Decision-making during hospitalization:: parents' and children's involvement

Background. Ethical duties of health professionals include the obligation to enhance their patients' competence and ability to participate. Aims and objectives. To explore what kind of decisions and how these decisions were made during a child's hospitalization. Design. During a 9-week period 24 children and their parents were followed during the course of events at the hospital. In total 135 hours of observations were made and analysed in two steps. Results. In most of the situations one or both parents were present with the child. Most decisions were of a medical nature, and commonly decisions were made in consultation with those affected by the decision. Although one or more persons protested in 83 of the 218 described situations, decisions were seldom reconsidered. Conclusions. The children and their parents were usually involved in the decision-making process. Children and parents made few decisions themselves and even if they disagreed with the decision made, few decisions were reconsidered. Relevance to clinical practice. Having a voice in decision-making helps the child to develop a sense of himself as a person and gives the parents a feeling that they are part of a team giving their child optimal care during hospitalization. Promoting children's rights is one of the most important roles for the children's nurse.