A Descriptive Qualitative Study of Home Care Experiences in Parents of Children with Tracheostomies

Caring for the child with a tracheostomy through the eyes of their caregiver: A photovoice study

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.

Digital education-supported telehealth intervention in mothers of children with tracheostomy: A quasi-experimental study

PURPOSE

The burden of care is high for parents of children with special care needs. Mothers need to be supported in home care to reduce the burden of care. This study aimed to determine the effects of providing digital education-supported telehealth application to mothers of children with tracheostomy receiving home care on the development of complications, hospital admission, care burden, and knowledge level of mothers.

DESIGN AND METHODS

A one-group quasi-experimental, pretest-posttest study. The study was conducted with mothers of children with tracheostomy in the pediatric pulmonology outpatient clinic of a university hospital (n = 37). Digital education-supported telehealth application was provided to mothers. The digitally assisted education intervention lasted 6 weeks. Data were collected using the Child and Mother Identification Form, Complication Development Follow-up Form, Hospital Admission Follow-up Form, Caregiver Burden Scale (CBS), and Tracheostomy Care Knowledge Evaluation Questionnaire. The data were collected at three time points: before, immediately after, and 3 months after the education. For data analysis, repeated-measures analysis of variance and the Shapiro-Wilk, Friedman's, and Cochran's Q tests were used.

RESULTS

In the study, 51% of the mothers were aged between 31 and 40 years; 56% of children were male and 37% were aged ≤3 years. A total of 62% of children aged ≥25 months received respiratory support through home care with tracheostomy and mechanical ventilator. There was no significant difference between the mean number of complications (p = 0.286) and number of hospital admissions (p = 0.079) in the pretest, posttest, and follow-up measurements. The mean CBS score of the mothers decreased in the pretest (36.08 ± 12.04), posttest (33.27 ± 9.58), and follow-up (32.76 ± 11.18) measurements; however, there was no significant difference (p = 0.058). The mean Tracheostomy Care Knowledge Level posttest (13.73 ± 1.28) and follow-up (13.97 ± 1.14) scores increased significantly compared with the pretest (12.14 ± 1.55) scores (p < 0.001).

CONCLUSIONS

The digital education-supported telehealth application provided to mothers reduced their care burden and increased their knowledge level. There was no change in the number of complications and hospital admissions.

PRACTICE IMPLICATIONS

Digital education-supported telehealth intervention, applied to parents of children requiring special care, is an effective and easy-to-access nursing intervention in reducing the burden of care.

Symptom and Technology Management Intervention Usefulness for Caregivers of Children With Tracheostomies and Feeding Tubes

BACKGROUND

Caregivers of children who require medical technology of tracheostomies and feeding tubes provide intensive and specialized care at home. They have extensive training in the hospital prior to their child's discharge; however, there is limited education about their child's care once they are at home. The Creating Opportunities for Personal Empowerment: Symptom and Technology Management Resources intervention focused on commonly experienced symptoms and technology used at home by caregivers.

OBJECTIVE

We present the findings from the intervention exit interviews to gain insight about the intervention from caregiver perspectives, notably their perceptions of usefulness, ease of use, and acceptability.

METHODS

A qualitative descriptive design was used to examine caregivers' perceptions of the intervention in exit interviews. These interviews were conducted upon completion of the intervention as part of feasibility testing.

RESULTS

Sixteen caregivers completed the study and participated in exit interviews. Caregivers described the themes of the best that you can do, a reminder that I am doing it the right way, and I wish I had these when my child first had the tracheostomy and feeding tube. Caregivers also provided feedback about the intervention's usefulness and suggestions for further refinement and future adaptations of the intervention.

CONCLUSIONS

Caregivers provided valuable insights about the intervention, describing its usefulness to them, the potential for usefulness for other caregivers of these children, and their experiences with care of their children at home. Future plans include efficacy testing and modifications to enhance the intervention based on caregiver feedback.

Sim-Based Home Tracheostomy Care: A Mixed Methods Study on Outcomes and Parental Preparedness

OBJECTIVES

To assess effects of a Simulation-Based Discharge Education Program (SDP) on long-term caregiver-reported satisfaction and to compare clinical outcomes for children with new tracheostomies whose caregivers completed SDP versus controls.

