Is the COVID-19 regulation that prohibits parental visits to their children who are patients in hospital invalid in terms of the Constitution? What should hospitals do?

This article deals with whether the COVID-19 regulation that prohibits parental visits to their children who are patients in hospital is invalid in terms of the Constitution of South Africa. The article contends that the ban on visits by parents to their children in hospital is a violation of the children's rights provisions of the Constitution regarding the 'best interests of the child', and the 'best interests standard' in the Children's Act 38 of 2005. The article also points out that the regulations are not saved by the limitations clause of the Constitution, because the restriction is not 'reasonable and justifiable' and a 'less restrictive means' can be used to achieve the same purpose of preventing the spread of the COVID-19 virus. The article concludes that the relevant regulation is legally invalid, and hospitals would be fully justified in allowing parental visits to child patients provided proper precautions are taken to contain the virus.

El consentimiento informado en el menor de edad en España: mayoría de edad, representación y teorías determinantes de la minoría de edad / Informed consent in minor in Spain: age of majority, representation, and determining theories minority

La minoría de edad, así como las situaciones y las figuras jurídicas que la acompañan, ocupan un lugar destacado a la hora de estudiar el consentimiento informado. La actuación del personal sanitario deberá ser muy distinta si estamos ante una persona considerada como menor o mayor de edad (AU)

The minority and legal situations and accompanying figures prominently when informed consent study the place. The performance of health workers must be very different if we have a person considered as a minor or an adult (AU)

El mejor interés del niño en neonatología: ¿es lo mejor para el niño? / The best interest of the child in neonatology: Is it best for the child?

Desde sus inicios, el estándar del mejor interés del niño estuvo unido a las decisiones de suspensión de tratamientos de soporte vital en unidades de neonatología y a la evaluación de los tratamientos aplicados al niño en función de su calidad de vida. Éste origen ha condicionado la interpretación del estándar desde dos extremos: uno vitalista y uno no vitalista que ha triunfado en la bioética occidental y ha llevado a la consagración del estándar del mejor interés del niño en la Convención de Derechos del Niño de Naciones Unidas. Un análisis detallado nos descubre un estándar simplista, utilitarista y proporcionalista, que ha cambiado el fundamento de la paternidad. Por ello creemos que el estándar del mejor interés del niño no es lo mejor para el niño en las unidades de neonatología y especialmente en los procesos de decisión sobre mantener o suspender los tratamientos de soporte vital

Since its inceptions, the standard of best interest of the child was linked to decisions about suspend life-sustaining treatments in neonatal units and evaluation of treatments applied to children in terms of their quality of life. This origin has conditioned the interpretation of the standard from two extremes: a vitalistic one, and a non vitalistic interpretation that triumphed in Western bioethics and has led to the consecration of the standard of best interest of the child in the Convention on the Rights of the Child of United Nations. A detailed analysis reveals a simplistic, utilitarian and proportionalist standard, which change the basis of parenthood. We therefore believe that the standard of the best interest of the child is not the best for the child in neonatal intensive care units and especially not in the process of withhold or withdrawal life-sustaining treatments

Child- and family-centered care in the treatment of children - knowledge, attitudes, practice.

Despite the advances in medical technology, health care improvements have not always been accompanied by commensurate attention to the child's well-being. Psychological and emotional status of children during hospital treatment is often underestimated. Namely, certain kind of institutional negligence is frequently present in everyday practice in children's institutions. Many hospitals in Bosnia and Herzegovina (B&H) have become child-friendly during the implementation of the Project on Child-Friendly Hospitals supported by UNICEF and WHO. Apart from the introduction of child friendly environment, staff in hospitals was trained to provide a holistic approach. The program was closely linked to the Baby Friendly Hospital Initiative that supported breastfeeding. A few years thereafter, our focus is still on the physical treatment of sick children, whereas the attention to their anxieties, fears and suffering has failed. A more serious approach to this problem is needed and should begin at an educational level in medical school programs. Accordingly, our philosophy (mission) should change from a mechanical (techno-) medicine to holistic medicine.

