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Dewan T, Mackay L, Asaad L, Buchanan F, Hayden KA, Montgomery L. Experiences of Inpatient Healthcare Services Among Children With Medical Complexity and Their Families: A Scoping Review. Health Expect 2024; 27:e14178. [PMID: 39229799 PMCID: PMC11372467 DOI: 10.1111/hex.14178] [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: 09/20/2023] [Revised: 07/24/2024] [Accepted: 07/25/2024] [Indexed: 09/05/2024] Open
Abstract
BACKGROUND Children with medical complexity (CMC) have high healthcare utilization and face unique challenges during hospital admissions. The evidence describing their experiences of inpatient care is distributed across disciplines. The aim of this scoping review was to map the evidence related to the inpatient experience of care for CMC and their families, particularly related to key aspects and methodological approaches, and identify gaps that warrant further study. METHODS This scoping review was conducted in accordance with JBI methodology and included all studies that reported experiences of acute hospital care for CMC/families. All study designs were included. Databases searched included EMBASE, CINAHL Plus with Full Text, Web of Science, MEDLINE(R) and APA PsycInfo from 2000 to 2022. Details about the participants, concepts, study methods and key findings were abstracted using a data abstraction tool. A thematic analysis was conducted. RESULTS Forty-nine papers were included: 27 qualitative studies, 10 quantitative studies, six mixed methods studies, two descriptive studies and four reviews. Some quantitative studies used validated instruments to measure experience of care, but many used non-validated surveys. There were a few interventional studies with a small sample size. Results of thematic analysis described the importance of negotiating care roles, shared decision-making, common goal setting, relationship-building, communication, sharing expertise and the hospital setting itself. CONCLUSION CMC and families value relational elements of care and partnering through sharing expertise, decision-making and collaborative goal-setting when admitted to hospital. PATIENT OR PUBLIC CONTRIBUTION This review was conducted in alignment with the principles of patient and family engagement. The review was conceptualized, co-designed and conducted with the full engagement of the project's parent-partner. This team member was involved in all stages from constructing the review question, to developing the protocol, screening articles and drafting this manuscript.
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Affiliation(s)
- Tammie Dewan
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Lyndsay Mackay
- College of Nursing, Trinity Western University, Langley, British Columbia, Canada
| | - Lauren Asaad
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Francine Buchanan
- Patient, Family and Community Engagement, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - K Alix Hayden
- Library and Cultural Resources, University of Calgary, Calgary, Alberta, Canada
| | - Lara Montgomery
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
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MacKay LJ, Chang U, Kreiter E, Nickel E, Kamke J, Bahia R, Shantz S, Meyerhoff H. Exploration of trust between pediatric nurses and children with a medical diagnosis and their caregivers on inpatient care units: A scoping review. J Pediatr Nurs 2024; 78:e1-e30. [PMID: 39085007 DOI: 10.1016/j.pedn.2024.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 05/26/2024] [Accepted: 05/26/2024] [Indexed: 08/02/2024]
Abstract
PROBLEM Trust is central to the development of nurse-patient relationships. Pediatric nurses encounter difficulties developing trust with children and their caregivers. The purpose of this scoping review was to identify, examine, and summarize available evidence on the concept of trust among nurses and children/caregivers when admitted to hospital inpatient care units. ELIGIBILITY CRITERIA Using the Joanna Briggs Institute (JBI) methodology for conducing and reporting scoping reviews, CINAHL, MEDLINE, PsycINFO, Cochrane DSR, Cochrane Central, and JBI EBP were searched for qualitative, quantitative, mixed methods, and review studies with no time limits published in English. Included studies presented findings on the experiences of developing trust between pediatric nurses and children under 18 years of age and their caregivers within inpatient care units. RESULTS A total of 12,269 titles and abstracts were reviewed independently by two reviewers. 366 full-text articles were retrieved, a final of 81 studies were included in the review. CONCLUSIONS Trust was bi-directional between nurses and children/caregivers, developed over time during multiple interactions, and foundational to the development of relationships. Distinct facilitators and barriers to the development of trust between nurses and children/caregivers were identified. The development of trust was rewarding and enriching for both nurses and children/caregivers and was the fundamental to the provision of safe and high-quality nursing care. IMPLICATIONS Findings provide nurses with direction and strategies on how to develop and maintain trust with children/caregivers on inpatient care units. The development of training programs and interventions geared at equipping nurses with the skills to develop trust with children/caregivers is needed.
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Affiliation(s)
- Lyndsay Jerusha MacKay
- School of Nursing, Trinity Western University, 22500 University Drive, Langley, British Columbia V2Y 1Y1, Canada.
| | - Una Chang
- School of Nursing, Trinity Western University, 22500 University Drive, Langley, British Columbia V2Y 1Y1, Canada.
| | - Elizabeth Kreiter
- Norma Marion Alloway Library, Trinity Western University, 22500 University Drive, Langley, British Columbia V2Y 1Y1, Canada.
| | - Emma Nickel
- Alberta Children's Hospital, 28 Oki Drive, Calgary, Alberta T3B 6A8, Canada.
| | - Janice Kamke
- School of Nursing, Trinity Western University, 22500 University Drive, Langley, British Columbia V2Y 1Y1, Canada.
| | - Rubinder Bahia
- School of Nursing, Trinity Western University, 22500 University Drive, Langley, British Columbia V2Y 1Y1, Canada.
| | - Sarah Shantz
- Alberta Children's Hospital, 28 Oki Drive, Calgary, Alberta T3B 6A8, Canada.
| | - Heather Meyerhoff
- School of Nursing, Trinity Western University, 22500 University Drive, Langley, British Columbia V2Y 1Y1, Canada.