METHODS

The study employed a mixed methods approach: (1) a qualitative analysis of feedback from caregivers who previously completed SDP, and (2) a quantitative retrospective case-control study comparing outcomes between children with new tracheostomies whose caregivers completed SDP versus controls, matched on discharge disposition and age. The primary outcome was emergency department visits for tracheostomy-related issues within 1 year of discharge.

RESULTS

Feedback from 18 interviews was coded into 5 themes: knowledge acquisition, active learning, comfort and preparedness, home application of skills, and overall assessment. Caregivers of 27 children (median age 26 months [interquartile range (IQR) 5.5 months-11 years]) underwent SDP training. Clinical outcomes of these children were compared with 27 matched children in the non-SDP group (median age 16 months [IQR 3.5 months-10 years]). There was no significant difference in ED visits for tracheostomy-related complications within 1 year of discharge between the SDP group and non-SDP group (2 [IQR 0-2] vs 1 [IQR 0-2], P = .2).

CONCLUSIONS

Caregivers reported overwhelmingly positive experiences with SDP that persisted even 4 years after training. Caregiver participation in SDP did not yield a significant difference in ED visits within 1 year of discharge for tracheostomy-related complications compared with control counterparts. Future steps will identify more effective methods for comparing and analyzing clinical outcomes to further validate impacts of simulation-based programs.

Experiences of parents of children with corrosive esophageal ingestion: a qualitative study

PURPOSE

To describe the experiences of parents of children treated for corrosive esophageal ingestion.

METHODS

In-depth interviews were conducted with 17 parents (nine mothers and eight fathers) of children who had suffered a corrosive esophageal ingestion requiring hospitalization. Online interviews were also conducted with parents of children who were still undergoing treatment for corrosive esophageal ingestion. The interview guide explored the parents' overall experiences and included research questions that explored the participants' perceptions, thoughts, feelings and problems. The interviews were digitally recorded and transcribed verbatim. Inductive reflective thematic analysis was performed using MAXQDA.

RESULTS

Analysis of the interview transcripts generated three themes and nine sub-themes describing parents' experiences: emotional consequences, social consequences and facilitators. The results reveal that caregivers experienced anxiety and difficulties, prompting them to seek support from their family and social environment.

CONCLUSION

These findings highlight the importance of identifying and understanding parental experiences. This understanding will also enable healthcare professionals to optimize the parental experience in caring for children with corrosive esophageal ingestion within a holistic clinical service. Understanding the experiences of children with corrosive esophageal ingestion from the parents' perspective identifies opportunities for systematic treatment and care.

Experiences of patients' primary caregivers with tracheostomy suctioning before discharge

PURPOSE

This study aimed to determine the experiences of primary caregivers of patients with tracheostomies on the tracheostomy suctioning procedure.

METHODS

This is a semi-structured qualitative study of 11 primary caregivers of patients with tracheostomies in one university hospital in a province in northwest Turkey. Data were collected using a semi-structured interview technique with the primary caregivers of the patients and interviews were audio-recorded. The content of the audio recordings obtained during each interview was evaluated by the researchers using the content analysis method. The data were categorized, coded, and analyzed by creating themes and sub-themes.

RESULTS

The experiences of primary caregivers with tracheostomy suctioning before discharge were classified under three themes and 11 sub-themes. The study's main themes were emotional reactions, information needs, and caring responsibility. Caregivers showed either positive or negative emotions when performed tracheostomy suctioning on their patients. Insufficient information on the patient care and recovery process were mostly emphasized topic by caregivers. Such that they express the knowledge deficiency on tracheostomy suctioning and counseling provided either by nurses/physicians. Thus compete with difficulties ends up with feelings of pressure and avoidance of caring responsibility.

CONCLUSION

Caregivers lack of knowledge and poor skills on tracheostomy suctioning ends up with fear, anxiety, and obstacles on patient caring. Implementing individualized education, supporting patients and their caregivers on tracheostomy suctioning, and following up on caregivers' abilities are valuable interventions.