Brinquedotecas hospitalares em Belém: Criação, espaço e funcionamento / Hospital toy library in Belem, Para State, Brazil: Creation, space and operation

A brinquedoteca hospitalar é um direito assegurado às crianças por meio da Lei n. 11.104/051, entretanto ainda não foi concretizado integralmente no país. Este estudo objetivou descrever e analisar as condições de serviços e espaços disponibilizados pelas brinquedotecas hospitalares em Belém do Pará. Fizeram parte da pesquisa quatro hospitais que possuem este serviço. Os dados foram coletados por meio de entrevistas individuais com dez técnicos, observações dos atendimentos e registro fotográfico. Dentre os principais resultados encontrados estão: (a) todos os hospitais eram públicos; (b) existem poucos registros acerca da implantação e funcionamento desses espaços; (c) no tocante ao acervo lúdico, este se diferenciou em relação à quantidade; (d) as equipes apresentam composição diferenciada em relação ao número de membros e formação; (e) são oferecidas atividades livres e dirigidas. O estudo permitiu verificar aspectos que favorecem a concretização dos objetivos de uma brinquedoteca e reflexões sobre possibilidades de melhorias.

The hospital toy library is a right granted to children through Law 11.104/05, though it’s not yet fully implemented in the country. This study was aimed at describing and analyzing the conditions of services and spaces made available by the hospital toy library in Belem, Para State, Brazil. Four hospitals with this service participated in the study. Data were collected through individual interviews with 10 technicians, observation of the service and photographic record. The main results found are: (a) all the hospitals with toy library were public; (b) there are few records regarding the deployment and operation of these spaces; (c) regarding the collection of toys, it differed in quantity; (d) teams present different compositions in relation to the number of members and to their education; (e) free and targeted activities are offered. This study allowed us to show aspects that promote the achievement of the objectives in toy library and reflections on possible improvements.

Brinquedotecas hospitalares em Belém: Criação, espaço e funcionamento / Hospital toy library in Belem, Para State, Brazil: Creation, space and operation

A brinquedoteca hospitalar é um direito assegurado às crianças por meio da Lei n. 11.104/051, entretanto ainda não foi concretizado integralmente no país. Este estudo objetivou descrever e analisar as condições de serviços e espaços disponibilizados pelas brinquedotecas hospitalares em Belém do Pará. Fizeram parte da pesquisa quatro hospitais que possuem este serviço. Os dados foram coletados por meio de entrevistas individuais com dez técnicos, observações dos atendimentos e registro fotográfico. Dentre os principais resultados encontrados estão: (a) todos os hospitais eram públicos; (b) existem poucos registros acerca da implantação e funcionamento desses espaços; (c) no tocante ao acervo lúdico, este se diferenciou em relação à quantidade; (d) as equipes apresentam composição diferenciada em relação ao número de membros e formação; (e) são oferecidas atividades livres e dirigidas. O estudo permitiu verificar aspectos que favorecem a concretização dos objetivos de uma brinquedoteca e reflexões sobre possibilidades de melhorias.(AU)

The hospital toy library is a right granted to children through Law 11.104/05, though it’s not yet fully implemented in the country. This study was aimed at describing and analyzing the conditions of services and spaces made available by the hospital toy library in Belem, Para State, Brazil. Four hospitals with this service participated in the study. Data were collected through individual interviews with 10 technicians, observation of the service and photographic record. The main results found are: (a) all the hospitals with toy library were public; (b) there are few records regarding the deployment andoperation of these spaces; (c) regarding the collection of toys, it differed in quantity; (d) teams present different compositions in relation to the number of members and to their education; (e) free and targeted activities are offered. This study allowed us to show aspects that promote the achievement of the objectives in toy library and reflections on possible improvements.(AU)

Seguridad clínica de los pacientes durante la hospitalización en pediatría / Clinical safety paediatric patients

