1
|
Torrent-Vernetta A, Soriano MM, Iglesias Serrano I, Izquierdo AD, Rovira Amigo S, Messa IM, Gartner S, Moreno-Galdó A. Arrangement of residence before hospital discharge for children on home-invasive mechanical ventilation. Pediatr Pulmonol 2024; 59:2080-2088. [PMID: 37983751 DOI: 10.1002/ppul.26758] [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: 07/08/2023] [Revised: 11/01/2023] [Accepted: 11/04/2023] [Indexed: 11/22/2023]
Abstract
Children on long-term home mechanical ventilation are a growing population due to clinical and technological advances and the benefit for the child's quality of life. Invasive home ventilation is one of the most complex therapies offered in the home setting, requiring adequate home environment and appropriate equipment and supplies before discharge. The transition from hospital to home represents a vulnerable period that can be facilitated with an established transition plan with multidisciplinary team involvement. Readiness for home care is achieved when the patient is stable and has been transitioned from a critical care ventilator to a home mechanical ventilator. In parallel, comprehensive competency-based training regarding the knowledge and skills needed to help families use the equipment confidently and safely. Before discharge, families should be counseled on an adequate home environment to ensure a safe transition. The residence arrangement may include physical space modifications, verifying electrical installation, or moving to another home. Durable medical equipment and supplies must be ordered, and community healthcare support arranged. Parents should receive practical advice on setting up the equipment at home and on preventive measures to minimize complications related to tracheostomy and ventilator dependence, including regular maintenance and replacement of necessary equipment. Given the overall impact of invasive ventilation on home life, a structured home care action package is essential to alleviate the burdens involved.
Collapse
Affiliation(s)
- Alba Torrent-Vernetta
- Pediatric Allergy and Pulmonology Section, Department of Pediatrics, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Growth and Development, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Center for Biomedical Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Majadahonda, Spain
| | - Maria Morillo Soriano
- Pediatric Allergy and Pulmonology Section, Department of Pediatrics, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ignacio Iglesias Serrano
- Pediatric Allergy and Pulmonology Section, Department of Pediatrics, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Growth and Development, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Ana Díez Izquierdo
- Pediatric Allergy and Pulmonology Section, Department of Pediatrics, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Growth and Development, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Sandra Rovira Amigo
- Pediatric Allergy and Pulmonology Section, Department of Pediatrics, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Growth and Development, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Center for Biomedical Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Majadahonda, Spain
| | - Inés Mir Messa
- Pediatric Allergy and Pulmonology Section, Department of Pediatrics, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Growth and Development, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Silvia Gartner
- Pediatric Allergy and Pulmonology Section, Department of Pediatrics, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Growth and Development, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Antonio Moreno-Galdó
- Pediatric Allergy and Pulmonology Section, Department of Pediatrics, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Growth and Development, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Center for Biomedical Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Majadahonda, Spain
| |
Collapse
|
2
|
Toly VB, Zauszniewski JA, Wang M, Russell KN, Ross K, Musil CM. Efficacy of a Resourcefulness Intervention to Enhance the Physical and Mental Health of Parents Caring for Technology-dependent Children at Home: A Randomized Controlled Trial. J Pediatr Health Care 2024; 38:337-353. [PMID: 37897454 PMCID: PMC11045667 DOI: 10.1016/j.pedhc.2023.09.012] [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: 09/28/2023] [Accepted: 09/30/2023] [Indexed: 10/30/2023]
Abstract
INTRODUCTION Parent caregivers of children who require lifesaving medical technology (e.g., mechanical ventilation, feeding tubes) must constantly maintain vigilance. Poor physical and psychological health can negatively impact their ability to do so. METHOD A two-arm randomized controlled trial was conducted with 197 parent caregivers of technology-dependent children (aged < 18 years) to test the efficacy of Resourcefulness Training1, a cognitive-behavioral intervention that teaches social (help-seeking) and personal (self-help) resourcefulness skills, in improving key outcomes including mental health-related quality of life (HRQOL), depressive cognitions and symptoms, perceived and physiological chronic stress, burden, and physical HRQOL at five-time points. RESULTS Mixed-effects models using the intent-to-treat principle indicated statistically significant improvement with intervention participants at six and/or nine months postintervention for depressive cognitions, perceived stress, and physical HRQOL, controlling for covariates. DISCUSSION Study findings support the efficacy of Resourcefulness Training to significantly decrease perceived stress and improve psychological/physical outcomes with these vulnerable caregivers.
