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Sherman J, Bower KL, Eskandanian K. "100 Things I Wish Someone Would Have Told Me": Everyday Challenges Parents Face While Caring for Their Children With a Tracheostomy. QUALITATIVE HEALTH RESEARCH 2024; 34:1108-1118. [PMID: 38193439 DOI: 10.1177/10497323231217387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
Equitable access to appropriate care, emergency department services, and in-home support aids are needed to minimize the occurrences of adverse events that have a significant impact on families. However, many families of children with medical complexity (CMC) lack consistent care due to issues of health inequity. We conducted 11 qualitative interviews with primary caregivers who were asked about their experiences of providing care to children who have a tracheostomy and are supported by multiple life-saving machines at home. Guided by ecological systems theory, we identified three themes that contextualize the lived experiences of the participants who expressed needs that arose from poor interactions within the mesosystem. Findings convey participant frustrations that result from insufficient support, ineffective training, and inadequate healthcare coverage. Although each theme is organized systematically to emphasize specific concerns within the mesosystem, together these themes emphasize the inextricable relationship between daily needs with systemic barriers to care. We provide a discussion of these needs with a broader context that also impacts the perceived quality of care among families managing the needs of their children who are supported by life-saving technology. By addressing existing challenges and identifying opportunities for improvement within the healthcare system, we seek to contribute to the collective effort of advocating for ethical systemic change on behalf of CMC and their families.
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Affiliation(s)
| | - Kyle L Bower
- Department of Human Development & Family Science, The University of Georgia, Athens, GA, USA
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Van Orne JA, Clutter P, Fredland N, Schultz R. Caring for the child with a tracheostomy through the eyes of their caregiver: A photovoice study. J Pediatr Nurs 2024; 79:59-68. [PMID: 39213803 DOI: 10.1016/j.pedn.2024.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 08/14/2024] [Accepted: 08/22/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE This qualitative descriptive study aimed to explore the daily experiences of caregivers of children with medical complexity with a tracheostomy at home. METHODS This study used photovoice, a participatory action research methodology. Adult English-speaking caregivers of children with a tracheostomy, living in Texas, with access to a smartphone were recruited. Photographs taken by participants and an interview guide were used to guide semi-structured interviews with caregivers. RESULTS Eight participants were recruited. After analyzing photographs and caregiver interviews, four main themes were identified: role transition, daily challenges, finding support, and thriving in the new normal. CONCLUSIONS Caregivers take on multiple roles, including providing medical care, advocating for their children, and educating others. While facing emotional challenges such as guilt, fear, and exhaustion, caregivers rely on external support systems, emphasizing the need for nurses and healthcare providers to provide comprehensive support and improve the accessibility of home nursing services. PRACTICE IMPLICATIONS The findings of this study can inform nurse-led interventions and advocacy efforts aimed at supporting marginalized children with medical complexity with a tracheostomy and their families. These efforts may include enhancing communication and collaboration between families, healthcare workers, and the public, providing comprehensive, proactive support for caregivers, and improving access to home nursing services.
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Affiliation(s)
- Julie A Van Orne
- Director of Nursing Research and Innovation, Cook Children's Medical Center, 801 7(th) Avenue, Fort Worth, TX 76104, USA.
| | - Paula Clutter
- Texas Woman's University, 6700 Fannin Street, Houston, TX 77030-2897, USA.
| | - Nina Fredland
- Texas Woman's University, 6700 Fannin Street, Houston, TX 77030-2897, USA.
| | - Rebecca Schultz
- Texas Woman's University, 6700 Fannin Street, Houston, TX 77030-2897, USA.