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Oulton K, Gibson F, Kenten C, Russell J, Carr L, Hassiotis A, Kelly P, Kerry S, Tuffrey-Wijne I, Whiting M, Wray J. Being a child with intellectual disabilities in hospital: The need for an individualised approach to care. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13153. [PMID: 37792824 DOI: 10.1111/jar.13153] [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: 11/10/2022] [Revised: 08/08/2023] [Accepted: 08/13/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND There is limited qualitative research focussed specifically on what it is like for children and young people with intellectual disabilities coming into hospital, with much of the evidence-base being about those with Autism Spectrum Condition or adults with intellectual disabilities. AIM To share rich detail of the emotional and physical impact on children and young people with intellectual disabilities of attending hospital, from their own and their parent's perspective. METHODS Talking Mats interviews, sticker survey and photography with children and young people with intellectual disabilities, and in-depth interviews, hospital diaries and photography with their parents. RESULTS AND CONCLUSIONS The multiple and compounding layers of complexity surrounding hospital care of children and young people with intellectual disabilities resulted in challenges associated with loss of familiarity and routine, undergoing procedures, managing sensory overload, managing pain and having a lack of safety awareness. An individualised approach to their care is needed.
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Affiliation(s)
- Kate Oulton
- School of Health Sciences, University of Surrey, Guildford, UK
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Faith Gibson
- School of Health Sciences, University of Surrey, Guildford, UK
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Charlotte Kenten
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Jessica Russell
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Lucinda Carr
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Angela Hassiotis
- UCL Division of Psychiatry, University College London, London, UK
| | - Paula Kelly
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Sam Kerry
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | - Mark Whiting
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hertfordshire, UK
| | - Jo Wray
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Ong N, Gee BL, Long JC, Zieba J, Tomsic G, Garg P, Lapointe C, Silove N, Eapen V. Patient safety and quality care for children with intellectual disability: An action research study. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2023; 27:885-911. [PMID: 35657332 DOI: 10.1177/17446295221104619] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Children with intellectual disability experience significant challenges in accessing and receiving high-quality healthcare leading to poorer health outcomes and negative patient experiences. Families of these children often report a need for healthcare staff to better understand, communicate, and collaborate for better care while staff acknowledge a lack of training. To address this, we utilised an action research framework with a pre- and post- survey to evaluate an integrated continuing professional development and quality improvement program combining strategies from education, behavioural psychology and quality improvement that was delivered in two departments within a tertiary children's Hospital in Metropolitan Sydney in 2019-2020. Parents reported noticeable changes in the clinical practice of staff, and staff acknowledged and attributed their shift in behaviour to raising awareness and discussions around necessary adaptations. The program demonstrates a novel method for knowledge translation to practice and systems improvements.
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Affiliation(s)
- Natalie Ong
- Child Development Unit, Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Brendan Loo Gee
- Academic Unit of Child Psychiatry South West Sydney (AUCS), UNSW Sydney & Ingham Institute, Sydney, NSW, Australia
| | - Janet C Long
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Jerzy Zieba
- Academic Unit of Child Psychiatry South West Sydney (AUCS), UNSW Sydney & Ingham Institute, Sydney, NSW, Australia and Department of Psychology, University of Rzeszow, Poland
| | - Gail Tomsic
- Child Development Unit, Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Pankaj Garg
- Specialist Disability Health Team, Department of Community Paediatrics, South Western Sydney Local Health District, Sydney, NSW, Australia
| | - Caleb Lapointe
- The KidsSim Centre, Children's Hospital at Westmead, Sydney, NSW, Australia
- The KidsSim Centre, Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Natalie Silove
- Child Development Unit, Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, Australia
| | - Valsamma Eapen
- Academic Unit of Child Psychiatry South West Sydney (AUCS), UNSW Sydney & Ingham Institute, Sydney, Australia
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Gréaux M, Moro MF, Kamenov K, Russell AM, Barrett D, Cieza A. Health equity for persons with disabilities: a global scoping review on barriers and interventions in healthcare services. Int J Equity Health 2023; 22:236. [PMID: 37957602 PMCID: PMC10644565 DOI: 10.1186/s12939-023-02035-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/11/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Persons with disabilities experience health inequities in terms of increased mortality, morbidity, and limitations in functioning when compared to the rest of the population. Many of the poor health outcomes experienced by persons with disabilities cannot be explained by the underlying health condition or impairment, but are health inequities driven by unfair societal and health system factors. A synthesis of the global evidence is needed to identify the factors that hinder equitable access to healthcare services for persons with disabilities, and the interventions to remove these barriers and promote disability inclusion. METHODS We conducted a scoping review following the methodological framework proposed by Arksey and O'Malley, Int J Soc Res Methodol 8:19-32. We searched two scholarly databases, namely MEDLINE (Ovid) and Web of Science, the websites of Organizations of Persons with Disabilities and governments, and reviewed evidence shared during WHO-led consultations on the topic of health equity for persons with disabilities. We included articles published after 2011 with no restriction to geographical location, the type of underlying impairments or healthcare services. A charting form was developed and used to extract the relevant information for each included article. RESULTS Of 11,884 articles identified in the search, we included 182 articles in this review. The majority of sources originated from high-income countries. Barriers were identified worldwide across different levels of the health system (such as healthcare costs, untrained healthcare workforces, issues of inclusive and coordinated services delivery), and through wider contributing factors of health inequities that expand beyond the health system (such as societal stigma or health literacy). However, the interventions to promote equitable access to healthcare services for persons with disabilities were not readily mapped onto those needs, their sources of funding and projected sustainability were often unclear, and few offered targeted approaches to address issues faced by marginalized groups of persons with disabilities with intersectional identities. CONCLUSION Persons with disabilities continue to face considerable barriers when accessing healthcare services, which negatively affects their chances of achieving their highest attainable standard of health. It is encouraging to note the increasing evidence on interventions targeting equitable access to healthcare services, but they remain too few and sparce to meet the populations' needs. Profound systemic changes and action-oriented strategies are warranted to promote health equity for persons with disabilities, and advance global health priorities.
