Future Health Care Professionals’ Knowledge of Developmentally Appropriate Care with Children in the Health Care Setting

By Jessica Wente, MS, CCLSFlorida Hospital for Children

Show of Hands

The U.S. Department of Health and Human Services (2010) reports that in 2009:

• 91.5% of children had contact with a health care professional

• 20 vaccinations by the age of 6

• 5 million children will have surgery in the United States every year

(Brady, Avner & Khine, 2011; Kain, Mayes, Caldwell-Andrews, Karas & McClain, 2006)

Hospitals are scary looking places…

• 90% of children have at least one fear in the hospital setting▫Needles and injections ▫Anesthesia induction

• When children resist treatment and medical care, this will cause ▫Schedule delays▫Increase in the number of staff▫Increase in resources

The Health Care Experience for Children

(Salmela, Salantera & Aronen, 2009; Brady, Avner, & Khine, 2011; Hamilton, 1995; MacLaren & Kain, 2009; Kain, Mayes, O’Connor & Cicchetti, 1996; Chorney & Kain, 2009; Eldridge & Kennedy, 2010)

•Hospitalization presents many challenges for children including:

(Bell, Johnson, Desai & McLeod, 2009; McCann & Kain, 2001; Eldridge & Kennedy, 2010; Bolig & Weddle, 1988)

The Health Care Experience for Children

•Children who are hospitalized may experience:

(Thompson, 1994; Chorney & Kain, 2009; McCann & Kain, 2001)

The Health Care Experience for Children

• Various factors contribute to a child’s emotional reaction to the hospital setting, including the child’s:

• Studies show that children who are most vulnerable to long-term negative outcomes in the hospital setting:

_

The Health Care Experience for Children

(Kain, Mayes, O’Connor, & Cicchetti, 1996; Eiser, 1990; Rennick et al, 2002; Thompson, 1985; Hurtig, Koepke, & Park, 1989; Brewer, Gleditsch, Syblik, Tietjens, & Vacik, 2006; Mahoney, Ayers, Seddon, 2010; Kain et al, 1996; Kain et al, 1996; Dahlquist, Gil, Armstrong, DeLawyer, Greene, & Quori, 1986; Thompson & Snow, 2009; Chorney & Kain, 2009)

Health Care Professionals Can Help

• Promote coping behaviors in children during procedures ▫ (Mahoney, Ayers, & Seddon, 2010; Brewer, Gleditsch, Syblik,

Tietjens, & Vacik, 2006; Lipsitz, Gur, Albano, & Sherman, 2011)

• Psychological preparation and support can improve “the efficiency of emergency care delivery as well as improve patient, family, and health care staff satisfaction” ▫ (Eldridge & Kennedy, 2010, p. 249)

•Health care professionals can also learn how to make certain routine treatments more bearable for children. ▫Example: reducing pain and distress in

infants (Hanson, Hall, Mills, Au, Bhagat, Hernandez, Slomba & Ali, 2010).

Health Care Professionals Can Help

Knowledge of child development is important for:

• Communicating with children

• Understanding how children perceive situations

• Understanding how children perceive pain and cope with it

Health Care Professionals Can Help

(Perrin & Perrin, 1983; Vacik, Nagy, & Jessee, 2001; Simons & Roberson, 2002)

•nurses’ knowledge deficits and poor communication with parents lead to poor pain management in children postoperatively▫ (Simons & Roberson, 2002)

•pediatric providers often do not utilize strategies to relieve pain and anxiety associated with immunizations▫ (Schechter, Bernstein, Zempsky, Bright & Willard

2010)▫ (Brady, Avner & Khine, 2011)

The Need for Further Training

Focus of Research

•How prepared are students in the health care field to work with children? ▫Nursing▫Medical▫Physician assistant▫Physical therapy▫Non-clinical health care students

Perrin & Perrin (1983)• Pediatricians, nurses, and child development students were

only accurate in estimating the age of the child less than 40% of the time

• Health care professionals and students often overestimated what young children were able to understand, and underestimated what older children were able to understand

• Learning how children understand illness may improve health care providers’ communication with children.

