Joumal of Advanced Nursing, 1992,17,1422-1429
Changing attitudes towards families of hospitalized children from 1935 to 1975: a case study Judith Young RN MScN Tutor, Faculty of Nurstng, Untverstty of Toronto, 50 St George Street, Toronto, Ontano M5S lAl, Canada
Acceptedforpublication 30 March 1992
YOUNG J (1992)
Journal of Advanced Nursing 17,1422-1429
Changmg attitudes towards fanulies of hospitalized children from 1935 to 1975: a case study The mtroduction of 'open' visitmg and family mvolvement m the care of hospitalized children created a revolution m the care of children m hospitals This historical study utilized the situation at the Hospital for Sick Children, Toronto (HSC), as a case study lllustratmg change Although psychological research provided a strong rationale for includmg families m the care of hospitalized children, change occurred slowly In this regard, HSC was typical of many children's hospitals However, there seemed to be a significant failure to leam from innovations elsewhere Paediatnc nurses, m particular, were slow to encourage family visiting and participation in care
INTRODUCTION The mdusion of famihes on the wards of paediahic hospitals was a radical change occumng only m recent decades Why were most children's hospitals so slow to welcome famihes? A histoncal perspechve on this question ofiFers mformahon and msight which may help to guide future pradice The situation at the Hospital for Sick Children, Toronto (HSC), Canada's oldest and largest paediatnc hospital, provides a case study which illustrates the changmg pattem of family visiting and partiapation in the care of children HSC has been known smce the late nmeteenth century for its mnovahve medical and surgical treatment However, the hospitai was reluctant to adopt innovations in psychosocial aspects of care and, m particular, was slow to allow famihes greater access to their children (Young 1987) Certam paediatnc hospitals did pioneer acceptance of families m their wards dunng the 1950s, although most hospitals canng for sick children did not welcome famihes until much later For many years, HSC professionals appeared to lack convidion that change was necessary This paper attempts to explam why a leadmg paediatnc lnstituhon progressed 1422
so slowly towards creatmg a more humane environment for its patients and, m particular, assesses the role of HSC curses m promoting or retarding change
™ ^ Pnmary sources of mformation for this histoncal study mduded FISC Annual Reports, mtemal newsletters, memorandums, regulations and mmutes of the Medical Advisory Board Nurses, doctors and former patients and parents provided sources of oral history Further perspechves on nursmg athtudes and behefs were gamed by reviewmg issues of the Canadtan Nurse which were pubhshed dunng the period studied Research papers and books on the psychosoaal welfare of children in hospital yielded secondary source matenal The years 1935 to 1975 were studied because major change towards mdusion of families occurred at HSC and elsewhere withm this penod For example, in 1935 pubhc ward visiting at HSC was restncted to 1 hour on Sunday aftemoons — a prachce which had been m existence for decades Regulations were considerably less restnctive for the small number of pnvate patients (HSC 1928) Such
Famtltes of hospttaltzed children
regulahons were the norm for children's hospitals at the hme On visihng days, parents sat by their child's bed Infants were viewed through a wmdow Visitors also had mmimal mterachon with nursmg or medical staff But, by 1975 most wards at HSC allowed imrestncted visitmg by parents who parttapated increasingly m the actual care of their children Although a major focus of the paper was on the role of nursing m promohng or retarding change, a bnef assessment of the effects of medical influences was also necessary In addition, mformahon conceming the social miheu of the hospitai and trends m child psychology and child-reanng practices provided background data significant to the course of events
CLASS DIFFERENCES SHAPE ATTITUDES TOWARDS FAMILIES Hospitals for children, an mnovation m the nmeteenth century, were founded for the sick fjoor Children received care and nounshment, but moral trainmg and guidance were of equal importance (Vogel 1980) HSC was no excephon It was founded m 1875 by a group of uppermiddle-dass women for 'sick, destitute and friendless children [and] sick children whose parents owing to poverty are unable to attend them' (HSC 1876) A wide social gulf separated the early lady managers and the famihes they served Though great compassion was shown for the phght of poor famihes, hospital personnel were considered sup>enor caregivers and p
