Commentary

Regressive behaviour after hospital admission of essentially healthy children is well documented and well recognised by those who nurse children. This study by Burke et al, however, is the first to consider not only the phenomena of regression and distress in chronically ill children with multiple hospital admissions but also the effect of repeated admissions on the functioning of the family unit.

Although only 50 children and their parents were included in the study, a power analysis indicated this number to be adequate to detect differences between the experimental and the control groups. The stratified randomisation used by the researchers to minimise the influence of the confounding variables of diagnosis and age is a strength of this study. The intervention programme is described in considerable detail, but little information is included on the duration of the sessions held in the home before and after hospital admission. Some insight into this aspect of the intervention would have been useful to readers and researchers interpreting the feasibility of using the strategy or contemplating a similar study. A more complete description of the intervention, however, will soon be published.¹

The strength of this study lies in the variety of variables assessed using previously validated instruments. When combined, the results provide valuable insight into aspects of child development, parental anxiety, coping, and family functioning as they relate to chronically ill children. The findings highlight the potential for the chronically ill child to regress after hospital admission. Frequent admissions to hospital (2–50) may therefore compromise the development of these children over time. An awareness of these findings, and the stress point intervention strategies used by the authors should assist all nurses who care for chronically ill children in hospital or at home.