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I want my

Mummy

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U'/.-.Viii,-/'''. i r O ? !

The Welfare of Sick Children in Hospital'

was the formal title of a report published in

Britain in 1959 w h i c h c a m e to be k n o w n as the Piatt R e p o r t , after Sir Harry Piatt, the c h a i r m a n of the
parliamentary committee which investigated the care of children in hospital.
The committee found that hospitals were miserable places for children, where they were expected to conform to
w a r d r o u t i n e s , not a l l o w e d t o play; w h e r e t o lie q u i e t l y w a s t h e a c c e p t e d n o r m , a n d w h e r e , under no
circumstances, were the parents allowed to visit outside the declared visiting hours.
Subsequent to the publication of the Piatt Report a revolution occurred in children's hospitals in Britain and other
western countries, including Australia. This paper explores these changes, and discusses implications for
paediatric care in hospitals and paediatric nursing education today.
Before 1960, when children were
admitted to hospital, parents were
expected to give their child into
the care of the nurses, doctors and
o t h e r health professionals. T h e
children were b a t h e d , dressed in
hospital clothes, then allowed to
s e e t h e i r m o t h e r s for a s h o r t
period, to say 'goodbye'. M o t h e r
h a d to leave, and, d e p e n d i n g on
the hospital, was allowed to visit
only at visiting times (Robertson
1952, Robertson

1953). Some

hospitals allowed visiting daily, for

1960s

a n d How I b y ,

H.P. Fickerill, w h o ran a small plastic

o n e or t w o hours, o t h e r s , only o n c e a

pioneers in the area of child psychology,

s u r g e r y c l i n i c , a d m i t t e d m o t h e r s with

w e e k , a n d s o m e n o t at all. T h e c h i l d

that

Robertson

demonstrated that these so-called 'settled-

their c h i l d r e n w h o were having surgery,

usually cried for a while, and then settled

in' children were in reality suffering acute

and found that p a t i e n t o u t c o m e s w e r e

down. Some things would make the child

s y m p t o m s of s e p a r a t i o n a n d loss, a n d

m u c h b e t t e r if t h e i r m o t h e r s

cry again, perhaps someone would walk

were dangerously withdrawn.

with t h e c h i l d r e n (Pickerill & Pickerill

through the door through which mother


had departed, or a person would c o m e

stayed

1945, Pickerill & Pickerill 1946).


Emerging theories and innovations

Such innovations were viewed

and play with the child briefly and then

with

P e r h a p s t h e earliest i n n o v a t o r in t h e

scepticism by t h e medical a n d nursing

leave. After a few days, the child would

c a r e of c h i l d r e n in h o s p i t a l w a s S i r

professions. It was believed that children

stop crying on such occasions, and would

James Spence w h o lived in Glasgow, in

were b e t t e r off w i t h o u t o v e r - e m o t i o n a l

sit quietly in his/her cot, calmly looking

the 1920s. H e was a p a e d i a t r i c i a n w h o ,

parents (jongkees 1945, Jensen & Comly

around. Nurses would then consider that

set up the first "mother a n d baby" unit,

1 9 4 8 , Prank 1952), a n d that r e l a t i o n s

the child had 'settled in', and that wards

w h e r e m o t h e r s were a l l o w e d t o slay

between

where most of the children had 'settled

with their babies when they w ere

d e t e r i o r a t e if t h e m o t h e r s w e r e in t h e

in' were happy wards (Robertson 1970).

a d m i t t e d to hospital ( S p e n c e 1947).

ward all the time (Forres 1953).

These wards were well-ordered, tidy and

In

S o m e authors of t h e day expressed t h e

q u i e t . It was n o t until t h e 1950s a n d

h u s b a n d and wife team, D r s Cecily and

New Zealand

in

the

1 9 5 0 s, a

parents

and n u rs e s would

view that hospital

admissions and

C o l l ^ i . m Vol 5 No 2 I (J'J8 1 7

f e a t u r e
the

involved in war work. Burlingham's and

Robertson & Robertson 1971, Robertson

e m o t i o n a l d e v e l o p m e n t ol t h e c h i l d ,

Freud's b o o k s on the nurseries p r o v i d e

& Robertson 1973). T h e first, A two-ycat-

w h o would grow t h r o u g h mastering an

graphic accounts of the effects ol separation

old (joes lo hospital (Robertson 1952) was

adverse situation (Hlom 1958).

on the children, as well as the effects of war

rejected by the BBC w h o feared that it

(Burlingham & Freud 1942, Burlingham &

w o u l d "... c r e a t e t o o m u c h a n x i e t y in

Bowlby and Robertson - the

Freud 1944). O n e of the most important

ordinary

revolutionaries

findings from these studies was that no

However, this film has b e c o m e a classic

surgery were advantageous

to

families"

(Langley

19 8 9 ) .

