An Exploration of the Child's Experience of Staying in Hospital from the Perspectives of Children and Children's Nurses using Child-Centered Methodology.

Globally the needs of children differ to those of adults; consequently, the "voice" of children in health care delivery is paramount to its effectiveness as a service. This qualitative study aims to present a contemporary "slice" of life in four children's wards in a typical United Kingdom children's hospital in the 21st century from the perspective of the service user (child) and significant service giver (Registered Children's Nurse). Phase one of the study involved the development of a child research advisory group (CRAG) with five local primary school children (aged 10-11 years) to assist in the co-production of research questions and data collection tool for child participants - two talking cartoon characters (Sprinkle Cupcake and Ronaldo Football) via an app/iPad. In phase two (main study), hospitalized children (n = 18) and Registered Children's Nurses (n = 8) were interviewed on one occasion within their ward setting using a semi-structured approach in July 2017. The emerging broad themes (using thematic analysis), were (1) children - the child's needs, relationships, fears, and concerns, alongside (2) nurses - children's nursing, job pressures, safe and effective care. Themes were then presented as tensions in that they represent the relationship between variables where the different elements in the relationship are held in tension, such that a change in one impacts upon the other. Similarities between the children and nurse participants include issues with the environment, lack of time to care (nurse), effects of nurse-led interventions, and valued role of play. Differences are largely around the role of the parent. The development and work of the CRAG and use of "tensions" to more effectively present the complexity of the findings are unique to this study. In conclusion, this study contributes to the development of a generalized knowledge base for policy, nursing education, and clinical practice by shedding light in how the complex hospital environment can be challenging for the child and children's nurse.