Changing attitudes towards families of hospitalized children from 1935 to 1975: a case study Judith Young RN MScN Tutor, Faculty of Nurstng, Untverstty of Toronto, 50 St George Street, Toronto, Ontano M5S lAl, Canada
Acceptedforpublication 30 March 1992
YOUNG J (1992)
Journal of Advanced Nursing 17,1422-1429
Changmg attitudes towards fanulies of hospitalized children from 1935 to 1975: a case study The mtroduction of 'open' visitmg and family mvolvement m the care of hospitalized children created a revolution m the care of children m hospitals This historical study utilized the situation at the Hospital for Sick Children, Toronto (HSC), as a case study lllustratmg change Although psychological research provided a strong rationale for includmg families m the care of hospitalized children, change occurred slowly In this regard, HSC was typical of many children's hospitals However, there seemed to be a significant failure to leam from innovations elsewhere Paediatnc nurses, m particular, were slow to encourage family visiting and participation in care
INTRODUCTION The mdusion of famihes on the wards of paediahic hospitals was a radical change occumng only m recent decades Why were most children's hospitals so slow to welcome famihes? A histoncal perspechve on this question ofiFers mformahon and msight which may help to guide future pradice The situation at the Hospital for Sick Children, Toronto (HSC), Canada's oldest and largest paediatnc hospital, provides a case study which illustrates the changmg pattem of family visiting and partiapation in the care of children HSC has been known smce the late nmeteenth century for its mnovahve medical and surgical treatment However, the hospitai was reluctant to adopt innovations in psychosocial aspects of care and, m particular, was slow to allow famihes greater access to their children (Young 1987) Certam paediatnc hospitals did pioneer acceptance of families m their wards dunng the 1950s, although most hospitals canng for sick children did not welcome famihes until much later For many years, HSC professionals appeared to lack convidion that change was necessary This paper attempts to explam why a leadmg paediatnc lnstituhon progressed 1422
so slowly towards creatmg a more humane environment for its patients and, m particular, assesses the role of HSC curses m promoting or retarding change
™ ^ Pnmary sources of mformation for this histoncal study mduded FISC Annual Reports, mtemal newsletters, memorandums, regulations and mmutes of the Medical Advisory Board Nurses, doctors and former patients and parents provided sources of oral history Further perspechves on nursmg athtudes and behefs were gamed by reviewmg issues of the Canadtan Nurse which were pubhshed dunng the period studied Research papers and books on the psychosoaal welfare of children in hospital yielded secondary source matenal The years 1935 to 1975 were studied because major change towards mdusion of families occurred at HSC and elsewhere withm this penod For example, in 1935 pubhc ward visiting at HSC was restncted to 1 hour on Sunday aftemoons — a prachce which had been m existence for decades Regulations were considerably less restnctive for the small number of pnvate patients (HSC 1928) Such
Famtltes of hospttaltzed children
regulahons were the norm for children's hospitals at the hme On visihng days, parents sat by their child's bed Infants were viewed through a wmdow Visitors also had mmimal mterachon with nursmg or medical staff But, by 1975 most wards at HSC allowed imrestncted visitmg by parents who parttapated increasingly m the actual care of their children Although a major focus of the paper was on the role of nursing m promohng or retarding change, a bnef assessment of the effects of medical influences was also necessary In addition, mformahon conceming the social miheu of the hospitai and trends m child psychology and child-reanng practices provided background data significant to the course of events
CLASS DIFFERENCES SHAPE ATTITUDES TOWARDS FAMILIES Hospitals for children, an mnovation m the nmeteenth century, were founded for the sick fjoor Children received care and nounshment, but moral trainmg and guidance were of equal importance (Vogel 1980) HSC was no excephon It was founded m 1875 by a group of uppermiddle-dass women for 'sick, destitute and friendless children [and] sick children whose parents owing to poverty are unable to attend them' (HSC 1876) A wide social gulf separated the early lady managers and the famihes they served Though great compassion was shown for the phght of poor famihes, hospital personnel were considered sup>enor caregivers and p