Collapse
|
3
|
Hornberger SR, Zhang Y, Zhang N, Giambra BK. Association between parental education level & outcomes for children with long-term ventilator dependence: Communication behaviors as moderating variables. J Pediatr Nurs 2024; 75:205-212. [PMID: 38194763 DOI: 10.1016/j.pedn.2023.12.028] [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: 07/18/2023] [Revised: 12/27/2023] [Accepted: 12/27/2023] [Indexed: 01/11/2024]
Abstract
PURPOSE The purpose of this study was to examine the correlation between parental education level and outcomes for children with long-term ventilator dependence (LTVD) and their families and whether parent communication behaviors with hospital nurses moderated the relationship. Advances in medical technology and policy changes allow children with LTVD to be cared for at home. The child's diagnosis and disease severity affect their health outcomes, as do their family's social determinants of health (SDoH) such as parent education. DESIGN AND METHODS This secondary data analysis used chi-square tests to evaluate the correlation between parental education level and outcomes. Generalized linear mixed effect models were used to examine the moderation effect of parent communication behaviors. RESULTS Lower parental education level was associated with more child respiratory infections and more parental uncertainty within one month following hospital discharge. Lower parent education level was also associated with fewer unplanned contacts with providers within one week post-discharge. Additionally, parent use of Verifying Understanding communication behaviors moderated the relationship between parental education level and number of respiratory infections and amount of parental uncertainty. Finally, parent use of Negotiating Roles moderated the association between education level and number of unplanned visits. CONCLUSIONS Contradicting previous research, lower parental education level does not consistently correspond to adverse outcomes and may be explained by parents' determination to ensure optimal outcomes for their children with LTVD. PRACTICE IMPLICATIONS Overall, healthcare providers should not be concerned that children with LTVD will have different outcomes based on their parents' education level.
Collapse
Affiliation(s)
- Sydney R Hornberger
- Indiana University School of Medicine: West Lafayette Campus, 715 Clinic Dr, West Lafayette, IN 47907, United States; Cincinnati Children's Hospital Medical Center: Division of Research in Patient Services, 3333 Burnet Ave, Cincinnati, OH 45229, United States.
| | - Yin Zhang
- Cincinnati Children's Hospital Medical Center: Division of Biostatistics and Epidemiology, 3333 Burnet Ave, Cincinnati, OH 45229, United States
| | - Nanhua Zhang
- Cincinnati Children's Hospital Medical Center: Division of Biostatistics and Epidemiology, 3333 Burnet Ave, Cincinnati, OH 45229, United States; University of Cincinnati College of Medicine: Department of Pediatrics, 3230 Eden Ave, Cincinnati, OH 45267, United States
| | - Barbara K Giambra
- Cincinnati Children's Hospital Medical Center: Division of Research in Patient Services, 3333 Burnet Ave, Cincinnati, OH 45229, United States; Cincinnati Children's Hospital Medical Center: Department of Pediatrics, 3333 Burnet Ave, Cincinnati, OH 45229, United States; University of Cincinnati College of Nursing, 3110 Vine St, Cincinnati, OH 45221, United States
| |
Collapse
|
4
|
Foran PL, Benjamin WJ, Sperry ED, Best SR, Boisen SE, Bosworth B, Brodsky MB, Shaye D, Brenner MJ, Pandian V. Tracheostomy-related durable medical equipment: Insurance coverage, gaps, and barriers. Am J Otolaryngol 2024; 45:104179. [PMID: 38118384 PMCID: PMC10939813 DOI: 10.1016/j.amjoto.2023.104179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 12/05/2023] [Indexed: 12/22/2023]
Abstract
PURPOSE Tracheostomy care is supply- and resource-intensive, and airway-related adverse events in community settings have high rates of readmission and mortality. Devices are often implicated in harm, but little is known about insurance coverage, gaps, and barriers to obtaining tracheostomy-related medically necessary durable medical equipment. We aimed to identify barriers patients may encounter in procuring tracheostomy-related durable medical equipment through insurance plan coverage. MATERIALS AND METHODS Tracheostomy-related durable medical equipment provisions were evaluated across insurers, extracting data via structured telephone interviews and web-based searches. Each insurance company was contacted four times and queried iteratively regarding the range of coverage and co-pay policies. Outcome measures include call duration, consistency of explanation of benefits, and the number of transfers and disconnects. We also identified six qualitative themes from patient interviews. RESULTS Tracheostomy-related durable medical equipment coverage was offered in some form by 98.1 % (53/54) of plans across 11 insurers studied. Co-pays or deductibles were required in 42.6 % (23/54). There was significant variability in out-of-pocket expenditures. Fixed co-pays ranged from $0-30, and floating co-pays ranged from 0 to 40 %. During phone interviews, mean call duration was 19 ± 10 min, with an average of 2 ± 1 transfers between agents. Repeated calls revealed high information variability (mean score 2.4 ± 1.5). Insurance sites proved challenging to navigate, scoring poorly on usability, literacy, and information quality. CONCLUSIONS Several factors may limit access to potentially life-saving durable medical equipment for patients with tracheostomy. Barriers include out-of-pocket expenditures, lack of transparency on coverage, and low-quality information. Further research is necessary to evaluate patient outcomes.
