Fernanda Loureiro, Maria de Fátima Frade, Maria Isabel Malheiro
Children's participation in nursing care appears to be relational, developmental and context-dependent. The findings suggest that participation experiences are shaped by interpersonal, communicative and organisational factors. However, the available evidence predominantly reflects the experiences of school-aged children and adolescents, highlighting the need for further research involving younger children.
BACKGROUND: Participation in healthcare is recognised as a fundamental right of children and a key component of child-centred care. However, evidence remains fragmented, particularly regarding the role of nursing care in supporting participation.
AIM: This systematic review aimed to identify, critically appraise, and synthesise qualitative evidence on children's experiences of participation in nursing care and the factors influencing this participation.
METHODS: A qualitative systematic review was conducted in accordance with JBI methodology. Databases searched included CINAHL, MEDLINE, ScieLo, Scopus, APA PsyArticles, Web of Science, ERIC, ProQuest and OpenAIRE with no date or language restrictions. 20 qualitative studies (2002-2025) were included and analysed using thematic synthesis.
RESULTS: Four themes were identified. Across predominantly school-aged children and adolescents, the child-nurse relationship emerged as an important aspect of participation, with trust, familiarity and supportive communication linked to opportunities for children to express their views. Participation was shaped by the child-parent-professional decisional triad, where adult dominance often restricted involvement to 'small' decisions. Access to developmentally appropriate information was described as important for understanding and engagement in care. Embodied and environmental factors, including non-verbal expression, play and child-friendly settings, also shaped participation experiences. Although participation generally increased with age, evidence relating to younger children was limited.
CONCLUSIONS: Children's participation in nursing care appears to be relational, developmental and context-dependent. The findings suggest that participation experiences are shaped by interpersonal, communicative and organisational factors. However, the available evidence predominantly reflects the experiences of school-aged children and adolescents, highlighting the need for further research involving younger children.