Problems Related to Nursing Services at the Department of Pediatrics

Abstract

Problem and contribution: Performing medical interventions in children is one of the deepest concern arousing situations for both hospital administrators and health care givers. Therefore, strengthening, developing the functions of nursing, improving the care quality and revealing and resolving the existing problems in terms of providing effective care are considered to be important. In accordance with the data obtained from this research, it was planned to determine the problems in podiatric clinics and develop nursing services addressing these issues. At the same time it is expected that it will provide a positive contribution to both nurses, institution and people receiving these services via improving quality in nursing services and providing cost-effective services. Method: The study was conducted as a descriptive research with the aim of determining the issues stemming from the service and the structure of the clinic and experienced by nurses working at paediatric clinics at two hospitals in Trabzon. To measure the service at paediatric clinics, a Likert-type scale developed by the authors was used. The reliability and validity of the scale was tested by factor analysis method, Crhomba Alpha. In the evaluation of the data, SPSS was used and significance tests were performed along with frequency and ratio analyses. Findings: Pediatric nurses in the study expressed their problems as the lack of teachers and training room where school-age children could continue their education (62.8%), the lack of sinks in patients’ rooms so that nurses could wash their hands (50.0%) and the problems related to visiting hours and visitors (34.3%).

Keywords

Pediatry, Pediatric clinic, Nursing services

Introduction

Nursing services, which make up an important part of health services, are comprised of patient care, health protection/promotion and rehabilitation services within health care system [1]. Although roles and functions of the nurses are defined in legal regulations and codes; roles and functions of the nurses may also differ according to policy of the institution where they are employed. As a result; some nurses may perform their roles and functions that they have learnt during academic education in the institutions where they are employed while others may have to work in line with policy of the institutions [2]; which causes the nurses not to provide functions of care and help–which are nurses’ independent functions- enough and not to use their professional knowledge and skills efficiently.

Pediatric nursing determines children’s care needs in terms of data related to cultural, social, medical conditions of children and their families; implements the planned care in order to meet care needs of children and assesses the outcomes of the care provided. Pediatric nursing evaluates the children holistically along with their families and social milieu and includes their families in each phase of the care to be given. Pediatric nursing assures children and their families a comfortable and safe setting. Pediatric nursing utilizes the correct and appropriate communicational techniques to make contact with children/their family and social milieu (http://www.saglik.gov.tr).

Depending on the age and development level of the children; their physical, mental and emotional reactions to the disease change. In this regard; it is necessary that nurses that work with children should be aware of physical, emotional, mental and social needs of the children and their families and touch on these issues in care. Children are immature against medical errors and therefore demonstrate different physical characteristics [3-5]. Due to the fact that children are in a fast growth-development period and their self-concept, coping-methods and social behaviors are less developed; nurses should be more sensitive in this sense [3,4]. Besides; educational status, previous hospital experiences, religious faith, cultural background and socio-economic status affect their perception of diseases and reactions to hospitalization; too. Therefore; the nurses should know how to determine the sources that will help them cope with problems produced by developmental crisis and diseases that affect children at different ages and problems caused by diseases in an effective way. Interventions made to the children are one of those most worrying concerns among both hospital administrators and those health care workers that will make the intervention [3,4]. Therefore; it is crucial to explore and to solve the current problems in order to enhance and to improve functions of nursing services and to increase the quality of care in provision of health care services of high quality. With the study results of the current study; it was aimed at determining the problems related to nursing services at department of pediatrics and improving these nursing services in relation with these problems. Meanwhile; we were of the opinion that positive contributions would be made both for nurses and the institutions and the customers through the enhanced quality and provision of cost-effective services in nursing services.

Methodology

The current study was descriptively undertaken to identify problems related to nursing services delivered by the pediatric nurses employed at department of pediatrics located in the city center of Trabzon Province. The population of the study was composed of all the pediatric nurses employed at department of pediatrics of a university hospital and a research and training hospital (n=99). A Likert type scale developed by the researchers was used in the study in order to collect the data and to measure services given at the department of pediatrics. Validity of the scale was tested with factor analyses while reliability of the scale was tested with Cronbach’s alpha method.

With the factor analysis; the aim was to remove irrelevant items and those items clustered under more than one subscale. First; Bartlett's sphericity test was conducted in order to see whether or not inter-item correlation was enough to perform factor analysis. According to the results (Approx. Chi-Square: 1249.564/ df: 325/ sig: 0.000); it was found that correlation was significant at 0.0001. When the results of factor analyses (through Varimax method) were examined; the 12th, 13th, 15th, 22nd and 25th items were removed because they were not overlapping or correlational. The factor distributions of the remaining items were shown. Accordingly; it was noted that the remaining 25 items were clustered into three factors that demonstrated an eigenvalue higher than 1.0 and accounted for 49.552% of total variance. These factors were termed as Basic Services (BS), Supporting Services (SS) and Social Services (SoS) (Table 1).

