My Great Aunt Elizabeth always used to say that children should be seen and not heard. The authors of a new report on pediatric care in hospitals beg to differ.


Most hospitals ask parents to fill out patient satisfaction surveys when evaluating the care of children. The opinions of the young patients themselves are seldom sought — and that makes no sense to Nancy Ryan-Wenger, R.N., director of nursing research and investigator with the Center for Innovation in Pediatric Practice at Nationwide Children's Hospital in Columbus, Ohio. "I knew from my previous research that parents do not always know what their children are thinking, feeling or experiencing," she says.

So Ryan-Wenger led an interdisciplinary research team in the first-ever study to systematically elicit the views of hospitalized children and adolescents on the quality of their nursing care. Nearly 500 Nationwide patients between the ages of 6 and 21 were asked two questions about their care: 1) "What do you most like about your nurses and what they do for you, and how does that make you feel?" and 2) "What don't you like about your nurses and what they do for you, and how does that make you feel?"

The children wrote their responses on tablet computers, with help from research assistants for the younger kids. Their responses were sorted into 18 categories of nurse behaviors, 12 that were regarded as positive, such as "gives me what I need when I need it," "checks on me often," "talks and listens to me" and "is nice and friendly to me." Six categories were regarded as negative, such as "wakes me up" or "doesn't give me what I need when I need it."

Researchers found that, overall, children felt their nurses cared about them, regardless of how many behaviors they did or did not like. Not surprisingly, nearly two-thirds said they didn't like it when nurses did things that hurt or made them uncomfortable, and that those kinds of nurse behaviors made them feel sad, bad, mad, scared or annoyed.

"The children were quite happy to share their experiences," Ryan-Wenger says, and there were very few similarities between child and parent feedback, "which lends support to our belief that the children's perspectives on their experiences are equally as important as parental perspectives."

The researchers recommend:

  • Providing pediatric patients with systematic opportunities to evaluate the quality of their care during hospitalization and other types of health care visits.
  • Holding nurses accountable for timely and appropriate responses to children's concerns about their care, and for communicating those concerns to other staff.
  • Continuing research to evaluate the link between children's perspectives on the quality of their care and the outcomes of that care.

The study was funded by the Robert Wood Johnson Interdisciplinary Nursing Quality Research Initiative. Results will be published in the January 2012 issue of the Journal of Nursing Care Quality and are available online now.

Bill Santamour is managing editor of Hospitals & Health Networks. Follow his tweets at