Tracheostomy care quality improvement in low- and middle-income countries: A scoping review

Tracheostomy is a lifesaving, essential procedure performed for airway obstruction in the case of head and neck cancers, prolonged ventilator use, and for long-term pulmonary care. While successful quality improvement interventions in high-income countries such as through the Global Tracheostomy Collaborative significantly reduced length of hospital stay and decreased levels of anxiety among patients, limited literature exists regarding tracheostomy care and practices in low and middle-income countries (LMIC), where most of the world resides. Given limited literature, this scoping review aims to summarize published tracheostomy studies in LMICs and highlight areas in need of quality improvement and clinical research efforts. Based on the PRISMA guidelines, a scoping review of the literature was performed through MEDLINE/PubMed and Embase using terms related to tracheostomy, educational and quality improvement interventions, and LMICs. Publications from 2000-2022 in English were included. Eighteen publications representing 10 countries were included in the final analysis. Seven studies described baseline needs assessments, 3 development of training programs for caregivers, 6 trialed home-based or hospital-based interventions, and finally 2 articles discussed development of standardized protocols. Overall, studies highlighted the unique challenges to tracheostomy care in LMICs including language, literacy barriers, resource availability (running water and electricity in patient homes), and health system access (financial costs of travel and follow-up). There is currently limited published literature on tracheostomy quality improvement and care in LMICs. Opportunities to improve quality of care include increased efforts to measure complications and outcomes, implementing evidence-based interventions tailored to LMIC settings, and using an implementation science framework to study tracheostomy care in LMICs.

Management of Discharge Instructions for Children With Medical Complexity: A Systematic Review

CONTEXT

Children with medical complexity (CMC) are at risk for adverse outcomes after discharge. Difficulties with comprehension of and adherence to discharge instructions contribute to these errors. Comprehensive reviews of patient-, caregiver-, provider-, and system-level characteristics and interventions associated with discharge instruction comprehension and adherence for CMC are lacking.

OBJECTIVE

To systematically review the literature related to factors associated with comprehension of and adherence to discharge instructions for CMC.

DATA SOURCES

PubMed/Medline, Embase, Cochrane Central Register of Controlled Trials, PsycInfo, Cumulative Index to Nursing and Allied Health Literature, Web of Science (database initiation until March 2023), and OAIster (gray literature) were searched.

STUDY SELECTION

Original studies examining caregiver comprehension of and adherence to discharge instructions for CMC (Patient Medical Complexity Algorithm) were evaluated.

DATA EXTRACTION

Two authors independently screened titles/abstracts and reviewed full-text articles. Two authors extracted data related to study characteristics, methodology, subjects, and results.

RESULTS

Fifty-one studies were included. More than half were qualitative or mixed methods studies. Few interventional studies examined objective outcomes. More than half of studies examined instructions for equipment (eg, tracheostomies). Common issues related to access, care coordination, and stress/anxiety. Facilitators included accounting for family context and using health literacy-informed strategies.

LIMITATIONS

No randomized trials met inclusion criteria. Several groups (eg, oncologic diagnoses, NICU patients) were not examined in this review.

CONCLUSIONS

Multiple factors affect comprehension of and adherence to discharge instructions for CMC. Several areas (eg, appointments, feeding tubes) were understudied. Future work should focus on design of interventions to optimize transitions.

Transitioning through adversity: Maternal experiences and post-traumatic growth in the context of infants diagnosed with esophageal atresia - A comprehensive qualitative study

PURPOSE

This study aimed to elucidate the experiences and growth trajectories of mothers who have infants with esophageal atresia, which would contribute to our understanding of their unique nursing care requirements and support the development of personalized nursing care strategies and interventions for these critically ill infants.

DESIGN AND METHODS

This study used a qualitative descriptive approach including face to face interviews with semi-structured questions. The interviews were audio-recorded and transcribed verbatim.

RESULTS

Eight mothers were interviewed between November 2021 to January 2022. The mothers described two categories of care experiences: "grief" and "post-traumatic growth". Subcategories included "beginning of chaos", "facing reality", "forced mother-infant separation", "deprived life", "deepened self-knowledge", "enhanced perception of social support", and "shift in life priorities".

CONCLUSIONS

The findings of this study indicated mother of infants with esophageal atresia experienced grief, and also reported growth. A better understanding of mothers' experience and positive changes may facilitate peditric nursing practice and promote mothers to attain good psychological adaptation to enable them to take good care of their children.