In t h e 1 9 5 0 s , J o h n Bowlby, a British

teaching tool in the world of paediatrics.

psychiatrist,

his

As o u t l i n e d earlier, R o b e r t s o n defined

theories on a t t a c h m e n t , separation and

three stages through which a child w h o

loss in children.

has been separated from his\her parents

He drew heavily on the work of Sigmund

for a n y l e n g t h of time g o e s - p r o t e s t ,

F r e u d , a n d on e t h o l o g y , t h e s t u d y of

despair' and denial (detachment).

b e h a v i o u r in a n i m a l s , p a r t i c u l a r l y t h e

T h e child first protests on being lelt, and

behaviour ol primates, and the way bonds

cries lor its mother. Then, as time goes on,

began

to publish

are formed with o l f - s p r i n g . I lis t h r e e -

the child begins to withdraw as it despairs,

volume work "Attachment, Separation and

cries some times, sits quietly at others, but

Loss" h a s b e c o m e a classic in c h i l d

is still able to be distracted if s o m e o n e

p s y c h o l o g y l i t e r a t u r e (Bowlby

comes to talk or play. T h e final stage occurs

1971a,

Bowlby 1971b, Bowlby 1971c).

when the child has given up hope of being

. B '.'."i4Wl

ffa&

H e theorised that in infancy and very early

taken h o m e , and is c h a r a c t e r i s e d by a

c h i l d h o o d , attachment behaviour, where

detachment

young children were kept within reach of

environment, and from people, including

their

his/her parents, who come to visit.

mothers,

was

instinctive,

an

from

the

everyday

Once Robertson and Bowlbys theories were

evolutionary protection mechanism lor the

accepted, it was recognised that the well-

survival ol the young.


James Robert . ' - ..Hi' ; 'I'.'-iim) efforts biowjbi

T h e breaking ol the attachment bond, or


separation,

was

dangerous

to

tiboitt chamjes in tbe wtiy children were cared foi in IJOI/HWS.

ordered, tidy and quiet children's wards of


the day were, in reality, places of emotional

the

suffering for their young patients.

psychological well-being of the child, and

matter how bad or dangerous the physical

if such a separation became p e r m a n e n t ,

e x p e r i e n c e s were that the c h i l d r e n had

then the child could be seen to grieve lor

suffered, if they were with their mothers at

Emerging theories in the US

that loss.

the time, there seemed to be little, if any,

In t h e U S in t h e

Bowlby and fames R o b e r t s o n t o g e t h e r

lasting emotional trauma to the children.

c h i l d r e n in h o s p i t a l w a s a t o p i c of

described three stages ol such grieving

At these nurseries was a y o u n g Scottish

interest. Rene Spitz, a psychologist, Dane

protest, despair and detachment (Robertson

social worker, the previously m e n t i o n e d

Prugh, a paediatrician, and David Levy, a

& Bowlby 1952). At first Robertson named

j a m c s R o b e r t s o n (Figure 1). R o b e r t s o n

psychiatrist, had begun to suggest links


between psychiatric illness in adolescence

the third stage 'denial' (Robertson 1953) but

had

separation on the nursery children, when

and adulthood with admissions to hospital

(Bowlby 1971a) because he argued that it

his own small daughter was admitted to

during childhood. T h e trauma endured by

fitted better with his concept of attachment.

h o s p i t a l . T h e e f f e c t on h e r s h o c k e d

children during operative procedures, as

Bowlby derived some ol his theoretical

Robertson, who concentrated his work on

well as separation from their parents while

g r o u n d w o r k from the writings of Anna

the ellect of hospitalisation on children

such trauma was being experienced, led to

F r e u d . D u r i n g W o r l d W a r II, in t w o

(Langley 1989).

significant psychoses in later life (Spitz

residential nurseries in Fngland, Anna Freud

Robertson worked closely with Bowlby.

1945, Levy 1945, Prugh et al 1953).

(Sigmund'!.

and

studying

the

effects

of

1950s

Bowlby coined the term 'detachment'

daughter)

been

1940s and

Dorothy

Of their many publications, their series of

In 1955, a c o m m i t t e e was set up by the

Burlingham had the opportunity to observe

films (made with Robertson's wife, Joyce)

citizens of New York City to examine the

children who had been separated from their

had a m a j o r i m p a c t ( R o b e r t s o n

1952,

effects of hospitalisation on children, and

parents, either because they had been

Robertson

1958,

suggested that unlimited visiting be allowed

o r p h a n e d , or because their fathers were

Robertson 1967, Robertson & Robertson

in children's wards (Citizens' Committee on

away l i g h t i n g a n d t h e i r m o t h e r s were

1968,

Children ol New York City, Inc. 1955).

