Children's participation in decisions regarding their nursing care: an ethnographic study of children, parents and nurses in the oncology setting

Background: The rights of children to freedom of expression and receiving information are underpinned by Articles 12 and 13 of the United Nations Convention on the Rights of the Child (UNCRC) (1989), which was ratified by the Malaysian government in 1995. There has been increasing shifts toward recognising the importance of children’s rights with many initiatives to realise and uphold the rights of children in Malaysia. However, no previous studies of children’s participation have been conducted in Malaysia. The aim of this study was to explore children’s participation in decisions regarding their nursing care from the perspective of the children, their parents, and nurses in an oncological ward in Malaysia. Methods: This was a focused ethnographic study. Participant observation was carried out with 61 participants (21 children, 21 parents, and 19 nurses) in the paediatric oncology-haematological ward, Malaysia. Semi-structured interviews were conducted with 21 participants (6 children, 7 parents, and 8 nurses). The existing documents pertinent to the research focus were examined to validate the participant observations and interview findings. Data were analysed using Roper and Shapira’s (2000) focused ethnographic data analysis techniques. Findings: There were different degrees of the participation of children in decisions among children diagnosed with leukaemia, including: being physically present, being informed, being consulted where children can express their wishes and opinions during the provision of nursing care, and being able to make their own decisions in relation to their nursing care. The degrees to which children participated in decisions fluctuated throughout the course of their hospitalization; moving from lesser degrees of participation (passive participant) to greater involvement (active participant) and vice-versa. The extent to which children participated in decisions were significantly influenced by the children’s preferences for participation. The preferences of children also fluctuated over the course of their illness and treatment. There were several factors contributing to children’s participation in decisions including; i) interpersonal relations in the child-parent-nurse interactions; ii) experiences of the child (veteran or novice); iii) attitude of nurses; iv) parental role; and v) the ward policy. Conclusion: The children want to be involved and really appreciate participation in communication and decisions but their opportunities for participation are somewhat limited. This study calls for a flexible model to assess children’s preferences for participation and different forms of participation for children in relation to decision-making in paediatric oncology

Understanding parental role in children’s participation in decision-making during hospitalization: an ethnographic study in Malaysia

Background: Despite a growing recognition internationally that children have a right to participate in matters that affect their lives, they are not always involved in decision-making processes concerning their health care. There is a deficit information on how parents influence children’s participation in decision-making in health care. The aim was to explore the role parents assume in the interaction process surrounding children’s participation in communication exchanges and decision-making in a paediatric oncology unit in Malaysia. Materials and Methods: This study adopted a focused ethnography design within a constructivist research paradigm. Participant observations and semi structured interviews were conducted with 22 parents, 22 children, and 19 nurses at a paediatric oncology unit in Malaysia. All observation fieldnotes and interview recordings were transcribed verbatim. Focused ethnographic data analysis technique was performed to analyze the data. Results: Three themes emerged from the situations where parents played their roles in the communication and decision-making process involving their child: (i) facilitators of communication, (ii) communication brokers, and (iii) communication buffers. Conclusion: Parents controlled the process of decision-making concerning their children’s health care, while the children prefer and welcoming parents as their consultant in decision-making process with regards to their health care

Children's experience in healthcare decisions: an overview

This article attempts to provide an overview of issues related to children’s participation in decisions relating to health care. It sets the discussion in the context of current debate about children’s participation in health care decisions and explores the extent to which children want to participate in the decision. This article concludes that children mostly occupy a minimal role in communication and decisions regarding their care. The patterns of participation of children in communication and decisions are differing and fluctuate between the children and within the same child throughout their hospitalisation, depending on the participating child, their preferences, and requirements at a particular time

The need to particularise the concept of spirituality within mental health services in Malaysia

People with mental health problem in Malaysia require access to spiritual care from their mental health services. However, the literature, which is dominated by Western scholars, brings the broad conception of spirituality into debate, which does not fit the paradigm of the religious worldview in countries such as Malaysia. This paper provides a narrative overview of the tensions inherent in the concept of spirituality as delivered in the literature. It begins a discussion on the place of spirituality in mental health care while highlighting the problematic concept of spirituality currently seen in the literature. This paper thus provides recommendations for future research on the need for particularising the concept of spirituality within mental healthcare in Malaysia

Factors predicting organizational commitment among nurses in state hospital Malaysia

With the rate of national nursing shortage increasing, organizational commitment is an extremely important factor for promoting retention of nurses. This descriptive predictive study aimed to determine the level of organizational commitment and determine the ability of perceived organizational support; the sub components of job satisfaction including pay, autonomy, task requirement, organizational policies, interaction, and professional status and years of experience among nurses in predicting organizational commitment. Sample included 416 nurses working in four state hospitals in Malaysia. The demographic data form developed by the researcher, Survey of Perceived Organizational Support developed by Eisenberger et al (1986), Index of Work Satisfaction developed by Stamps (1997) and Organizational Commitment Questionnaire developed by Mowday, Steers and Porter (1979) were used to collect data. Cronbach’s coefficient alpha of the questionnaires were .80, .80 and .95, respectively. The Cronbach’s coefficient alpha of the sub components of Index Work Satisfaction ranged from .67 to .72. Descriptive statistics and stepwise multiple regression were used to analyze data. The results revealed that (1) almost half of the samples (48.80 %) had high organizational commitment, 44.23 % of the samples had moderate organizational commitment, and another 6.97 % of the samples had low organizational commitment. (2) Professional status, autonomy, interaction, task requirement and years of experience could predict the organizational commitment (b = .52, .17, p < .01; b = .13, .11, .09, p < .05 respectively). Overall, all predictors explained 33% of variability in the organizational commitment among nurses in state hospitals. Results of this study provide information for nurse administrators to maintain these predicting factors in nursing practice in order to foster a high level of organizational commitment among the nurses

