Doctor of Philosophy (PhD) / This study was conducted to increase our understanding of children and young people’s experience of a hospital environment and to identify the salient attributes of the physical environment in their experience. There were three specific aims: to describe children and young people’s experience of a hospital environment and identify what constitutes a supportive paediatric environment; to examine the role of the physical environment in patients’ feeling of well-being; and to highlight the capacity of participatory research with children and young people to inform evidence-based paediatric design. At this stage, there has been very little healthcare design research carried out with populations of children and young people. Well-being research with children and young people in paediatric environments that identifies the potential supportive attributes in this environment is also very limited. Historically research on children’s health and well-being has been dominated by a focus on the prevalence of disorders, problems and disabilities. More recently, in response to the change to health promotion, positive attributes have been included in well-being and satisfaction measures. At this stage, there are still many fewer positive measures. Within the body of literature that exists in healthcare, healthcare design research, and well-being research, there are only a small number of participatory studies that focus on children and young people’s experience of hospitalisation, and an even smaller number that include children and young people’s experience of hospital environments. The picture that is created by the research that exists is patchy. There is a need for a more holistic understanding of children and young people’s experience of hospitalisation and of hospital environments from their own perspectives. Based on these gaps in current knowledge, two research questions were developed. The first was concerned with describing children and young people’s experience of the sociophysical environment of a paediatric hospital. The second question was concerned with understanding the role of the physical environment in children and young people’s feeling of well-being in a hospital environment. In addressing these questions, the intention was to identify attributes within the hospital setting which collectively comprise a supportive environment for children and young people and which contribute to children and young people’s feeling of well-being in a paediatric setting. The current study was conducted as an exploratory qualitative case study and carried out at the Children’s Hospital at Westmead, in Sydney, Australia. Using participatory research techniques, the sequence of the study included two pilot studies and the main study. The focus was on understanding the experiences of longer-term patients of a paediatric hospital environment. In the main study 25 children and young people, aged between 9-18 years, who had been in hospital for at least a week completed semi-structured interviews in which they talked about their response to the environment of the hospital and their experience of hospitalisation. Data analysis was completed using a combination of concept mapping and thematic analysis techniques. Preliminary findings were used as the basis of a further member-checking task carried out with a further six children and young people before conclusions were reached. The findings reveal that children and young people’s experience of a paediatric setting involves a number of major areas of influence including their personal situation, their social experience, their interaction with the physical environment, opportunities and characteristics of the organisation, and the effect of time. The findings also reveal that children’s feeling of well-being within this experience is linked to their ability to feel comfortable in the environment, to maintain a positive state of mind, and to remain positively engaged with the experience and the environment. This research reveals a dynamic relationship between children and young people and a paediatric environment that children and young people actively manage and shape. It reveals some of the key considerations in children and young people’s experience of hospitalisation. It also reveals why these considerations are important and what role they play in patients’ experience and feeling of well-being. These findings provide the basis for further research and they have implications for future design and research practice in paediatric healthcare settings.

Doctor of Philosophy (PhD) / This study was conducted to increase our understanding of children and young people’s experience of a hospital environment and to identify the salient attributes of the physical environment in their experience. There were three specific aims: to describe children and young people’s experience of a hospital environment and identify what constitutes a supportive paediatric environment; to examine the role of the physical environment in patients’ feeling of well-being; and to highlight the capacity of participatory research with children and young people to inform evidence-based paediatric design. At this stage, there has been very little healthcare design research carried out with populations of children and young people. Well-being research with children and young people in paediatric environments that identifies the potential supportive attributes in this environment is also very limited. Historically research on children’s health and well-being has been dominated by a focus on the prevalence of disorders, problems and disabilities. More recently, in response to the change to health promotion, positive attributes have been included in well-being and satisfaction measures. At this stage, there are still many fewer positive measures. Within the body of literature that exists in healthcare, healthcare design research, and well-being research, there are only a small number of participatory studies that focus on children and young people’s experience of hospitalisation, and an even smaller number that include children and young people’s experience of hospital environments. The picture that is created by the research that exists is patchy. There is a need for a more holistic understanding of children and young people’s experience of hospitalisation and of hospital environments from their own perspectives. Based on these gaps in current knowledge, two research questions were developed. The first was concerned with describing children and young people’s experience of the sociophysical environment of a paediatric hospital. The second question was concerned with understanding the role of the physical environment in children and young people’s feeling of well-being in a hospital environment. In addressing these questions, the intention was to identify attributes within the hospital setting which collectively comprise a supportive environment for children and young people and which contribute to children and young people’s feeling of well-being in a paediatric setting. The current study was conducted as an exploratory qualitative case study and carried out at the Children’s Hospital at Westmead, in Sydney, Australia. Using participatory research techniques, the sequence of the study included two pilot studies and the main study. The focus was on understanding the experiences of longer-term patients of a paediatric hospital environment. In the main study 25 children and young people, aged between 9-18 years, who had been in hospital for at least a week completed semi-structured interviews in which they talked about their response to the environment of the hospital and their experience of hospitalisation. Data analysis was completed using a combination of concept mapping and thematic analysis techniques. Preliminary findings were used as the basis of a further member-checking task carried out with a further six children and young people before conclusions were reached. The findings reveal that children and young people’s experience of a paediatric setting involves a number of major areas of influence including their personal situation, their social experience, their interaction with the physical environment, opportunities and characteristics of the organisation, and the effect of time. The findings also reveal that children’s feeling of well-being within this experience is linked to their ability to feel comfortable in the environment, to maintain a positive state of mind, and to remain positively engaged with the experience and the environment. This research reveals a dynamic relationship between children and young people and a paediatric environment that children and young people actively manage and shape. It reveals some of the key considerations in children and young people’s experience of hospitalisation. It also reveals why these considerations are important and what role they play in patients’ experience and feeling of well-being. These findings provide the basis for further research and they have implications for future design and research practice in paediatric healthcare settings.

