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Brenner M, Alexander D, Quirke MB, Eustace-Cook J, Leroy P, Berry J, Healy M, Doyle C, Masterson K. A systematic concept analysis of 'technology dependent': challenging the terminology. Eur J Pediatr 2021; 180:1-12. [PMID: 32710305 PMCID: PMC7380164 DOI: 10.1007/s00431-020-03737-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/22/2020] [Accepted: 07/09/2020] [Indexed: 01/08/2023]
Abstract
There are an increasing number of children who are dependent on medical technology to sustain their lives. Although significant research on this issue is taking place, the terminology used is variable and the concept of technology dependence is ill-defined. A systematic concept analysis was conducted examining the attributes, antecedents, and consequences of the concept of technology dependent, as portrayed in the literature. We found that this concept refers to a wide range of clinical technology to support biological functioning across a dependency continuum, for a range of clinical conditions. It is commonly initiated within a complex biopsychosocial context and has wide ranging sequelae for the child and family, and health and social care delivery.Conclusion: The term technology dependent is increasingly redundant. It objectifies a heterogenous group of children who are assisted by a myriad of technology and who adapt to, and function with, this assistance in numerous ways. What is Known: • There are an increasing number of children who require medical technology to sustain their life, commonly referred to as technology dependent. This concept analysis critically analyses the relevance of the term technology dependent which is in use for over 30 years. What is New: • Technology dependency refers to a wide range of clinical technology to support biological functioning across a dependency continuum, for a range of clinical conditions. It is commonly initiated within a complex biopsychosocial context and has wide-ranging sequelae for the child and family, and health and social care delivery. • The paper shows that the term technology dependent is generally portrayed in the literature in a problem-focused manner. • This term is increasingly redundant and does not serve the heterogenous group of children who are assisted by a myriad of technology and who adapt to, and function with, this assistance in numerous ways. More appropriate child-centred terminology will be determined within the TechChild project.
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Affiliation(s)
- Maria Brenner
- School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, 24 D'Olier Street, Dublin 2, Ireland.
| | - Denise Alexander
- grid.8217.c0000 0004 1936 9705School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, 24 D’Olier Street, Dublin 2, Ireland
| | - Mary Brigid Quirke
- grid.8217.c0000 0004 1936 9705School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, 24 D’Olier Street, Dublin 2, Ireland
| | - Jessica Eustace-Cook
- grid.8217.c0000 0004 1936 9705Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Piet Leroy
- grid.5012.60000 0001 0481 6099Pediatric Intensive Care Unit & Pediatric Procedural Sedation Unit, Maastricht UMC and Faculty of Health, Life Sciences & Medicine, Maastricht University, Maastricht, Netherlands
| | - Jay Berry
- grid.2515.30000 0004 0378 8438Department of Medicine and Division of General Pediatrics, Boston Children’s Hospital and Harvard Medical School, Boston, MA USA
| | - Martina Healy
- Department of Paediatric Anaesthesia, Paediatric Critical Care Medicine and Paediatric Pain Medicine, Children’s Health Ireland Crumlin, Dublin, Ireland ,grid.8217.c0000 0004 1936 9705School of Medicine, Faculty of Health Sciences, Trinity College Dublin, the University of Dublin, Dublin, Ireland
| | - Carmel Doyle
- grid.8217.c0000 0004 1936 9705School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, 24 D’Olier Street, Dublin 2, Ireland
| | - Kate Masterson
- grid.8217.c0000 0004 1936 9705School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, 24 D’Olier Street, Dublin 2, Ireland ,grid.416107.50000 0004 0614 0346Paediatric Intensive Care Unit, The Royal Children’s Hospital, Melbourne, Australia
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Brenner M, O'Shea MP, Larkin P, Berry J. Key constituents for integration of care for children assisted with long-term home ventilation: a European study. BMC Pediatr 2020; 20:71. [PMID: 32061253 PMCID: PMC7023713 DOI: 10.1186/s12887-020-1979-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 02/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The number of children requiring long-term home ventilation has consistently increased over the last 25 years. Given the growing population of children with complex care needs (CCNs), this was an important area of focus within the Models of Child Health Appraised (MOCHA) project, funded by the European Union (EU) under the Horizon 2020 programme. We examined the structures and processes of care in place for children with CCNs and identified key constituents for effective integration of care for these children at the community and acute care interface across 30 EU/ European Economic Area (EEA) countries. METHODS This was a non-experimental descriptive study with an embedded qualitative element. Data were collected by a Country Agent in each of the 30 countries, a local expert in child health services. Data were analysed using descriptive statistics and a thematic analysis was undertaken of the free text data provided. RESULTS A total of 27 surveys were returned from a possible 30 countries (90.0%) countries. One respondent indicated that their country does not have children on long-term ventilation (LTV) in the home, therefore, responses of 26 countries (86.7%) were analysed. None of the responding countries reported that they had all of the core components in place in their country. Three themes emerged from the free text provided: 'family preparedness for transitioning to home', 'coordinated pathway to specialist care' and 'legal and governance structures'. CONCLUSIONS While the clinical care of children on LTV in the acute sector has received considerable attention, the results identify the need for an enhanced focus on the care required following discharge to the community setting. The results highlight the need for a commitment to supporting care delivery that acknowledges the complexity of contemporary child health issues and the context of the families that become their primary care givers.
