Article Trust in The Nurse Survey of Hospitalised Children Summary

Article Trust in The Nurse Survey of Hospitalised Children Summary ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Article Trust in The Nurse Survey of Hospitalised Children Summary I’m studying for my Writing class and don’t understand how to answer this. Can you help me study? Summarizing the given article in correct APA format with accurate use of in-text citation. jocn.15466.pdf Received: 27 November 2019 | Revised: 1 June 2020 | Accepted: 13 August 2020 DOI: 10.1111/jocn.15466 ORIGINAL ARTICLE Trust in the nurse: Findings from a survey of hospitalised children Rosemarie Sheehan MSc, RGN, RCN, Assistant Director of Nursing1 Gerard Fealy MEd, PhD, RGN, Professor2 1 Children’s Health Ireland, Dublin, Ireland 2 University College Dublin, Dublin, Ireland | Abstract Aims and objectives: To measure hospitalised children’s trust in the nurse. Correspondence Rosemarie Sheehan, Children’s Health Ireland, Dublin, Ireland. Email: [email protected] Background: Trust is central to the therapeutic relationship between the nurse and Funding information The authors declare they received no financial support for the research, authorship and/or publication of this paper. 452, 1999]). the patient. There can be no trusting relationship between the nurse and child if the parents have no trust or block the relationship (Bricher [Journal of Clinical Nursing, 8: Design: This study was a cross-sectional, correlational descriptive design using a selfcomplete questionnaire to measure children’s trust in nurses, to examine the relationship between children’s trust and their parents, and the correlations between trust and medication adherence, fear and interactions with the nurse. Methods: A modified version of the Children’s Trust in General Nurses Scale designed by Rotenberg et al. (Journal for Specialists in Pediatric Nursing, 20: 298, 2015) was used. This Scale is a short self-report questionnaire designed to elicit information on children’s beliefs in, and attitudes to, trust in nurses. The Strengthening the Reporting of Observational Studies in Epidemiology statement for observational studies was applied (von Elm [British Medical Journal, 335: 806, 2007]). Results: The results indicated high levels of trust beliefs in the nurse. The children’s and parents’ trust beliefs were found to be correlated. Gender did not influence trust beliefs. Younger children had higher levels of trust than older children, particularly in relation to the perceived honesty of the nurse. Trust beliefs in the nurse lessened with previous exposure to the hospital setting. One-fifth of children reported fear of the nurse. Positive interaction with the nurse was shown to be positively related to adherence to care. Relevance to clinical practice: Children’s level of trust in the nurse can be measured. A trusting child is likely to be less fearful and experience clinical procedures as less threatening and is more likely to adhere to treatment. Children’s nurses should recognise that trust can change with age and with multiple hospital admissions. KEYWORDS adherence, children, children’s nurse, fear, hospital, parent, trust, trust scale J Clin Nurs. 2020;29:4289–4299. wileyonlinelibrary.com/journal/jocn © 2020 John Wiley & Sons Ltd | 4289 4290 | SHEEHAN and FEALY 1 | I NTRO D U C TI O N Trust involves the belief in the goodness of another’s moral intentions, not just his or her habits (Baier, 1986). In nursing, trust is a relational process that is dynamic and fragile, involving an individual’s deepest needs and vulnerabilities (Carter, 2009). Furthermore, building trusting relationships in nursing has been described as a moral and healing art because of the inherent power asymmetry in the nurse–patient relationship (Carter, 2009). It is the cornerstone of all therapeutic relationships, and without trust, stable relationships are not possible (Carter, 2009). Article Trust in The Nurse Survey of Hospitalised Children Summary Trust is highly complex. It exists in the one-on-one relationship, it is a social phenomenon and applies to the organisation and system as a whole, and is fundamental to the effective functioning of the health system (Carter, 2009; Dinc & Gastmans, 2012; Meyer, Ward, Coveney, & Rogers, 2008; Sellman, 2007). The importance of trust in improving patient outcomes and satisfaction is an intangible asset and should be fostered as a validation of investment in nursing (Rutherford, 2014). Children’s nursing involves an interdependent triad of the child, nurse and parents/guardians where family-centred care is the cen- What does this paper contribute to the wider global clinical community? • The evidence from this study lends further support to the view that children understand the concept of trust and expect their nurses to be trustworthy. • Children may experience being in hospital with reference to the level of threat that treatments and procedures present to them, and hence, their level of trust in the nurse and in other health professionals is important to establish in assessment and care planning. • Children’s trust in healthcare professionals