Analysis
‘Favouritism’ Is there evidence of problems elsewhere? Chief executive of the charity the Children’s Heart Federation Anne Keatley-Clarke thinks there is. ‘It seems to be linked to whether your face fits, not just in Leeds but across the board. There tends to be a degree of favouritism. Parents who question things or complain seem to get poorer support than those who don’t.’ She wants to see the introduction of consistent standards setting out what families can expect, something NHS England is looking at as part of a wider ongoing review into congenital heart services. This, she thinks, will also help address some of the gaps in information, adding that the focus on death rates is too narrow. ‘Yes, you can say children are not any more likely to die, but that does not tell you anything about the quality of care. ‘You need to look at morbidities for that. Do the children have more complications after surgery? Are they more likely to need repeat operations?’ To read the Leeds review, go to tinyurl.com/leeds-review-2014 Nick Triggle is a freelance writer NURSING CHILDREN AND YOUNG PEOPLE
How arts-based approaches can put the fun into child-focused research Giving children a range of media allows them to be more creative and produces better data, say Bernie Carter and Karen Ford WHEN UNDERTAKING qualitative health research with children it is important to consider how to generate data that genuinely reflects children’s perspectives. Although researchers can adapt and use well-established techniques, such as interviews and focus groups, there are more innovative and more child-centred methods. Arts-based approaches can readily take into account children’s different capacities and competencies and can be successful in giving the child more control over, or involvement in, the process of data generation. Such methods also allow the researcher greater flexibility in pacing, language, simplicity of explanations, an ability to follow a child’s story and interpret his or her drawings. Arts-based methods are effective at making the process of data collection engaging and fun, and this is essential to maintain a child’s attention. Robust, well-planned, participatory arts-based approaches, such as drama, drawing, photography, storytelling, collage and music, can introduce ‘serious fun’ into research, Alamy
by NHS England into the deaths of children with cardiac defects at Bristol Royal Hospital for Children gets under way. Inquests on children who have died have exposed failings in care, breakdowns in communication and, at times, an apparent lack of empathy with parents when concerns were raised about treatment. What is more, the accusation of services showing a lack of compassion has echoes with some of the findings of the Francis Inquiry into Stafford Hospital. Association of British Paediatric Nurses president Rory Farrelly says post-Francis it is essential nurses do everything they can to apply compassionate care in ‘everyday practice’. He urges them to re-read the Francis report to remind themselves of how such failings happen. But he adds: ‘We [children’s nurses] have a strong history of delivering compassionate care using a family-centred approach. We should build on this and recognise where we are getting it right and spread the good practice.’
and trigger genuinely child-centred data. These data tap into children’s dialogic, visual and creative modes of expression, giving the adult researcher a clearer means of understanding, interpreting and re-presenting data. Researchers need to work gently and sensitively to understand the context and meaning in a drawing. For example, in one study, a child drew tulips outside the hospital. Initial impressions were that they were a form of embellishment and that they had no particular meaning. In fact, they represented the flowers the child’s father grew at home. Simply interviewing the child is unlikely to have uncovered her desire to sustain a sense of home while in hospital. Choosing which method to use requires careful thought, as the choice can subtly and/ or overtly influence how children are able to express themselves and what they can create. Researchers would be wise not to step too far out of their own zone of expertise and comfort. Careful decisions about the specifics of the approaches used need to be made. For example, deciding whether to supply a child with a palette of six or 12 colours can influence what the child can create. Choosing collage and providing a range of materials rather than just giving a child a packet of six crayons and a sheet of paper are likely to produce richer data. Children using collage can create 3D artwork, whereas those using crayons will be more limited. In one case, a child used feathers in a collage to represent how her stomach felt ‘fluffy and wobbly’ before her operation. The meaning only became clear when she explained why she had used the feathers. Had she been presented with different materials – say, foil – she might not have been able to share her feelings at all. Bernie Carter is professor of children’s nursing, University of Central Lancashire, and clinical professor, University of Tasmania, and Karen Ford is assistant director of nursing, Royal Hobart Hospital, Tasmania
Researchers need to be aware that the materials used can indirectly affect how children express themselves
This article is based on Carter B, Ford K (2013) Researching children’s health experiences: the place for participatory, child-centred, arts-based approaches. Research in Nursing and Health. 36, 1, 95-107. April 2014 | Volume 26 | Number 3
Downloaded from RCNi.com by ${individualUser.displayName} on Nov 30, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