1 8 Co!lei;m Vol 5 N o 2 199H

1953,

Robertson

Robertson & Robertson

1969,

The Piatt Report

Visiting s h o u l d be e n c o u r a g e d ,

Because ol the work of Spence, Bowlby,

p a r e n t s be allowed to help as much as

A n n a Hreud a n d R o b e r t s o n , t h e British

possible with the care of their children.


of

s t r u c t LI red

play,

and

and

government became concerned about the

Provision

effects of h o s p i t a l i s a t i o n on c h i l d r e n .

schooling for hospitalised children were

Parliament appointed Sir Harry Piatt, who

also seen as important (Piatt 1959),

was then President of the Royal College

T h e Australian Pacdialric Association in

of S u r g e o n s , to h e a d a p a r l i a m e n t a r y

1959 d i s c u s s e d t h e Piatt R e p o r t , a n d

committee.

made r e c o m m e n d a t i o n s that separate

1 lis report, entitled "The Welfare of Children

children's hospitals be provided in large

in Hospital", published in 1959, b e c a m e

cities, and separate children's wards, or

k n o w n a r o u n d t h e w o r l d as t h e "Piatt

areas, b e made available in smaller towns

Report" (Piatt 1959), T h e Plait Report

and c e n t r e s . 1 lowevcr, no m e n t i o n was

c o n t a i n e d 55 main r e c o m m e n d a t i o n s .

made ol allowing parents to be admitted

T h e y ranged Irom a r e c o m m e n d i n g that

with their children (MacDonald, Dods &

children not be admitted to hospital at all

Collins 1959). h took many years for such

il it can possibly be avoided, to ensuring

radical c h a n g e s to be i m p l e m e n t e d in

that daily prayers and Sunday school are

hospitals" in Australia,

provided. However, the most important


and far-reaching r e c o m m e n d a t i o n s were

Piatt's legacy

those

their

T h e 1960s and 1970s were exciting times

presence in hospital with their children.

lor those working in paediatrics. Another

Piatt strongly recommended that mothers

parliamentary committee, this time relating

be admitted with their children, especially

to the health ol children in Britain, which

if the child was under live years of age.

came to be known as the Court Report,

regarding

parents, and

was published in 1976. This reinforced the


P l a t l R e p o r t r e c o m m e n d a t i o n s in its
section dealing with children in hospital
( C o u r t 1976). Associations whose aims
were to implement the recommendations
ol the Piatt Report came into being. In
Britain, the National Association for the
Welfare

ol

Children

in

Hospital

A ward at the Mater Children's Hospital lirishanc in I9H: tidy and ordered.
Co1k-Ki.ni Vol 5 N o 2 1998 1 9

feature
( N A W C H ) began, and, in Australia, the

Australia to e x a m i n e their facilities for

parents and other family members as well.

Association lor the Welfare of Children in

children in hospitals (Association for the

Paediatric nursing models that have evolved

Hospital (AWCI-l).

Welfare of C h i l d r e n in H o s p i t a l 1989).

since the changes initiated by Piatt have been

O v e r time, t h e i r n a m e s have c h a n g e d .

Ihe

based on this concept. T h e 'care-hy-parenl'

3 10 h o s p i t a l s w h i c h

responded

N A W C H is now Action for Sick Children,

provided a database of psychosocial care

unit is an extension of family centred care.

A W C H is the Association for the Welfare

Irom w h i c h f u r t h e r r e s e a r c h c o u l d b e

T h e first care-by-parent units were opened


in Kentucky in 1966 (james 1969, James

of Child Health.

conducted, and provided an overview of the

T h e Association for the Welfare ol Children

state ol care of c h i l d r e n in h o s p i t a l in

1972). Others followed in the US and UK.

in Hospital published many documents and

Australia. The results d e m o n s t r a t e d that

In such a model, a parent (or care-giver) is

a r t i c l e s lo p r o m o t e i m p r o v e d c a r e lor

Australian h o s p i t a l s w e r e , in the m a i n ,

a c c o m m o d a t e d with the child. T h e unit

children in Australian hospitals. O n e of the

providing appropriate facilities for children.

has bedrooms, a kitchen and living rooms

m o s t influential ol t h e s e was a p o l i c y

However, the report warned that, in the

for t h e c h i l d a n d p a r e n t . P a r e n t s are

document, prepared in 1974, and published

light of economic rationalism, if some of

educated about the child's treatment, and

as a supplement in the Medical Journal oj

these services were cut a decline in the

allowed to care for the child. T h e level of

Australia in August 1975 (Association lor the

standard of care lor hospitalised children in

involvement ol the parent depends on the

Welfare of Children in Hospital 1975).

