conditions
of hospitals
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when their
child is in
neonatal
intensive
care.
Scandinavia
n Journal of
Caring
Sciences.
24(1).
pp.139-146.
obstructed
presence of
parents while
their child is
present in
Neonatal
Intensive Care
Unit (NICU).
two NICUs
who
registered
specific
timelines for
which they
were present
in the
hospital.
where the
interview
was circled
around
their time
spent in
NICU and
aspects
affecting
their
presence.
accommodat
ion types
offered.
While
occupants of
parent
rooms in at
the units
showed
higher
presence in
comparison
to those who
stayed at
maternity
wards,
homes or
family
hotels. The
motivators
of presence
of parents
were their
responsibilit
ies towards
their
children,
condition of
child and
urge to have
control.
to be
friendly
which
provides
quite
contributing
and
outstanding
facilities to
these
parents and
take their
will of being
with their
children into
consideratio
n. However,
the study
limits the
scope and
ways which
could ensure
fulfilment of
this need to
facilitate
presence of
parents in
such units.
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While a
friendly
environment
, effective
staff
treatment
and quality
care served
as
facilitating
factor, a
non-friendly
environment
, parents' ill
health and
home
responsibilit
ies are the
obstructing
factors.
Mikkelsen,
G. and
Frederiksen,
K., 2011.
Family‐
centred care
of children
in hospital–
a concept
analysis.
Journal of
2011,
Denmark
This research
aimed at
conducting an
effective
analysis of
provision of
family-centred
care to
hospitalised
children.
A systematic
and
appropriate
literature
review have
been
conducted
including
various
articles and
methodologi
25 articles
from 1951
to 2009
were
utilised to
conduct
this
analysis
and to
determine
the concept
This
research
weighed on
the concept
of
developing
healthy
relationship
between the
management
and parents
While the
arguments
present in
this research
are strong
enough to
define the
concept, it is
still required
of them to
be clarified
12

advanced
nursing.
67(5).
pp.1152-
1162.
es provided
by Risjord to
differentiate
between
colloquial
and
theoretical
analysis and
principles
delivered by
Penrod,
Hupcey and
Morse have
been used to
analyse
concept's
scientific
maturity.
of family-
centred
care given
to
hospitalised
children.
which could
provide a
better care
and
treatment to
hospitalised
children. It
also argued
on the
concept of
involving
parents at
step of
treatment to
ensure a
comfortable
environment
for them
while their
child is
hospitalised.
effectively
to ensure
better
understandi
ng of the
research. It
is still
unclear on
the
partnership
of
professional
s and
parents and
the conflict
is not
effectively
explained in
the research.
Kästel, A.,
Enskär, K.
and Björk,
O., 2011.
Parents’
views on
information
in childhood
cancer care.
European
2011,
Sweden
The aim of this
research was
to effectively
identify the
views of
parents
regarding
information
provided by
the caring
Qualitative
method have
been chosen
for the study.
Structured
interviews
were
conducted to
derive
information
8 families,
belonging
to different
background
s were
indulged in
five
interviews
each. The
interviews
The results
of these
structured
interview
denoted the
importance
of fulfilling
the needs of
parents.
Such
While the
research
carried out
highlights
ways in
which
improvemen
t could be
obtained
through
13

Journal of
Oncology
Nursing.
15(4).
pp.290-295.
units whose
children have
been suffering
from cancer.
from
families
whose
children
have been
suffering
from cancer.
of these
personnels
were taken
during the
initial year
of illness of
their child.
fulfilment is
purely based
on the
information
which is
provided to
them. It also
explored the
manner and
ease of
procurement
of
information
regarding
the medical
care. It
determined
the need for
distinctive
instructions
to be given
to parents to
enhance
their coping
with the
situations.
provision of
information,
however,
the
information
limits to
achieve
aspects of
provision of
such
information.
Ananth, P.,
and et. al.,
2015.
Hospital use
in the last
2015,
United
States
The objectives
of this research
was to identify
the hospital
use by
Quantitative
Analysis is
being used
along with
linear
1,252
children
have been
analysed in
this
Quite useful
information
have been
derived
from this
This
research is
quite useful
to determine
the type and
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year of life
for children
with life-
threatening
complex
chronic
conditions.
Pediatrics.