Your defenses need a chance to build back

up so your body can fight the disease.

Vacik, Nagy, & Jessee (2001)• Nursing, social work, child life, and counseling

education students

• “many problems encountered during a child’s hospitalization might be avoided if adults could view the situation from the child’s perspective and with a child’s understanding,” (p. 429)

• “the students correctly categorized by age, children’s statements regarding illness concepts only 38% of the time and correctly identified knowledge statements 50% of the time,” (p. 429)

Resting gives whatever’s the matter

with you time to heal.

How can children get better again?

Eat fruit and

chicken soup.

Medicine helps your body attack the germs.

Concrete Early

Preoperational

Concrete Late Formal Operational

• Does knowledge of developmentally appropriate care (DAC) and intent to attend training on DAC vary by field of study?

• Does knowledge of DAC and intent to attend training on DAC vary by intent to work with children?

• How do demographics and participant characteristics predict knowledge of DAC and intent to attend training on DAC?

Research Questions

The InstrumentDevelopmentally Appropriate Care for Children in the Health Care SettingThank you for taking time to complete this questionnaire! Please read instructions for each

section carefully and complete to the best of your ability. Each page has a front and back portion to complete.

Part IThis portion of the questionnaire will test your knowledge of developmentally appropriate

practice with children in the hospital setting.  These items have been developed using material from a retired Child Life Professional

Certification Exam. These items are not representative of each domain that is tested on the exam and many items have been altered for clarity for individuals in fields other than child life. As a result, your performance on this survey is not an accurate assessment of what your performance would be on the Child Life Professional Certification Exam. The Child Life Council has given the principal investigator of this study express permission to use these retired exam items that are protected under copyright law.

 Directions: Please circle the answer that you believe to be correct. Throughout the

questionnaire, assume the following ages for each developmental stage unless otherwise specified in the question:

Infants (Under 1 year)Toddlers (1-2)Preschoolers (3-5)School-Age (6-11)Adolescent (12-18)

 

This is an improvement on past measures used to

assess health care professionals’ and

students’ knowledge.

Scale Reliabilities

•Patient-Practitioner Orientation Scale α = 0.76

•Confidence in providing DAC scale α = 0.87•Interest in future training scale α =

0.91

Statistics about the sample

Frequency Percent Mean Standard Deviation

Field of Study Nursing Medical Physician Assistant Physical Therapy Non-Clinical Health Care

1972001125486

30.430.817.38.313.3

Gender Female Male

481167

74.225.8

Race White/non-Hispanic Black/non-Hispanic Hispanic/Latino Asian/Pacific Islander Native American Multi-racial Other

4663345750198

72.15.17.011.6 0.0 2.91.2

Graduate/Undergraduate Graduate Undergraduate

501147

77.322.7

Age 25.1 5.06

Table 4-1. Characteristics of Students in the Overall Sample

Statistics about the sample by fieldTable 4-2. Characteristics of Student Samples by Field of Study

Nursing Medical Physician Assistant

Physical Therapy

Non-Clinical Health Care

Gender Female Male

190 (96.4)7 (3.6)

102 (51.3)97 (48.7)

94 (83.9)18 (16.1)

38 (70.4)16 (29.6)

57 (66.3)29 (33.7)

Race White/non-Hispanic Black/non-Hispanic Hispanic/Latino Asian/Pacific Islander Multi-racial Other

152 (77.2)11 (5.6)17 (8.6)12 (6.1)5 (2.5)0 (0.0)

121 (61.1)14 (7.1)12 (6.1)38 (19.2)8 (4.0)5 (2.5)

99 (88.4)1 (.9)6 (5.4)6 (5.4)0 (0.0)0 (0.0)

42 (77.8)0 (0.0)3 (5.6)8 (14.8)0 (0.0)1 (1.9)

