Eliciting the Childs' Voice in Patient Experience

Saturday, 7 November 2015

Pamela Hinds, PhD, RN, FAAN
Department of Pediatrics, George Washington University, Washington, DC, USA
Mia K. Waldron, MSN-Ed, RN-BC, CPN
Nursing Research & Quality Outcomes, Children's National Health System, Washington, DC, USA

Practice problem – Patient satisfaction surveys have become a widely accepted measure of the quality of health care and are an important nurse sensitive indicator. However, these surveys have been focused on adults or the parents of children who receive care. To provide the best care for each patient, using a patient-family- centered care approach; the child’s voice must be considered.

Purpose– The project goal is to determine the feasibility of obtaining the child’s perspective, in regards to patient satisfaction with the nursing care received. Patient satisfaction was evaluated utilizing a 5-item electronic survey. The survey documented the perspectives of three age groups: 6-8 year olds, 9-12 year olds, and 13-17 year olds. The survey response options were illustrated on a separate sheet with three faces that ranged from smiling fully, to a neutral (straight line), to a frown. Corresponding word response formats (TRUE, SOMETIMES, and NOT TRUE) were printed below each face for all participants. Children approached, were inpatients for at least 24 hours, or outpatients, at the conclusion of their PACU s stay.

Summary of literature – Every year approximately 3 million children are hospitalized in the United States according to the National Center for Health Statistics1. The well and ill child’s voice in reporting on subjective symptom and quality of life experiences is now well established in the literature with emphasis on children ages 8 years and older with selective examples of younger children, including 5 to 7 year olds2-6.  The concept of children having a voice in their own health care has also gained credibility with children being included on inpatient rounds and in end-of-life decision making7-9.

Outcomes – The primary aim of this project was to demonstrate the feasibility of querying children about their satisfaction with nursing care experiences here at a free standing Children’s Health system in Mid- Atlantic The children and families were all receptive to participation in this survey; we had no refusals from families or children. The anticipated time for completion of the introduction, instructions, and implementation of the survey was 15 minutes; however in practice the time spent was less than 10 minutes for each encounter, inclusive of instructions and reading questions aloud in certain cases. A total of 36 children were interviewed from the three clinical areas representing all age ranges. Outcomes for this project were overwhelmingly positive and demonstrated both the feasibility and lack of burden for this type of patient satisfaction survey.

Conclusion and implications – Implications for pediatric nursing as a result of this project are the opportunity for patient experience recovery on occasions there are issues  with nursing prior to their discharge. Incorporation of the voice of children in planning care and decision- making is an important enhancement to nursing practice by eliciting the care experience feedback from the perspective of the child patient at the point of care in addition to only the parent. The further implications of this work will be the groundwork for establishing a link between patient experience perceptions of both parents and children, and post-hospital outcomes.