136(5).
pp.938-946.
children who
were suffering
from Life-
threatening
Complex
Chronic
Conditions
(LT-CCCs).
models to
determine
hospital
days,
admissions,
costs as well
as
interventions
like surgeries
and
mechanical
ventilations.
research
who were
between the
age group
1-18 years
who, within
40 US
hospitals,
died in
2012. For
such
Quantitativ
e analysis,
Paediatric
Health
Information
System
database
has been
accessed to
determine
the
statistical
information
derived for
this study.
research
which gave
useful
information
about how
many
children
required
hospital
services,
costs
incurred
within their
hospitalisati
on and
diseases due
to which
long-term
hospitalisati
on was
required.
number of
conditions
which
require such
intense
medical
attention
and greatest
hospital use.
However, it
lacks the
qualitative
aspects and
experiences
of parents
and children
who were
hospitalised
with such
grieve
diseases.
Smith, J.,
Swallow, V.
and Coyne,
I., 2015.
Involving
2015,
United
Kingdom
Objective of
this research
was to foster
collaboration,
engagement
Concept
Synthesis
has been
used in the
research to
For this
qualitative
research,
30 studies
were
Research
finds all the
factors
which
emphasise
The most
effective
aspect of
this study is
that it
15

parents in
managing
their child's
long-term
condition—
A concept
synthesis of
family-
centered
care and
partnership-
in-care.
Journal of
paediatric
nursing.
30(1).
pp.143-159.
and
empowerment
as methods to
effectively
enhance the
scope of
improvement
in treatments
given to
children
suffering from
long-term
conditions.
determine
attributes
and
antecedents
underpinning
partnership
in-care and
family-
centred care
models.
effectively
reviewed to
determine
factors
which
support the
concept of
this study.
on
entrenched
professional
practices,
unclear
roles as well
as limited
guidelines
to support
implementat
ions. The
central
focus of this
study was to
identify
ways in
which trust
could be
built by
professional
s by taking
their views
into
consideratio
n.
clearly
provides a
structure of
how parent
involvement
could
enhance the
relationship
between
parents and
professional
s and how
such
effective
partnerships
could
support the
parents of
children
with long-
term
conditions.
Identification of Themes
After determining appropriate research articles, next step calls for identification of
prominent themes which could further give an in-depth review of the study. For this research,
most crucial themes are described below:
Theme 1: Impact of Long-term hospitalisation of children on parents' health
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From this research, almost all the articles determined effectively the impact of long-term
hospitalisation of children on the health of parents. Parents seem to be suffering from post
traumatic stress symptoms even after discharge of their children. The article by Linda S. Franck,
Jo Wray, Caryl Gay, Annette K. Dearmun, Kristy Lee and Bruce A. Cooper, (2015), effectively
determines that there are various conditions which induces such a negative aspect and stress on
parents while their child is hospitalised.
Out of all the subjects, 32.7% of parents showed levels of post traumatic stress
symptoms. This research also gives an insight to the need of various actions that are required to
be taken to improve this experience and reduction of such a stress.
Theme 2: Factors influencing parental presence in hospital
The article by Helena Wigert, Marie Berg, Anna-Lena Hellstorm, (2010) gives a quite
crucial theme for determining experience of parents while in hospital. This study effectively
determines that there are various factors which influences parents' time in hospital, especially in
Neonatal Intensive Care Unit.
Interviews by various parents helped in a structured analysis of the factors that either
obstruct or facilitate their presence with their children. The study derives that if the environment
is friendly and supportive, parents are likely to be then involved while their children are present
in the hospital. However, the opposite restrains and restricts their presence in the hospital. As per
this research, it derives that effective and contributing environment is in dire need for hospitals to
enhance the involvement of parents in medical processes of the unit. In addition to this, the
theme also identifies that attention must be given to parents to consider whether they like to be
present or not. It must be upon their own will to witness the treatment given to their children by
the NICU.
Theme 3: Family-centred care
As per the study by Gitte Mikkelsen and Kirsten Frederiksen, (2011), family-centred care
is a concept that must be included in giving healthcare services to children. This study gives light
to the concept that it would influence care given to hospitalised children by involving their
parents in treatments.
However, this aspect has its own advantages and limitations and such consequences are
outlined as well as discussed within this study. It also outlines the perspective of ill children and
analysis the intensity in which the involvement of parents should be within the treatment. Thus,
17

this theme has put emphasis on the concept of family-centred care and its application within
healthcare settings.
