Child and parental surveys about pre-hospitalization information provision.

BACKGROUND: There is little available information about what children and parents would like to know about a forthcoming hospitalization and what they currently receive. METHODS: The current study was a survey of 102 children between the ages of 6 and 10 years and their parents recruited either from the Recovery Unit following day surgery or from the wards following overnight admissions at Sydney Children's Hospital, Australia. Information was obtained about each child's experience in hospital, the nature and format of information that they had received prior to the admission, and what information the child/parent thought would be helpful to receive. RESULTS: Parents recorded a total of 163 questions asked by children prior to their admission. Questions related to timing (e.g. duration of admission, length of procedure), pain, procedural information, anaesthesia, needles, whether parents can be present, activities to do in hospital, seeking explanations ('Why' questions), hospital environment, seeking reassurance and miscellaneous questions. Children who were satisfied with the amount of information they received before coming to hospital subsequently reported that they would be significantly less scared should they need to come back to hospital for a future procedure. A total of 46.7% of children received information about their hospitalization from their parent(s) and a further 12% from a doctor and parent. CONCLUSIONS: Children were found to have many questions about a forthcoming hospitalization. Parents were found to have a major role as information providers. Further research is needed to assess parental confidence and competence to meet their child's information needs.

Validity and reliability of medical and surgical oncology patient acuity tools.

PURPOSE/OBJECTIVES: To develop valid and reliable medical and surgical acuity tools as part of an overall classification system for patients with cancer. SETTING: An acute care, tertiary, research, academic oncology hospital in the southeastern United States. SAMPLE: Clinical nursing experts in medical and surgical oncology; 125 patient observations for the surgical oncology acuity tool, and 75 patient observations for the medical oncology acuity tool. METHOD: The nursing division developed a medical oncology acuity tool and a surgical oncology acuity tool using the Johns Hopkins Oncology Patient Classification System as a model. They then studied the validity of developed tools using content validity indexes (CVIs). Two independent raters studied the interrater reliability of each tool. FINDINGS: CVIs for items on the surgical tool ranged from 0.57-1.0; the overall CVI for this tool was 0.86. CVIs for items on the medical tool ranged from 0.25-1.0. The overall CVI for this tool was 0.88. Pearson correlation coefficients were r = 0.95 (p < 0.001) for the surgical oncology acuity tool and r = 0.92 (p < 0.001) for the medical tool. Interrater reliability, tested continually for four years, was greater than 95%. CONCLUSIONS: The tools are reliable and valid. IMPLICATIONS FOR NURSING PRACTICE: Medical and surgical oncology acuity tools that are nursing diagnosis based, interface with nursing standards of care, are easy to use, and require no calculation provide reliable quantification of nursing work loads based on the care needs of patients with cancer. Supervisors use data from these tools to determine variable nursing hours per patient per day, establish productivity for units, make staffing and scheduling decisions, assign patients, work on budgets, and, ultimately, establish charges for nursing services. As the needs of medical and surgical oncology patients evolve, continued refinement of indicators and acuity levels will be needed. As other medical and surgical oncology tools are developed, further comparison will be warranted. Additional study would determine if the tools could be modified for these nursing uses in other cancer centers as well as in designated medical and surgical oncology units of other types of hospitals. Oncology acuity systems also could be established in the future as the basis for third-party reimbursement.