is one element of their emotional response to their encounter with the healthcare system. • A child’s level of trust in healthcare professionals is not static and changes over time and with exposure to the healthcare system and trust can therefore be moderated and enhanced through clinicians’ interpersonal skills, developed through education. tral concept involving the children’s nurse working in partnership with the family to promote, maintain and restore health and well-being. In children’s nursing, trust is particularly important as it can develop where trust in less reliable sources can develop (Rowe & serve to counterbalance the patient’s vulnerability (Bricher, 1999). Alexander, 2015). This was demonstrated in the 1990s in the mis- Despite its importance, the concept of trust in nursing is complex, trust by parents of the MMR vaccine, where uptake significantly de- elusive and poorly understood (Bell & Duffy, 2009). There is a pau- clined (Gille, Smith, & Mays, 2015). city of literature on the child–nurse relationship and the factors that Baier (1929–2012) developed a theory of trust that remains rel- influence the development of trust between the sick child, parents evant in understanding the role of trust in nursing today (Peter & and the children’s nurse. Morgan, 2001; Sellman, 2007). According to Baier (1986), the cardinal features of trust are vulnerability, risk, care and power, and 1.1 | Background the trustee is required to have reasonable confidence that others will act with goodwill towards them (Carter, 2009). Sellman (2007) suggests that Baier’s emphasis on goodwill, or the absence of ill will, Healthcare systems are inherently about relationships and many is an important feature of trust, separating it from other concepts, of the problems and challenges they face are relationship-based such as reliance and confidence, and is important for nurses to un- (Gilson, 2003; Ozawa & Sripad, 2013). Trust in healthcare relation- derstand as it demonstrates why patients trust nurses and other ships has been shown to have positive outcomes for patients, which healthcare workers, despite many documented reports of abuses includes improved self-reported health, improved patient accept- and betrayals of trust. Thus, trust involves the belief in the good- ance and adherence to treatment, improved satisfaction with care, ness of another’s moral intentions not just their habits (Peter & symptom improvement, feeling safe in hospital, improved access and Morgan, 2001). quality of care, all of which lead to better health for the individual and Trust is particularly relevant to nursing hospitalised as it the general population (Brennan et al., 2013; Mollon, 2014; Ozawa has been found to be important in helping children to feel safe & Sripad, 2013).Article Trust in The Nurse Survey of Hospitalised Children Summary In healthcare settings trust has been described as in hospital (Salmela, Aronen, & Salanterä, 2010). The fragility of the emotional glue binding leaders and employees, enhancing team- the child’s trust is seen during the frequent breaches of trust, work, communication and productivity (Bell & Duffy, 2009; Peter & particularly around painful procedures, which children can per- Morgan, 2001). Despite its importance, trust has become scarce in ceive adult behaviour as threatening, causing them to distrust healthcare (Bell & Duffy, 2009). Increasingly in the media there are nurses, especially if the extent of pain in procedures is underrated reports of breaches of trust across the healthcare services and ac- (Bricher, 1999; Salmela et al., 2010). Lack of trust between the counts of failures to protect the patient, rising healthcare costs with- nurse and the child’s family can result in parents refusing treat- out service improvements, and a public’s general nonacceptance that ment or medications for their child, withdrawing from mutual there is not a solution for every possible illness (Bell & Duffy, 2009). relations, rudeness, over vigilance with a watching and ques- When there is widespread public distrust in the epistemic authority tioning demeanour, aggression and anger (Thompson, Hupcey, & of healthcare experts, their credibility is challenged and a void can Clark, 2003). Children’s trust and that of their parents are closely | SHEEHAN and FEALY 4291 aligned and parents are the main barriers to building a child’s trust pretests with age-appropriate children. Following this, the lower age (Bricher, 1999; Rotenberg, Bretts, & Woods, 2015). Children have limit was raised to 9 years. described the interpersonal qualities of the nurse that lead to trust We measured the children’s levels of trust in the nurse, the and the importance of the professional aspects to the nurse’s role relationship between the children’s trust levels and their parents’ (Brady, 2009; Coyne, 2006; Fletcher et al., 2011; Pelander & Leino- views of their child’s trust in the nurse and the correlations be- Kilpi, 2010; Randall, Brook, & Stammers, 2008). The attributes de- tween trust, adherence, fear and interactions with the nurse. We scribed include humorous, fun, cheerful, nice, kind, pleasant, calm, used