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‘Favouritism’ Is there evidence of problems elsewhere? Chief executive of the charity the Children’s Heart Federation Anne Keatley-Clarke thinks there is. ‘It seems to be linked to whether your face fits, not just in Leeds but across the board. There tends to be a degree of favouritism. Parents who question things or complain seem to get poorer support than those who don’t.’ She wants to see the introduction of consistent standards setting out what families can expect, something NHS England is looking at as part of a wider ongoing review into congenital heart services. This, she thinks, will also help address some of the gaps in information, adding that the focus on death rates is too narrow. ‘Yes, you can say children are not any more likely to die, but that does not tell you anything about the quality of care. ‘You need to look at morbidities for that. Do the children have more complications after surgery? Are they more likely to need repeat operations?’ To read the Leeds review, go to tinyurl.com/leeds-review-2014 Nick Triggle is a freelance writer NURSING CHILDREN AND YOUNG PEOPLE
How arts-based approaches can put the fun into child-focused research Giving children a range of media allows them to be more creative and produces better data, say Bernie Carter and Karen Ford WHEN UNDERTAKING qualitative health research with children it is important to consider how to generate data that genuinely reflects children’s perspectives. Although researchers can adapt and use well-established techniques, such as interviews and focus groups, there are more innovative and more child-centred methods. Arts-based approaches can readily take into account children’s different capacities and competencies and can be successful in giving the child more control over, or involvement in, the process of data generation. Such methods also allow the researcher greater flexibility in pacing, language, simplicity of explanations, an ability to follow a child’s story and interpret his or her drawings. Arts-based methods are effective at making the process of data collection engaging and fun, and this is essential to maintain a child’s attention. Robust, well-planned, participatory arts-based approaches, such as drama, drawing, photography, storytelling, collage and music, can introduce ‘serious fun’ into research, Alamy
by NHS England into the deaths of children with cardiac defects at Bristol Royal Hospital for Children gets under way. Inquests on children who have died have exposed failings in care, breakdowns in communication and, at times, an apparent lack of empathy with parents when concerns were raised about treatment. What is more, the accusation of services showing a lack of compassion has echoes with some of the findings of the Francis Inquiry into Stafford Hospital. Association of British Paediatric Nurses president Rory Farrelly says post-Francis it is essential nurses do everything they can to apply compassionate care in ‘everyday practice’. He urges them to re-read the Francis report to remind themselves of how such failings happen. But he adds: ‘We [children’s nurses] have a strong history of delivering compassionate care using a family-centred approach. We should build on this and recognise where we are getting it right and spread the good practice.’
and trigger genuinely child-centred data. These data tap into children’s dialogic, visual and creative modes of expression, giving the adult researcher a clearer means of understanding, interpreting and re-presenting data. Researchers need to work gently and sensitively to understand the context and meaning in a drawing. For example, in one study, a child drew tulips outside the hospital. Initial impressions were that they were a form of embellishment and that they had no particular meaning. In fact, they represented the flowers the child’s father grew at home. Simply interviewing the child is unlikely to have uncovered her desire to sustain a sense of home while in hospital. Choosing which method to use requires careful thought, as the choice can subtly and/ or overtly influence how children are able to express themselves and what they can create. Researchers would be wise not to step too far out of their own zone of expertise and comfort. Careful decisions about the specifics of the approaches used need to be made. For example, deciding whether to supply a child with a palette of six or 12 colours can influence what the child can create. Choosing collage and providing a range of materials rather than just giving a child a packet of six crayons and a sheet of paper are likely to produce richer data. Children using collage can create 3D artwork, whereas those using crayons will be more limited. In one case, a child used feathers in a collage to represent how her stomach felt ‘fluffy and wobbly’ before her operation. The meaning only became clear when she explained why she had used the feathers. Had she been presented with different materials – say, foil – she might not have been able to share her feelings at all. Bernie Carter is professor of children’s nursing, University of Central Lancashire, and clinical professor, University of Tasmania, and Karen Ford is assistant director of nursing, Royal Hobart Hospital, Tasmania
Researchers need to be aware that the materials used can indirectly affect how children express themselves
This article is based on Carter B, Ford K (2013) Researching children’s health experiences: the place for participatory, child-centred, arts-based approaches. Research in Nursing and Health. 36, 1, 95-107. April 2014 | Volume 26 | Number 3
Downloaded from RCNi.com by ${individualUser.displayName} on Nov 30, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
9
