Reading assignment

Title of paper:
Hospitalized children drawing their pain: the contents and cognitive and emotional characteristics of pain drawings.


Publication:
Journal of Child Health Care

Method:

Aim:
The aim of the study was to examine how children’s illness and hospitalization are associated with the contents and cognitive and emotional characteristics of their drawings about their pain experiences. The pain drawings of the hospitalized children are compared to healthy control groups and the impact of the child’s illness diagnosis on the content, cognitive quality and emotional disturbance of the drawings in the hospitalized group were analysed.


Study Design:
Group 1:
37 inpatients children at a university hospital in four wards. Aged from 5-11 years
Hospitalized children’s diagnoses:
37.8% (1/3) problems in locomotive systems, such as rheumatoid arthritis, myositis (inflammation of muscle) and Legg-Perthes-Gakve (inflammation of both bone and cartilage)
8.1% Accidents
16% problems in various tumours = cerebral tumours, Wilms’ tumours and kidney tumours.
10.8% Hematologic diseases
2.7% Diseases of circulatory organs
5.4% metabolic disorders
2.7% Diseases of nervous system
8.1% Diseases of urinary tract
8.1% of digestives system

Group 2:
22 healthy children – 8 from a day care centre (Kindergarten) aged 1-7 years, 14 from a small local elementary school aged 7-11 years.

The hospitalized and control groups did not differ in their age and gender. The whole sample consisted of 59 children (37 girls and 22 boys) The children’s aged ranged from 5-11 years.

At the time of data collection the children had been in hospital from 1 day to 26 weeks. All had undergone examinations and treatments, more than half of them had undergone an operation, they were in hospital either from examination or preventive or conservative care. Pain experienced could be a symptom of a diagnosed illness, or caused by medical or diagnostic procedures or basic nursing. Pain was caused by accidents such as falls, blows and burns. These children also had ‘inexplicable’(which cannot be explained) pains which were not caused by a particular illness or injury.

Procedure:
For Hospitalization Group
• 10 mins on average to complete drawing task.
• A4 paper
• A set of 6 colours – red, blue, green, black, yellow & brown
• Draw a picture that showed a lot of pain, and then talked about what they depicted (means show in a form of picture).

For Healthy Group (received identical instructions to the hospitalization group)
• Please draw a picture that shows a lot of pain and tell about what you have depicted.
• Child-carer & teacher instructed them on routine drawing task in their curriculum.

Result : content of the pain drawings.


Discussion:
Drawing is a universal language of children and the use of drawing has been
widely recommended as a means of assessment of, and communication with,
children. The children experiences of illness, pain and hospitalization are highly stressful, and they like other children faced difficulties in expressing out their pain meaning. This study also show meaningful differences between ill and hospitalized and healthy children in the cognitive and contextual (according to) dimensions of their pain experiences.

• The results concerning the emotional experiences of hospitalized children
was counter intuitive (immediate understanding), showing more emotional disturbance among control children.

• In the thematic (a test used in psychiatry – whereby to interpret a series of drawings) content indicated higher demands, distress and strain among the hospitalization children. They also experienced more often as targets of medical procedures.

• Somehow, there are some hospitalization children drew their own actions aiming to managing the pain.

• Hospitalization children drew to expressed in technical, non-human and operational aspects of pain, indicating control and non-emotionality.

• Healthy children ides of pain involved the family coming together, seeking and receiving consolation and a deeper expression of emotions.

• Similarities in both group children preferred to draw themselves in pain or a part of a person in pain, or placed their pain in a certain part the body.

• Hospitalization children showed lower cognitive performance in expressing pain.(especially older children who are frightened about pain which may have tendency to regress to a more primitive level of reasoning)

• The reason being the hospitalization children the low cognitive performance level may lie in the fact that illness and frequent hospitalizations interrupt children’s school participation and thus training of cognitive skills and also the children’s motivation and concern about their illness. The poorer cognitive quality lack of human details and decorations in the drawings may reflect a lack of concentration and energy, which is sapped by illness and fronted by ‘being brave and enduring’. The adult-like control and formality depicted in the drawings of the hospitalized children supports a multiple interpretation of cognitive aspects in child development.

• The healthy group children expressed more emotional disturbance than the hospitalized children, indicated by strongly shaded and disintegrated drawings, because this group may have included children with acute family problems and conflicts in their lives, which explains their greater emotional disturbance.

• Wherelse for the hospitalization children they have parents, siblings and friends to care for their illness, which becomes emotionally compensates for their suffering. Hospitalized children receive attention and love, which reflects their harmonious emotional development.

Conclusion:
Children’s drawings are used frequently in educational settings for evaluation and in clinical settings for diagnosing the quality of family relations, emotional disturbance and subconscious processes. Drawing is one of the most natural ways of expression among children; it can provide information about the drawer. This study even though is a small study, in a specific illness related focus, given the results that show meaningful differences between hospitalization children and healthy children.

In this study demonstrates that children’s pain stories can be read from their pain drawings. The evaluation of children’s drawings seems to be a relatively simple and useful aid in clinical practice to find out children’s pain-related emotions.
The drawings from the children may provide guidance for intervention aiming at pain alleviation and at reducing distress and anxiety, to strengthen faith in using children’s drawings in clinical practice and encourage further research in this important area. The moral obligation of nursing is to shed light on the experiences of those most vulnerable within health care.

I may not be in the BOLD hospital play group, but art therapy may be one of the important useful medium for the children in the hospital to express out their pain.