a modified version of The Children’s Trust in Nurse’s Scale helpful, good-listener and honest (Brady, 2009; Pelander & Leino- (CTNS) developed by Rotenberg et al. (2015) to measure children’s Kilpi, 2004; Randall et al., 2008). trust. This scale is a short self-report questionnaire designed to Rotenberg describes interpersonal trust as comprising three elicit information on children’s beliefs in, and attitudes to, trust fundamental elements: honesty, emotional and reliability, with in nurses by assessing the three elements of trust described by each differentiated by two domains, cognitive/affective and be- Rotenberg et al. (2008, 2015), namely: honesty, reliability and haviour, and two dimensions of target of trust, specificity and emotion. A separate questionnaire measured parents’ beliefs of familiarity (Rotenberg, 2010; Rotenberg, Petrocchi, Lecciso, their child’s perceived beliefs on a four-point scale for trust and & Marchetti, 2014; Rotenberg et al., 2008, 2015). Honesty de- fear and on a five-point scale for adherence and interaction. In the scribes a belief that others engage in behaviour that is benign children’s scale there are twelve questions, four questions spe- and not malicious in nature. Reliability describes the belief cifically designed to assess each of the three elements of trust that others will do as they say and keep their word or promise. described by Rotenberg et al. (2015). Participants were asked to Emotional refers to the belief that others will not cause emotional indicate their beliefs on a series of statements using a 5-point harm, are trustworthy with information and will not criticise or Likert scale from “highly likely” to “highly unlikely.” As this scale cause embarrassment. Trust results from the reciprocal process measured the intensity of beliefs, the “very likely” response was whereby individuals demonstrate matching patterns of trust and assigned a score of 5 and the “highly unlikely” was assigned a score a common social history is established (Rotenberg, 2010). Article Trust in The Nurse Survey of Hospitalised Children Summary Based of 1. Scores were computed by adding a participant’s individual on this framework, Rotenberg et al. (2008) developed a scale to item scores. In consultation with the scale’s developer, the scale measure school children’s trust in nurses and doctors (Rotenberg and parent questionnaire was modified for the particular clinical et al., 2008, 2015). Rotenberg et al. (2015) argue that, by using setting. the framework, nurses could target children with interventions Cronbach’s alpha coefficient demonstrated an overall index of to promote trust. Using the constructs in Rotenberg’s framework reliability for the CTNS of ? = 0.702, similar to that reported by can describe children’s levels of trust in the nurse and thereby Rotenberg et al. (2008, 2015). All inter-item correlations for the reli- enable nurses to plan interventions to develop and enhance chil- ability of the CTNS were in the range of 0.309–0.449. dren’s trust, particularly where trust is low. Based on Rotenberg’s We invited one parent and their child who were admitted to framework, we formulated the following question: what is the one of the hospitals’ 4-day short-stay units to complete the CTNS level of trust in the nurse among hospitalised children? Our study questionnaire. Unless otherwise indicated by the staff on the unit, aimed to measure hospitalised children’s trust in the nurse and to all children aged 9–12 years and one of their parents/guardians were measure parents’ perceived level of trust in the nurse. approached by the researcher or staff member on the unit during the recruitment period. As this was a convenience sampling method, 2 | M E TH O DS those children and their parents who consented to participate during the recruitment period were recruited. Some measures were taken to alleviate difficulties in producing representative results, which in- We conducted a cross-sectional, correlational descriptive study cluded setting a participant quota of 120 similar to the participant using a questionnaire to measure children’s trust in the nurse in size used by Rotenberg et al. (2015) and using four different sites the hospital setting and their parents’ reports of their child’s trust within the hospital. The recruitment period was 6 weeks during April in the nurse. We recruited a nonprobability sample of child-parent/ and May 2016. guardian dyads at four short-stay/day-care treatment units of a large The study protocols were subjected to full ethical review by the urban children’s university teaching hospital in Ireland. The day units institutional ethical review boards of both the hospital and univer- were chosen as the location for this study due to ease of access and sity. The study protocol set out the child protection guidelines to be convenience for both researcher and the hospital, as this was the followed in entering the hospital clinical departments and in gaining first time such a survey was conducted at the hospital. The sam- access to children and their parents. The ethical approval protocol ple consisted of children aged between 9–12 