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? 