Participation in communication and decisions with regards to nursing care: The role of children

Objective: The study was to examine the role of children in communication and decisions regarding their nursing care in a paediatric oncology ward in Malaysia. Methods: The principles of focused ethnography underpinned the study design. Fieldwork took place over six months in one 32-bedded paediatric oncology ward. Twenty-one children, ranging in ages from 7 to 12 years diagnosed with leukaemia, their parents and 19 nurses participated. Data collection consisted of participant observation and semi-structured interview. Results: Hospitalized children employed different roles of passive or active participants during the communication and decisions about their nursing care. Importantly, children are more likely to become active participants in the communication process when nurses interact directly with them, listening to them and giving them opportunities to ask questions in either the presence or absence of their parents. Equally, children are likely to bemore passive participants when nurses do not communicate directly with them, choosing instead to directly interact with the child’s parents. This study highlighted that the role of children as active and passive participants is not permanently engaged by individual children, rather their role fluctuates throughout the hospi- talization journey. The fluctuations of a child’s role are highly dependent on their preferences: how and when they want to be included in the communication and decisions process. Children’s roles in communication and decisions are also varied and dependent on their particular con- texts. A child’s participation in one situation does not consistently reflect their participation with their role in other situations. The ways in which the children participate were oscillated throughout their hospitalization

Parental knowledge and practice towards foreign body aspiration in children

Foreign body aspiration is a frequently identified leading cause of mortality and respiratory crises in children aged 5 and below. This study aimed to assess parental awareness and behaviour concerning foreign body aspiration in children. Employing a random sampling method, a cross-sectional study was conducted among 160 parents in Pahang, Malaysia. Questionnaires were distributed via various social media platforms, and statistical analyses, including the Chi-square test for frequency comparison was applied. The findings revealed that 50% of participants exhibited proficient knowledge, while approximately 50.6% demonstrated inadequate practices regarding foreign body aspiration in young children. Additionally, a notable correlation was identified between gender and being a first-time parent in relation to knowledge and practices associated with foreign body aspiration in children. This study emphasizes the imperative role of healthcare institutions in organizing targeted educational workshops, specifically tailored for mothers and first-time parents, to elevate awareness and readiness for foreign body aspiration in children, thus effectively mitigating potential risks

The knowledge of secondhand smoke among parents of asthmatic children and their efficacy beliefs in protecting their child from secondhand smoke exposure

Objective: This study aimed to evaluate parents' knowledge of secondhand smoke (SHS) and their efficacy beliefs in protecting their child from SHS exposure and the relationship between knowledge of SHS and the efficacy beliefs in protecting their child from SHS. Method: This study employed a cross-sectional research design at the paediatric clinic of an urban Malaysian public hospital. The population consisted of 120 parents of patients younger than 13 seeking regular follow-up care for bronchial asthma at the hospital's paediatric clinic. The data was collected via a self-administrated questionnaire. Result: Overall, 88 parents (73.3%) reported had adequate knowledge about SHS, and 67 parents (56.7%) had efficacy beliefs in protecting their children from SHS exposure. There is a statistically significant weak positive correlation between parents' knowledge about SHS and efficacy beliefs in protecting their children from exposure to SHS (r = 0.19, p = 0.03). A significant association was observed between monthly household income and efficacy beliefs in protecting their children from exposure to SHS (χ2= 7.81; p= 0.02). Parents’ knowledge of secondhand SHS was associated with the information they acquired about SHS from healthcare professionals (β = 0.54, p < 0.05) and friends (β = -0,25, p < 0.05). Conclusion: The findings highlight the critical role of education in empowering parents to take proactive measures to protect their children from secondhand smoke exposure. It has substantial implications for the health education programmes and interventions, emphasising the need to provide correct information to parents to boost their confidence and, eventually, improve child health, reduced healthcare costs, and better overall well-being for the community

Framework analysis: A worked example from a midwifery research

Objective Framework analysis is a pragmatic approach for real-world investigations and has been commonly used in health care research. Although the theoretical part of framework analysis has been well documented, there is limited literature describing its practical use. The objective of this paper is to demonstrate systematic and explicit guidance in using framework analysis by giving an example of a study exploring women's experience of postnatal depression. Method Data presented in this paper comes from semi-structured interviews of 33 women (from three different cultural backgrounds) attending for a child or postnatal care in six purposively selected maternal and child health (MCH) clinics in Kuala Lumpur. Results Data were analyzed using framework analysis, which consists of three interrelated stages. In the first stage (data management), a careful selection of the data (transcripts) to be reviewed was made. The initial categories were developed based on the selected transcripts, and the initial themes were decided (known as a thematic framework). In the second stage (descriptive accounts), the thematic framework was investigated to identify any linkage and similarity between one category to another. The third stage of the analysis (explanatory accounts) involved checking exactly how the level of matching between the phenomena was distributed across the whole set of data. Using framework analysis, four themes were identified to explain the women's experience of postnatal depression namely the changes, causal explanations, dealing with postnatal depression, and perceived impacts. Conclusions The details of each stage of the analysis were explained to guide researchers through essential steps in undertaking framework analysis. Health care researchers may find a worked example addressed in this paper as useful when analyzing qualitative data