years and one of their adhered to the strict guidelines on documenting the measures that parents or guardians. Rotenberg et al. (2008, 2015) had previously would be taken on avoidance of risks and protection from harm, and tested the scale in the nonacute setting in children aged 8–12 years. the methods by which parents and children would be approached, The scale was reviewed by a senior nurse and paediatrician at the and invited to give both verbal and written informed consent to hospital, who suggested raising the lower age limit and cognitive participate and recruited. The study was granted ethical approval 4292 | SHEEHAN and FEALY following full ethical review. Article Trust in The Nurse Survey of Hospitalised Children Summary At the local unit level, the researcher participants (78%, n = 99) had a previous admission to hospital and team encountered challenges in gaining access to some children experience of a children’s nurse. and families. Some nurses indicated fear that they would appear in a negative light in a study which involved questioning children and families on trust in the nurses. 3.2 | Children’s Trust in Nurses Scale responses Data were analysed using SPSS, Version 20 (2016). Descriptive statistics were used to describe and summarise the data, and t tests The mean trust score for the total CTNS was 47.26 (SD 7.06) out of and ANOVA were used to test hypothesised relationships between a total possible score of 60, and the vast majority (95%, n = 111 of the children’s trust and independent variables including the child’s respondents’ scores were >36 (Table 2). The highest overall score gender, age and their parents’ views of their child’s trust in the nurse. was in the reliability subscale was 17.13 (SD 2.39), while the lowest A p-value of <.05 was considered statistically significant in this overall score was in the honesty subscale at 15.32 (SD 2.81; Table 2). study. We applied the Strengthening the Reporting of Observational Twelve children (10.4%) reported no trust in the nurse and one-fifth Studies in Epidemiology (STROBE) Statement guidelines for report- (n = 21; 17.6%) of the children reported fear of the nurse. One-fifth ing cross-sectional studies (von Elm, 2007; File S1). of the sample of children (17.6%, n = 21) reported that the nurse was too busy to play or take them to the playroom. 3 | R E S U LT S 3.1 | Sample characteristics 3.3 | Parents’ responses The vast majority of the parents reported high levels of children’s The study sample comprised 127 child–parent/guardian dyads. The trust/belief in the nurse (92.9%, n = 118) and the majority (87.2%, sample included 67 boys and 60 girls. The children ranged in age n = 109) also reported that their child was not afraid of the nurse. from 9 to 12 years. The boys’ mean age was 10.16 (SD 1.06) and that However, a small proportion (12.8%, n = 16) reported that their child of the girls was 10.63 (SD 1.2). Of the parents/guardians recruited, feared the nurse. Parents also reported their child’s adherence to a two-thirds were female (68%, n = 76) and the remainder were male. nurse’s treatments, such as taking medication and interaction with For the purposes of analysis and comparisons, the reason for admis- the nurse. A small number of parents (9.7%, n = 12) reported that sion to hospital was categorised into acute/short-term illness and their child was either quite unlikely or very unlikely to adhere to a chronic long-term illness (Table 1). Fewer than half (42%, n = 52) of nurse’s instructions. Furthermore, twenty parents (16.9%) reported the children presented with an acute illness/short-term illness and that their child was quite or very unlikely to interact with the nurse. over half (58%, n = 69) the children had a chronic/long-term illness. The number of times children had been admitted to hospital was also grouped as follows: group 1: first admission; group 2: 2–3 ad- 3.4 | Assumptions of normality of the scale missions; and group 3: >4 admissions (Table 2). Most of the child While visual inspection of the histogram and box plots confirmed a TA B L E 1 Conditions children presented to hospital with Acute and short-term (41%, n = 52) Chronic and long-term (54%, n = 69) somewhat normal distribution of the CTNS scores, the Shapiro–Wilk test yielded a p-value of .011, indicating that we could not assume a normal distribution in the sample. General surgery e.g., Appendectomy, Orchidopexy Cancers e.g., Osteosarcoma, Neuroblastoma Ophthalmology Minor surgeries Anaemias e.g., Sickle-cell anaemia Analysis of the correlation matrix examined correlations between Dental Tooth extractions Gastrointestinal e.g., Crohn’s disease parent- and child-reported trust, fear, adherence to treatment and Orthopaedic e.g., wrist fracture, Pre-op assessment Orthopaedics and rheumatology e.g., Juvenile arthritis Ot … Article Trust in The Nurse Survey of Hospitalised Children Summary Purchase answer to see full attachment Student has agreed that all tutoring, explanations, and answers provided by the tutor will be used to help in the learning process and in accordance with Studypool’s honor code & terms of service . Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