Australia would result.

parent's willingness to undertake the tasks


involved, and the child's agreement for the

1 his d o c u m e n t was a c c e p t e d as official


policy of the N e w South Wales H e a l t h

Current models in

parent lo take such a role (Cleary 1992). In

Commission in September 1975, endorsed

paediatric nursing

a c a r e - b y - p a r c n t unit, the nurses' (and

by t h e N a t i o n a l H e a l t h a n d M e d i c a l

I he major guiding principle in m o d e r n

doctors') perceptions ol the parents' and

R e s e a r c h C o u n c i l in D e c e m b e r

1977,

paediatric nursing is family centred care,

child's ability to cope with the demands of

accepted as official policy by the Capital

where it is recognised that the pacdiatric

this type ol care influence the carc-by-

Territory Health Commission in O c t o b e r

nurse cares not only for the child, but the

parent model. T h e carc-by-parenl model

1978, and endorsed by the Minister lot-

... an overview of the state of


care of children in hospital
demonstrates that Australian
hospitals were, in the main,
providing appropriate facilities
for children.

Health, Tasmania in 1980.


This health care policy relating lo children
and their families was updated by A W C H
in 1984 (Association lor the Welfare ol
Children in Hospital 1984).
Other

policy

documents

followed,

i n c l u d i n g r e c o m m e n d a t i o n s lor play in
hospitals, (Association lor the Welfare of
Children in Hospital 1986), and for care of
children

undergoing

anaesthesia

(Association lor the Welfare of Children in


Hospital 1989). More recent publications
encompassed

t h e provision

o I play

f a c i l i t i e s ( W a r d 1 9 9 5 , fiecher
f a c i l i t i e s for p a r e n t s (Yu

1995),

1983) a n d

innovations such as visiting grandparent


schemes (Jensen

1995). Since

their

b e g i n n i n g s , b o t h A W C H and N A W C H
have continued to produce literature and
guidelines about the care of children in
hospitals, as well as to advise governments
(Association for the Welfare of Children in
Hospital 1973, Haris et al 1983, Lubitz
1992, H o g g & Rodin 1993). T h e y have
also fostered research into related topics.
In 1992, A W C H surveyed h o s p i t a l s in
2 0 Collegian Vol 5 No 2 1998

A happy customer

would not be suitable for all families, but it

m o t h e r " , and argued t h a t m o t h e r s h a d

a l t h o u g h as late as 1 9 8 3 , a r e p o r t by

has proven effective in the care of many.

r e s p o n s i b i l i t i e s for t h e c a r e of o t h e r

A W C H of a visit to hospitals in south-east

Partnership in care is a n o t h e r model of

children, homes, and husbands (Meadow

Queensland showed that parents were not

p a e d i a t r i c nursing, which

1964, 1969 & 1972). This left them with

always w e l c o m e ( S i m m o n s 1983). O n e

was

first

suggested by Anne Casey in 1988 (Casey


1988, Casey & Mobhs, 1988). T h e parents
(and family) are actively involved by all
the h e a l t h slafl w h o are caring for t h e
child. Care is planned around the ability
a n d i n c l i n a t i o n of t h e p a r e n t s t o be
involved,

that

is,

a partnership

is

d e v e l o p e d b e t w e e n the parents and t h e


health staff. A similar model is negotiated
care, where care plans are written based on
n e g o t i a t i o n with t h e parent a b o u t how
much of the child's care they wish to be
responsible for, and how much they would
rather leave to the nurses (Smith 1995).
Both m o d e l s w o r k well in p a e d i a t r i c s .
Parents

find

that

they

have

more

responsibility and say in their child's illness,


or condition, and the treatment. Negotiated
care is perhaps more flexible than o t h e r

A yotuuj patient in a ward oj ibe Matei ( biidrat's iiospitai note ibe toys, cards and child's possessions.

models, but all are recognised as relevant to

very few resources to spend on the child in

sometimes hears disparaging remarks about

the care of children in hospital.

hospital, w h o was, the mother knew, well

t h e p r e s e n c e of parents in wards. Such

'Hospital-in-the home' is another model of

c a r e d for. It was a r g u e d t h a t m o t h e r s

attitudes can he changed, as they were in

p a e d i a l r i c care w h i c h has l o u n d to b e

resented being made to stay with the child

t h e 1960s a n d 1970s, by a m i x t u r e ol

w o r k a b l e in p a e d i a t r i c s . It was first

who was in hospital, when others needed

perseverance and education.