Objetivo. Describir la incidencia y tipos de eventos adversos (EA) en pacientes en edad pediátrica y su evitabilidad. Material y métodos. Análisis de las hospitalizaciones pediátricas. Se utilizó la fusión de las bases de datos del Estudio nacional de efectos adversos ligados a la hospitalización (ENEAS), del Estudio de los efectos adversos de la asistencia hospitalaria en el Principado de Asturias (EAPAS) y del Estudio de los efectos adversos de la asistencia hospitalaria en Aragón, configurando una muestra de 41 hospitales y 8.407 historias revisadas. Evento adverso fue considerado todo daño causado más por la asistencia sanitaria que por el proceso de enfermedad. Resultados. Identificamos 24 pacientes pediátricos que sufrieron un EA, que acumularon un total de 29 EA. Frente a los pacientes adultos, los niños sufrieron una menor proporción de EA, de tal forma que, tomando como categoría de referencia los pacientes de 16 a 44 años, ser menor de esa edad supone una reducción del riesgo a la mitad. El 3,61% de los pacientes pediátricos sufrieron un EA y el 65,5% (19) fueron evitables. La proporción de EA fue de 3,8% en lactantes (0-18 meses), 4,0% en preescolares, y 2,6% en niños de 6 a 16 años, comparados con un 6,4% en adultos jóvenes. Respecto al tipo de EA, los relacionados con la medicación (37,9%) fueron los EA más frecuentes en niños. Conclusiones. La epidemiología de los eventos adversos en niños es diferente a la de los adultos. Mejorar su conocimiento permitirá desarrollar estrategias para minimizarlos(AU)

Objective. To describe the incidence and types of adverse events in children and how they can be prevented. Material and methods. Analysis of paediatric hospitalisations in the ENEAS Study, the Asturias Study on hospitalisation –related adverse events (EAPAS) and the Aragon Study of the Adverse Effects related to the hospitalisation, which involved a retrospective medical record review of a population-based, representative sample of all paediatric hospital discharges. Adverse events were defined as an injury caused by medical management, rather than by disease processes. Results. We were able to identify 24 paediatric patients suffering 29 AEs directly associated with medical care. Compared to non-elderly adult patients, infants and adolescents suffered lower rates of adverse events. Of these, 65.5% (19 AE) were considered as preventable. Adverse events occurred in 3.61% of paediatric hospitalisations. Adverse events rates were 3.8% in infants (0-1.5 years), 4.0% in children 1.5–6 years of age, and 2.6% in children 7–16 years of age, compared with a rate of 6.4% in non-elderly adults. Medication related (37.9%) events were the most common types of adverse event. Conclusions. The epidemiology of adverse events in children is different to that in adults. To reduce the adverse events that occur in hospitalized children, knowledge of AE epidemiology in paediatric patients will help in the development of prevention strategies to avoid or to minimise them(AU)

Are we following the European charter? Children, parents and staff perceptions.

BACKGROUND: In 1988, the European Association for Children in Hospital (EACH) established a charter of rights setting out the guiding principles for the treatment of children in hospital. Our aim was to ascertain whether children, parents and staff in a children's hospital believe the European Charter is conformed to. METHODS: A total of 111 parents (response rate = 90%), 50 children (response rate = 100%), 61 nurses (response rate = 55%) and 41 doctors (response rate = 25%) agreed to participate. Questionnaires based on the 10 rights in the EACH Charter were administered to children, parents and staff. RESULTS: The majority of children and parents were happy with the relationship they had with staff. However, the findings suggest that children, parents and staff are concerned with the lack of facilities in hospital, including parental accommodation, play, education, age-appropriate wards and lack of privacy. Staff felt that many children undergo unnecessary admission and treatment in hospital. Many staff are reluctant to discuss issues such as side effects of medications with patients and do not encourage children to ask questions. Contrary to expectations, clinicians were reluctant to consider children under 16 as capable of giving consent, and most parents and children felt that children should be over 17 and 18 respectively. CONCLUSION: This paper highlights patients' and staff's perceptions regarding children's rights in hospital and discusses the changes needed to fully conform to the EACH Charter.

Abuse of children with disabilities in hospital: issues and implications.

Children with disabilities are among the most vulnerable in our society and are more likely to be abused or neglected than non-disabled children. Health professionals in all settings have an important role in child protection as they are often the first to see the signs of abuse and are in a position to identify risk of abuse. Aside from intentional abuse, there are a number of healthcare practices that can be construed as abuse or neglect. Such practices may have become shrouded under normal clinical routines and continue unchallenged, for example, assuming that disabled children cannot give informed consent or that their privacy and dignity do not have to be maintained as they do not feel embarrassed at having their bodies examined. A health professional or student is guilty of abusive practice if he or she intentionally carries out such practices, allows them to continue by not speaking up or does not learn about the signs and symptoms of abuse in children with disabilities and how to understand their communications. Identifying and stopping both intentional and subtle abusive practices is a complex task requiring changes in attitudes held by many in the health services.