Article Trust in The Nurse Survey of Hospitalised Children Summary ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Article Trust in The Nurse Survey of Hospitalised Children Summary I’m studying for my Writing class and don’t understand how to answer this. Can you help me study? Summarizing the given article in correct APA format with accurate use of in-text citation. jocn.15466.pdf Received: 27 November 2019 | Revised: 1 June 2020 | Accepted: 13 August 2020 DOI: 10.1111/jocn.15466 ORIGINAL ARTICLE Trust in the nurse: Findings from a survey of hospitalised children Rosemarie Sheehan MSc, RGN, RCN, Assistant Director of Nursing1 Gerard Fealy MEd, PhD, RGN, Professor2 1 Children’s Health Ireland, Dublin, Ireland 2 University College Dublin, Dublin, Ireland | Abstract Aims and objectives: To measure hospitalised children’s trust in the nurse. Correspondence Rosemarie Sheehan, Children’s Health Ireland, Dublin, Ireland. Email: [email protected] Background: Trust is central to the therapeutic relationship between the nurse and Funding information The authors declare they received no financial support for the research, authorship and/or publication of this paper. 452, 1999]). the patient. There can be no trusting relationship between the nurse and child if the parents have no trust or block the relationship (Bricher [Journal of Clinical Nursing, 8: Design: This study was a cross-sectional, correlational descriptive design using a selfcomplete questionnaire to measure children’s trust in nurses, to examine the relationship between children’s trust and their parents, and the correlations between trust and medication adherence, fear and interactions with the nurse. Methods: A modified version of the Children’s Trust in General Nurses Scale designed by Rotenberg et al. (Journal for Specialists in Pediatric Nursing, 20: 298, 2015) was used. This Scale is a short self-report questionnaire designed to elicit information on children’s beliefs in, and attitudes to, trust in nurses. The Strengthening the Reporting of Observational Studies in Epidemiology statement for observational studies was applied (von Elm [British Medical Journal, 335: 806, 2007]). Results: The results indicated high levels of trust beliefs in the nurse. The children’s and parents’ trust beliefs were found to be correlated. Gender did not influence trust beliefs. Younger children had higher levels of trust than older children, particularly in relation to the perceived honesty of the nurse. Trust beliefs in the nurse lessened with previous exposure to the hospital setting. One-fifth of children reported fear of the nurse. Positive interaction with the nurse was shown to be positively related to adherence to care. Relevance to clinical practice: Children’s level of trust in the nurse can be measured. A trusting child is likely to be less fearful and experience clinical procedures as less threatening and is more likely to adhere to treatment. Children’s nurses should recognise that trust can change with age and with multiple hospital admissions. KEYWORDS adherence, children, children’s nurse, fear, hospital, parent, trust, trust scale J Clin Nurs. 2020;29:4289–4299. wileyonlinelibrary.com/journal/jocn © 2020 John Wiley & Sons Ltd | 4289 4290 | SHEEHAN and FEALY 1 | I NTRO D U C TI O N Trust involves the belief in the goodness of another’s moral intentions, not just his or her habits (Baier, 1986). In nursing, trust is a relational process that is dynamic and fragile, involving an individual’s deepest needs and vulnerabilities (Carter, 2009). Furthermore, building trusting relationships in nursing has been described as a moral and healing art because of the inherent power asymmetry in the nurse–patient relationship (Carter, 2009). It is the cornerstone of all therapeutic relationships, and without trust, stable relationships are not possible (Carter, 2009). Article Trust in The Nurse Survey of Hospitalised Children Summary Trust is highly complex. It exists in the one-on-one relationship, it is a social phenomenon and applies to the organisation and system as a whole, and is fundamental to the effective functioning of the health system (Carter, 2009; Dinc & Gastmans, 2012; Meyer, Ward, Coveney, & Rogers, 2008; Sellman, 2007). The importance of trust in improving patient outcomes and satisfaction is an intangible asset and should be fostered as a validation of investment in nursing (Rutherford, 2014). Children’s nursing involves an interdependent triad of the child, nurse and parents/guardians where family-centred care is the cen- What does this paper contribute to the wider global clinical community? • The evidence from this study lends further support to the view that children understand the concept of trust and expect their nurses to be trustworthy. • Children may experience being in hospital with reference to the level of threat that treatments and procedures present to them, and hence, their level of trust in the nurse and in other health professionals is important to establish in assessment and care planning. • Children’s trust in healthcare professionals is one element of their emotional