APPLICATION TO PRACTICE

Pediatric nurses' insight into the experience of mothers caring for infants with esophageal atresia could facilitate increased physical intimacy and optimized interaction time to understand the unique personality of these infants. Collaborating with mothers could enhance nurses' comprehension of their perspectives, concerns, and needs, and could guide intervention strategies.

Providing care for children with tracheostomies: a qualitative interview study with parents and health professionals

OBJECTIVES

To explore the experience of caring for children with tracheostomies from the perspectives of parents and health professional caregivers.

DESIGN

Qualitative semistructured interview study.

SETTING

One region in England covered by a tertiary care centre that includes urban and remote rural areas and has a high level of deprivation.

PARTICIPANTS

A purposive sample of health professionals and parents who care for children who have, or have had, tracheostomies and who received care at the tertiary care centre.

INTERVENTION

Interviews undertaken by telephone or video link.

PRIMARY AND SECONDARY OUTCOME MEASURES

Qualitative reflexive thematic analysis with QSR Nvivo 12.

RESULTS

This paper outlines key determinants and mediators of the experiences of caregiving and the impact on psychological and physical health and quality of life of parents and their families, confidence of healthcare providers and perceived quality of care. For parents, access to care packages and respite care at home as well as communication and relationships with healthcare providers are key mediators of their experience of caregiving, whereas for health professionals, an essential influence is multidisciplinary team working and support. We also highlight a range of challenges focused on the shared care space, including: a lack of standardisation in access to different support teams, care packages and respite care, irregular training and updates, and differences in health provider expertise and experiences across departments and shift patterns, exacerbated in some settings by limited contact with children with tracheostomies.

CONCLUSIONS

Understanding the experiences of caregiving can help inform measures to support caregivers and improve quality standards. Our findings suggest there is a need to facilitate further standardisation of care and support available for parent caregivers and that this may be transferable to other regions. Potential solutions to be explored could include the development of a paediatric tracheostomy service specification, increasing use of paediatric tracheostomy specialist nurse roles, and addressing the emotional and psychological support needs of caregivers.

Caregiver Perceptions of a Tracheostomy "Go-Bag" Standardization Initiative

INTRODUCTION

This project aimed to standardize and improve the emergency tracheostomy "go-bag" provided by our institution and to increase "go-bag" compliance, supply organization, and emergency preparedness and confidence among caregivers of tracheostomy-dependent children.

METHOD

We provided caregivers with a new trifold "go-bag," containing four zippered pockets. Diagram-based supply checklists were placed in each "go-bag" to assist with supply organization and supply checks performed by the clinical team. Caregiver questionnaires were administered before and after "go-bag" distribution to assess the impact of the practice change.

RESULTS

Between July 1, 2020 and February 28, 2021, 43% (n = 30) of tracheostomy-dependent children followed by the Department of Otolaryngology received a new "go-bag." Overall, "go-bag" compliance, supply organization, and caregiver confidence related to providing care at home and intervening in an emergency improved from baseline. Caregivers reported overwhelmingly positive feedback regarding the new "go-bag" design and utility.

DISCUSSION

These findings support the use of standardized, user-friendly tracheostomy "go-bags" provided by health care institutions and the performance of routine "go-bag" supply checks to ensure patient safety and caregiver preparedness.

Amplifying patient voices amid pandemic: Perspectives on tracheostomy care, communication, and connection

OBJECTIVE

To investigate perspectives of patients, family members, caregivers (PFC), and healthcare professionals (HCP) on tracheostomy care during the COVID-19 pandemic.

METHODS

The cross-sectional survey investigating barriers and facilitators to tracheostomy care was collaboratively developed by patients, family members, nurses, speech-language pathologists, respiratory care practitioners, physicians, and surgeons. The survey was distributed to the Global Tracheostomy Collaborative's learning community, and responses were analyzed.

RESULTS

Survey respondents (n = 191) from 17 countries included individuals with a tracheostomy (85 [45 %]), families/caregivers (43 [22 %]), and diverse HCP (63 [33.0 %]). Overall, 94 % of respondents reported concern that patients with tracheostomy were at increased risk of critical illness from SARS-CoV-2 infection and COVID-19; 93 % reported fear or anxiety. With respect to prioritization of care, 38 % of PFC versus 16 % of HCP reported concern that patients with tracheostomies might not be valued or prioritized (p = 0.002). Respondents also differed in fear of contracting COVID-19 (69 % PFC vs. 49 % HCP group, p = 0.009); concern for hospitalization (55.5 % PFC vs. 27 % HCP, p < 0.001); access to medical personnel (34 % PFC vs. 14 % HCP, p = 0.005); and concern about canceled appointments (62 % PFC vs. 41 % HCP, p = 0.01). Respondents from both groups reported severe stress and fatigue, sleep deprivation, lack of breaks, and lack of support (70 % PFC vs. 65 % HCP, p = 0.54). Virtual telecare seldom met perceived needs.

