School Activity for the Reduction of Distress, Pain and Negative Emotions in Children Experiencing Hospital School

Study Overview
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Brief Summary
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Aim of present study is to evaluate the efficacy of hospital school experience in the reduction of distress, pain and negative emotion in children from 8 to 12 years old, hospitalized in oncology and pediatric wards. Investigators also want to explore the ideas and opinions of teachers and parents about hospital school service. Hypothesis: the investigators expect a reduction in pain, distress and negative emotions.

Detailed Description
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The school service into the hospital was born as an attempt to support emotionally, relationally and cognitively the hospitalized children, who have to spend a lot of time alone, without being educated by teachers with their classmates. There are not many studies in the Italian contest about this issue and with the present study the investigators intended to implement the acknowledgement about this theme. The principal aim of this study is to explore if the school service reduces negative emotions experienced by oncological children as well as perceived pain and distress. To evaluate this aims, the investigators organized the study in 3 sections: the first is about the emotions experienced by oncological children between 8 and 12 years old, who benefit from the school service into the hospital; the second is about their parents' opinions and believes about the hospital school service; the third is about opinions, training and educational method dedicated by hospital school teachers and not hospital school teachers (who previously thought to our oncology children sample).

Official Title
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Cross - Observational Study About Hospital School Experience for the Reduction of Distress, Pain and Negative Experience and for the Promotion of School Experience's Continuity. The Point of View of Teachers, Children and Parents

Conditions
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Hospital School Experience

Intervention / Treatment
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* Other: Hospital School Experience, point of view of the children
* Other: Hospital School Experience, point of view of the hospital teachers
* Other: Hospital School Experience, point of view of the non hospital teachers
* Other: Hospital School Experience, point of view of parents


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria for children: age between 8 and 12 years old knowledge of Italian language consent for study participation recovery be/not be in contact with classmates (group A and group B) Exclusion Criteria for Children: patients who have already had hospital school experience in the past cognitive disability patients that cannot complete the study because of health or mental issues incoming during the period of the research Inclusion criteria for hospital teachers: Italian knowledge Being a hospital teacher Exclusion criteria for hospital teachers: - Have earlier experience as a hospital children in other hospitals Inclusion criteria for not hospital teachers: Italian knowledge Being a teacher of the hospitalized children in the past or present time exclusion criteria for not hospital teachers: A past experience as a hospital teacher Inclusion criteria for parents: Italian knowledge consent for study participation Health or mental issues that can cause problems in completing questionnaires or answering questions Exclusion criteria for parents: Cognitive disability Health or mental issues that can cause problems in completing questionnaires or answering questions

