Future Health Care Professionals’ Knowledge of Developmentally Appropriate Care with Children in the Health Care Setting By Jessica Wente, MS, CCLS Florida 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… The Health Care Experience for Children • 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 (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) The Health Care Experience for Children • 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 longterm negative outcomes in the hospital setting: _ (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 Help • 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 (Perrin & Perrin, 1983; Vacik, Nagy, & Jessee, 2001; Simons & Roberson, 2002) The Need for Further Training • 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) 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. 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) How can children get better again? Resting gives whatever’s the matter with you time to heal. Eat fruit and chicken soup. Medicine helps your body attack the germs. Preoperational Concrete Early Concrete Late Your defenses need a chance to build back up so your body can fight the disease. Formal Operational • “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) Research Questions • 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? The Instrument Developmentally Appropriate Care for Children in the Health Setting on This is anCare improvement Thank you for taking time to complete this questionnaire! Please read instructions for each past measures used to assess section carefully and complete to the best of your ability. Each page has a front and back health care professionals’ portion to complete. and students’ knowledge. Part I This 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) Scale Reliabilities • Patient-Practitioner Orientation Scale • Confidence in providing DAC scale • Interest in future training scale α = 0.76 α = 0.87 α = 0.91 Statistics about the sample Table 4-1. Characteristics of Students in the Overall Sample Frequency Percent Field of Study Nursing Medical Physician Assistant Physical Therapy Non-Clinical Health Care 197 200 112 54 86 30.4 30.8 17.3 8.3 13.3 Gender Female Male 481 167 74.2 25.8 Race White/non-Hispanic Black/non-Hispanic Hispanic/Latino Asian/Pacific Islander Native American Multi-racial Other 466 33 45 75 0 19 8 72.1 5.1 7.0 11.6 0.0 2.9 1.2 Graduate/Undergraduate Graduate Undergraduate 501 147 77.3 22.7 Age Mean 25.1 Standard Deviation 5.06 Table 4-2. Characteristics of Student Samples by Field of Study Statistics about the sample by field Table 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) 23 (46.9) 15 (30.6) 3 (6.1) 1 (2.0) 7 (14.3) 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) M = 24.5 SD = 1.94 M = 26.3 SD = 3.65 M = 26.4 SD = 4.40 Year in Program Graduate 1st Year 2nd Year 3rd Year 4th Year Other Undergraduate 1st Year 2nd Year Age 131 (89.7) 15 (10.3) M = 24.2 SD = 7.42 M = 26.1 SD = 4.95 Results • 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 • Post hoc analysis: Were students who intend to work with children more engaged in more professional experience with children? Results • 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) 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 nonclinical 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?