Theme 4: View of parents on information provided to them
From information presented above in the article by Anne Kästel, Karin Enskär and Olle
Björk, (2011), parents must be given importance while disclosing crucial information about
harmful medical conditions like cancer. This study makes way for how improvement could be
achieved in treatment as well as how parents could better cope up with their child's illness.
However, while approaching parents regarding their views on information provided to them,
dissimilar and contrast views were given in respect to acquisition of information. While the study
reveals that some parents acquired necessary information quite easily, others really had to
struggle for it. This theme provides a deep insight on how, when and what information must be
provided to parents which hospitalised children. It gives a light on current practice and how
improvements could be achieved in respect to provision of information and dealing with
hospitalisation of children.
Theme 5: Hospital use of children
A study by Prasanna Ananth, Patrice Melvin, Chris Feudtner, Joanne Wolfe and Jay G.
Berry, (2015), highlights aspects regarding hospital usage of children suffering from Life-
Threatening Complex Chronic Conditions. This quantitative approach gives insight to various
conditions which causes long-term hospitalisation and frequent hospital use of children.
This study has used quantitative methods like use of statistics and effective data applying
a range of multi-variable analysis taking information of numerous hospitals into consideration.
Through such a wide analysis, research reveals that various diseases and life-threatening
conditions results in such robust and intensive requirements for hospital and medical services.
The research reveals that cost incurred by parents to acquire medical services depends
heavily on condition their child is suffering with. It revealed that children suffering from
immunological/haematological conditions required greatest hospital used along with various
other conditions including respiratory systems, metabolism, etc. Thus, this theme would be
useful regarding information about a number of chronic conditions inducing higher hospital use
and cost incurred for the same. However, still this research is purely based on statistical and
quantitative information and lacks in providing a qualitative insight on experiences of parents of
children suffering from such conditions.
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Theme 6: Achievement of improvement in treatments
Joanna Smith, Veronica Swallow and Imelda Coyne, (2015) through their article,
provided their a combined view of how involving parents of children suffering with long-term
conditions could help in achieving improvement in nursing and medical practices. Parents, in this
study are given central role considering their knowledge about their children and prioritising
their concern while treating their child to ensure a better health condition. This theme emphasise
the need to improve collaboration of medical professionals and parents ensuring quality
treatment given to children suffering with long-term conditions. Existing practices along with
their limitations are evaluated by this theme in hope to improve experience of parents whose
children are hospitalised.
Summary
This chapter is quite effective in emphasising on parents' experiences while their child is
hospitalised for long-term. It gives a detailed and critical review of the literature and showed
areas and aspects covered by the articles in respect to determining experiences of parents. This
chapter also identifies the need for further recommendations in existing medical practice that
could ensure effective improvements in parents' conditions and experiences while their children
are hospitalised.
CHAPTER 4- DISCUSSION
This chapter undertakes a brief discussion of themes mentioned above in respect to
existing medical guidelines and literature. All the six themes identified above provides analysis
and useful information about parents' experiences. However, below is the discussion of various
themes used in this research which emphasises on experiences of parents:
Discussion on Themes
Parental Health
The existing literature is based on impact on parents' health while their children remain
hospitalised. It is quite a negative experience which makes it natural to implicate negative impact
on their health. Non-cooperation and non-acquisition of support and effective information about
their children' s health amplifies the negative effects on their health. This also cause difficulties
in treatments given to their children.
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As per Frank Muscara and et. al. (2015), the experience of parents having children with
some serious illness is quite distressing. The degree up to which distress levels affects these
parents and their coping up with such levels depends on different individuals. While some shows
spontaneous recovery, others take a substantial amount of time. The existing literature presents
information about various symptoms and after effects like Post -Traumatic Stress Symptoms
which negatively impacts their health to sometimes clinically dangerous methods. This study
calls for support given to such parents and take measures to understand their condition and
provide them with utmost support and comfort to better cope up with the situation.
Parental Presence
As per various guidelines set out by General Medical Council UK, parents must be
considered while providing treatment to their children. Their presence must be dependant on
their own will while treatment is given to their child. However, it is crucial that the professionals
provide them effective and friendly environment for them to be present and provide their
assistance in care given to their child. Such support would put a positive impact on their
experience and it could help in building an effective bond and sense of optimism in their minds.