Bakgrund Det behövs ökade kunskaper om hur sjuksköterskan kan involvera familjen och utföra en familjecentrerad omvårdnad. Ett tydligt arbetssätt kring familjecentrerad omvårdnad kan underlätta utförandet av arbete i att involvera familjen i omvårdnaden. Sjuksköterskor behöver utveckla förståelse av vad familjen innebär för den sjuka barnet och ta det som utgångspunkt i familjecentrerat arbetssätt. Syfte Syftet är att beskriva sjuksköterskornas erfarenhet av familjecentrerad omvårdnad till barn som är inneliggande på sjukhus. Metod Strukturerad litteraturstudie med inslag av den metodologi som används vid systematiska översikter. Elva artiklar analyserades, åtta kvalitativa, två kvantitativa och en mixad metod från databaser PubMed och CINAHL. Resultat Sjuksköterskorna upplever att familjecentrerad omvårdnad, när den appliceras korrekt och med tillräckliga kunskaper, är positiv och gör att omvårdnadsarbetet blir av god kvalitet. Det framkommer också att relationen mellan sjuksköterskor och familjen förstärker kommunikationen och delaktighet. Däremot upplever sjuksköterskorna att de inte har tillräckliga kunskaper och tydliga rutiner vilket leder till att alla sjuksköterskor jobbar på olika sätt. Slutsats Sjuksköterskor behöver mer kunskap kring familjecentrerad omvårdnad. Att involvera familjen har många fördelar och underlättar sjuksköterskornas arbete men det kräver att sjuksköterskorna har tillräckligt med kunskap om familjecentrerad omvårdnad. Om sjuksköterskan inte har tillräckligt med verktyg så upplevs det i stället som något negativt. / Background More knowledge about how nurses can involve the family and perform family-centred careis needed. A clear way of working around family-centred care facilitates the performance of work and nurses are positive about involving the family in caring. Nurses need to develop an understanding about the family´s importance to the sick child and take that as a starting point in family-centred work. Aim The aim it’s to describe nurse’s experiences of family centred care of hospitalized children. Method A structure literature study with elements of the methodology used in systematic reviews. There’s a total of eleven studies, eight qualitative, two quantitative and one mixed methods from database PubMed and CINAHL. Results The nurses feel that family-centred care, when applied correctly and with sufficient skills, is positive and makes nursing work of good quality. Also, the relations-ships between the nurses and families enhances the communication and the participation of the families in the care. However, nurses experience that do not have sufficient knowledge and routines about family-centred care witch lead to every nurse work on different ways. Conclusions Nurses needs more knowledge about family-centred care. To involve family, have many benefits and facilitates nurse´s work but the needs at the nurse have good knowledge about how family-centred care. If the nurse does not have sufficiently tools is family-centred care experiences as something negative.

Hospitalization means a lot of changes for a child. A child does not feel well, is isolated from home, friends, and comes to a new unknown environment full of white coats, fear, and different illnesses. After coming to hospital, a child loses the feeling of safety and is afraid. Fulfilling the child´s needs of certainty and safety is crucial for the child´s healthy development that is why the thesis deals with this topic. The aim of the thesis is to map to what extend the needs of safety and certainty of children are fulfilled in chosen departments. The thesis aims to find out in what way the asked children adapt to the hospital environment and to map the nurses´ approach to the children in the context of fulfilling the needs of safety and certainty as well. In the theoretical part, classification of children´s needs is described and the needs of certainty and safety are characterized. This part deals with adaptation of a child to the hospital environment and cooperation with the family, the role of parents during child´s hospitalisation, and the issue of hospitalism. For the empirical part, qualitative research was chosen via a method of semi-structured interviews with hospitalized children and nurses. The research sample was created by 17 children of younger school age and 6 nurses in the same ratio from three children´s department of Motol University Hospital. When interviewing children, we were finding out how they feel at hospital, what they experience, if they have visitors, if they are not afraid, and how they are informed about the diagnosis, check-ups, and the length of hospitalization. We were interviewing nurses about ensuring the needs of certainty and safety, decreasing fear and pain, common hospitalization of parents and children, and preparation of children for check-ups. On the basis of the analysis of results, we made a conclusion that the needs of safety and certainty are fulfilled to a great extend at children. Children generally adapt to the hospital environment well. Nurses treat them with love and try to devote themselves to them, encourage them and substitute their parents if they are not hospitalized with them. We think, however, that they do no devote enough time to psychosocial anamnesis and that is why an adaptation questionnaire was created which will serve nurses after admitting a child to hospitalization.