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Nygård C, Clancy A, Kitzmüller G. Balancing on life's ladder: A meta-ethnography of the existential experiences of siblings of children with complex care needs. J Adv Nurs 2024; 80:2629-2646. [PMID: 38062620 DOI: 10.1111/jan.15991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 10/16/2023] [Accepted: 11/14/2023] [Indexed: 06/13/2024]
Abstract
AIM To synthesize and interpret existing qualitative research on the existential experiences of siblings of children with complex care needs. DESIGN Noblit and Hare's interpretive meta-ethnography. METHODS The study has been registered in the international prospective register for systematic reviews (PROSPERO). Noblit and Hare's 7-step procedure was followed and reciprocal translation was performed to analyse the data and develop a line of argument synthesis. DATA SOURCES A comprehensive systematic literature search of five databases, along with extensive manual searches, was completed in November 2022. The final sample comprised 18 studies published between 2010 and 2022. RESULTS A line of argument, expressed through an overarching metaphor, "balancing on life's ladder", illustrates the core findings of siblings' fluctuating experiences of existential well-being, and encapsulates four third-order themes: the emotional turmoil of siblings, interrupted family life, siblings strive to be themselves and siblings struggle to cope. CONCLUSION Growing up with a sibling with complex care needs made children feel invisible, lonely and struggling to find the courage to cope. By adopting a lifeworld approach, nurses can become aware of healthy siblings' unmet needs. Future research is needed on how nurses can contribute to siblings' existential well-being, in primary - and secondary health care settings. IMPLICATIONS The study provides insight into siblings' existential experiences and factors improving their well-being, enabling nurses to provide a more optimized lifeworld-led clinical practice. IMPACT Healthcare, nursing education and practice should be informed by the knowledge of existential issues. Nurses are well-positioned to work alongside families to provide family-centered care. Our findings have implications for health policies tailored to the needs of children with chronically ill siblings. REPORTING METHOD This review adheres to the Equator and improving reporting of meta-ethnography (eMERGe) guidelines. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution, because the data comprised previously published studies.
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Affiliation(s)
- Carina Nygård
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT, The Arctic University of Norway, Harstad, Norway
| | - Anne Clancy
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT, The Arctic University of Norway, Harstad, Norway
| | - Gabriele Kitzmüller
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT, The Arctic University of Norway, Narvik, Norway
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Sobotka SA, Lynch E, Golden SLS, Nageswaran S. Home Health Nursing Agencies' Services for Children With Medical Complexity: Parent and Nurse Perspectives. Acad Pediatr 2024; 24:477-485. [PMID: 38278479 DOI: 10.1016/j.acap.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/16/2024] [Accepted: 01/21/2024] [Indexed: 01/28/2024]
Abstract
OBJECTIVE Many children with medical complexity (CMC) require the services of home health nurses (HHNs). Home health agencies (HHAs) hire, train, and manage nurses. For children to flourish, families, nurses, and HHAs must establish successful working relationships. Our objective was to understand the perspectives of parents and nurses about HHAs. METHODS In Illinois (IL) from 2019 to 2022, HHNs for and parents of children with invasive mechanical ventilation were interviewed. In North Carolina (NC) from 2012 to 2013, parents of CMC were interviewed, and from 2013 to 2014 HHNs participated in focus groups. Each dataset was initially analyzed separately for main themes relating to HHAs. Using collaborative thematic analysis, we determined themes common across datasets. RESULTS In IL, 23 mothers, 12 fathers, and 20 nurses were interviewed. In NC, 19 mothers, 6 fathers, and 1 grandmother were interviewed; and 4 focus groups of 18 nurses were conducted. Four common themes were identified. 1) HHAs do not have a uniform process for hiring and assigning nurses to cases. 2) HHAs have marked variability in training offered to nurses. 3) Shift scheduling, notifications, and communications with the HHAs frustrate parents and nurses. 4) Nurses and parents have little allegiance to specific HHAs; they frequently change agencies or work with several simultaneously. CONCLUSIONS Parents and nurses perceive practices for hiring, training, and staffing as inconsistent, and experience communication challenges. HHA-level problems may contribute to issues with HHN retention and complicate the lives of the families of CMC. Further research about this critical health care sector is needed.