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Affiliation(s)
- Maria Brenner
- School of Nursing & Midwifery, Trinity College Dublin University of Dublin, 24 D'Olier Street, Dublin 2, Ireland.
| | - Miriam P O'Shea
- School of Nursing & Midwifery, Trinity College Dublin University of Dublin, 24 D'Olier Street, Dublin 2, Ireland
| | - Philip Larkin
- Institut Universitaire de Formation et de Recherche en Soins, Bureau 01/157, SV-A Secteur Vennes, Rte de la Corniche 10, CH-1010, Lausanne, Switzerland
| | - Jay Berry
- Department of Medicine and Division of General Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, USA
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Brenner M, O'Shea MP, McHugh R, Clancy A, Larkin P, Luzi D, Pecoraro F, Olaso EM, Lignou S, Alma M, Satherley RM, Tamburis O, Warters A, Wolfe I, Hilliard C, Berry J, Alexander D, Rigby M, Blair M. Principles for provision of integrated complex care for children across the acute-community interface in Europe. THE LANCET CHILD & ADOLESCENT HEALTH 2019; 2:832-838. [PMID: 30336897 DOI: 10.1016/s2352-4642(18)30270-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 07/30/2018] [Accepted: 08/08/2018] [Indexed: 11/17/2022]
Abstract
This Viewpoint presents and discusses the development of the first core principles and standards for effective, personalised care of children living with complex care needs in Europe. These principles and standards emerged from an analysis of data gathered on several areas, including the integration of care for the child at the acute-community interface, the referral-discharge interface, the social care interface, nursing preparedness for practice, and experiences of the child and family. The three main principles, underpinned by a child-centric approach, are access to care, co-creation of care, and effective integrated governance. Collectively, the principles and standards offer a means to benchmark existing services for children living with complex care needs, to influence policy in relation to service delivery for these children, and to provide a suite of indicators with which to assess future service developments in this area.
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Affiliation(s)
- Maria Brenner
- School of Nursing & Midwifery, Trinity College Dublin, University of Dublin, Dublin, Ireland.
| | - Miriam P O'Shea
- School of Nursing & Midwifery, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - Rebecca McHugh
- School of Nursing & Midwifery, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - Anne Clancy
- Department of Health and Care Sciences, The Arctic University of Norway, Harstad, Norway
| | - Philip Larkin
- Lausanne University Medical Centre, Lausanne, Switzerland
| | - Daniela Luzi
- Institute for Research on Population and Social Policies, Italian National Research Council, Rome, Italy
| | - Fabrizio Pecoraro
- Institute for Research on Population and Social Policies, Italian National Research Council, Rome, Italy
| | - Elena Montañana Olaso
- School of Nursing & Midwifery, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - Sapfo Lignou
- School of Population Sciences and Health Services Research, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Manna Alma
- Faculty of Medical Sciences, University of Groningen, Groningen, Netherlands
| | - Rose-Marie Satherley
- School of Population Sciences and Health Services Research, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Oscar Tamburis
- Institute for Research on Population and Social Policies, Italian National Research Council, Rome, Italy
| | - Austin Warters
- School of Nursing & Midwifery, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - Ingrid Wolfe
- Evelina London Children's Healthcare, Guy's and St Thomas' NHS Trust, London
| | - Carol Hilliard
- Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
| | - Jay Berry
- Department of Medicine and Division of General Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Denise Alexander
- Imperial College of Science, Technology, and Medicine, London, UK
| | - Michael Rigby
- Section of Paediatrics, Faculty of Medicine, Imperial College of Science, Technology, and Medicine, London, UK
| | - Mitch Blair
- Section of Paediatrics, Faculty of Medicine, Imperial College of Science, Technology, and Medicine, London, UK
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Children's complex care needs: a systematic concept analysis of multidisciplinary language. Eur J Pediatr 2018; 177:1641-1652. [PMID: 30091109 DOI: 10.1007/s00431-018-3216-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 07/02/2018] [Accepted: 07/16/2018] [Indexed: 12/20/2022]
Abstract
Complex care in the arena of child health is a growing phenomenon. Although considerable research is taking place, there remains limited understanding and agreement on the concept of complex care needs (CCNs), with potential for ambiguity. We conducted a systematic concept analysis of the attributes, antecedents, and consequences of children's CCNs from a multidisciplinary perspective. Our data sources included PubMed, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO. Inclusion criteria included publications in peer-reviewed journals between January 1990 and December 2017, written in the English language. One hundred and forty articles were included. We found that children's CCNs refer to multidimensional health and social care needs, in the presence of a recognized medical condition or where there is no unifying diagnosis.Conclusion: Children's CCNs are individual and contextualized, are continuing and dynamic, and are present across a range of settings, impacted by family and healthcare structures. There remain extensive challenges to caring