Collapse
Affiliation(s)
- Palmer L Foran
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University, Baltimore, MD, United States
| | | | | | - Simon R Best
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University, Baltimore, MD, United States
| | - Sarah E Boisen
- Pediatric Intensive Care Unit, Seattle Children's Hospital, Seattle, WA, United States
| | | | - Martin B Brodsky
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH; Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, United States; Department of Physical and Rehabilitation, Johns Hopkins University, Baltimore, MD, United States
| | - David Shaye
- Department of Otolaryngology-Head & Neck Surgery, Harvard Medical School Massachusetts Eye and Ear, United States
| | - Michael J Brenner
- Department of Otolaryngology-Head & Neck Surgery, University of Michigan, Ann Arbor, MI, United States; Global Tracheostomy Collaborative, Raleigh, NC, United States; Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Vinciya Pandian
- Center for Immersive Learning and Digital Innovation Johns Hopkins University School of Nursing, Baltimore, MD, United States; Global Tracheostomy Collaborative, Raleigh, NC, United States; Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, United States; Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States.
| |
Collapse
|
5
|
Xiao L, Amin R, Nonoyama ML. Long-term mechanical ventilation and transitions in care: A narrative review. Chron Respir Dis 2023; 20:14799731231176301. [PMID: 37170874 PMCID: PMC10184211 DOI: 10.1177/14799731231176301] [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] [Indexed: 05/13/2023] Open
Abstract
OBJECTIVES Individuals dependent on long-term mechanical ventilation (LTMV) for their day-to-day living are a heterogenous population who go through several transitions over their lifetime. This paper describes three transitions: 1) institution/hospital to community/home, 2) pediatric to adult care, and 3) active treatment to end-of-life for ventilator-assisted individuals (VAIs). METHODS A narrative review based on literature and the author's collective practical and research experience. Four online databases were searched for relevant articles. A manual search for additional articles was completed and the results are summarized. RESULTS Transitions from hospital to home, pediatric to adult care, and to end-of-life for VAIs are complex and challenging processes. Although there are several LTMV clinical practice guidelines highlighting key components for successful transition, there still exists gaps and inconsistencies in care. Most of the literature and experiences reported to date have been in developed countries or geographic areas with funded healthcare systems. CONCLUSIONS For successful transitions, the VAIs and their support network must be front-and-center. There should be a coordinated, systematic, and holistic plan (including a multi-disciplinary team), life-time follow-up, with bespoke consideration of jurisdiction and individual circumstances.