response to their encounter with the healthcare system. • A child’s level of trust in healthcare professionals is not static and changes over time and with exposure to the healthcare system and trust can therefore be moderated and enhanced through clinicians’ interpersonal skills, developed through education. tral concept involving the children’s nurse working in partnership with the family to promote, maintain and restore health and well-being. In children’s nursing, trust is particularly important as it can develop where trust in less reliable sources can develop (Rowe & serve to counterbalance the patient’s vulnerability (Bricher, 1999). Alexander, 2015). This was demonstrated in the 1990s in the mis- Despite its importance, the concept of trust in nursing is complex, trust by parents of the MMR vaccine, where uptake significantly de- elusive and poorly understood (Bell & Duffy, 2009). There is a pau- clined (Gille, Smith, & Mays, 2015). city of literature on the child–nurse relationship and the factors that Baier (1929–2012) developed a theory of trust that remains rel- influence the development of trust between the sick child, parents evant in understanding the role of trust in nursing today (Peter & and the children’s nurse. Morgan, 2001; Sellman, 2007). According to Baier (1986), the cardinal features of trust are vulnerability, risk, care and power, and 1.1 | Background the trustee is required to have reasonable confidence that others will act with goodwill towards them (Carter, 2009). Sellman (2007) suggests that Baier’s emphasis on goodwill, or the absence of ill will, Healthcare systems are inherently about relationships and many is an important feature of trust, separating it from other concepts, of the problems and challenges they face are relationship-based such as reliance and confidence, and is important for nurses to un- (Gilson, 2003; Ozawa & Sripad, 2013). Trust in healthcare relation- derstand as it demonstrates why patients trust nurses and other ships has been shown to have positive outcomes for patients, which healthcare workers, despite many documented reports of abuses includes improved self-reported health, improved patient accept- and betrayals of trust. Thus, trust involves the belief in the good- ance and adherence to treatment, improved satisfaction with care, ness of another’s moral intentions not just their habits (Peter & symptom improvement, feeling safe in hospital, improved access and Morgan, 2001). quality of care, all of which lead to better health for the individual and Trust is particularly relevant to nursing hospitalised as it the general population (Brennan et al., 2013; Mollon, 2014; Ozawa has been found to be important in helping children to feel safe & Sripad, 2013).Article Trust in The Nurse Survey of Hospitalised Children Summary In healthcare settings trust has been described as in hospital (Salmela, Aronen, & Salanterä, 2010). The fragility of the emotional glue binding leaders and employees, enhancing team- the child’s trust is seen during the frequent breaches of trust, work, communication and productivity (Bell & Duffy, 2009; Peter & particularly around painful procedures, which children can per- Morgan, 2001). Despite its importance, trust has become scarce in ceive adult behaviour as threatening, causing them to distrust healthcare (Bell & Duffy, 2009). Increasingly in the media there are nurses, especially if the extent of pain in procedures is underrated reports of breaches of trust across the healthcare services and ac- (Bricher, 1999; Salmela et al., 2010). Lack of trust between the counts of failures to protect the patient, rising healthcare costs with- nurse and the child’s family can result in parents refusing treat- out service improvements, and a public’s general nonacceptance that ment or medications for their child, withdrawing from mutual there is not a solution for every possible illness (Bell & Duffy, 2009). relations, rudeness, over vigilance with a watching and ques- When there is widespread public distrust in the epistemic authority tioning demeanour, aggression and anger (Thompson, Hupcey, & of healthcare experts, their credibility is challenged and a void can Clark, 2003). Children’s trust and that of their parents are closely | SHEEHAN and FEALY 4291 aligned and parents are the main barriers to building a child’s trust pretests with age-appropriate children. Following this, the lower age (Bricher, 1999; Rotenberg, Bretts, & Woods, 2015). Children have limit was raised to 9 years. described the interpersonal qualities of the nurse that lead to trust We measured the children’s levels of trust in the nurse, the and the importance of the professional aspects to the nurse’s role relationship between the children’s trust levels and their parents’ (Brady, 2009; Coyne, 2006; Fletcher et al., 2011; Pelander & Leino- views of their child’s trust in the nurse and the correlations be- Kilpi, 2010; Randall, Brook, & Stammers, 2008). The attributes de- tween trust, adherence, fear and interactions with the nurse. We scribed include humorous, fun, cheerful, nice, kind, pleasant, calm, used a modified version of The Children’s