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Affiliation(s)
- Mélanie Gréaux
- Faculty of Education, University of Cambridge, Cambridge, UK.
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Ong N, Lucien A, Long JC, Weise J, Walton M, Burgess A. What do healthcare staff think about the quality and safety of care provided to children and young people with an intellectual disability? A qualitative study using the framework method of analysis. BMJ Open 2023; 13:e071494. [PMID: 37491102 PMCID: PMC10373726 DOI: 10.1136/bmjopen-2022-071494] [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: 07/27/2023] Open
Abstract
OBJECTIVE To elicit patient safety issues pertaining to children and young people with intellectual disability in hospital from healthcare staff perspectives. This follows a previous paper of parent interviews of patient safety experiences of their child in hospital. DESIGN Qualitative study. SETTING We conducted semi-structured interviews and focus groups of staff of tertiary children's hospitals based on the domains of the Patient Safety Education Framework and using the framework methodology for data analysis. PARTICIPANTS There were 29 female and 7 male staff aged between 27 and 70 years from a range of departments and specialties including ancillary staff. INTERVENTION Questions based on the patient safety framework were developed from consultation with parents, researchers and clinicians exploring staff views and experiences of safety and quality care of these children in hospital. During April 2021 to May 2022, 22 interviews and 3 focus groups were conducted of staff who have had experience caring for children and young people with intellectual disability in the last 12 months in the hospital. RESULTS Key themes elicited include Definition of Safety, Need to consider additional vulnerabilities of children and young people with intellectual disability in hospital, Communication is key to safe care, Parent and family perspectives on safe care, Management challenges compromising safety and Service system gaps in preventing, identifying and managing risk. CONCLUSIONS Staff need to consider additional vulnerabilities, mitigate negative attitudes and biases towards better engagement and relationships with parents, children and young people of this population. Improvement of current systems that prevent the identification, prevention and management of risk and safety issues for this population need to be undertaken. Future developments include combining data from parent interviews, academic and grey literature in developing safety competencies in this population for training and education of staff across the health system.
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Affiliation(s)
- Natalie Ong
- Children's Hospital Westmead Clinical School, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Child Development Unit, The Sydney Children's Hospitals Network, Westmead, New South Wales, Australia
| | - Abbie Lucien
- Faculty of Medicine, School of Psychiatry, UNSW, Sydney, New South Wales, Australia
| | - Janet C Long
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Janelle Weise
- Department of Developmental Disability Neuropsychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Merrilyn Walton
- Office of Teaching and Learning in Medicine, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Annette Burgess
- Medical Education, Education Office, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
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Armitage L, Walter F. Nurses' perception of what makes a good care experience for children and young people with intellectual disabilities align with parents' perceptions. Evid Based Nurs 2023; 26:119. [PMID: 36854610 DOI: 10.1136/ebnurs-2022-103571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 03/02/2023]
Affiliation(s)
- Leah Armitage
- Department of Biomolecular Science, University of Manchester Institute of Science and Technology, Manchester, UK
| | - Florian Walter
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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Mohd FN, Said AH, Mat Naji AS. Perceptions Toward Healthcare and Dental Care Services among Parents and Caretakers of People with Intellectual Disability (PWID)-A Questionnaire Study. J Int Soc Prev Community Dent 2023; 13:54-61. [PMID: 37153925 PMCID: PMC10155881 DOI: 10.4103/jispcd.jispcd_157_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 12/12/2022] [Accepted: 01/14/2023] [Indexed: 05/10/2023] Open
Abstract
Aim and Objective In Malaysia, there was lack of local evidence on the perception of parents/caretakers of people with intellectual disabilities (PWID) about healthcare. Thus, this study aims to assess the perceptions toward healthcare services of parents or caretakers for PWID. Materials and Methods Online survey using Google Forms was conducted on parents/caretakers of PWID who attended the special care dentistry clinic and special community centers in Kuantan, Pahang. A questionnaire was developed for data collection. Cronbach alpha was conducted to measure the reliability. Content and face validation was performed to establish the validity. Data entry and analysis were done using IBM statistical package for social sciences (SPSS) version 24. This study only involved univariate (descriptive) data analysis in which categorical data were summarized in actual numbers and percentages. Results The respondents' perceptions toward healthcare access and services were reasonably good; about 50% disagreed and strongly disagreed on having difficulty accessing healthcare facilities. 65% and 55% of parents/caretakers brought PWID for regular health and dental checkups. The majority agreed and strongly agreed (about 73%) that healthcare staff gave equal services and good support and showed positive attitudes toward PWID under their care. Insufficient healthcare information and below-par communication skills remained the main barriers faced by the parents/caretakers of PWID. About 13% of the respondents reported experiencing discrimination in receiving health and dental services for PWID under their care. The Cronbach alpha scores for sections 2 and 4 were 0.892 and 0.681, respectively. Conclusion Most of the respondents felt that Malaysia's healthcare services for PWID were fairly good. However, it was intriguing to find that some still experienced discrimination. This shows that education about intellectual disability is salient for healthcare workers and should be embedded in the current curriculum.