Such positive thinking could allow them to cope up with situation and illness of their child in a
better manner and would be better for their health.
Family-centred care
Within medical and healthcare settings, a need which is constantly arising is the adoption
of a culture fostering family-centred care given in hospitals. It is a practice of developing an
effective relationship between parents and the medical professionals. However, current practices
are not very much inclined in ways which promotes this practice. According to a research by
Shields, L., and et. al., (2012), this practice must be included in healthcare settings in a way
which could ensure quality treatment. This theme puts emphasis on ensuring satisfaction of
parents.
However, there are negative implications of this practice. As per guidelines by General
Medical Council, UK, patient must be a doctor's first concern. While their hospitalisation, there
are various harsh measures and treatments that are required to be taken to ensure safety of the
patient. Involvement of parents and providing family-centred care might reduce or in some cases,
eradicate the possibility for professionals to take such measures. It is thus, necessary for these
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professionals to include parents of children who are hospitalised but must govern their decisions
which is in the best interest of patients.
Parents' view on information
Appropriate, timely and accurate information is necessary to ensure quality care. It
consists of treatment provided to their child, medicines regarding their treatment, possible after
effects, etc. Such aspects provide information to parents about whether appropriate treatment is
being given to their child or not. As per Department of Health, parents possess the right to access
each and every information which concerns healthcare provided to their child.
This research depicts that consent plays a very important role in giving accurate and
effective treatment to children. However, current practice within the healthcare is required to
improve this element to elevate the experience parents have while hospitalisation of their
children. Providing all the possible information timely would enable parents to cope better with
serious illnesses like cancer. Thus, it is of vital importance that the right to information is
accessed by parents and is well provided by professionals.
Hospital Usage
This theme its centred around children's hospital use. Information of such aspect is quite
useful in terms of determining type of diseases and illness which causes long-term
hospitalisation of children. Such studies give insight as to what medical prevention measures
must be taken to reduce such vast numbers of hospital usage. While the existing literature
emphasises on rising hospital admissions, National Health Service, has drawn out various
guidelines which could be implemented by parents and carers to ensure protection of their
children from various harmful diseases and chronic conditions.
According to these guidelines, people must take various measures to protect children
from suffering chronic diseases and other severe illness. These guidelines include various
hygienic methods and other measures that could be taken in order to ensure less hospital use and
admissions.
Improvement in Treatments
Existing literature emphasised on demand of improving the medical practices and
treatments provided by professionals to children with long-term conditions. The main aspect of
this theme relates with involving parents during healthcare services.
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Antje Aarthun, Knut A. Øymar and Kristin Akerjordet, (2019) gave insight on how
decision-making while provision of care could improve due to parental involvement during
hospitalisation of children. According to their study, parents' experience and their ability to deal
with their child' s situation could enhance if their role is increased in healthcare provided to their
offspring. Medical professional and healthcare staff have a very prominent role in strengthening
parents' sense of consistency and cooperation which could enhance scope of quality care and
could help achieving improvement in experience of parents whose children have been
hospitalised.
Recommendations for research, practice and education
There is always a scope of improvement in every research and effective guidance would
further provide room for recommendation which could remove and reduce the limitations of
literature review. There are three wide areas where these recommendations could be applied:
Research
Various studies undertaken to determine parents' experience during long-term
hospitalisation of their children requires a broader scope and wider research to cover the areas of
limitations as well. For instance, study by Prasanna Ananth, Patrice Melvin, Chris Feudtner,
Joanne Wolfe and Jay G. Berry, (2015) could have researched on various qualitative aspects
regarding experiences of parents bearing the loss of children with chronic conditions. Along with
this, Helena Wigert, Marie Berg, Anna-Lena Hellstorm, (2010) could have further developed
their study to define methods through which parental presence could have been facilitated.
Practice
The whole study and each article depicted that an immediate need is arising to ensure that
modifications in existing healthcare practice are required to be implemented. The sole reason
being welfare of patients as well as experiences of parents. Healthcare staff must play a vital role
in determining that effective information is being provided to parents along with proper support
and comfort given to parents whose children are within the premises requiring medical attention.
Such practices would enhance professionalism along with ensuring trust between the hospital
management and parents.
