|Year : 2014 | Volume
| Issue : 2 | Page : 139-142
Fears of school-age children and parental perceptions of nursing support during hospitalization in a selected pediatric hospital, Mangalore
Helma Maria Monteiro1, Asha P Shetty2, Praveen V Bagali1
1 Department of Pediatric Nursing, K Pandyarajah Ballal Nursing Institute, College of Nursing Ullal, Mangalore, India
2 Department of Pediatric Nursing, Yenepoya Nursing College, Yenepoya University, Deralakatte, Mangalore, Karnataka, India
|Date of Web Publication||1-Jul-2014|
Asha P Shetty
Principal Yenepoya Nursing College, Yenepoya University, Deralakatte, Mangalore - 575 018, Karnataka
Source of Support: None, Conflict of Interest: None
Background: A child's hospitalization is usually an unpleasant and difficult experience, both for the child and parents. Unfamiliarity of the environment, uncertainty regarding outcomes, and painful procedures are just a few stressors during hospitalization that can create overwhelming anxiety for children and their parents. Objectives: The objectives of the study were to assess the fears of school-age children during their hospitalization, assess parental perceptions of nursing support during their child's hospitalization, and to find association between children's fear and selected variables. Materials and Methods: To accomplish the objectives of the problem under study, nonexperimental typical descriptive design was adopted. The study was conducted in Regional Advanced Pediatric Care Center, Mangalore with the sample size of 60 hospitalized school-age children and their parents. Non-probability purposive sampling technique was used to select the sample. The researcher used background proforma for children and parents, Modified Child Medical Fear Scale and Modified Nurse Parent Support Tool to collect data from hospitalized school-age children and their parents, respectively. The tools were assessed for their reliability with the similar sample and found reliable. Informed consent was obtained from the study subjects. Results: Majority of the school-age children (91.67%) had moderate fear and 8.33% had high fear of hospitalization. Majority (70%) of parents have perceived fully satisfactory nursing support and 30% were satisfied with nursing support provided during their child's hospitalization. There was no significant association between the fears and selected demographic variables such as age of the child, gender, number of days of hospitalization, and previous experience of hospitalization. There was no significant difference between the fears in different age-groups of hospitalized school-age children to the different areas of fear in the hospital, i.e., environmental, procedural, interpersonal, and intrapersonal fears. Conclusion: Nurses should encourage children to express their fears and discuss their coping strategies. Nurses can promote the quality of family-centered care and should be aware of the importance of the several types of nursing support in meeting the requests of parents.
Keywords: Fear, hospitalization, parental perceptions of nursing support, school-age children
|How to cite this article:|
Monteiro HM, Shetty AP, Bagali PV. Fears of school-age children and parental perceptions of nursing support during hospitalization in a selected pediatric hospital, Mangalore. Muller J Med Sci Res 2014;5:139-42
|How to cite this URL:|
Monteiro HM, Shetty AP, Bagali PV. Fears of school-age children and parental perceptions of nursing support during hospitalization in a selected pediatric hospital, Mangalore. Muller J Med Sci Res [serial online] 2014 [cited 2019 Oct 16];5:139-42. Available from: http://www.mjmsr.net/text.asp?2014/5/2/139/135748
| Introduction|| |
Hospitalization is the very stressful time for young children and their parents. Unfamiliarity of the environment, uncertainty regarding outcomes, and painful procedures are just a few stressors during hospitalization that can create overwhelming anxiety for children and their parents. 
Fear of unfamiliar things and people in the hospital environment is another stressor for young children. The stressors of hospitalization may cause young children to experience short- and long-term negative outcomes. Adverse outcomes are related to the length and number of admissions, multiple invasive procedures, and parent's anxiety. 
Parents frequently experience multiple negative emotions and have interruptions in normal functioning in response to their child's hospitalization. Fear, anxiety, and frustration are more common feelings expressed by parents. Parents of hospitalized children may become angry for several reasons including restrictions on visiting hours and unexpected deterioration in their child's condition. 
Parents need support from the nursing staff to learn about their child's illness, treatment measures, and hospital rituals and rules. They want nurses who care about them, listen to their feelings and concerns, and understand them as individuals. They also need to feel that the nursing staffs are providing the best possible care to their child with special, individualized approach. 