Collapse
Affiliation(s)
- Lena Xiao
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Reshma Amin
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Mika Laura Nonoyama
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada
| |
Collapse
|
6
|
Alexander D, Quirke MB, Berry J, Eustace-Cook J, Leroy P, Masterson K, Healy M, Brenner M. Initiating technology dependence to sustain a child's life: a systematic review of reasons. JOURNAL OF MEDICAL ETHICS 2022; 48:1068-1075. [PMID: 34282042 PMCID: PMC9726963 DOI: 10.1136/medethics-2020-107099] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 06/13/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Decision-making in initiating life-sustaining health technology is complex and often conducted at time-critical junctures in clinical care. Many of these decisions have profound, often irreversible, consequences for the child and family, as well as potential benefits for functioning, health and quality of life. Yet little is known about what influences these decisions. A systematic review of reasoning identified the range of reasons clinicians give in the literature when initiating technology dependence in a child, and as a result helps determine the range of influences on these decisions. METHODS Medline, EMBASE, CINAHL, PsychINFO, Web of Science, ASSIA and Global Health Library databases were searched to identify all reasons given for the initiation of technology dependence in a child. Each reason was coded as a broad and narrow reason type, and whether it supported or rejected technology dependence. RESULTS 53 relevant papers were retained from 1604 publications, containing 116 broad reason types and 383 narrow reason types. These were grouped into broad thematic categories: clinical factors, quality of life factors, moral imperatives and duty and personal values; and whether they supported, rejected or described the initiation of technology dependence. The majority were conceptual or discussion papers, less than a third were empirical studies. Most discussed neonates and focused on end-of-life care. CONCLUSIONS There is a lack of empirical studies on this topic, scant knowledge about the experience of older children and their families in particular; and little written on choices made outside 'end-of-life' care. This review provides a sound basis for empirical research into the important influences on a child's potential technology dependence.
Collapse
Affiliation(s)
- Denise Alexander
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Mary Brigid Quirke
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Jay Berry
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | | | - Piet Leroy
- Pediatric Intensive Care Unit & Pediatric Procedural Sedation Unit, Maastricht UMC+, Maastricht, The Netherlands
| | - Kate Masterson
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Martina Healy
- Paediatric Intensive Care, Our Lady's Hospital Crumlin, Crumlin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Maria Brenner
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| |
Collapse
|
7
|
Giambra BK, Spratling R. Examining Children With Complex Care and Technology Needs in the Context of Social Determinants of Health. J Pediatr Health Care 2022; 37:262-268. [PMID: 36462998 DOI: 10.1016/j.pedhc.2022.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/09/2022] [Accepted: 11/11/2022] [Indexed: 12/05/2022]
Abstract
Children with complex care and technology needs require daily, intensive care from family caregivers. These children are understudied, particularly in relation to the social determinants of health (SDOH) that affect their health, well-being, and quality of life. This paper examines the salient research on SDOH among this population, focusing on the Healthy People 2030 domains. Gaps in the research are identified and recommendations for future research, practice, policy, and education are presented. Pediatric nurses, advanced practice nurses, and other health care provider teams that care for these children and families can improve their health by examining and addressing SDOH.
Collapse
|
8
|
Ischander M, Lozowski-Sullivan S. Psychologist's Unique Role in Improving Quality of Life of Children with Chronic Lung Diseases and Their Families. Pediatr Clin North Am 2022; 69:951-963. [PMID: 36207105 DOI: 10.1016/j.pcl.2022.05.008] [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] [Indexed: 11/05/2022]
Abstract
Pediatric chronic lung diseases burden their patients and families with heavy treatment loads, frequent extensive clinic visits to multiple providers, frequent emergency department visits and hospitalizations, and contribute to significant psychosocial issues with caregiver's burnout. The purpose of this chapter is to outline the psychosocial impact of the major pediatric chronic lung diseases and the unique role of the psychologist in relieving this burden. These include severe asthma, cystic fibrosis, bronchopulmonary dysplasia, and dependence on home mechanical ventilation.
Collapse
Affiliation(s)
- Mariam Ischander
- Department of Pediatric and Adolescent Medicine, Division of Pulmonology and Sleep Medicine, Western Michigan University, Homer Stryker MD School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008, USA.