[The child care shared between the family and the nursing team in the hospital: a perspective for its humanization]. / O cuidado compartilhado entre a família e a enfermagem à criança no hospital: uma perspectiva para a sua humanização.

The article presents a reflection concerning the necessity of a shared care to the child in the hospital between the families and the nursing as a humanization strategy of the care. It weaves some considerations concerning the humanized, familiar and nursing care to the child in the hospital. It finds out that, despite the legislation in force, the limits of the families' performance in the hospital context are still little defined. It concludes that the reconstruction of new relations between the nursing and the families of the interned children will be possible from the exercise of the shared care.

Who owns the child in hospital? A preliminary discussion.

AIM: To 'own' a person is considered an infringement of human rights, but we suggest that concepts of ownership influence interactions between parents and staff when a child is admitted to hospital. This paper aims to stimulate debate and contains an explanation of the exploration of the literature for research and discussion of ownership of the child. METHOD: A wide variety of library indexes, databases and populist media were examined although it was impossible to examine all literature which may have contained references to this topic, and, apart from databases which contained abstracts in English, we could not include literature written in any language other than English, Swedish, and Icelandic. FINDINGS: We found no research that examines how concepts of ownership of a child affects communication between health professionals and parents and, ultimately, the delivery of health care. This paper begins discussion on the issues. DISCUSSION: Historical literature shows that ownership of humans has been a part of many cultures, and parents were once considered to own their children. Ownership of another has legal connotations, for instance in guardianship struggles of children during marriage breakup and in ethical debates over surrogacy and products of assisted conception. Within health care, it becomes a contentious issue in transplantation of body parts, in discourse on autonomy and informed consent, and for religious groups who refuse blood transfusions. In health care, models such as family centred care and partnership in care depend on positive communication between parents and staff. If a hospital staff member feels that he/she owns a child for whom he/she is caring, then conflict between the staff member and the parents over who has the 'best interests of the child' at heart is possible. CONCLUSION: We encourage debate about concepts of who owns the hospitalized child - the parents or the staff? Should it be argued at all? Is the whole concept of ownership of another, be it adult or child, the ethical antithesis to modern beliefs about human rights? Comment on this issue is invited.

"Holding the child down" for treatment in paediatric haematology: the ethical, legal and practice implications.

Very little has been written about involuntary treatment for adult patients and even less about such treatment for paediatric patients. Ethical dilemmas for nurses in such situations have not been clearly articulated and there are no clear guidelines available in this area. The following findings from a qualitative, longitudinal study on the psycho-social aspects of treatment for childhood leukaemia and related diseases are offered as preliminary work on this important professional issue. The feelings of parents when confronted with the necessity of holding their child down so that they may receive probably curative treatments for acute lymphoblastic leukaemia are described and some of the ethical and legal issues confronting nurses who provide these treatments are explored.

Conocimientos y expectativas sobre la hospitalización en escolares de Córdoba, en el ámbito rural # / Knowledges and hopes about hospitalization in a rural area of Cordoba schoolchildren´s population

Fundamento: La edad pediátrica constituye un grupo de población especialmente vulnerable al estrés de la hospitalización. Al niño hospitalizado es necesario proporcionarle junto a los cuidados sanitarios, atención psicológica y educativa.Método: Se realiza un estudio de corte transversal de conocimientos y expectativas sobre la hospitalización en escolares de la provincia de Córdoba, en medio rural, mediante cuestionario.Resultados: Participaron niños de 8 a 13 años, de 4 colegios (n =279). El análisis de los datos obtenidos muestra que el nivel de conocimientos de los escolares resultó insuficiente, con puntuación media de 4,4 sobre 10. Dan gran importancia a los cuidados y la atención (44,8 por ciento de los niños) y a la visita de familiares y amigos (44,08 por ciento). Consideraron lo mejor del Hospital el mimo y los cuidados (37,99 por ciento) y la curación más rápida (17,92 por ciento); lo peor, el dolor y la enfermedad (17,56 por ciento) y las comidas-instalaciones-ruidos (17,20 por ciento). Para la mayoría de los niños el hospital es "aburrido" (54,48 por ciento) y "no se juega" (30,11 por ciento).Conclusiones: necesidad de incrementar y estructurar la actividad ludopedagógica y reforzar el aspecto psico-social de la atención hospitalaria en la edad pediátrica, necesidad de adaptar el hospital a las necesidades del niño (AU)