Trust in Nurse’s Scale helpful, good-listener and honest (Brady, 2009; Pelander & Leino- (CTNS) developed by Rotenberg et al. (2015) to measure children’s Kilpi, 2004; Randall et al., 2008). trust. This scale is a short self-report questionnaire designed to Rotenberg describes interpersonal trust as comprising three elicit information on children’s beliefs in, and attitudes to, trust fundamental elements: honesty, emotional and reliability, with in nurses by assessing the three elements of trust described by each differentiated by two domains, cognitive/affective and be- Rotenberg et al. (2008, 2015), namely: honesty, reliability and haviour, and two dimensions of target of trust, specificity and emotion. A separate questionnaire measured parents’ beliefs of familiarity (Rotenberg, 2010; Rotenberg, Petrocchi, Lecciso, their child’s perceived beliefs on a four-point scale for trust and & Marchetti, 2014; Rotenberg et al., 2008, 2015). Honesty de- fear and on a five-point scale for adherence and interaction. In the scribes a belief that others engage in behaviour that is benign children’s scale there are twelve questions, four questions spe- and not malicious in nature. Reliability describes the belief cifically designed to assess each of the three elements of trust that others will do as they say and keep their word or promise. described by Rotenberg et al. (2015). Participants were asked to Emotional refers to the belief that others will not cause emotional indicate their beliefs on a series of statements using a 5-point harm, are trustworthy with information and will not criticise or Likert scale from “highly likely” to “highly unlikely.” As this scale cause embarrassment. Trust results from the reciprocal process measured the intensity of beliefs, the “very likely” response was whereby individuals demonstrate matching patterns of trust and assigned a score of 5 and the “highly unlikely” was assigned a score a common social history is established (Rotenberg, 2010). Article Trust in The Nurse Survey of Hospitalised Children Summary Based of 1. Scores were computed by adding a participant’s individual on this framework, Rotenberg et al. (2008) developed a scale to item scores. In consultation with the scale’s developer, the scale measure school children’s trust in nurses and doctors (Rotenberg and parent questionnaire was modified for the particular clinical et al., 2008, 2015). Rotenberg et al. (2015) argue that, by using setting. the framework, nurses could target children with interventions Cronbach’s alpha coefficient demonstrated an overall index of to promote trust. Using the constructs in Rotenberg’s framework reliability for the CTNS of ? = 0.702, similar to that reported by can describe children’s levels of trust in the nurse and thereby Rotenberg et al. (2008, 2015). All inter-item correlations for the reli- enable nurses to plan interventions to develop and enhance chil- ability of the CTNS were in the range of 0.309–0.449. dren’s trust, particularly where trust is low. Based on Rotenberg’s We invited one parent and their child who were admitted to framework, we formulated the following question: what is the one of the hospitals’ 4-day short-stay units to complete the CTNS level of trust in the nurse among hospitalised children? Our study questionnaire. Unless otherwise indicated by the staff on the unit, aimed to measure hospitalised children’s trust in the nurse and to all children aged 9–12 years and one of their parents/guardians were measure parents’ perceived level of trust in the nurse. approached by the researcher or staff member on the unit during the recruitment period. As this was a convenience sampling method, 2 | M E TH O DS those children and their parents who consented to participate during the recruitment period were recruited. Some measures were taken to alleviate difficulties in producing representative results, which in- We conducted a cross-sectional, correlational descriptive study cluded setting a participant quota of 120 similar to the participant using a questionnaire to measure children’s trust in the nurse in size used by Rotenberg et al. (2015) and using four different sites the hospital setting and their parents’ reports of their child’s trust within the hospital. The recruitment period was 6 weeks during April in the nurse. We recruited a nonprobability sample of child-parent/ and May 2016. guardian dyads at four short-stay/day-care treatment units of a large The study protocols were subjected to full ethical review by the urban children’s university teaching hospital in Ireland. The day units institutional ethical review boards of both the hospital and univer- were chosen as the location for this study due to ease of access and sity. The study protocol set out the child protection guidelines to be convenience for both researcher and the hospital, as this was the followed in entering the hospital clinical departments and in gaining first time such a survey was conducted at the hospital. The sam- access to children and their parents. The ethical approval protocol ple consisted of children aged between 9–12 years and one of their adhered to