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Affiliation(s)
- Sarah A Sobotka
- Section of Developmental and Behavioral Pediatrics, Department of Pediatrics (SA Sobotka, E Lynch), The University of Chicago, Chicago, IL.
| | - Emma Lynch
- Section of Developmental and Behavioral Pediatrics, Department of Pediatrics (SA Sobotka, E Lynch), The University of Chicago, Chicago, IL
| | | | - Savithri Nageswaran
- Department of Pediatrics (S Nageswaran), Wake Forest University School of Medicine, Winston-Salem, NC
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Scheid A, Sahai S. Psychological Care of the Family of Children with Medical Complexities. Pediatr Ann 2024; 53:e93-e98. [PMID: 38466327 DOI: 10.3928/19382359-20240109-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Advances in medical knowledge and treatments have made possible the survival of children with diseases that require lifelong care, and increasing numbers of families with children with medical complexity are presenting for health care. Owing to an increase in home-based care, the responsibility of complicated treatment regimens falls on parents and family caregivers. Based on studies and national survey, parents of children with medical complexity fare worse in mental health and family functioning. This review describes screening tools and research studies for family functioning and psychological health. These data also help in designing a family centered approach to the care of parents and caregivers to create a medical home and community support systems that integrate psychological and emotional interventions. Physician communication can be optimized by educational tools of brief intervention and community connections. [Pediatr Ann. 2024;53(3):e93-e98.].
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Hirt E, Wright A, Kehring A, Wang Y, Toraño V, Boles J. "Fitting the Pieces Together": The Experiences of Caregivers of Children With Medical Complexity. Hosp Pediatr 2023; 13:1056-1066. [PMID: 37916264 DOI: 10.1542/hpeds.2022-007112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
BACKGROUND AND OBJECTIVES Families of children with medical complexity manage a multitude of care responsibilities that must be carefully coordinated alongside typical family roles and activities. Currently, little is known about this experience from the perspectives of caregivers; therefore, the purpose of this study was to explore the experience of caregiving for a child with medical complexity while identifying unmet medical and psychosocial needs. METHODS Nineteen caregivers were recruited from the pediatric complex care clinic at an academic medical center in the United States. Each participant completed an in-depth, narrative interview that was audio-recorded and transcribed; transcripts were analyzed using an inductive coding approach. RESULTS Participants described their caregiving experiences along 4 themes: (1) the many responsibilities of caregiving, (2) insufficient respite care and skilled support, (3) financial limitations and costs of care, and (4) challenges with mental health and wellbeing. Participants identified unmet needs in 6 dimensions: (1) transition stress, (2) communication across teams, (3) learning to be an advocate, (4) purposefully inclusive environments, (5) finding connections and community, and (6) the challenges of coronavirus disease 2019. CONCLUSIONS Caregivers of children with medical complexity identify a host of experiences and unmet needs that challenge the physical, emotional, and psychosocial wellbeing of themselves and their families. With more attention to the holistic experience of caregiving for this population, providers and teams can better anticipate needs and provide services and programs that enhance caregiver and family wellbeing simultaneously.
