Reframing a sense of self: a constructivist grounded theory study of children's admission to hospital for surgery

Children are significant users of healthcare and their needs are different to those of adults. Whilst important gains have been made in children's hospital care since the last half of the 20th century, there is a recent trend to reduce dedicated paediatric services in Australia. In order to provide healthcare services that are child centred and that truly respond to the needs of children, children's perspectives on their healthcare are essential. Yet the inclusion of children's perspectives in health services and research is lacking. It is through listening to, and hearing children, that health care can move closer to meeting their needs. This qualitative study explored the experiences of 10 primary school aged children (six to twelve years of age) admitted to hospital for surgery, from their perspective. A constructivist grounded theory approach was used that incorporated flexible, child centred research techniques including interviews and the 'draw and write technique'. This thesis presents a substantive theory: children's reframing of their sense of selves to incorporate the experiences of hospitalisation and surgery. The children were active participants embedded within the phenomenon. Admission to hospital for surgery presented a form of adversity for the children in what was an embodied experience of contrasts. Major concepts of the experience were: 'being scared'; 'hurting'; and 'having fun'. There were two major processes the children engaged in for reframing their sense of self to incorporate the experience. The first was around their meaning making activities, expressed as 'coming to know' and the second was their ability to move on from the adversity and reintegrate the experience into their normal lives, expressed as 'bouncing back'. In order for the children to successfully incorporate the experience into their sense of self, a supportive context or holding environment was necessary, expressed as 'being held'. Children were the primary source of knowledge about their views and experiences for this study. The findings highlight the importance of centring children's healthcare on the needs of children and their families. The findings suggest that ongoing problems with paediatric practices continue to impact negatively on children's experiences of hospitalisation. Although there is a body of evidence about what constitutes best practice, in reality, practices fall short of these recommendations.