CONCLUSION

PFC with a tracheostomy perceived most risks more acutely than HCP in this global sample. Broad stakeholder engagement is necessary to achieve creative, patient-driven solutions to maintain connection, communication, and access for patients with a tracheostomy.

Adapting user-centered design principles to improve communication of peer parent narratives on pediatric tracheostomy

BACKGROUND

Parents who have to make tracheostomy decisions for their critically ill child may face forecasting errors and wish to learn from peer parents. We sought to develop an intervention with peer parent narratives to help parents anticipate and prepare for future challenges before making a decision.

METHODS

To ensure that the intervention reflects parents' needs (rather than experts' opinions), we adapted a user-centered design (UCD) process to identify decision-critical information and refine the presentation format by interviewing parents who had tracheostomy decision making experience. Phase 1 (n = 10) presented 15 possible forecasting errors and asked participants to prioritize and justify the problematic ones. It also asked participants to comment on the draft narratives and preferred delivery mode and time of the intervention. Phase 2 (n = 9 additional parents and 1 previous parent) iteratively collected feedback over four waves of user interviews to guide revisions to the informational booklet.

RESULTS

Phase 1 revealed that parents wanted information to address all forecasting errors as soon as tracheostomy becomes an option. They also highlighted diverse family situations and the importance of offering management strategies. The resulting prototype booklet contained five sections: introduction, child's quality of life, home care, practical challenges, and resources. Feedback from Phase 2 focused on emphasizing individualized situations, personal choice, seriousness of the decision, and caregiver health as well as presenting concrete illustrations of future challenges with acknowledgement of positive outcomes and advice. We also learned that parents preferred to use the booklet with support from the care team rather than read it alone.

CONCLUSIONS

A UCD process enabled inclusion of parental perspectives that were initially overlooked and tailoring of the intervention to meet parental expectations. Similar UCD-based approaches may be valuable in the design of other types of patient communications (e.g., decision aids).

The associations between the clinical course of children with tracheostomy and their mothers' depression, burnout, burden, and self-esteem

AIMS AND OBJECTIVES

The aim of this study was to evaluate the clinical features of children with tracheostomy and the predictors of psychological status of their primary caregivers in order to determine the associations between the children's clinical course with their caregivers' psychological status.

BACKGROUND

The caregivers of children with tracheostomy are responsible for providing basic tracheostomy care at home. All these responsibilities may be associated with significant changes in family members' lifestyles, daily routines and family dynamics.

DESIGN

This study is a cross sectional study.

METHODS

Data of the family's socioeconomic status and clinical status of children with tracheostomy were noted in four paediatric pulmonology centers. The Beck Depression Inventory, Maslach Burnout Inventory, Zarit Caregiver Burden Scale, and Rosenberg Self-esteem Scale were used for psychological measurements of the caregivers. The STROBE checklist was used for this study.

RESULTS

Eighty-five children and their primary caregivers were enrolled in the study. The children's median age was 4.1 years. Thirty-eight of them were dependent on home ventilators. Twenty-one had bacterial colonisation. All children's primary caregivers were their mothers. Beck Depression Inventory scores of mothers of children with colonisation were higher. Number of hospitalizations in previous 6 months was related to mothers' emotional exhaustion and depersonalization scores. Duration of children's hospitalizations in previous 6 months was positively correlated to mothers' emotional exhaustion, depersonalization, and Beck Depression Inventory scores.

CONCLUSIONS

Mothers of children with tracheostomy may experience psychological conditions, such as high levels of depression, burnout, burden and low levels of self-esteem. Frequent and long-term hospitalizations of children correlated with mother's depression and burnout. Therefore, primary caregivers should be evaluated and supported psychologically.