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Affiliation(s)
- Farah N Mohd
- Special Care Dentistry Unit, Department of Oral Diagnosis and Oral Maxillofacial Surgery, Kulliyyah of Dentistry, International Islamic University Malaysia, Kuantan, Malaysia
| | - Abdul H Said
- Department of Family Medicine, Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan, Malaysia
- Address for correspondence: Dr. Abdul Hadi Said, Department of Family Medicine, International Islamic University Malaysia, Kuantan 25200, Malaysia. E-mail:
| | - Ahmad Syahir Mat Naji
- Dental Clinic Pekan, Pekan District, Dental Health Unit, Oral Health Department, Ministry of Health, Kuantan, Malaysia
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Ong N, Mimmo L, Barnett D, Long J, Weise J, Walton M. Reported clinical incidents of children with intellectual disability: A qualitative analysis. Dev Med Child Neurol 2022; 64:1359-1365. [PMID: 35578400 PMCID: PMC9790611 DOI: 10.1111/dmcn.15262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/26/2022] [Accepted: 04/14/2022] [Indexed: 12/30/2022]
Abstract
AIM To qualitatively explore reported clinical incidents of children with intellectual disability aged 0 to 18 years. METHOD A secondary qualitative evaluation using latent content analysis was used on retrospective hospital incident management reporting data (1st January-31st December 2017) on 1367 admissions for 1018 randomly selected patients admitted to two tertiary children's hospitals in New South Wales, Australia. Sex and age at admission in children with and without intellectual disability: 83 (43.7%) versus 507 (43.1%) females and 107 (56.3%) versus 670 (56.9%) males, p=0.875; median age 3 years (0-18y) versus 4 years (0-18y), p=0.122. Of these, 44 patient safety incident reports for children with intellectual disability (sex, SD, and range) and 167 incident reports for children without intellectual disability (sex, SD, and range) were found and analysed. RESULTS Ten themes were synthesized from the data and represented the groups with and without intellectual disability. Children with intellectual disability had a significantly higher proportion of care issues identified by their parents. They also had higher rates of multiple reported clinical incidents per admission compared to children without intellectual disability. INTERPRETATION Mechanisms to advocate and raise patient safety issues for children with intellectual disability are needed. Partnerships with parents and training of staff in reporting clinical incidents for this population would enhance the embedding of reasonable adaptations into incident management systems for ongoing monitoring and improvement. WHAT THIS PAPER ADDS Children with intellectual disability experienced multiple patient safety incidents per admission compared to children without intellectual disability. Children with intellectual disability had significantly increased rates of parent-identified incidents. Issues with medication, communication, delays in diagnosis and treatment, and identification of deterioration were noted.
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Affiliation(s)
- Natalie Ong
- School of Public Health, Faculty of Medicine and HealthUniversity of SydneyCamperdownNSWAustralia,Child Development Unit; Children's Hospital at WestmeadSydney Children's Hospitals NetworkWestmeadNSWAustralia
| | - Laurel Mimmo
- School of Population HealthUniversity of New South Wales Medicine, University of New South WalesKensingtonNSWAustralia,Clinical Governance UnitSydney Children's Hospitals NetworkSydneyNSWAustralia
| | - Diana Barnett
- Child Development Unit; Children's Hospital at WestmeadSydney Children's Hospitals NetworkWestmeadNSWAustralia
| | - Janet Long
- Australian Institute of Health Innovation, Faculty of Medicine and Health SciencesMacquarie UniversityMacquarie ParkNSWAustralia
| | - Janelle Weise
- Department of Developmental Disability Neuropsychiatry (3DN)University of New South Wales Medicine, University of New South WalesRandwickNSWAustralia
| | - Merrilyn Walton
- School of Public Health, Faculty of Medicine and HealthUniversity of SydneyCamperdownNSWAustralia
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Mimmo L, Hodgins M, Samir N, Travaglia J, Woolfenden S, Harrison R. 'Smiles and laughter and all those really great things': Nurses' perceptions of good experiences of care for inpatient children and young people with intellectual disability. J Adv Nurs 2022; 78:2933-2948. [PMID: 35451515 PMCID: PMC9544709 DOI: 10.1111/jan.15256] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 02/11/2022] [Accepted: 03/23/2022] [Indexed: 11/28/2022]
Abstract
AIM To understand what constitutes a good experience of care for inpatient children and young people with intellectual disability as perceived by nursing staff. DESIGN Interpretive qualitative study. METHODS Focus groups with clinical nursing staff from speciality neurological/neurosurgical and adolescent medicine wards across two specialist tertiary children's hospitals in Australia were conducted between March and May 2021. Data analysis followed interpretative analysis methods to develop themes and codes which were mapped to a conceptual model of safe care. RESULTS Six focus groups with 29 nurses of varying experience levels were conducted over 3 months. Themes and codes were mapped to the six themes of the conceptual model: use rapport, know the child, negotiate roles, shared learning, build trust and relationships, and past experiences. The analysis revealed two new themes that extended the conceptual model to include; the unique role of a paediatric nurse, and joy and job satisfaction, with a third contextual theme, impacts of COVID-19 pandemic restrictions. With the perspectives of paediatric nurses incorporated into the model we have enhanced our model of safe care specifically for inpatient paediatric nursing care of children and young people with intellectual disability. CONCLUSION Including perceptions of paediatric nurses confirmed the position of the child with intellectual disability being at the centre of safe care, where care is delivered as a partnership between nursing staff, child or young person and their parents/family and the hospital systems and processes. IMPACT The enhanced model offers a specialized framework for clinical staff and health managers to optimize the delivery of safe care for children and young people with intellectual disability in hospital.