Table 1. Validity and reliability analyses, Note 1. Factor loading was accepted as = 0.40. Note 2. Basic Services. Supporting Services and Social Services demonstrated in the table were abbreviated as follows: Basic Services (BS). Supporting Services (SS) and Social Services (SoS).

BS included 1st, 2nd, 7th, 11th, 16th, 18th, 21st, 23rd, 24th, 26th, 27th, 28th, 29th, 30th, 31st items; SS included 3rd, 4th, 5th, 6th, 14th, 17th items and SoS included 8th, 9th, 10th, 19th, 20th items.

As a conclusion according to the factor analysis done it was seen that scale designed for services of pediatric department was significant at 0.0001 (Approx. Chi-Square: 1249.564/df: 325/sig: 0.000), total scale eigenvalue was 12.883 and the scale-items explained 49% of total variance. Therefore, the scale was validated and was found to be reliable with a Cronbahc’s Alpha: 0.877.

Scores of items used in the study scale ranged from 1-2.3 (low), 2.4-3.7 (moderate) to 3.8-5 (high). A higher score indicates a greater problem.

Administration of Data Collection Tool

For the data collection forms; ethics approval from the Ethics Board of Clinic Researches at Trabzon Kanuni Training and Research Hospital (KTRH), General Directorate of Trabzon Public Hospitals Union and Office of Chief Physician of University Hospital was received. Data collection forms were administered by the researchers to 99 nurses working at Training and Research Hospital and University Hospital between the 8th of March and the 8th of April, 2016.

Data analysis

In the evaluation of the data, SPSS was used and significance tests were performed along with frequency and ratio analyses.

Findings

Socio- Demographic and professional characteristics of the participant pediatric nurses were demonstrated as follows:

It was found out that 49.5% of the participant nurses belonged to 20-29 age group, 58.6% of them had undergraduate education level or higher level, 93.9% of them were female, 59.6% of them did not have any children, 34.3% of them worked as a nurse for ≤ 4 years and 50.5% of them were employed at department of pediatrics for ≤ 4 years (Table 2).

Table 2. The Distribution of Nurses According to Socio-Demographic and Professional Characteristics

In the study; in relation with the care of the pediatric patients it was stated that the pediatric nurses had difficulties in providing basic nursing services due to inadequacy of physical conditions of patient rooms, isolation of children with infectious diseases and injection and IV interventions. And also, it was noted that pediatric nurses had difficulties in support services due to visiting hours, inability to answer wishes of visitors and talking to and convincing pediatric patients about the treatment of their diseases while pediatric nurses (56.8%) experienced difficulties in social services due to lack of playgrounds and lack of teachers and teaching rooms at the department of pediatrics (Table 3).

Table 3: The distribution of the problems experienced related to nursing services of nurses

In the study; it was emphasized that nurses working at the University Hospital mostly suffered mostly from such problems as lack of security personnel at the department of pediatrics. insufficient number of auxiliary staff during night shift/duty services and inadequacy of physical conditions of patient rooms and it was noted that there was a significant difference between the type of the hospital where the nurses worked and mean scores. As for the support services; nurses working at the University Hospital stated that they had the biggest difficulties in visiting hours and answering the wishes of visitors and it was noted that the mean scores were higher and again there was a significant difference between the type of the hospital where the nurses worked and mean scores. In the study; it was stated that nurses working at the University Hospital suffered from such problems related to social services as lack of bookcases and children-books. lack of teachers and teaching rooms for the continuation of education of pediatric patients at the department of pediatrics and there was a significant difference between the type of the hospital where the nurses worked and mean scores (Table 4).

Table 4: The distribution of the problems experienced according to working hospital of nurses

In sum; it was identified in the study that pediatric nurses working at the University Hospital had more problems in basic services and support services and their mean scores were higher (Table 5).

Table 5: The distribution of the problems experienced related to the nursing services of nurses

Discussion

Nursing functions are too important to ignore within the health services. It should be ensured that all the patients receiving services at hospitals get care services that guarantee patient safety and satisfaction under scientific basis and with the same standards at all phases of health care. Nurses are the health care personnel that have the opportunity to detect the changes in patients’ conditions first. Nurses should integrate philanthropic behaviors with care, improve and offer care to patients by accepting patients with their loneliness, unhappiness, neediness and pain and using proper care needs and knowledge for recovery and treatment. At hospitals where this is not achieved, it is impossible to talk about quality of nursing services and patient satisfaction [6]. On the other hand; the most problematic and failing services at hospitals are nursing services. Nurse administrators experience numerous problems in executing their tasks due to laws and policies, duties, powers and responsibilities determined by policies of institutions where they are employed, institution’s administration type, lack of financial and human resources and problems caused by other health care members [1]. Therefore; the current study that was undertaken to explore problems related to nursing services of nurses working at the department of pediatrics was conducted with nurses most of whom were aged between 20 and 29 years, had undergraduate degree and above, were female and worked in the profession and at department of pediatrics for ≤ 4 years.