the strict guidelines on documenting the measures that parents or guardians. Rotenberg et al. (2008, 2015) had previously would be taken on avoidance of risks and protection from harm, and tested the scale in the nonacute setting in children aged 8–12 years. the methods by which parents and children would be approached, The scale was reviewed by a senior nurse and paediatrician at the and invited to give both verbal and written informed consent to hospital, who suggested raising the lower age limit and cognitive participate and recruited. The study was granted ethical approval 4292 | SHEEHAN and FEALY following full ethical review. Article Trust in The Nurse Survey of Hospitalised Children Summary At the local unit level, the researcher participants (78%, n = 99) had a previous admission to hospital and team encountered challenges in gaining access to some children experience of a children’s nurse. and families. Some nurses indicated fear that they would appear in a negative light in a study which involved questioning children and families on trust in the nurses. 3.2 | Children’s Trust in Nurses Scale responses Data were analysed using SPSS, Version 20 (2016). Descriptive statistics were used to describe and summarise the data, and t tests The mean trust score for the total CTNS was 47.26 (SD 7.06) out of and ANOVA were used to test hypothesised relationships between a total possible score of 60, and the vast majority (95%, n = 111 of the children’s trust and independent variables including the child’s respondents’ scores were >36 (Table 2). The highest overall score gender, age and their parents’ views of their child’s trust in the nurse. was in the reliability subscale was 17.13 (SD 2.39), while the lowest A p-value of <.05 was considered statistically significant in this overall score was in the honesty subscale at 15.32 (SD 2.81; Table 2). study. We applied the Strengthening the Reporting of Observational Twelve children (10.4%) reported no trust in the nurse and one-fifth Studies in Epidemiology (STROBE) Statement guidelines for report- (n = 21; 17.6%) of the children reported fear of the nurse. One-fifth ing cross-sectional studies (von Elm, 2007; File S1). of the sample of children (17.6%, n = 21) reported that the nurse was too busy to play or take them to the playroom. 3 | R E S U LT S 3.1 | Sample characteristics 3.3 | Parents’ responses The vast majority of the parents reported high levels of children’s The study sample comprised 127 child–parent/guardian dyads. The trust/belief in the nurse (92.9%, n = 118) and the majority (87.2%, sample included 67 boys and 60 girls. The children ranged in age n = 109) also reported that their child was not afraid of the nurse. from 9 to 12 years. The boys’ mean age was 10.16 (SD 1.06) and that However, a small proportion (12.8%, n = 16) reported that their child of the girls was 10.63 (SD 1.2). Of the parents/guardians recruited, feared the nurse. Parents also reported their child’s adherence to a two-thirds were female (68%, n = 76) and the remainder were male. nurse’s treatments, such as taking medication and interaction with For the purposes of analysis and comparisons, the reason for admis- the nurse. A small number of parents (9.7%, n = 12) reported that sion to hospital was categorised into acute/short-term illness and their child was either quite unlikely or very unlikely to adhere to a chronic long-term illness (Table 1). Fewer than half (42%, n = 52) of nurse’s instructions. Furthermore, twenty parents (16.9%) reported the children presented with an acute illness/short-term illness and that their child was quite or very unlikely to interact with the nurse. over half (58%, n = 69) the children had a chronic/long-term illness. The number of times children had been admitted to hospital was also grouped as follows: group 1: first admission; group 2: 2–3 ad- 3.4 | Assumptions of normality of the scale missions; and group 3: >4 admissions (Table 2). Most of the child While visual inspection of the histogram and box plots confirmed a TA B L E 1 Conditions children presented to hospital with Acute and short-term (41%, n = 52) Chronic and long-term (54%, n = 69) somewhat normal distribution of the CTNS scores, the Shapiro–Wilk test yielded a p-value of .011, indicating that we could not assume a normal distribution in the sample. General surgery e.g., Appendectomy, Orchidopexy Cancers e.g., Osteosarcoma, Neuroblastoma Ophthalmology Minor surgeries Anaemias e.g., Sickle-cell anaemia Analysis of the correlation matrix examined correlations between Dental Tooth extractions Gastrointestinal e.g., Crohn’s disease parent- and child-reported trust, fear, adherence to treatment and Orthopaedic e.g., wrist fracture, Pre-op assessment Orthopaedics and rheumatology e.g., Juvenile arthritis Ot … Article Trust in The Nurse Survey of Hospitalised Children Summary Purchase answer to see full attachment Student has agreed that all tutoring, explanations, and answers provided by the tutor will be used to help in the learning process and in accordance with Studypool’s honor code & terms of service . Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10