52 (61.2)7 (8.2)7 (8.2)11 (12.9)6 (7.1)2 (2.4)

Year in Program Graduate 1st Year 2nd Year 3rd Year 4th Year Other Undergraduate 1st Year 2nd Year

23 (46.9)15 (30.6)3 (6.1)1 (2.0)7 (14.3)

131 (89.7)15 (10.3)

74 (37.2)50 (25.1)6 (3.0)69 (34.7)

54 (48.2)58 (51.8)

54 (100.0) 41 (47.7)32 (37.2)9 (10.5)

Age M = 24.2 SD = 7.42

M = 24.5SD = 1.94

M = 26.3 SD = 3.65

M = 26.4 SD = 4.40

M = 26.1SD = 4.95

Table 4-2. Characteristics of Student Samples by Field of Study

•Does knowledge of DAC vary by field of study?

Results

•Post hoc analysis: Did professional experience vary by field of study?

Results

•Post hoc analysis: Did knowledge of DAC vary by clinical field of study?

Results

•Does intent to attend training on DAC vary by field of study?

Results

Results• Post hoc analysis: Were students who intend to

work with children more engaged in more professional experience with children?

•Does knowledge of DAC vary by intent to work with children?

Results

•Did interest in future training on DAC vary by intent to work with children?

Results

•How do demographics, life experiences, and participant attitudes predict knowledge of DAC?▫Significantly associated with:

patient practitioner orientation (β = .21, p < .001)

Age (β = .15, p < .001) clinical vs. non-clinical fields of study (β

= .15, p < .001) with lower levels of knowledge in the non-

clinical students▫Negatively associated with confidence in

providing DAC (β = -.08, p = .045)

Results

•How do demographics and participant characteristics predict intent to attend training on DAC?▫Predictive:

Confidence in providing DAC (β = .13, p = .003) Personal experience with children (β = 12, p

= .003) Female (β = -.17, p < .001) Younger (β = -.09, p = .03)

▫Interestingly, there was no significant relationship between knowledge of DAC and intent to attend training on DAC (β = .00, p = .921)

Results

Limitations•Cross-sectional design•Correlation ≠ causation•All items on instrument weren’t validated

(CLC items)•Generalizability

Recommendations for Future Research•Instrument

▫Child Life Council’s updated core competencies

▫Child Life Council’s updated exam items▫Stronger experience variables/measures

•Relationship between DAC and patient-centered care

•Further studies should be done including non-clinical health care students

•What predicts DAC for physician assistant students?

Implications for Practice•Provide opportunities for training

▫In-services, courses, and experience-based trainings

▫Target students who plan to work with children & PAs

•Students may also benefit from learning how to be patient-centered

•Identify champions for DAC training

Implications for Practice• According to Adult Learning Theory, training

should:▫Be directly applicable to students’ professions▫Relate to students’ experiences▫ Involve problem-centered approaches to learning

(Abela, 2009; Kaufman, 2003)• Go beyond courses to teach DAC (Hafferty, 1998)

▫Formal Curriculum (courses and clinical experience)

▫ Informal curriculum (interactions b/w professors and students)

▫Hidden curriculum (organizational and cultural influences)

Implications for Practice

•Humanism in Medicine: Indiana University

•For professionals already in the field, Levetown & the Committee on Bioethics (2008) notes that it is difficult to engage physicians in further training due to lack of time and monetary reward in doing so▫Align incentives▫training should be an appropriate length and

at a good time

Open Discussion

•What are you doing for training and in-services at your hospital?

•What are your incentives?

•What challenges are you facing?

Evidence-Based Training!

• For example, a “1-hour teaching session had measurable effects on the use of pain-reducing strategies at 1 and 6 months after the intervention. This research supports the hypothesis that small-group teaching sessions at the site of care can be associated with changes in practice behaviors,” (Schechter, Bernstein, Zempsky, Bright & Willard, 2010, p. e1514).

Thank you for your time!

•Questions? Comments? Feedback?