suggested in 1954 in London, where the

her at home. After the publication of these

1 lowever, the Piatt recommendations are

Paediatric Unit of St. Mary's Hospital set

a r t i c l e s , few w e r e b r a v e e n o u g h

to

n o t u n i v e r s a l l y in p l a c e in A u s t r a l i a n

up a p r o g r a m w h i c h t o o k n u r s i n g a n d

c o n t i n u e this line of a r g u m e n t . In 1994

children's h o s p i t a l s . In s o m e h o s p i t a l s ,

medical care to families living in areas of

Philip Darbyshire wrote a b o u t the lived

c h i l d r e n a r e still r o u t i n e l y d r e s s e d in

inner London (Lightwood el al 1957). T h e

experiences of parents w h o stayed with

h o s p i t a l p y j a m a s . In s o m e

" h o s p i t a l - i n - l h e - h o m e " model has again

their hospitalised children in a Scottish

c h i k l r c n of similar ages are not nursed

lound

children's ward ( D a r b y s h i r e 1994). I le

together, and wards are arranged according

fa v o u r

with

the

e c o n o in i c

hospitals

found that while most parents were happy

to type of illness. Only a few anaesthetists

care administrators, as it is supposed to

to slay with their c h i l d r e n , s o m e were

allow parents to stay with their children

provide a quality health care sci~vice which

resentful that they were expected to stay

until the child is anaesthetised, and some

can be delivered in t h e patients' h o m e s

w h e n t h e c a r e ol t h e c h i l d was t h e

hospitals do n o t routinely allow parents

(Couriel & Davies 1988), This, ol course,

responsibility of the nurses Also, some

to b e p r e s e n t

rationalistic perspective of present health

as t h e c h i l d

regains

m e a n s that c h i l d r e n can be d i s c h a r g e d

parents found that t h e c o n d i t i o n s under

consciousness in the recovery room. Both

earlier, while still receiving the treatment

which they were expected to live as live-in

ol these are Piatt recommendations.

they require (Jennings 1994)

parents were unsatisfactory.

T h e benefits of allowing parents to stay

To see how well the changes recommended

with their child until he/she is unconscious

Impact of the Piatt

by t h e Piatt Report ( a n d s u b s e q u e n t ,

following anaesthetic induction, and for

recommendations

relevant

been

them to be present when the child regains

Larly in the debate about whether parents

implemented over the 40 years since its

consciousness have been d o c u m e n t e d

should be allowed to stay with their

publication, one needs to work in present-

(LaRosa-Nash

hospitalised child, Roy Meadow, a British

day c h i l d r e n ' s w a r d s . P a r e n t s a r e n o w

Arguments against parents being allowed

paediatrician, w role o I "the c a p t i v e

allowed in paediatric w a r d s in Australia

in

publications)

have

to

&

recovery

Murphy

rooms

1996).

include

the

C o l l e g i a n V o l 5 N o 2 1'Jc)fi 2 1

f e a t u r e
possibility that staff may have to care of

at least two Registered Sick Children's

now lake at least five years to train (three at

parents

Nurses

undergraduate level, one year of clinical

adversely

affected

by

the

on

duly

24

hours

day

(Department of Health 1991). Australian

experience and another year of post-

incidents may occur while children arc

hospitals have no such legal requirement.

graduate study). Child-focussed nurse

recovering consciousness, and the privacy

A survey conducted in 1993 showed that

education with limited adult general nursing

of other child patients must be protected.

in Queensland, of a sample of one third of

exposure is not currently offered anywhere,

However, a controlled study found that

the hospitals in Queensland, showed that

but it should be considered as an option.

there was no significant difference in

only two percent of nurses who worked

The Piatt Report and its ensuing literature

anxiety levels in parents who were with

w i t h c h i l d r e n in those hospitals had

can form the basis for specialist paediatric

t h e i r c h i l d r e n d u r i n g i n d u c t i o n and

paediatric qualifications (Shields 1993). It

nursing programs, and lor practice-based

recovery from anaesthesia and parents who

is reasonable to suggest that the situation

research in paediatric nursing.

were not (Blcsch & fisher 1996). Research

could be similar in other states.

is necessary to substantiate the other

When nurses were trained in hospitals,

Conclusion

arguments lor not allowing parents into

children's hospitals in Australia offered

Care of children in hospital has come a

the anaesthetic and recovery rooms.

training leading to general registration, but

long way since the changes b r o u g h t

with an emphasis on nursing children. As a

about

atmosphere and stress, that

critical

by

the

Piatt

Report

were

Education of paediatric nurses

result, there was a continuous supply of

i m p l e m e n t e d in the 1960s. A model

Tor the changes begun in the 1960s and

nurses with training in paediatrics. With the

which ensured parents had few visiting

1970s to he fully implemented, education

transition to university education, this

rights, or say about their children's care

of children's nurses, paediatricians and

supply of specialised nurses no longer exists.

in h o s p i t a l s has been r e p l a c e d by

allied health staff who treat children and

Current nurse education pursues general

models which involve the parents in all

families is the key. In Britain, all wards

nursing with limited exposure to the special

levels ol care and decision making, and

which accept children must, by law, have

nursing needs of children. Paediatric nurses

which, in many cases, means the child


lives in h o s p i t a l w i t h

its p a r e n t s .