Quality and design of hospital buildings are very important so that patients can get rid of stress, anxiety and troubles they are subject to in hospital environments [7]. The fact that work environment be healthy and safe is very important not only for providing patients with a service of quality but also health and safety of employees and positive worker productivity [8]. Hospital buildings that are well managed and comfortable affect worker performance positively whereas hospital buildings with insufficient physical conditions affect worker performance negatively; which will reduce the quality of care nurses give to patients [7]. Positive working settings affect all the health care personnel and maintain excellence in services and as a result improve patient outcomes [8].

In the study; it was identified that pediatric nurses had moderate level of problems due to poor physical conditions of patient rooms. When basic nursing services were examined in terms of type of hospital where pediatric nurses worked; it was found out that nurses working at University Hospital had more problems due to poor physical conditions of patient rooms and there was a significant difference between the type of the hospital where the nurses worked and mean scores (p=0.000).

Similar to our study; the study done by Ozturk et al. stated that 26% of the nurses had problems related to physical condition and interior equipments of the hospital buildings. The study of Bostan et al. [10] pointed out that more than half of the nurses told that work settings were not organized in a way to protect their physical health [10]. In the study of Cam et al. [11]; it was indicated that health care workers had significant problems caused by work environment, could not integrate themselves with the institution, could not work productively and were not satisfied [11].

Despite experienced mainly by the pediatric nurses working at the university hospital; another problem of the participant nurses of the current study was that there were no security personnel around when they had difficulties related to visiting hours and answering wishes of visitors. It was identified that there was a significant difference between the type of the hospital where the nurses were employed and their mean scores (p=0.000).

It is crucial that safety of both patients and employees should be guaranteed at hospitals by security personnel for 24 h. Particularly; departments of pediatrics are places where risk for child abduction is high, therefore more security measures should be taken and alarm and warning systems with pink codes should be installed at hospitals. Thus; hospital management should make plans to ensure safety of life and property of patients and health care personnel and to take necessary actions against the recognized risky patient groups in particular. Besides; liability of personnel should be determined and they should be trained for the safety and security of the health care facilities [7].

In the current study; it was noted that more than half of the nurses emphasized that play needs of pediatric patients could not be met properly due to lack of play ground at departments of pediatrics. It was seen that nurses working at University Hospital, especially, had more than one problem related to lack of play grounds at departments of pediatrics and the difference between the type of the hospital where the nurses were employed and their mean scores was significant (p=0.000). Play for a hospitalized child matters a lot in the sense that his developmental needs are answered [12]. It is important for pediatric nurses to assess play of child and to determine developments in child continuously [4]. Pediatric nurses organize playgrounds and games for sick children. In each department of pediatrics, there should be places for games or play rooms where game materials and toys are available [12]. The fact that nurses use plays and games in the treatment and care of children in order to comfort the children emotionally and to help them express their emotions and thoughts will provide important contributions to the recovery period of the children. Besides; offering children play grounds and game opportunities at hospital setting may help them feel safe, discharge pent-up energy and cope with stress [4]. It is necessary to build up play grounds and game units at health care facilities in order to enhance quality of health care services and to hire professionals such as game therapists for these units [13].

In the current study; nurses working at department of pediatrics stated that they had difficulty in meeting needs of children due to lack of hospital schools, teachers and children-books or insufficient number of teachers and childrenbooks for the pediatric patients to continue school education. It is underlined that disease in a hospitalized child causes stress, fear and tension; which may result in lack of appetite and sleep disorders [14]. Therefore; it is argued that engaging those pediatric patients who are not critically ill but treated at hospitals with light and easy game activities supports and strengthens them morally, reading and taking up various mental activities entertains them and provides them with nice time; which affects health positively, increases morale and shortens hospital stay [15-17].

Since there were not any studies on nursing services provided at departments of pediatrics in literature; the study findings could not be compared to further findings from other studies. It is recommended that concept of patientcentered health care services should be expanded and new studies on department of pediatrics should be done in order to solve problems seen at departments of pediatrics. Besides; conducting new studies on department of pediatrics as well as other departments will increase efficacy of delivery of health care services.

In sum; majority of the participant nurses told that they had problems mostly due to poor physical conditions of patient rooms, they had difficulties in answering the wishes of visitors, in talking to and convincing pediatric patients about the treatment of their diseases and there were problems due to lack of security personnel in case of a security problem, lack of play grounds at department of pediatrics and insufficient number of teachers and teaching rooms. Besides, it was found out that pediatric nurses working at University Hospital faced more problems about basic and support nursing services and their mean scores were higher.

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