Archives

Guest Editorial

'We Are Just Kids': Children within healthcare relationships

Annette Dickinson
Division of Health Care Practice, Auckland University of Technology, Auckland, New Zealand

Article Text

Most paediatric nurses will claim that the child is an essential part of the health care relationship between nurse and family. 'Surely', they will say, 'it is obvious that the child, who is the catalyst for the relationship between nurse and family, must be part of that relationship.' However, it is often these taken-for-granted assumptions that catch us out. Children, particularly those with chronic illness, tell a very different story. In recent interviews children told me how excluded they felt. They 'watched-on' while the nurse related to the adults in the family. Some of them told me, rather mischievously, how they watched the nurse caring for them struggle with medications, equipment and other treatment modalities rather than seek the advice of the 'competent child expert' sitting in the bed beside them. However, more often these children expressed anger, frustration and distress that they were not included in the relationship. They talked of feeling scared and vulnerable. When health professionals occasionally did allow them to say something, the children perceived that their contributions were dismissed as 'being silly' or unreliable. In my study, children rarely describe relationships with health professionals in which they felt respected, valued and included, 'after all,' they told me 'we are just kids' (Dickinson 2004: 118). Of even more concern is that these children perceived that this lack of inclusion by health professionals reflected a lack of care about them, as Erin explains:

They think we are just kids and they can just give us medicine and we will be well in a couple of weeks. It seems to me they don't really care about us. (Dickinson 2004: 118)

Sadly this finding is not new. Other authors have described healthcare relationships where children have felt excluded and marginalised (Angst & Deatrick 1996; Bircher 2000; Hogan, Etz & Tudge 1999; Sartain, Clarke & Heyman 2000; Smith & Taylor 2000). So what is happening here? Clearly while we think we are including children they continue to feel excluded or silenced. It seems that the very voices that can give us the greatest insight to the illness experience and how it can be best managed are being lost within the healthcare relationship. I believe that children are telling us that there are things that we don't do well and I think it is time we listened.

Firstly, children tell us that we do not respect their expertise. The child who lives with the illness day by day holds the greatest insight into what it is to experience illness. They come to know what the illness feels like, what treatments are necessary, what works and what doesn't. They often develop quite sophisticated knowledge about their medications and treatment. The difficulty is that we do not give this knowledge and experience the same value as that held by the adults around them. As Hogan, Etz and Tudge (1999) describe 'adult experiences are equated with object reality (ie affording relative certainty) while children's experiences have been seen as comparatively illusionary and unreliable' (1999: 97). But who is to say that an adult's account is any more reliable than that of the child? As those of us who work in healthcare settings know there is nothing certain about the illness journey. We all understand situations differently, so why should children's experiences and perceptions of a situation be any less valid than those of adults. These might be different from our perceptions and expressed in different ways but they are no less valid. For those who have taken time to listen, children can and do provide us with essential information and instruction on managing the illness experience. We need to appreciate and respect that 'little expert' sitting in the bed beside us.

Which bring me to the next thing that children tell us we don't do well. We don't give them uninterrupted time to tell their story their way. Children, with their varying cognitive and communication abilities, need time to explain their illness experience and time to respond to our questioning. Sometimes, through adult eyes, their way of telling us seems long and convoluted, and we therefore cannot resist the temptation of jumping in or interpreting what we think they are trying to say. Long story-telling does not fit well in the busy world of practice. If children need time to express their concerns then we must find ways of making time to listen. Children also need the opportunity to tell it their way. Not all children have the linguistic skills to communicate verbally and need to be afforded the opportunities offered by art, re-enactment or role-play to express themselves. I recall that in my own practice there was nothing more powerful than watching a four year old re-enacting the insertion of an intravenous cannula to get a sense of what that experience meant to her! Allowing and facilitating children in using the full range of communicative strategies at their disposal should be not something reserved for when the play specialist comes along but something that becomes an integral part of practice of every health professional who works with children.

It is time we listened to the children for whom we care. Yes, they are 'kids ' without grown-up understandings and behaviours, but they are not 'just kids'. Children have a valuable and important contribution to make to the healthcare relationship. It is time for us to accept the challenge that we, the people offering care, haven't got it right. We need to listen to each child and value and respect the contribution they bring. Only then will our claims to the centrality of the child within the healthcare relationship be a reality. Only then will our practice get the nod of approval from the knowing, responding, and connecting child.

Toggle references

Navigate: Archives | Contents | Top of page

Related Publications from eContent Management