Pioneering research by writers such as


Robertson and Bowlby p r o v i d e d the
basis

for

such

changes.

Nursing

education based on the large body of


work which has evolved since the 1950s
is offered by some universities at postgraduate level. However, if the shortage
of paediatric nurses is to be addressed,
consideration

s h o u l d be g i v e n

to

implementing an undergraduate degree


in paediatric nursing to ensure that
appropriately prepared nurses care for
sick children.

Acknowledgments
This w o r k is funded by the N a t i o n a l
Health and Medical Research Council
Dora Lush Memorial Scholarship, the
Queensland Nursing Council, the Mater
Children's H o s p i t a l and the Centaur

with limited adult


exposure is not

Memorial Fund (or Nurses.

nursing

The photograph of James Robertson is


published with the kind permission of Mrs
Joyce Robertson, and permission for the use
of the other photographs has been given by
the Mater Miscricordiae Hospitals.

2 2 Collegian Vol 5 No 2 1998

References

N a t i o n a l A s s o c i a t i o n lor t h e W e l f a r e of

A s s o c i a t i o n Im t h e W e l l a r e of C ' l u l d i c n in

C h i l d r e n in H o s p i t a l , L o n d o n

H o s p i t a l 1971 H e a l t h c a r e p o l i c y r e l a t i n g l o
c h i l d r e n a n d t h e i r families AMrcii/ Journal of
Australia.

2, S u p p 2 1-1 i

.lames VI.. W h e e l e r W L

H a c k e n b r o t h M , N u b o e r J F 1966 Sir 1 larry

1969 T h e c a r e - b y -

p a r e n t u n i t . Pediatrics 4 3 : 4 8 8 - 4 9 I

H o s p i t a l 1 9 8 4 . A recommended healthcare
policy relatnu] In children and their families.

cross-infection

50 7 2 - 7 4

159-160

an e v a l u a t i o n ol ' H o s p i t a l at I Ionic". Journal of

I lospital 1 9 8 6 . A recommended policy

J e n s e n R 1995 T h e A W C H h o s p i t a l w a r d

telatina to the provision of play for children

g r a n d p a r e n t s c h e m e . ( Inldren in Hospital 21 (4 j : 6 - 7

in hospital A s s o c i a t i o n for t h e W e l f a r e of

J e n s e n R A C o i n l y III I 1948 C h i l d - p a r e n t

C h i l d r e n in I lospital S y d n e y

p r o b l e m s a n d t h e h o s p i t a l . Nervous Child 7

A s s o c i a t i o n for t h e W e l f a r e ol C h i l d r e n in

200-203
lohnson A

I lospital 1 9 8 9 . A recommended polity

1 9 9 4 . C a r e of c h i l d r e n in h o s p i t a l

relating lo the provision of aire foi children

w h e r e h a v e w e been,, w h e r e a r e w e g o i n g ?

itndertjotnt] anaesthesia. A s s o c i a t i o n for t h e

i Vidoecassettei

W e l l a r e of C h i l d r e n in H o s p i t a l : S y d n e y

I lospital: Adelaide

Women's and Children's

23:70-106

R c n d l e - S h o i t 1 1 9 6 5 M o t h e r s in h o s p i t a l w i t h

R o b e i i s o n I 1 9 6 7 Kiile. 2 years ; JFUWIIII. in jostcrcaie

A s s o c i a t i o n l o r t h e W e l f a r e of C h i l d r e n in

foi 27 days [film] 1 9 6 7 . L o n d o n , T a v i s t o c k

H o s p i t a l 1989 A recommended policy

I n s t i t u t e of H u m a n R e l a t i o n s

relating to (f'f provision o) care foi children

R o b e r t s o n I, R o b e r t s o n I 1968 Jane t ~ months- in

A s s o c i a t i o n for t h e

loshrcare for todays

W e l f a r e ol C h i l d r e n in I lospital: S y d n e y

ifilm) L o n d o n ,

R o b e r t s o n J, R o b e r t s o n J 1969 John, IT month*.


day> in a residential nursery (Jilm) L o n d o n ,

in H o n g K o n g Childien in Hospital 2 l! 3J 8-9

T a v i s t o c k Inst it Lite of H u m a n R e l a t i o n s

lilesch P, F i s h e r M L . 1996 T h e i m p a c t ol

parental presence on parental anxiety and


satisfaction. AORN Journal 63(4}:671-768

R o b e r t s o n J, R o b e r t s o n J 1971 Thomas, 2 yeais f


months, in fostei'carc for todays

R o b e r t s o n I 1970 Youmj childien in hospital

22:590-601)

Tavistock P u b l i c a t i o n s . L o n d o n .