| | - Sheryl Lozowski-Sullivan
- Department of Pediatric and Adolescent Medicine, Division of Psychology, Western Michigan University, Homer Stryker MD School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008, USA
| |
Collapse
|
9
|
Esmaeili M, Asgari P, Dehghan Nayeri N, Bahramnezhad F, Fattah Ghazi S. A contextual needs assessment of families with home invasive mechanical ventilation patients: A qualitative study. Chronic Illn 2022; 18:652-665. [PMID: 34486412 DOI: 10.1177/17423953211026362] [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] [Indexed: 11/16/2022]
Abstract
OBJECTIVES With the advancement of technology the number of patients surviving critical illness has increased. Home mechanical ventilation (HMV) is a growing option for patients requiring long-term mechanical ventilation. Caring for these patients is demanding and challenging. The aim of this study was to explore family caregivers'(carers) needs when providing care to adult patients under HMV from the perspective of nurses, home care attendants, and the caregivers themselves. METHODS Overall, 15 participants (nine carers, three home nurses, and three home care attendants) were selected by purposive sampling. Data were collected by in-depth semi-structured interviews and structured observation. Finally, data were analyzed through conventional content analysis with MAXQDA software. RESULTS Three categories of carers'needs were identified, including educational needs (basic and emergencies), psychological needs, and economic needs. In addition, since the needs, feelings, and views of caregivers change over time, the noted needs were divided into three periods: Pre-discharge preparation, initial transition from hospital to home, and appropriate long-term follow-up. CONCLUSION The study results showed that the families of patients under invasive HMV require a standard discharge plan based on their care needs, financial concerns, and psychological screening before discharge as well as a suitable long-term follow-up plan in collaboration with a multidisciplinary treatment team, insurance providers, and home care services.
Collapse
Affiliation(s)
- Maryam Esmaeili
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Parvaneh Asgari
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Nahid Dehghan Nayeri
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Bahramnezhad
- Nursing and Midwifery Care Research Center, Spiritual Health Group, Research Center of Quran, Hadith and Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Samrand Fattah Ghazi
- Assistant professor, Fellowship of Critical Care Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
10
|
Toly VB, Zauszniewski JA, Yu J, Sattar A, Rusincovitch B, Musil CM. Resourcefulness Intervention Efficacy for Parent Caregivers of Technology-Dependent Children: A Randomized Trial. West J Nurs Res 2022; 44:296-306. [PMID: 34965784 PMCID: PMC9166934 DOI: 10.1177/01939459211062950] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Parent caregivers of children who require lifesaving technology (e.g., mechanical ventilation, feeding tubes) must maintain a high level of vigilance 24/7. A two-arm randomized controlled trial tested the efficacy of a resourcefulness intervention on parents' mental/physical health and family functioning at four time points over six months. Participants (n = 93) cared for their technology-dependent children <18 years at home. The intervention arm received teaching on social (help-seeking), personal (self-help) resourcefulness skills; access to the intervention video and skill application video-vignettes; four weeks of skills reinforcement using daily logs; four weekly phone contacts; and booster sessions at two- and four-month postenrollment. The attention control arm received phone contact at identical time points plus the current standard of care. Statistically significant improvement was noted; fewer depressive cognitions and improved physical health for the intervention participants than attention control participants over time after controlling for covariates. The findings support the resourcefulness intervention efficacy.
Collapse
Affiliation(s)
| | | | - Jiao Yu
- Institute for Social Research and Data Innovation, University of Minnesota
| | - Abdus Sattar
- Department of Population and Quantitative Health Science, School of Medicine, Case Western Reserve University
| | | | - Carol M. Musil
- Frances Payne Bolton School of Nursing, Case Western Reserve University
| |
Collapse
|
11
|
Fernández-Medina IM, Granero-Molina J, Hernández-Padilla JM, Jiménez-Lasserrotte MDM, Ruiz-Fernández MD, Fernández-Sola C. Socio-family support for parents of technology-dependent extremely preterm infants after hospital discharge. J Child Health Care 2022; 26:42-55. [PMID: 33599522 DOI: 10.1177/1367493521996490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Parents of extremely preterm infants (<28 weeks of gestation) report high levels of stress and anxiety related to daily needs after hospital discharge. Social support has a significant role in reducing the negative psychological impact of preterm birth and parents' adaptation to caregiving. We conducted a hermeneutic phenomenological study using Gadamer's approach to explore and describe the experiences of parents of technology-dependent extremely preterm infants of socio-family support after hospital discharge. The study was conducted in four several Spanish organizations for families with preterm infants. It includes 17 semi-structured interviews (12 mothers and 5 fathers). Three main themes emerged from the analysis: post-discharge formal support for extremely preterm infants and families, home neonatal care: family support, and a thread of hope: parent-to-parent support. The parents' main support resources to deal with everyday difficulties are healthcare professionals, their partners, grandmothers, and peer parents of extremely preterm infants. The findings may be used to guide healthcare professionals in the creation of a support program according to preferences and needs of parents.