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Affiliation(s)
- Laurel Mimmo
- Clinical Governance UnitThe Sydney Children's Hospitals NetworkSydneyNSWAustralia
- Population Child Health Research GroupSchool of Women's and Children's HealthFaculty of MedicineUniversity of New South WalesSydneyNSWAustralia
| | - Michael Hodgins
- Population Child Health Research GroupSchool of Women's and Children's HealthFaculty of MedicineUniversity of New South WalesSydneyNSWAustralia
| | - Nora Samir
- Population Child Health Research GroupSchool of Women's and Children's HealthFaculty of MedicineUniversity of New South WalesSydneyNSWAustralia
| | - Joanne Travaglia
- Centre for Health Services ManagementFaculty of HealthUniversity of Technology SydneySydneyNSWAustralia
| | - Susan Woolfenden
- Population Child Health Research GroupSchool of Women's and Children's HealthFaculty of MedicineUniversity of New South WalesSydneyNSWAustralia
| | - Reema Harrison
- Centre for Health Systems and Safety ResearchAustralian Institute of Health InnovationFaculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNSWAustralia
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Appelgren M, Persson K, Bahtsevani C, Borglin G. Swedish registered nurses' perceptions of caring for patients with intellectual and developmental disability: A qualitative descriptive study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:1064-1076. [PMID: 34009687 DOI: 10.1111/hsc.13307] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 12/11/2020] [Accepted: 01/07/2021] [Indexed: 06/12/2023]
Abstract
Patients with intellectual and developmental disability (IDD) are often misinterpreted and misunderstood. Studies show that, in general, healthcare professionals have limited knowledge about IDD, and registered nurses (RNs) often report feeling unprepared to support this group of patients. Therefore, more knowledge about how to adequately address care for this patient group is warranted. This qualitative study employs an interpretative descriptive design to explore and describe Swedish RNs' perceptions of caring for patients with IDD, here in a home-care setting. Twenty RNs were interviewed between September 2018 and May 2019, and the resulting data were analysed through an inductive qualitative content analysis. The study adheres to consolidated criteria for reporting qualitative research (COREQ). Our analysis found that nurses' perceptions of caring for patients with an IDD could be understood from three overarching categories: nursing held hostage in the context of care, care dependent on intuition and proven experience and contending for the patients' right to adequate care. Our findings show that the home-care context and organisation were not adjusted to the needs of the patients. This resulted in RNs feeling unable to provide care in accordance with their professional values. They also explained that they had not mastered the available augmentative and alternative communication tools, instead using support staff as interpreters for their patients. Finally, on a daily basis, the RNs caring for this group of patients took an active stance and fought for the patients' right to receive the right care at the right time by the right person. This was particularly the case with issues involving psychiatric care.
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Affiliation(s)
- Marie Appelgren
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
- City of Malmö, Borough Administration Operation Support Management, Malmö, Sweden
| | - Karin Persson
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Christel Bahtsevani
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Gunilla Borglin
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
- Department of Health Sciences, Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden
- Department of Nursing Education, Lovisenberg Diaconal University College, Oslo, Norway
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Nicholson E, Conlon C, Mimmo L, Doherty E, Guerin S. Unscheduled healthcare for children with intellectual disabilities: A systematic scoping review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2022; 35:736-751. [PMID: 35322908 PMCID: PMC9314007 DOI: 10.1111/jar.12994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 11/30/2022]
Abstract
Background The provision of unscheduled healthcare for children with intellectual disability is less researched than that focused on hospital settings or for adult services. The aim of the scoping review was to map the evidence base in this area and identify areas for future study. Method A five‐stage scoping review framework was adopted. CINAHL, PubMed, SCOPUS, PsycINFO, Embase, ProQuest Dissertation & Theses and Google Scholar were searched. Studies published in English after 1/1/2000 were considered eligible for inclusion. Results A total of 3158 titles and abstracts were screened, 137 full‐text articles were reviewed, and 25 papers met the inclusion criteria. Descriptive themes focused on inequities, needs and experiences of families', poor GP training, and limitations of existing evidence. Conclusion Describing trends in healthcare utilisation by this population is valuable for monitoring quality of healthcare, however, addressing observed inequities will require approaches that recognise specific issues within the health system that result in inequities.
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Affiliation(s)
- Emma Nicholson
- Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), UCD School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland.,School of Psychology, Faculty of Science and Health, Dublin City University, Dublin, Ireland
| | - Ciara Conlon
- Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), UCD School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Laurel Mimmo
- School of Public Health & Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Edel Doherty
- J.E. Cairnes School of Business & Economics, National University of Ireland Galway, Galway, Ireland
| | - Suzanne Guerin
- UCD Centre for Disability Studies, UCD School of Psychology, University College Dublin, Dublin, Ireland
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13
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Bogetz JF, Trowbridge A, Lewis H, Jonas D, Hauer J, Rosenberg AR. Forming Clinician-Parent Therapeutic Alliance for Children With Severe Neurologic Impairment. Hosp Pediatr 2022; 12:282-292. [PMID: 35141756 DOI: 10.1542/hpeds.2021-006316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Care for children with severe neurologic impairment (SNI) often involves complex medical decision-making where therapeutic alliance between clinicians and families is essential. Yet, existing data suggest that communication and alliance are often lacking. This study aimed to examine aspects important to developing therapeutic alliance between clinicians and parents of children with SNI. METHODS A purposive sample of expert clinicians and parents of children with SNI completed brief demographic surveys and 1:1 semistructured interviews between July 2019 and August 2020 at a single tertiary pediatric academic center. Interviews focused on the inpatient experience and transcriptions underwent thematic analysis by a study team of qualitative researchers with expertise in palliative care and communication science. RESULTS Twenty-five parents and 25 clinicians participated (total n = 50). Many parents were mothers (n = 17, 68%) of school-aged children with congenital/chromosomal conditions (n = 15, 65%). Clinicians represented 8 professions and 15 specialties. Responses from participants suggested 3 major themes that build and sustain therapeutic alliance including: (1) foundational factors that must exist to establish rapport; (2) structural factors that provide awareness of the parent/child experience; and (3) weathering factors that comprise the protection, security, and additional support during hard or uncertain times. Participants also shared concrete actions that promote these factors in clinical practice. CONCLUSION Therapeutic alliance between clinicians and parents of children with SNI consists of at least 3 factors that support communication and medical decision-making. These factors are facilitated by concrete actions and practices, which enhance communication about the care for children with SNI.