B o w l h y J 1 9 7 1 c Loss Vol. 3. P e n g u i n ,

R o b e r t s o n J 195 3 A two-ytar-old

Hai mondsworth
Vol 2. P e n g u i n .

ijoes to hospital a

ijuidi to the film L o n d o n . T a v i s t o c k P u b l i c a t i o n s

1 l a r m o n d s w o i ill

R o b e r t s o n I 1952 A tivo-yeai-old

B o w l h y J 1971a Attachment

(film) L o n d o n ,

T a v i s t o c k I n s t i t u t e ol H u m a n R e l a t i o n s

Blom G F 1958 T h e r e a c t i o n s of h o s p i t a l i s e d

B o w l h y J 1 9 7 1 b . Sepaiaiion.

lavistock

I n s t i t u t e ol H u m a n R e l a t i o n s

flecher Y 1995 Play in h o s p i t a l : its d e v e l o p m e n t

Vol. I. P e n g u i n .

tjoes to hospital a

scientific film record. L o n d o n , Tavistock Publications

H a r m o n d s w o i th

R o b e r t s o n I 195.3 S o m e r e s p o n s e s of y o u n g

B u r l i n g h a m I),- Freud A 1944 Infants without families


Alien a n d L l n w m , L o n d o n
time, a yrai's work in a residential wai nursery

Allen

and Unwin, London

c h i l d r e n British lounuil of I'hy-ical

Medicine

18:11 14
1911-1988

Children in I lospital 1 5i 1'' 1-4

p r a c t i c e Ntirshuj Times S 4 i ' 4 4 ) : 6 7 - 6 8

case study

8(41:8-9

P a r e n t - p r e s e n t i n d u c t i o n of

a n a e s t h e s i a in c h i l d i e n Pediatric

C i t i z e n s ' C o m m i t t e e o n c h i l d r e n of N e w York
1955 Liberal visiting p o l i c i e s t o r
Journal of Pediatrics,

Nursing

22i'2'H09-l I I

69i7;:7-25

C l e a r ) ' I. 1992: ( arinij for childien w hospital, par tut*.

I n s t i t u t e of H u m a n R e l a t i o n s
y o u n g c h i l d r e n t o s e p a r a t i o n from theii
m o t h e r s . ( oiirner 2 131 141
S h i e l d s I. 1 9 9 3 R e p o r t t o Q u e e n s l a n d N u r s e s
U n i o n of F i n p l o y e e s . Results ol s u r v e y

Levy D M 1 9 4 5 P s y c h i c t r a u m a of o p e r a t i o n s in
c h i l d r e n Amiriuvti Journal e/ Diseasis of (.hildhood

46:710-716

R o b e r t s o n J. R o b e i t s o n I 197.3 Lucy. 2r month-,, in

R o b e r t s o n J ,-., Howl b y I 1952 R e s p o n s e s of

L a R o s a - N a s h PA, M u r p h y J M . i 19961 A clinical

C ascy A. 1988 A p a r t n e r s h i p w i t h c h i l d a n d

Nwsina

Toms 4 9 3 8 2 - 3 8 6
fosle'care for to days ijilni". L o n d o n , T a v i s t o c k

LangleyLI. I 989 James Robertson

C a s e y A, M o b b s S. 1988 P a r t n e r s h i p in

c h i l d r e n in h o s p i t a l s

c h i l d r e n t o t h e loss of m a t e r n a l c a r e
J o n g k c c s I.BW 1945 D o c t o r s , h o s p i t a l s a n d

B u r l i n g h a m D , F r e u d A 1942 VOHPII; childien in ivar-

C i t y , Inc

h o s p i t a l i s a t i o n a n d illness American Journal

Relations

C h i l d r e n in H o s p i t a l : S y d n e y

family. StmorNuisc

to

of Orthopsychiatry.

iftlinl. London, Tavistock Institute of Human

A s s o c i a t i o n for t h e W e l f a r e of

c h i l d r e n t o illness. Paedialncs

Mitiistiy ol Health, Central Health Services


Council, London
Prugh DC,- Staub RM : Sands H H ; Ktrschbauni
RM, Lemhan FA 195.3 A study of the
emotional reactions of children and families

R o b e r t s o n J 1958 G o i n g t o h o s p i t a l w i t h m o t h e r

one of children (and families}

undenjoimj anaesthesia

a n d b a b y t o g e t h e r British Medical .Journal 2 3 3 7

unit. Australian J'aediatric Journal 1:98-101

I lospital 1992 National surrey report on


in hospital

P i c k e n l l C M , Pickerill H P 1 9 4 6 . K e e p i n g m o t h e r

their children: experiences with a mother-in

A s s o c i a t i o n for t h e W e l f a r e of C h i l d r e n in
psycho-social

British Medical Journal Feb 3

P l a n H 1959 The welfare of children in hospital.

