Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Bowlby's Children: The Forgotten Revolution in Australian Children's Nursing

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Bowlby's Children: The Forgotten Revolution in Australian Children's Nursing

Article excerpt

INTRODUCTION

Walk through any Australian children's hospital today and one is overwhelmed by the effort hospital administration and staff have made to make it as pleasant an environment as possible. There are bright toys and playgrounds, walls covered in pictures, staff in animal-print uniforms and televisions playing all the current children's shows. Most importantly, children are surrounded by family and friends, and parents are able to stay with their child indefinitely. In this way, today's children's nursing focuses on the psychological and emotional needs of the child in the context of the family, while providing the physical and medical necessities. Fifty years ago this practice would have been radical. Grandparents of current child patients remember a very different hospital experience in Australian public hospitals, from that of their grandchildren today. A former senior staff member at a public celebration event in 1995 reminisced in this way:

I recall at one time children were well behaved, they were tied into their beds, so that busy nurses could keep track of them. There was order in the wards. Parents gave their child to the hospital to be treated. It is indeed strange to remember this isolation of the sick when today the child is treated within the context of the family. (Anonymous)

'Gave' is a strange expression for how children were admitted to hospital. Mothers from that time spoke to each other of the agony they suffered from their children's hospitalisations. There was no choice, if you wanted your child to heal. The child had to be good and not cry; the parents had to be submissive to the system. Both were without voice in the face of a medical authority that excluded parental involvement.

The revolution altered the way children were nursed so that hospital policy allowed increasingly more visiting of children, until parents were eventually permitted at any time, to the extent of residential services being available for them during their child's stay. This turnaround came about because of a growing awareness of the psychological needs of children due to the work of John Bowlby and James Robertson, who were researching the effects of separation on children in hospitals. Bowlby and Robertson publicised their findings in various media and fought for parent involvement in the hospital system from the 1940s through to the 1980s. As the hospital system gradually altered, parents were included in the care of their children. Alsop-Shields and Mohay (2001: 50) describe Bowlby and Robertson as 'theorists, scientists and crusaders for improvements in the care of children in hospital,' with the theoretical work carried out by Bowlby supported by the 'impressive speaking powers' of Robertson. Both men engaged in the campaign to change the conditions of children in hospitals. Bowlby wrote may letters to The Lancet, engaging with the hospital system at the level of practitioners, while Robertson made films and 'travelled widely, accepting speaking engagements in many countries to proclaim his message about the importance of allowing parents to stay with their children in hospital' (Alsop-Shields & Mohay 2001: 54). When Bowlby began his research, and for some time throughout the mid to late twentieth century, hospital stays were more extended than they are today. Children's hospitalisations were traumatic for both the parent and the child as 'simple abdominal surgery required a week-long admission, [and] serious illnesses, such as tuberculosis, up to 3 years' (Prugh et al. 1953). This meant a prolonged separation between the child and his/her family.

BATTLE TO CHANGE THE SYSTEM

Bowlby's research centred on the effect on children of separation from their mothers and the long term affects of the resultant anxiety. This is borne out by Bowlby's concern for the future behaviour of small children evacuated during World War II. He wrote to the British Medical Journal in 1939 that 'The evacuation of small children between the ages of two and five introduces major psychological problems' (Bowlby 1939). …

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