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Affiliation(s)
- Jori F Bogetz
- Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
- Treuman Katz Center for Bioethics, Center for Clinical and Translational Research
- Palliative Care Resilience Research Laboratory, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington
| | - Amy Trowbridge
- Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
- Treuman Katz Center for Bioethics, Center for Clinical and Translational Research
- Palliative Care Resilience Research Laboratory, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington
| | - Hannah Lewis
- Treuman Katz Center for Bioethics, Center for Clinical and Translational Research
| | - Danielle Jonas
- Silver School of Social Work, New York University, New York, New York
| | - Julie Hauer
- Seven Hills Pediatric Center, Groton, Massachusetts
| | - Abby R Rosenberg
- Palliative Care Resilience Research Laboratory, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington
- Division of Hematology Oncology, Department of Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
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14
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Mimmo L, Harrison R, Travaglia J, Hu N, Woolfenden S. Inequities in quality and safety outcomes for hospitalized children with intellectual disability. Dev Med Child Neurol 2022; 64:314-322. [PMID: 34562021 PMCID: PMC9293445 DOI: 10.1111/dmcn.15066] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 07/26/2021] [Accepted: 09/01/2021] [Indexed: 01/06/2023]
Abstract
AIM To investigate if there are inequities in quality and safety outcomes for children with intellectual disability admitted to two tertiary paediatric hospitals. METHOD A cross-sectional study of 1367 admissions for 1018 randomly selected patients admitted for more than 23 hours to one of two tertiary children's hospitals in Sydney, Australia (1st January-31st December 2017). Electronic medical records were manually interrogated to identify children with intellectual disability (including developmental delay). Data extracted included patient demographics, length of stay, number of admissions, and reported clinical incidents. RESULTS In total, 12.3% (n=125) of children admitted during the study period had intellectual disability, which represented 13.9% (n=190) of admissions. Sex and age at admission in children with and without intellectual disability were similar: 83 (43.7%) vs 507 (43.1%) females and 107 (56.3%) vs 670 (56.9%) males, p=0.875; median age 3 years (0-18y) vs 4 years (0-18y), p=0.122. Children with intellectual disability had significantly greater median length of stay (100.5h vs 79h, p<0.001) and cost of admission (A$11 596.38 vs A$8497.96) than their peers (p=0.001). Children with intellectual disability had more admissions with at least one incident compared to children without intellectual disability (14.7% vs 9.7%); this was not statistically significant (p=0.06). INTERPRETATION Children with intellectual disability experience inequitable quality and safety outcomes in hospital. Engaging children and families in clinical incident reporting may enhance understanding of safety risks for children with intellectual disability in hospital.
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Affiliation(s)
- Laurel Mimmo
- School of Population HealthFaculty of MedicineUniversity of New South WalesSydneyNew South WalesAustralia,Clinical Governance UnitThe Sydney Children’s Hospitals NetworkSydneyNew South WalesAustralia
| | - Reema Harrison
- Health Management ProgramsFaculty of MedicineSchool of Population HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Joanne Travaglia
- Faculty of HealthCentre for Health Services ManagementUniversity of Technology SydneySydneyNew South WalesAustralia
| | - Nan Hu
- Faculty of MedicineSchool of Women’s and Children’s HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Susan Woolfenden
- Faculty of MedicineSchool of Women’s and Children’s HealthUniversity of New South WalesSydneyNew South WalesAustralia,Community Child HealthSydney Children’s Hospital, RandwickSydneyNew South WalesAustralia
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15
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Ong N, Long JC, Weise J, Walton M. Responding to safe care: Healthcare staff experiences caring for a child with intellectual disability in hospital. Implications for practice and training. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2022; 35:675-690. [DOI: 10.1111/jar.12978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 11/07/2021] [Accepted: 01/09/2022] [Indexed: 12/27/2022]
Affiliation(s)
- Natalie Ong
- Child Development Unit, Children's Hospital Westmead Clinical School University of Sydney Sydney New South Wales Australia
| | - Janet C. Long
- Australian Institute of Health Innovation Macquarie University Sydney New South Wales Australia
| | - Janelle Weise
- Department of Developmental Disability Neuropsychiatry University of New South Wales Sydney New South Wales Australia
| | - Merrilyn Walton
- Department of Public Health, Faculty of Medicine and Health University of Sydney Sydney New South Wales Australia
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16
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Ní Shé É, McDonald FEJ, Mimmo L, Ross XS, Newman B, Patterson P, Harrison R. What Are the Psycho-Social and Information Needs of Adolescents and Young Adults Cancer Care Consumers with Intellectual Disability? A Systematic Review of Evidence with Recommendations for Future Research and Practice. CHILDREN (BASEL, SWITZERLAND) 2021; 8:1118. [PMID: 34943314 PMCID: PMC8699987 DOI: 10.3390/children8121118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/17/2021] [Accepted: 11/26/2021] [Indexed: 11/17/2022]
Abstract
People with intellectual disability have unmet health needs and experience health inequalities. There is limited literature regarding cancer care for children, adolescents, and young adults (AYA) with intellectual disability despite rising cancer incidence rates in this population. This systematic review aimed to identify the psycho-social and information support needs of AYA cancer care consumers with intellectual disability to generate recommendations for future research and cancer care service delivery enhancement. We searched eight databases yielding 798 articles. Following abstract and full-text review, we identified 12 articles meeting our inclusion criteria. Our three themes related to communication and accessible information; supports and system navigation, cancer service provider training, and reasonable adjustments. There was a lack of user-friendly, accessible information about cancer and screening programs available. Both paid and family carers are critical in accessing cancer supports, services, and screening programs for AYA with intellectual disability. Ongoing training should be provided to healthcare professionals regarding the importance of care screening for AYAs with intellectual disability. This review recommends that AYA with intellectual disability and their family carers be involved in developing tailored cancer services. This should focus on enabling inclusive screening programs, accessible consent, and challenging the enduring paternalism of support services via training and appropriate communication tools.