Collapse
Affiliation(s)
| | - José Granero-Molina
- Department of Nursing, Physiotherapy and Medicine, 16721University of Almería, Spain.,Faculty of Health Sciences, 16721Universidad Autónoma de Chile, Chile
| | - José Manuel Hernández-Padilla
- Department of Nursing, Physiotherapy and Medicine, 16721University of Almería, Spain.,Department of Adult, Child and Midwifery, School of Health and Education, Middlesex University, UK
| | | | | | - Cayetano Fernández-Sola
- Department of Nursing, Physiotherapy and Medicine, 16721University of Almería, Spain.,Faculty of Health Sciences, 16721Universidad Autónoma de Chile, Chile
| |
Collapse
|
12
|
Meister KD, Pandian V, Hillel AT, Walsh BK, Brodsky MB, Balakrishnan K, Best SR, Chinn SB, Cramer JD, Graboyes EM, McGrath BA, Rassekh CH, Bedwell JR, Brenner MJ. Multidisciplinary Safety Recommendations After Tracheostomy During COVID-19 Pandemic: State of the Art Review. Otolaryngol Head Neck Surg 2021; 164:984-1000. [PMID: 32960148 PMCID: PMC8198753 DOI: 10.1177/0194599820961990] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/06/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE In the chronic phase of the COVID-19 pandemic, questions have arisen regarding the care of patients with a tracheostomy and downstream management. This review addresses gaps in the literature regarding posttracheostomy care, emphasizing safety of multidisciplinary teams, coordinating complex care needs, and identifying and managing late complications of prolonged intubation and tracheostomy. DATA SOURCES PubMed, Cochrane Library, Scopus, Google Scholar, institutional guidance documents. REVIEW METHODS Literature through June 2020 on the care of patients with a tracheostomy was reviewed, including consensus statements, clinical practice guidelines, institutional guidance, and scientific literature on COVID-19 and SARS-CoV-2 virology and immunology. Where data were lacking, expert opinions were aggregated and adjudicated to arrive at consensus recommendations. CONCLUSIONS Best practices in caring for patients after a tracheostomy during the COVID-19 pandemic are multifaceted, encompassing precautions during aerosol-generating procedures; minimizing exposure risks to health care workers, caregivers, and patients; ensuring safe, timely tracheostomy care; and identifying and managing laryngotracheal injury, such as vocal fold injury, posterior glottic stenosis, and subglottic stenosis that may affect speech, swallowing, and airway protection. We present recommended approaches to tracheostomy care, outlining modifications to conventional algorithms, raising vigilance for heightened risks of bleeding or other complications, and offering recommendations for personal protective equipment, equipment, care protocols, and personnel. IMPLICATIONS FOR PRACTICE Treatment of patients with a tracheostomy in the COVID-19 pandemic requires foresight and may rival procedural considerations in tracheostomy in their complexity. By considering patient-specific factors, mitigating transmission risks, optimizing the clinical environment, and detecting late manifestations of severe COVID-19, clinicians can ensure due vigilance and quality care.
