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

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 100h 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.