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Affiliation(s)
- Éidín Ní Shé
- School of Population Health, University of New South Wales, Sydney, NSW 2052, Australia
- Centre for Health Systems and Safety, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW 2190, Australia; (B.N.); (R.H.)
| | - Fiona E. J. McDonald
- Canteen Australia, Sydney, NSW 2042, Australia; (F.E.J.M.); (X.S.R.); (P.P.)
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2052, Australia
| | - Laurel Mimmo
- School of Women’s and Children’s Health, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia;
- Clinical Governance Unit, The Sydney Children’s Hospitals Network, Westmead, NSW 2145, Australia
| | | | - Bronwyn Newman
- Centre for Health Systems and Safety, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW 2190, Australia; (B.N.); (R.H.)
| | - Pandora Patterson
- Canteen Australia, Sydney, NSW 2042, Australia; (F.E.J.M.); (X.S.R.); (P.P.)
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2052, Australia
| | - Reema Harrison
- Centre for Health Systems and Safety, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW 2190, Australia; (B.N.); (R.H.)
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17
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Bogetz JF, Revette A, DeCourcey DD. Clinical Care Strategies That Support Parents of Children With Complex Chronic Conditions. Pediatr Crit Care Med 2021; 22:595-602. [PMID: 33813549 DOI: 10.1097/pcc.0000000000002726] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Children with complex chronic conditions often receive inpatient and end-of-life care in the ICU, yet little is known about the clinical care strategies that best support this unique group of parents. This study aimed to elucidate supportive clinical care strategies identified by bereaved parents of children with complex chronic conditions. DESIGN Qualitative analysis of 21 open-response items from the cross-sectional "Survey of Caring for Children with Complex Chronic Conditions" querying communication, decision-making, and end-of-life experiences. SETTING Large tertiary care children's hospital. PATIENTS Parents of children with complex chronic conditions who received care at a large academic institution and died between 2006 and 2015. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS An iterative multistage thematic analysis of responses was used to identify key themes pertaining to clinical care strategies that support parents of children with complex chronic conditions. Open-ended responses were analyzed from 110 of 114 (96%) of survey respondents. The majority of parents had children with congenital/chromosomal complex chronic conditions who died 3.9 years (interquartile range, 2.2-6.7 yr) prior to their parents' study participation. Although informational themes related to clear honest communication, consistent messaging, and enhanced care coordination were identified, parents emphasized the relational aspects of clinical care including inclusivity of their expertise about their child's needs, recognition of their unique experience as parents, and maintenance of connection with clinicians through bereavement. CONCLUSIONS Clinical care strategies that support parents of children with complex chronic conditions reflect the unique needs of this group of children. Relational strategies such as including parents as experts in their child's care were paramount to parents of children with complex chronic conditions throughout their child's medical journey and at end of life.
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Affiliation(s)
- Jori F Bogetz
- Division of Bioethics and Palliative Care, Department of Pediatric, University of Washington, Seattle, WA
- Treuman Katz Center for Bioethics, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA
- Palliative Care Resilience Research Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA
- Survey and Data Management Core, Dana-Farber Cancer Institute, Boston, MA
- Division of Medical Critical Care, Department of Pediatrics, Boston Children's Hospital, Boston, MA
| | - Anna Revette
- Survey and Data Management Core, Dana-Farber Cancer Institute, Boston, MA
| | - Danielle D DeCourcey
- Division of Medical Critical Care, Department of Pediatrics, Boston Children's Hospital, Boston, MA
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18
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Louch G, Albutt A, Harlow-Trigg J, Moore S, Smyth K, Ramsey L, O'Hara JK. Exploring patient safety outcomes for people with learning disabilities in acute hospital settings: a scoping review. BMJ Open 2021; 11:e047102. [PMID: 34011599 PMCID: PMC8137174 DOI: 10.1136/bmjopen-2020-047102] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To produce a narrative synthesis of published academic and grey literature focusing on patient safety outcomes for people with learning disabilities in an acute hospital setting. DESIGN Scoping review with narrative synthesis. METHODS The review followed the six stages of the Arksey and O'Malley framework. We searched four research databases from January 2000 to March 2021, in addition to handsearching and backwards searching using terms relating to our eligibility criteria-patient safety and adverse events, learning disability and hospital setting. Following stakeholder input, we searched grey literature databases and specific websites of known organisations until March 2020. Potentially relevant articles and grey literature materials were screened against the eligibility criteria. Findings were extracted and collated in data charting forms. RESULTS 45 academic articles and 33 grey literature materials were included, and we organised the findings around six concepts: (1) adverse events, patient safety and quality of care; (2) maternal and infant outcomes; (3) postoperative outcomes; (4) role of family and carers; (5) understanding needs in hospital and (6) supporting initiatives, recommendations and good practice examples. The findings suggest inequalities and inequities for a range of specific patient safety outcomes including adverse events, quality of care, maternal and infant outcomes and postoperative outcomes, in addition to potential protective factors, such as the roles of family and carers and the extent to which health professionals are able to understand the needs of people with learning disabilities. CONCLUSION People with learning disabilities appear to experience poorer patient safety outcomes in hospital. The involvement of family and carers, and understanding and effectively meeting the needs of people with learning disabilities may play a protective role. Promising interventions and examples of good practice exist, however many of these have not been implemented consistently and warrant further robust evaluation.