Education
It is a dire need to educate healthcare professionals the methods that could be applied to
amplify a sense of comfort and trust in parents and allow them to give their full support and
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consent to measures and treatment methods applied by hospitals. Moreover, parents of
hospitalised children must also be educated in terms of dealing in a better manner with child's
illness and methods which could be applied by them to ensure that their child gets proper care
even after their discharge from the healthcare facilities.
Review Limitations
Outlining limitations gives scope for further improvement and ensuring better practice in
ways which could contribute to a better research. The study conducted above was based on a
topic that was quite subjective in nature. Thus, it was a very hectic task to gather information that
could seem accurate and serve well to research criteria. Various resources have been utilised to
fulfil the requirements of this study, such as time and cost. Limited resources were applicable to
conduct a research with such vast scope and area of coverage and thus, it was difficult for
including each aspect of such a study. Along with this, with such a subjective content, each
perspective has to be taken into consideration which serve effectively to the research which
requires expertise and enhanced knowledge. However, maximum effort and attempt have been
put in to conduct the study and include each aspect contributing to fulfilment of its agenda and
analysing parents' experience effectively.
CONCLUSION
Thus, it is concluded from the above information, that it is crucial to determine parents'
experiences whose children have been long-term hospitalised. Various research methods like
thematic analysis could be utilised to conduct effective research and collect information that
could be used to analyse aspects of the research. Lastly, it is crucial to improve medical practices
and training and education must be given to health care professionals in order to achieve
improvement in experiences of parents of long-term hospitalised children.
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REFERENCES
Books and Journals
Aarthun, A., Øymar, K.A. and Akerjordet, K., 2019. Parental involvement in decision‐making
about their child’s health care at the hospital. Nursing open. 6(1). pp.50-58.
Ananth, P., and et. al., 2015. Hospital use in the last year of life for children with life-threatening
complex chronic conditions. Pediatrics. 136(5). pp.938-946.
Braun, V., and et. al., 2019. Thematic analysis. Handbook of Research Methods in Health Social
Sciences, pp.843-860.
Calvert, K., 2015. Maximizing academic library collections: measuring changes in use patterns
owing to EBSCO Discovery Service. College & Research Libraries. 76(1). pp.81-99.
Franck, L.S., and et. al., 2015. Predictors of parent post-traumatic stress symptoms after child
hospitalization on general paediatric wards: a prospective cohort study. International
journal of nursing studies. 52(1). pp.10-21.
Hadi, M.A. and Closs, S.J., 2016. Ensuring rigour and trustworthiness of qualitative research in
clinical pharmacy. International journal of clinical pharmacy. 38(3). pp.641-646.
Kästel, A., Enskär, K. and Björk, O., 2011. Parents’ views on information in childhood cancer
care. European Journal of Oncology Nursing. 15(4). pp.290-295.
Mikkelsen, G. and Frederiksen, K., 2011. Family‐centred care of children in hospital–a concept
analysis. Journal of advanced nursing. 67(5). pp.1152-1162.
Muscara, F., and et. al., 2015. Parent distress reactions following a serious illness or injury in
their child: a protocol paper for the take a breath cohort study. BMC psychiatry. 15(1).
p.153.
Noble, H. and Smith, J., 2015. Issues of validity and reliability in qualitative research. Evidence-
based nursing. 18(2). pp.34-35.
Shields, L., and et. al., 2012. Family‐centred care for hospitalised children aged 0‐12 years.
Cochrane database of systematic reviews. (10).
Smith, J., Swallow, V. and Coyne, I., 2015. Involving parents in managing their child's long-term
condition—A concept synthesis of family-centered care and partnership-in-care.
Journal of paediatric nursing. 30(1). pp.143-159.
Wigert, H., Berg, M. and Hellström, A.L., 2010. Parental presence when their child is in neonatal
intensive care. Scandinavian Journal of Caring Sciences. 24(1). pp.139-146.
Online
Child hospital stays 'keep rising'. 2019. [Online] Available Through:
<https://www.bbc.com/news/health-21415142>
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<https://www.ncbi.nlm.nih.gov/pubmed/21917594>
Wray J., and et. al. (2019). Parent Stress and Coping During Child Hospitalisation. [Online]
Available Through: <https://www.nature.com/articles/pr20101631>
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APPENDIX- 1
CASP Qualitative Appraisal Tool
Illustration 2: CASP Checklist
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Illustration 3: CASP Checklist
Illustration 4: CASP Checklist
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