for these children and their families, precluding the possibility that any one profession can possess the requisite knowledge or scope to singularly provide high-quality competent care. What is Known: • Complex care is a growing phenomenon and population prevalence figures show that there is an increasing number of children with complex care needs (CCNs). However, the concept has not been systematically analyzed before, leaving it generally ill-defined and at times confusing. What is New: • This is the first time this concept has been systematically analyzed and this analysis provides a much-needed theoretical framework for understanding the multidimensional nature of CCNs in children. • Children's CCNs refer to multidimensional health and social care needs in the presence of a recognized medical condition or where there is no unifying diagnosis. They are individual and contextualized, are continuing and dynamic, and are present across a range of settings, impacted by family and healthcare structures. It is clear that the very nature of CCNs precludes the possibility that any one profession or discipline can possess the requisite knowledge or scope for high-quality competent care for this population.
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Evaluating the Reliability and Validity of the Arabic Version of the Parents Perceptions of Uncertainty Scale (A-PPUS). J Pediatr Nurs 2017; 36:179-185. [PMID: 28888500 DOI: 10.1016/j.pedn.2017.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 06/24/2017] [Accepted: 06/24/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Uncertainty often accompanies illness and may be a major aversive component of the patients' treatment process. There is evidence that parental uncertainty has a negative impact on their own and on their child's coping strategies and may affect family functioning. Key to the provision of competent care, to address uncertainty, is the use of an appropriate validated assessment tool to understand key parental concerns. The 'Parent Perception of Uncertainty Scale' (PPUS) has been widely used for this purpose. AIM This study reports on the validity and reliability testing of the Arabic version of the Parents Perception of Uncertainty Scale (A-PPUS). METHODS The scale was translated to Arabic using the translation-back-translation method. Appropriate statistical tests were performed including measurements of internal consistency, item to total scale correlation, and univariate and multivariate analyses. RESULTS The study included 240 parents of children with chronic illnesses. Cronbach's alpha coefficient of the whole scale was 0.93. All the items were positively correlated to the total score. The univariate and multivariate analysis supported the previous tests and the assertion that the Arabic version of the PPUS provided a relevant measure of the uncertainty level. CONCLUSION This study has identified that the A-PPUS is a reliable tool for parent report of their uncertainty, in the UAE and Arabic population.
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Brenner M, Connolly M, Cawley D, Howlin F, Berry J, Quinn C. Family and healthcare professionals' perceptions of a pilot hospice at home programme for children: a qualitative study. BMC Palliat Care 2016; 15:89. [PMID: 27793144 PMCID: PMC5084337 DOI: 10.1186/s12904-016-0161-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 10/19/2016] [Indexed: 12/01/2022] Open
Abstract
Background Parents commonly report a significant improvement in quality of life following the provision of hospice and supportive care and have identified a need for such a service in the home. The purpose of this study was to understand the experiences of families receiving a nurse led pilot hospice at home programme and the experiences of healthcare professionals delivering and engaging with the programme. Methods An exploratory, qualitative study was conducted, including telephone interviews with parents and focus groups and individual interviews with healthcare professionals. All parents of families who received the programme of care between June 2014 and September 2015 and healthcare professionals delivering and engaging with the programme were invited to participate. Results Seven parents participated in telephone interviews. Four focus groups took place, two with external stakeholders (18 participants in total), one with in-patient hospice staff (13 participants) and one with the hospice at home team (8 participants). Two additional interviews took place with individual stakeholders who were unable to attend a scheduled focus group. Themes from interviews with parents focused on the value of having consistent and expert care. The findings from healthcare professionals centred on communication within and across services, education and training and lone working. Conclusions The pilot hospice at home programme was welcomed by all those who took part in the study. The programme may be improved by enhanced clarification of roles, enhanced access to multi-disciplinary services, greater communication across services and improved information provision to families.
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Affiliation(s)
- Maria Brenner
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street,, Dublin 2, Ireland.
| | - Michael Connolly
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Des Cawley
- Department of Nursing and Health Science, Athlone Institute of Technology, Athlone, Ireland
| | - Frances Howlin
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Jay Berry
- Department of Medicine and Division of General Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
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