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Affiliation(s)
- Gemma Louch
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
- NIHR Yorkshire and Humber Patient Safety Translational Research Centre, Bradford, UK
| | - Abigail Albutt
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
- NIHR Yorkshire and Humber Patient Safety Translational Research Centre, Bradford, UK
| | | | - Sally Moore
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Kate Smyth
- NIHR Yorkshire and Humber Patient Safety Translational Research Centre, Bradford, UK
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Lauren Ramsey
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
- NIHR Yorkshire and Humber Patient Safety Translational Research Centre, Bradford, UK
| | - Jane K O'Hara
- NIHR Yorkshire and Humber Patient Safety Translational Research Centre, Bradford, UK
- School of Healthcare, University of Leeds, Leeds, UK
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Mimmo L, Woolfenden S, Travaglia J, Harrison R. Creating equitable healthcare quality and safety for children with intellectual disability in hospital. Child Care Health Dev 2020; 46:644-649. [PMID: 32468634 PMCID: PMC7496444 DOI: 10.1111/cch.12787] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/25/2020] [Accepted: 04/02/2020] [Indexed: 11/26/2022]
Abstract
Children with intellectual disability are susceptible to poor experiences of care and treatment outcomes, and this may compound existing health inequities. Evidence to date indicates three priority areas that must be addressed in order to reduce these inequities in the safety and quality of care for children with intellectual disability. Firstly, we need reliable methods to identify children with intellectual disability so that healthcare organizations understand their needs. Secondly, we need to develop quality metrics that can assess care quality and unwarranted care variation for children with intellectual disability in hospital. Finally, for a comprehensive understanding of the safety and quality of care for these children, and how to improve, it is critical that healthcare organizations partner with parents/carers and enable children with intellectual disability to voice their experiences of care. Children with intellectual disability have higher healthcare utilization than their peers; yet, their voice is rarely sought to optimize the safety and quality of their healthcare experience. Patient experience narratives enhance our understanding of the genesis of adverse events. By addressing these priorities, children with intellectual disability will be identified, and health services will measure and understand the problematic and beneficial variations in care delivery and can then effectively partner with children and their parents/carers to address the inequities in care quality and create safer healthcare.
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Affiliation(s)
- Laurel Mimmo
- Health Management, School of Public Health and Community Medicine, Faculty of MedicineUniversity of New South WalesSydneyNew South WalesAustralia,Clinical Governance UnitSydney Children's Hospitals NetworkSydneyNew South WalesAustralia
| | - Susan Woolfenden
- School of Women’s and Children’s Health, Faculty of MedicineUniversity of New South WalesSydneyNew South WalesAustralia,Community Child HealthSydney Children's HospitalRandwickNew South WalesAustralia
| | - Joanne Travaglia
- Health Services Management, Centre for Health Services Management, Faculty of HealthUniversity of Technology SydneySydneyNew South WalesAustralia
| | - Reema Harrison
- Health Management, School of Public Health and Community Medicine, Faculty of MedicineUniversity of New South WalesSydneyNew South WalesAustralia
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20
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Providing Quality Care to the Intellectually Disadvantaged Patient Population During the COVID-19 Pandemic. Crit Care Nurs Q 2020; 43:480-483. [PMID: 32833782 DOI: 10.1097/cnq.0000000000000331] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The coronavirus pandemic has impacted global health care delivery within a short period of time and has spotlighted the needs of vulnerable patient populations. The recommended initiatives to prevent the viral spread have included strategies such as social distancing, hand hygiene, and wearing protective personal equipment. These activities are community-wide focused, however, may be difficult to achieve for those individuals with intellectual disabilities, thus making this population susceptible to viral spread of infection. This article discusses the experience at a large urban teaching hospital in regard to the care of intellectually disadvantaged patients with COVID-19 infection.
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21
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Mimmo L, Woolfenden S, Travaglia J, Harrison R. Partnerships for safe care: A meta-narrative of the experience for the parent of a child with Intellectual Disability in hospital. Health Expect 2019; 22:1199-1212. [PMID: 31560839 PMCID: PMC6882263 DOI: 10.1111/hex.12968] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/18/2019] [Accepted: 08/30/2019] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To systematically identify and synthesize peer-reviewed qualitative evidence of the parental experience of hospitalization with a child with Intellectual Disability. SEARCH STRATEGY Key words, synonyms and MeSH subject headings that related to the three key concepts of parental experience, children with Intellectual Disability and hospital settings were applied to six electronic databases: Medline, CINAHL, Embase, PsycINFO, Scopus and Web of Science. Titles and abstracts of publications between January 2000 and February 2019 were screened for relevance. INCLUSION CRITERIA Empirical qualitative research involved participants aged 0-18 years, involved children with Intellectual Disability, involved participants hospitalized as an in-patient and involved participants focused on parent perspective. DATA EXTRACTION AND SYNTHESIS Data were extracted and synthesized using a meta-narrative approach. RESULTS Eleven publications met the inclusion criteria. Data synthesis revealed three research traditions contributing to this meta-narrative: Paediatric Nursing Practice, Intellectual Disability Healthcare and Patient Experience. A total of five themes were identified: (a) being more than a parent, (b) importance of role negotiation, (c) building trust and relationships, (d) the cumulative effect of previous experiences of hospitalization and (e) knowing the child as an individual. DISCUSSION AND CONCLUSION This review presents a working model for professional-parent partnership for the safe care of children with Intellectual Disability in hospital. Shifting paediatric healthcare to whole of hospital/multidisciplinary models of care that centre on the child will necessitate partnerships with the parent to identify and manage the needs of the child with Intellectual Disability, in order to achieve safe and equitable care for these children.
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Affiliation(s)
- Laurel Mimmo
- Faculty of MedicineSchool of Public Health and Community MedicineUniversity of New South WalesSydneyNew South WalesAustralia
- Clinical Governance UnitSydney Children's Hospitals NetworkSydneyNew South WalesAustralia
| | - Susan Woolfenden
- Community Child HealthSydney Children's HospitalSydneyNew South WalesAustralia
- Faculty of MedicineSchool of Women's and Children's HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Joanne Travaglia
- Faculty of HealthCentre for Health Services ManagementUniversity of Technology SydneySydneyNew South WalesAustralia
| | - Reema Harrison
- Faculty of MedicineSchool of Public Health and Community MedicineUniversity of New South WalesSydneyNew South WalesAustralia
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