Incorporating education into the holistic care of pediatric

patients: The CL@RCH (Children’s Learning at The

RCH) projectLiza HopkinsTsharni ZazrynSue WilksKira Macleod

Royal Children’s Hospital Education Institute

CL@RCH: Overall premise

• To strengthen the capacity of a children’s hospital to keep children engaged with learning in a dynamic and flexible environment.

CL@RCH: context

• Development of a new children’s hospital

CL@RCH: Our questions1.What do children and young people value

about learning during hospitalisation?2.In what ways do they and their families

use the hospital environment to stay engaged in learning related activities while in the hospital?

3.How can physical spaces where children and young people spend time across the hospital be used to strengthen the promotion of children’s learning?

CL@RCH: Our questions (2)4.What partnerships could or should be

developed to enhance learning opportunities at the RCH and how should these partnerships be fostered?

5.What are the critical components for children’s learning applicable to a hospital environment?

CL@RCH products• Learning spaces literature review• Learning spaces issues and needs

framework• Consultation report• Snapshot booklet• Key messages framework• Set of principles for teaching and

learning• RCH procedure for education support

Literature review findings• Effective spaces connect with best practice

teaching and learning• Learners need ownership of the learning space• Technology connects learners wherever they

are• The importance of the outdoor environment • Connecting spaces with people – a holistic

learning environment• Arts based pedagogy contributes to education,

well-being and health

Consultation methodology• Consultations with:• 57children & young people (3-19

years)• 29 parents • 10 external education professionals• 23 RCH Education Institute staff• 4 junior medical doctors

Example: Children & young people• Across all areas of hospital • except ED & ICU• purposive & convenience sampling

• Stimulus – photographic slide show• Semi-structured interview questions• A3 design activity

Photographic stimuli

Children & young people questionsDomain Examples of guiding questions

Children as learners • Which activities in the photos would you like to do? Why?• What sort of activities/things have you done today while here in the hospital?

What was your favourite? Why?• How do you know when you have learnt something?• Can you tell me about something you have learnt whilst here in the hospital?

Learning communities • Do you like working/playing with other children/people? Why?• Do you sometimes like working/playing on your own? Why?

Continuity of learning • Have you worked with a teacher/play therapist here? What was that like?• Do you keep in touch with your friends from school while you are in the

hospital? How? Why?

Physical spaces • What is your favourite place to learn? What makes it your favourite place?• What areas of the hospital do you spend time in? What do you do while you

are there? Are there things you wish you could do there?

A3 design activity

Children and young people• Children and young people have a deep

and broad understanding of what ‘learning’ is

• Fun/games/interactivity are the key to engagement in learning opportunities in a hospital setting

• Children and young people are social beings and learning opportunities should reflect this

Children and young people (2)• Children and young people want to

access activity rooms and outdoor spaces for social interactions

• Children and young people want more appropriate fit outs for furniture/activities in activity rooms and are capable of being included in decision making in this regard

Children and young people:Perceptions of learning

“... I like working in groups more. Because ... everyone has different ideas, and so ... you can learn different things off

different people, and, if your answer’s wrong or something, they can be up there to help you learn different ways that they’ve

learnt how to learn it.”

“It feels good. Before you didn’t know what it is. You now know how to do it.”

“It’s easier to learn when working with others. You learn more... it’s sometimes better [to work alone] if you need to concentrate.”

“If you work with other people, they might get something wrong.”

“You can teach it to someone else.”

“I know something else.”

Parents• Parents value and expect the inclusion of

education and learning support as part of the holistic care of their children

• Many parents have limited knowledge of the education support that is available in hospital

• Parents of hospitalised children undervalue the early years of education

• “Um, cause she’s only at Kinder I don’t think it’s ... much of an issue. The Kinder stuff they do is all play to learn, it’s not sit down and write ... it’s all blocks and play dough ... and things like that.”

Parents (2)• Parents of hospitalised children view

learning and education as formal schooling only

“There’s nothing you guys can do that is actually gunna get me over the thorough dislike I have of the fact that he’s not at school.”

“He doesn’t bring his work from school, his homework in here – he conveniently forgets a lot! And um, that’s actually a concern for me now”

“I hate it when she misses school. I really hate it.” “And ... during the school term we’ve organised work from school

and he’s had to do some schoolwork. So you can’t just take games all the time.”

Parents (3)• Parents highlighted a need to reduce

social and educational barriers for their hospitalised children and were unaware of the opportunities available for better connections to be established

• Families want to be able to utilise the outside spaces more

• Communication between school and hospital is critical

Parent comments• “... I’m trying to explain to her that she needs her education to

further her um expenditure on – going forth in her life ...”• “[Education] - it’s very important for her to be all she can be.”• “... just to maximise all opportunities he’s got. To give him

opportunities to do whatever he wants to do really. And um, cause I know that education can give you access to things ... and education allows you to achieve things that other people don’t think you can.”

• “And even if he makes it up to 20 [years old] you know, he’s still going to need to think ahead ... So if he does, then he’s going to need to be able to go forward and have a job.”

• “I want her to be able to think well, you know she can do anything in life if she wants to. But she also needs to be, we have to try and keep her normal, too. So school and her health are very… on my top of the list.”

Education Institute staff• Integration of education into a health

dominated environment is challenging and takes a considerable time to be achieved

• There is an increasing understanding from ward teams about the role of the Education Institute and the teachers

• Communication and consultation are key to teachers being successful in their role

Education Institute staff (2)• There are vast differences (both positive

and negative) between teaching and learning in a school setting and teaching and learning in a hospital setting

• There is the potential to better involve parents in the education and learning opportunities in this setting, but in some instances it is better to allow parents ‘time out’

Education Institute staff comments

“... what I’ve seen in the play and learning spaces [in the hospital] are safe spaces. So they’re one of the very few

places in the hospital where there’s no procedures undertaken. No medical staff can come in, unless it’s to engage in learning or play activities. And that’s a really

important thing for children in a hospital to have. A space that they know if someone comes in with a lanyard on, they’re not going to be doing something to them that they don’t want.”

“I always think a space in which students are comfortable to take risks I think is one of the most important things.”

What we hope to achieve• Outputs – procedure incorporated into the

RCH & an evidence-based framework to guide teaching & learning in a paediatric setting

• Embed notion of ‘children as learners’ into the core business of the new hospital

• See evidence of this in:• budgets• key messages• infrastructure• decision making processes

Recommendations• The RCH Education Institute and RCH

Executive should continue to advocate and provide opportunities for patients as learners

• Government and non-government education organisations, and the RCH Education Institute, need to provide opportunities to build parent knowledge and skills

• The education support available in the hospital needs to be publicised to staff, patients and visitors

Acknowledgements• Thanks to the children, families, hospital

& non-hospital-based professionals who have generously given their time and voice to this research

• The work of the Royal Children’s Hospital Education Institute is made possible by funding provided by the Victorian Government Department of Education and Early Childhood Development

More info

http://www.oecd.org/edu/ceri/inventorycases.htm