Relationships Between Symptoms and the Hospital Care Environment in Children and Adolescents with Cancer

Symptoms related to cancer and its treatment are a major source of distress for children and adolescents with cancer. Children and adolescents who are hospitalized often report more symptoms than those in the outpatient setting. The hospital environment with its frequent disruptions and associated noise also can contribute to symptoms. Nurses are in an important position to influence the hospital environment in a manner that can worsen or improve symptoms. The purpose of this study is to investigate relationships between symptoms reported by hospitalized children and adolescents with cancer and the hospital care environment. Study participants will be 50 school-age children and adolescents who are hospitalized for at least 3 days and nights.

Participants will report the presence, intensity, frequency, and distress associated with each of nine commonly reported symptoms for each 12-hour shift. Sound and light levels in participants' rooms will be measured continuously using a sound pressure level meter and data logger. Room entries will be identified using a motion-detection camera. Room entries by nursing staff will be matched with the medical record to identify types of cares occurring with each entry. A mixed effects statistical model will identify relationships between nursing care activities, sound and light levels, and reported symptoms. The long term goal of this research is to develop and test an intervention targeted at structuring the hospital environment to improve symptom management in the hospital setting.