Advanced Nursme) 19 9 0 5 - 9 1 1

A s s o c i a t i o n for t h e W e l f a r e ol C h i l d r e n in

P i c k e n l l H P , - P i c k e n l l C M 19 15 F . h m i n a t i o n ol

b e n e f i t s h o s p i t a l i s e d c h i l d . Hospital Topics
J e n n i n g s P 1994 L e a r n i n g t h r o u g h e x p e r i e n c e :

N S W D e p a r t m e n t ol H e a l t h : S y d n e y

Piatt. Journal of Bone and hint Surifeiy - British


Volume. 4 8 : 6 1 4 - 6 2 6

lames VL. I 972 C a r e by parent unit cuts costs

A s s o c i a t i o n for l h e W e l f a r e of C h i l d r e n in

O s m o n d - C l a r k e H, Wilson PD, RossJP,

c o n d u c t e d by the Queensland Pacdiatnc


N u r s e s ' A s s o c i a t i o n Incoi p o r a t e d a n d t h e
Royal C h i l d i e n ' s H o s p i t a l , B n s b a n e

L i g h t w o o d k. B n m b l e c o m b e F S W . K e i n h o l d J D h .

S i m m o n s W 198.3 Q u e e n s l a n d S t u d y T o u t .

and muses m partnership. Scutari Press: L o n d o n

Uurnriid L D , D a v i s I A. 1 9 5 7 A L o n d o n trial

2 0 t h . F e b r u a r y - 1st. M a r c h . 198.3. R e p o r t foi

G o u r i e l J M . D.ivies I1 i I 9 8 8 i C o s t s and benefits

of h o m e c a i e loi sick c h i l d r e n , f(inert 1:31.3 317

Association lor die Welfare of Children in I lospital

of a c o m m u n i t y special c a r e b a b v s e r v i c e .
[hitish Medical Journal

L u b i t z I. 1992 W i t h A W C H i n t o t h e 1 9 9 0 s

296:1043-1046

Children in Hospital I Hi 2 i: 1-3

C o u r t S F ) M 1976 Report of the Commiltit on Child


Health Senmts

Vol

1&2

I IMSO, London

D e p a r t m e n t of I lealth 1991 Welfare of ibiidnn

and

yoimt] piople m hospital. 1 I M S O . L o n d o n


F o r r e s H 1 9 5 3 F m o l i o n a l d a n g e r s t o c h i l d r e n in
h o s p i t a l Mmtal

American Journal of Nursme! 52i 1 i - 7 6 - 7 7


H a r i ^ S . M e r r i n g t o n D , R a p l e y S. I (ait D 198.3
T h e lirsl t e n y e a r s of A W C L 1 h o w it all
began
HogH C

Interface 8 ( 3 ) : 3 - 7
R o d i n | 1993 /VAIVCH Quality

of suh-committee appointed hy the Executive of the


Pacdiattic

Association.

October

M e a d o w R 1972 H o s p i t a l v i s i t i n g ol c h i l d r e n
Proceedinas Royal
Meadow S R

Health 12: 5 8 - 6 5

Frank R 1952 P a r e n t s a n d t h e p e d i a t r i c n u r s e . The

Nottingham

M a c D o n a l d W B . D o d s I , C o l l i n s V L 1 9 5 9 Rrt.orl
Australian

Society Mediane

1964 N o

65:

341-342

t h a n k s , I'd r a t h e r s t a y at

home- Mothers who do not want to


accompany their child into hospital- their
class, their laniilies. and then reading habits.
British Medical Journal 2-. 8 1 3 - 8 1 4
M e a d o w S.R. 1969 T h e c a p t i v e m o t h e r . /Wixt'fs

Review.

of Disease in ( hildhood 4 4 . 3 6 2 - 3 6 7

S m i t h F 1995 Cbildnn's HHJ-SIFII/ in piactice- the


SpenceJC

model. Blackwell S c i e n c e

Oxlot'd

1 9 4 7 T h e care of c h i l d r e n in h o s p i t a l .

Bntiih Medical Journal I',44901:1 25-1 30


S p i t z RA 1945 I lospitalisni. an m q u i i y uHo t h e
g e n e s i s ol p s y c h i a t n c c o n d i t i o n s in e a r l y
c h i l d h o o d , hi: Freud A- F l a i t n i a n n H .
Kris L (edsl The l-'sydioaiialytic Study of the
Chill.

1:53-74

W a r d M 1 9 9 5 T h e u s e a n d b c n c l i l s of p r o c e d u r a l
plav t h e r a p y at P O W C H . Chtldttn m Hospital
2 11.3 .'.7-8
Yu IS. W o r s l e y J 1 9 8 3 I.iving-in p a r e n t s : i h e
h i d d e n c o s t s ( hildnn in Hospital 8 i 3 i : 2 3-2-1

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