The main purpose of this study was to assess the fears of hospitalized school-age children regarding procedural interventions, hospital environment, interpersonal and intrapersonal aspects, and about parent's perception of nursing support which includes emotional support, esteem support, care-giving support, and informational support during their child's hospitalization.
| Materials and Methods|| |
The conceptual framework of the present study was based on Nightingale's environmental theory. The research approach used was nonexperimental descriptive approach with a typical descriptive design. Schematic representation of the conceptual framework is given in [Figure 1].
|Figure 1: Conceptual framework related to fears of hospitalized school-age children and parental perceptions based on Nightingale's environmental model|
Click here to view
The study was conducted in Regional Advanced Pediatric Care Center, Mangalore with the sample size of 60 hospitalized school-age children and their parents. Non-probability purposive sampling technique was used to select the sample. The researcher used background proforma for children and parents, modified child medical fear scale, and modified nurse parent support tool to collect data from hospitalized school-age children and their parents, respectively. Interview method was used to collect data from hospitalized school-age children and parents.
| Results|| |
Description of Background Characteristics of the Sample
As mentioned in [Table 1], percentage distribution of hospitalized children according to their age shows that samples were equally distributed (33.34%) in the age-group of 6-8 years, 9-10 years, and 11-12 years. Distribution of the sample according to gender shows that maximum of them (53.33%) were males and 46.67% were females. Distribution of sample according to number of days of hospitalization reveals that majority, i.e., 95% of samples were being admitted for <5 days and only 5% (i.e., 3 out of 60) were being admitted for 6-10 days. Table also indicates that according to previous experience of hospitalization, majority, i.e., 70% of school-age children got admitted once, 26.67% got admitted twice, and only 3.33% got admitted thrice.
|Table 1: Description of background characteristics of the children n = 60|
Click here to view
Background Characteristics of Parents
Distribution of parents of hospitalized school-age children according to their age shows that the highest percentage (51.67%) of the samples belonged to the age-group of 20-30 years, 36.67% belonged to the age-group of 31-40 years, and 11.66% belonged to the age-group of 41-50 years; majority (95%) of samples were females and 5% were males, all of the them were married and living with their family. The findings related to the educational status of parents reveal that the maximum, i.e., 43.33% had primary education, 36.67% had no formal education, and only 20% had high school education, 50% of the samples occupation was daily wages, and 50% were unemployed. Majority (83.33%) had a family income of less than or equal to Rs.5,000. Highest percentage (73.33%) of parents belonged to the nuclear family and remaining 26.6% were from joint family.
Analysis of Assessing Fears of School-age Children During Hospitalization
[Figure 2] shows that highest percentage (91.67%), i.e., 55 out of 60 of school-age children had moderate fear and 8.33% had high fear of hospitalization.
[Table 2] shows that the school-age children had highest mean percentage (65.33%) of fears in the area of intrapersonal fears which had mean and standard deviation (SD) of 9.8 ± 2. Area-wise analysis shows that mean percentages in the area of environmental fear, procedural fear, and interpersonal fear are 59.44%, 52.77%, and 32.85%, respectively.
|Figure 2: Bar diagram showing fears of school-age children during hospitalization|
Click here to view
Analysis of Parental Perception of Nursing Support During Their Child's Hospitalization
Analysis shows that 70% of parents have perceived nursing support as fully satisfactory and 30% as satisfactory. Area-wise analysis shows that parental perception of nursing support was highest (80%) in the area of emotional support. Mean percentage in the area of care-giving support, esteem support, and informational support was 75.75%, 72.22%, and 67.79%, respectively.
Association Between Children's Fears and Selected Variables
Chi-square test was computed to find the association between fears and the selected demographic variables which revealed that there was no significant association between the fears experienced by the hospitalized school-age children and selected variables such as age [c2 (2) = 0.436, P = 0.804], gender [c2 (1) = 0.390, P = 0.533], number of days of hospitalization [c2 (1) = 0.2871, P = 0.592], and previous experience of hospitalization [c2 (1) = 0.2597, P = 0.610].
Difference Between the Fears of Different Age-groups of Hospitalized School-age Children to Different Areas of Fears in the Hospital
The findings of analysis of variance (ANOVA) revealed that there was no significant difference between the fears in different age-groups of hospitalized school-age children to the different areas of fear in the hospital, i.e., environmental [F (2,57) = 0.69, P = 0.505], procedural [F (2,57) = 0.94, P = 0.397], interpersonal [F (2,5)7=0.9, P = 0.412], and intrapersonal fears [F (2,57) = 0.25, P = 0.779].
| Discussion|| |
The findings of the present study are in consistent to the study conducted in Nepal (2003) indicated that children have moderate fear of hospitalization with a mean of 18.7 (SD = 5.7). 