Collapse
Affiliation(s)
- Kara D. Meister
- Clinical Assistant Professor, Aerodigestive and Airway Reconstruction Center, Lucile Packard Children’s Hospital, Stanford Children’s Health, Stanford, Palo Alto, California, United States
- Clinical Assistant Professor, Center for Pediatric Voice and Swallowing Disorders, Department of Otolaryngology – Head & Neck Surgery, Division of Pediatric Otolaryngology, Lucile Packard Children’s Hospital, Stanford Children’s Health, Stanford, Palo Alto, California, United States
| | - Vinciya Pandian
- Associate Professor, Department of Nursing Faculty, Johns Hopkins University, Baltimore, Maryland, United States
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, Maryland, United States
| | - Alexander T. Hillel
- Associate Professor, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, United States
| | - Brian K. Walsh
- Professor, Department of Health Sciences, Liberty University, Lynchburg, United States
| | - Martin B. Brodsky
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, Maryland, United States
- Associate Professor, Department of Physical and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, United States
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Karthik Balakrishnan
- Clinical Assistant Professor, Aerodigestive and Airway Reconstruction Center, Lucile Packard Children’s Hospital, Stanford Children’s Health, Stanford, Palo Alto, California, United States
- Clinical Assistant Professor, Center for Pediatric Voice and Swallowing Disorders, Department of Otolaryngology – Head & Neck Surgery, Division of Pediatric Otolaryngology, Lucile Packard Children’s Hospital, Stanford Children’s Health, Stanford, Palo Alto, California, United States
| | - Simon R. Best
- Associate Professor, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, United States
| | - Steven B. Chinn
- Assistant Professor, Department of Otolaryngology – Head and Neck Surgery, University of Michigan, Michigan, United States
| | - John D. Cramer
- Assistant Professor, Department of Otolaryngology – Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, United States
| | - Evan M. Graboyes
- Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, United States
- Hollings Cancer Center, Charleston, South Carolina, United States
| | - Brendan A. McGrath
- Anesthesiology Consultant, University of Manchester, NHS Foundation Trust, National Tracheostomy Safety Project, Manchester, United Kingdom
| | - Christopher H. Rassekh
- Professor, Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Joshua R. Bedwell
- Associate Professor, Baylor College of Medicine, Houston, Texas, United States
- Associate Professor, Division of Pediatric Otolaryngology-Head and Neck Surgery, Texas Children’s Hospital, Houston, Texas, United States
| | - Michael J. Brenner
- Associate Professor, Department of Otolaryngology – Head & Neck Surgery, University of Michigan, Ann Arbor, Michigan, United States, and President-elect, Global Tracheostomy Collaborative, Raleigh, North Carolina, United States
| |
Collapse
|
13
|
Boss RD, Henderson CM, Raisanen JC, Jabre NA, Shipman K, Wilfond BS. Family Experiences Deciding For and Against Pediatric Home Ventilation. J Pediatr 2021; 229:223-231. [PMID: 33068566 DOI: 10.1016/j.jpeds.2020.10.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/06/2020] [Accepted: 10/09/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To understand what considerations drive family decisions for, and against, pediatric home ventilation. STUDY DESIGN Qualitative interviews with parents of children who faced a decision about home ventilation in the previous 5 years at 3 geographically dispersed institutions. RESULTS In total, 38 families (42 parents) were interviewed; 20 families opted for pediatric home ventilation, and 18 families opted against. Approximately one-quarter of children had isolated chronic lung disease; the remainder had medical complexity that was expected to remain static or decline. Parent perspectives about home ventilation generally reflected whether the child was early, or later, in their disease trajectory. Early on, parents often interpreted prognostic uncertainty as hope and saw home ventilation as a tool permitting time for improvement. For families of children later in their disease course, often already with home technology and home nursing, home ventilation held less possibility for meaningful improvement. Nearly all families experienced the decision as very emotionally distressing. Reflecting back, most families described feeling satisfied with whatever decision they made. CONCLUSIONS The 2 principal groups of families in our cohort-those with children whose respiratory insufficiency might improve, and those with children facing chronic decline-warrant targeted counseling approaches about initiating home ventilation. The distressing nature of this decision should be anticipated and family supports reinforced.
Collapse
Affiliation(s)
- Renee D Boss
- Johns Hopkins School of Medicine, Baltimore, MD; Johns Hopkins Berman Institute of Bioethics, Baltimore, MD
| | - Carrie M Henderson
- University of Mississippi Medical Center, Jackson, MS; Center for Bioethics and Medical Humanities, Jackson, MS
| | | | - Nicholas A Jabre
- Johns Hopkins School of Medicine, Baltimore, MD; Johns Hopkins Berman Institute of Bioethics, Baltimore, MD
| | - Kelly Shipman
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA; Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| |
Collapse
|
14
|
Abstract
PURPOSE OF REVIEW The aim of this review is to provide an update on the management of pediatric tracheostomies. RECENT FINDINGS Recent literature has focused on optimization of care for children with tracheostomies including prevention and management of skin breakdown, timing of tracheostomy tube changes, the role of multidisciplinary and team-based approaches to education and management of tracheostomy patients, ideal timing of surveillance endoscopy, and the emerging role of telemedicine in the care of tracheostomy patients. SUMMARY A focus on quality improvement and a systematic, team-based approach to care has the potential to improve the quality of care for pediatric tracheostomy patients.
Collapse
|