Ages Eligible for Study
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Minimum Age: 8 Years
Maximum Age: 12 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| children in hospital school in contact with outside school<br>children experience school's lesson with the hospital teacher in the school's room or into their bedrooms and the investigator give before/after the lesson 2 questionnaire (PANAS-C and PH-C) and the VAS to evaluate the aim's study. Then, the investigator asks the children to make 2 paintings: one about the hospital school experience (what is for him/her the hospital school) and one about the outside school (what he/she do/did outside during school). | Other: Hospital School Experience, point of view of the children<br>* Operators of the PANAS-C, PH-C and VAS ask the children to answer the questionnaire before/after the school lesson; then they ask the children to make 2 paintings about hospital and not hospital school experience.<br>|
| children in hospital school NOT in contact with outside school<br>it's the same of the previous group (children experiencing hospital school still in contact with outside school); the only difference of this group is that children are not in contact with the outside school. | Other: Hospital School Experience, point of view of the children<br>* Operators of the PANAS-C, PH-C and VAS ask the children to answer the questionnaire before/after the school lesson; then they ask the children to make 2 paintings about hospital and not hospital school experience.<br>|
| hospital teachers<br>teachers have to answer to some questions (qualitative interview) and fill in CEESQ schedule | Other: Hospital School Experience, point of view of the hospital teachers<br>* operators interview hospital teachers and make them complete a questionnaire (CEESQ)<br>|
| outside teachers<br>teachers have to answer to some questions (qualitative interview) and fill in CEESQ schedule | Other: Hospital School Experience, point of view of the non hospital teachers<br>* operators interview the teachers and make them complete a questionnaire (CEESQ)<br>|
| Parents<br>parents have to answer some questions (qualitative interview) | Other: Hospital School Experience, point of view of parents<br>* Operators interview parents<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Positive and Negative affect before/after hospital school experience | PANAS - C (Positive and Negative Affect Scale for Children): original version by Laurent (1999), italian version by Ciucci and collaborators. 30-item numerical scale assessing two dimensions (positive and negative affect, 15-item each) on a 5 point likert scale. Validated for children between 8 and 12 years old. Aim of this scale is to evaluate the presence of positive and negative emotions before/after an experience/activity. | PANAS - C is completed by the child before and after the school experience (average 3 months); it takes around 5 minutes for each investigation. | 
| Change in Distress level before/after hospital school experience | PH - C (Psychological Hyperarousal Scale for Children): original version by Laurent (2004), italian version by Ciucci and collaborators. Numerical scale composed by 18 items measured on a 5 point Likert Scale. Aim of this scale is to evaluate the presence/absence of distress before and after the activity. | PH - C is completed by the child before and after the school experience (average 3 months); it takes around 3 minutes for each investigation. | 
| Change in Pain level before/after hospital school experience | visual analogue scale (VAS) for children, by Scott, Ansell, & Huskisson (1977). It's a likert scale measuring perceived pain from 0 (no pain) to 10 (maximum pain). | VAS is completed by the child before and after the school experience (average 3 months); it takes around 30 seconds for each investigation. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| explorative interview for parents | it's a partially structured interview concerning ideas and opinions of parents about hospital school service | Investigators interview the parent in a silent and private room within 1 year after child's recruiting | 
| explorative interview for hospital teachers | it's a partially structured interview concerning ideas and opinions of hospital teachers about hospital school service, methods of learning and teaching | investigators interview the hospital teacher in a silent and private room within 3 months after child's recruiting | 
| explorative interview for outside teachers | it's a partially structured interview concerning ideas and opinions of outside teachers about hospital school service | investigators arranged an appointment to interview the teacher within 1 year after child's recruiting | 
| research form for investigator | it's a research partially structured form regarding informations about how it's organised hospital school service | within 3 months after child's recruiting, the researcher observes a lesson and then fills in the form | 
| research form for the outside teacher | it's a research partially structured form regarding informations about how it's organised hospital school service | through study completion, an average of 1 year, the outside teacher fill in the form after a lesson | 
| child's emotions and ideas about hospital school service | investigators ask the child to draw the hospital school service and then is asked what he/she has drawn, what it represents, what's for him/her the best moment of hospital school | within 1 year after child's recruiting, investigators ask the child to draw when present in the Oncology Day Hospital or in the oncology/pediatric ward and then pick the draw | 
| child's emotions and ideas about outside school service | investigators ask the child to draw the outside school service and then is asked what he has drawn, what it represents, what's for him/her the best moment of school; also, children is asked if he/she perceives a difference between outside school and hospital school service | within 1 year after child's recruiting, investigators ask the child to draw when present in the Oncology Day Hospital or in the oncology/pediatric ward and then pick the draw | 
| emotions and self efficacy of hospital teachers | CEESQ (Crèche Educators Emotional Style Questionnaire): italian version by Ciucci, Baroncelli and Toselli (2015); numerical scale measuring emotions and self efficacy on a likert scale from 0 to 5; it takes around 10/15 minutes | the investigator asks the teacher to fill in the questionnaire, within 3 months after child's recruiting | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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hospital school, pain, distress, negative emotions, school continuity, child