RELEVANCE TO CLINICAL PRACTICE

Preventing mothers of children with tracheostomy from experiencing psychological conditions such as depression, burnout, burden and low self-esteem can also increase the quality of care for children.

Anxiety Levels of Primary Caregivers of Children With Tracheostomy During the COVID-19 Pandemic

We aim to evaluate the anxiety levels of caregivers of children with tracheostomy during the COVID-19 (coronavirus disease 2019) pandemic. Caregivers of 31 children with tracheostomy and 105 healthy children (control group) were included. The State-Trait Anxiety Inventory was administered via teleconference in order to investigate how participants describe how they feel at a particular moment (State) and how they generally feel (Trait). The trait anxiety levels of caregivers of children with tracheostomy were significantly higher (P = .02). Their state anxiety levels were similar. The state and trait anxiety levels of caregivers of children with tracheostomy correlated (r = 0.70, P < .001). At the end of the teleconference, caregivers of children with tracheostomy experienced greater anxiety relief than controls (P < .001). Trait anxiety scores were higher among caregivers of children with tracheostomy, but their state anxiety levels were comparable to those of controls. Caregivers with high trait anxiety also exhibited high state anxiety. Informing caregivers of children with tracheostomy about COVID-19 via teleconference can reduce their anxiety during such stressful times.

Gaining Experience Over Time: The Family Caregivers' Perception of Patients with a Tracheostomy in Home Care

Background

The transition of tracheostomy patients to the home poses many challenges for both the patient and the family. Identifying and understanding the experiences of family caregivers pave the road for discovering and meeting care needs. This study has been aimed to explain the experiences of family caregivers of patients with a tracheostomy about patient care at home.

Materials and Methods

This qualitative study was conducted using a conventional content analysis approach from September 2018 to January 2019. Participants included nine family caregivers and one professional caregiver who were selected through purposive sampling method. The in-depth interviews were conducted at home or in health centers using field notes. Data were recorded manually and analyzed using the five-step method proposed by Granehim and Lundman.

Results

The data led to the emergence of 1591 initial codes, 23 subcategories, and 6 categories. Categories include the need for training, the need for receiving care support, care challenges, care burden, gaining experience, hope, and inner satisfaction.

Conclusions

In this study, the family caregivers faced with lots of challenges in caring patients with tracheostomy so that they were in needs of training and support from professionals. Although they got skillful in care and endure burden, they were so hopeful and satisfied with their attempts. Hence, there is a need for official nongovernmental organizations with the aim of maintaining care and protecting their families.

Caregivers experiences in symptom management for their children who require medical technology at home

PURPOSE

The purpose of this study is to explore the daily care experiences of caregivers of children who require medical technology. Specific aims were to gain an understanding of their perceptions of (a) how caregivers manage symptoms for their children who require medical technology at home, (b) why the caregivers seek emergency department (ED) and hospital care, and (c) what the caregivers need to manage their child's symptoms at home. The research question was asked, what are the education, skills, and support caregivers report needing to effectively manage their child's symptoms and prevent avoidable ED visits and hospitalizations?

DESIGN AND METHODS

Interpretive phenomenology was used to examine how caregivers manage their children's symptoms and technology at home, and their reasons for seeking emergency care through ED visits and/or hospitalizations. Self-identified nine primary caregivers of children who required medical technology participated in this study. Semi-structured interviews explored the caregiver's perceptions of the child's needs for symptom and technology management, and needs for education, skills, and support.

RESULTS

Three themes were found in the participant interviews. Theme 1 was Knowing my child's normal and having confidence with daily caregiving. Theme 1 included a subtheme of Caregivers are proactive and advocates for their child. Theme 2 was This is much different from my child's normal…this is an emergency. Theme 3 was We cannot sleep and we are exhausted. In regard to education, skills, and support, caregivers described their preparation and training in the hospital before their child's discharge from the hospital with a tracheostomy and feeding tube, but lacked knowledge of new situations and symptoms at home with medical technology.

PRACTICE IMPLICATIONS

This study confirms the need for interventions for these caregivers to enhance education, skills, and support caregivers need to effectively manage their child's symptoms and prevent avoidable ED visits and hospitalizations, specifically enhancement of care at home. More education for caregivers of children who require medical technology is recommended to facilitate quality care for the child; few interventions have addressed care for these children, and none address education and management of symptoms and medical technology.