A similar study conducted by Ginimol (1998) in Udupi district reveals that 63.63% had mild fear, 36.66% had moderate fear with a mean 30.77 and standard deviation 14.44 on the day of admission, and 88.88% had mild fear and 11.11% had moderate fear on the day before discharge. 
In the present study, area-wise analysis shows that mean percentages in the area of intrapersonal fear, environmental fear, procedural fear, and interpersonal fear are 65.33%, 59.44%, 52.77%, and 32.85%, respectively.
Another study conducted in Nepal in 2004 revealed that Nepalese children reported higher fear scores than the American children. 
Study conducted in London (1992) reported that 90% of parents expressed satisfaction with the information given at diagnosis, the preparation they received before discharge, and the outpatient follow-up services. 
The similar study conducted in Canada (2002) found no significant relationship between children's responses and their age, the invasive procedures to which they were exposed, severity of illness, and length of hospital stay. 
| Conclusion|| |
Based on the study findings, it can be concluded that majority of the school-age children (91.67%) had moderate fear of hospitalization. Majority of children had fear in intrapersonal area (65.33%) which includes fear of sleeping alone in the bed, being with doctor and nurse in treatment room, etc. and only 32.85% of fear in the area of interpersonal fear which includes being separated from siblings and parents due to hospitalization.
Based on parental perceptions of nursing support, it can be concluded that majority of parents (70%) have perceived nursing support as fully satisfactory. Area-wise analysis shows that parental perception of nursing support was highest (80%) in the area of emotional support and least importance for the informational support (67.79%).
Findings of the study will help the nurses to recognize school-age children's fears which will enable nurses to consider the factors and areas of fear development in children to plan nursing care activities in such a way to reduce fears of children. It also helps the nurses to identify parents expectations related to nursing care of their sick child, thus improving family-centered quality care to hospitalized children.
The study has implications in the area of nursing education, nursing practice, administration, and research. Nursing educators and administrators can plan various in-service training program for the staff of the pediatric wards on assessment of fears of hospitalized school-age children thus to plan the care based on emotional needs of children. Administrators can teach the nursing staff about parental reactions during their child illness and hospitalization.
A similar study can be replicated/conducted using large sample to generalize the findings. A study can be done to assess to coping strategies used by the children against the hospitalized fear and effectiveness of in-service education to improve nurse - parent communication can be evaluated.
| Acknowledgements|| |
I am grateful to my guide Prof. Dr. (Mrs). Asha P. Shetty, co-guide Mr. Praveen V. Bagali, Medical superintendent, Regional Advanced Pediatric Care Center, Mangalore all the participants (children and parents) for their cooperation and support during the study.
| References|| |
|1.||Melnyk BM. Intervention studies involving parents of hospitalized young children: An analysis of the past and future recommendations. J Pediatr Nurs 2000;15:4-13. |
|2.||Ammentorp J, Mainz J, Sabroe S. Parents′ priorities and satisfaction with acute pediatric care. Arch Adolesc Med 2005;159:127-31. |
|3.||Mahat G, Scoloveno MA. Comparison of fears and coping strategies reported by Nepalese school age children and their parents. J Pediatr Nurs 2003;18:305-13. |
|4.||Ginimol A. A study of self reported fears of hospitalized school age children, and the association between the child′s fear and the anxiety level of mother in a selected hospital of Udupi district. Unpublished master of nursing dissertation submitted to Manipal University; 1998. |
|5.||Mahat G, Scoloveno MA, Cannella B. Comparison of children′s fears of medical experiences across two cultures. J Pediatr Health Care 2004;18:302-7. |
|6.||Lessing DN, Swift PG, Metcalfe MA, Baum JD. Newly diagnosed diabetes: A study of parental satisfaction. Arch Dis Child 1992;67:1011-3. |
|7.||Rennick JE, Johnston CC, Dougherty G, Platt R, Ritchie JA. Children′s psychological responses after critical illness and exposure to invasive technology. J Dev Behav Pediatr 2002;23:133-44. |
[Figure 1], [Figure 2]
[Table 1], [Table 2]