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Affiliation(s)
- Elise Hirt
- Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Alyssa Wright
- Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Allysa Kehring
- Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Yinuo Wang
- Vanderbilt University, Nashville, Tennessee
| | | | - Jessika Boles
- Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee
- Vanderbilt University, Nashville, Tennessee
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Brittan MS, Chavez C, Blakely C, Holliman BD, Zuk J. Paid Family Caregiving for Children With Medical Complexity. Pediatrics 2023; 151:e2022060198. [PMID: 37248869 PMCID: PMC10233733 DOI: 10.1542/peds.2022-060198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 05/31/2023] Open
Abstract
OBJECTIVES We evaluated Colorado's paid family caregiver certified nursing assistant (CNA) program by assessing stakeholders' perceptions of the model's strengths and potential areas for improvement. METHODS A professional bilingual research assistant conducted key informant interviews of English- and Spanish-speaking certified nursing assistant (CNA) family caregivers (FCs), primary care providers, and pediatric home health administrators of children with medical complexity in the family caregiver CNA program. Interview questions focused on the program's benefits, drawbacks, and implications for the child and caregiver's quality of life. Transcripts were coded and analyzed, and themes summarizing program benefits and disadvantages were identified. RESULTS Semistructured interviews were completed by phone with 25 FCs, 10 home health administrators, and 10 primary care providers between September 2020 and June 2021. Overall, the program was highly valued and uniformly recommended for prospective families. Perceived benefits included: (1) fulfilling the desire to be a good parent, (2) providing stable and high-quality home health care, (3) benefitting the child's health and wellbeing, and (4) enhancing family financial stability. Perceived drawbacks included: (1) FCs experiencing mental and physical health burdens, (2) difficult access for some community members, (3) extraneous training requirements, and (4) low program visibility. CONCLUSIONS Given the perceived benefits of the family CNA program, the model may be considered for future dissemination to other communities. However, additional research and program improvements are needed to help make this a more equitable and sustainable home health care model for children with medical complexity.
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Affiliation(s)
- Mark S. Brittan
- Section of Pediatric Hospital Medicine, Children’s Hospital Colorado
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Denver, Aurora, Colorado
| | - Catia Chavez
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Denver, Aurora, Colorado
| | | | - Brooke Dorsey Holliman
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Denver, Aurora, Colorado
| | - Jeannie Zuk
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Denver, Aurora, Colorado
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Jacobs S, Davies N, Butterick KL, Oswell JL, Siapka K, Smith CH. Shared decision-making for children with medical complexity in community health services: a scoping review. BMJ Paediatr Open 2023; 7:10.1136/bmjpo-2023-001866. [PMID: 37012004 PMCID: PMC10083859 DOI: 10.1136/bmjpo-2023-001866] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 03/02/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Children with medical complexity is an increasing population whose parents and healthcare providers face multiple decisions. Shared decision-making is a process where patients, their families and healthcare providers collaborate to make decisions based on clinical evidence and informed preferences of the family. Shared decision-making has benefits for the child, family and healthcare providers, including improved parental understanding of the child's difficulties, increased participation, improved coping skills and more efficient healthcare use. It is, however, poorly implemented. AIMS AND METHODS A scoping review was conducted to explore shared decision-making for children with medical complexity in community health services, including how shared decision-making is defined in research, how it is implemented, including barriers and facilitators and recommendations for research. Six databases were systematically searched for papers published in English up to May 2022: Medline, CINAHL, EMBASE, PsycINFO, PubMed, Cochrane Database of Systematic Reviews and sources of grey literature. The review is reported according to the Preferred Reporting Items for Scoping Reviews. RESULTS Thirty sources met the inclusion criteria. Most factors can either be a facilitator or barrier to shared decision-making depending on the context. Two significant barriers to shared decision-making in this population include uncertainty about the child's diagnosis, prognosis, and treatment options and the presence of hierarchy and power imbalance during clinical encounters with healthcare providers. Further influencing factors include continuity of care, the availability of accurate, accessible, adequate, and balanced information and the interpersonal and communication skills of parents and healthcare providers. CONCLUSION Uncertainty about diagnosis, prognosis and treatment outcomes for children with medical complexity are additional challenges to the known barriers and facilitators to shared decision-making in community health services. Effective implementation of shared decision-making requires advancement of the evidence base for children with medical complexity, reducing power imbalance in clinical encounters, improving continuity of care, and improving the availability and accessibility of information resources.
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Affiliation(s)
- Sonja Jacobs
- Community Children's Therapies, Barts Health NHS Trust, London, UK
| | - Nathan Davies
- Research Department of Primary Care & Population Health, University College London, London, UK
| | | | - Jane L Oswell
- Community Children's Therapies, Barts Health NHS Trust, London, UK
| | | | - Christina H Smith
- Division of Psychology and Language Sciences, University College London, London, UK
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