1
|
Bayav S, Çobanoğlu N. Indications and practice of home invasive mechanical ventilation in children. Pediatr Pulmonol 2024. [PMID: 38251866 DOI: 10.1002/ppul.26873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 12/26/2023] [Accepted: 01/11/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND Developments and technological advances in neonatal and pediatric intensive care units have led to a prolonged life expectancy of pediatric patients with chronic respiratory failure. Therefore, the number of hemodynamically stable pediatric patients with chronic respiratory failure who need mechanical ventilator assistance throughout the day has significantly increased. AIMS Numerous conditions, including parenchymal lung diseases, airway disorders, neuromotor disorders, or respiratory defects, can lead to chronic respiratory failure. For individuals who cannot tolerate non-invasive mechanical ventilation (NIMV), invasive mechanical ventilation (IMV) is the only suitable choice. Due to increasing need, mechanical ventilator technology is continuously evolving. RESULTS As a result of this process, home-type mechanical ventilators have been produced for patients requiring long-term IMV. Patients with chronic respiratory failure can be safely monitored at home with these ventilators. DISCUSSION Home follow-up of these patients has many benefits such as an increase in general quality of life and a positive contribution to their emotional and cognitive development. CONCLUSION In this compilation, indications for home-based IMV, features of home invasive mechanical ventilators (HMVs), patient monitoring, and the detailed advantages of using IMV at home will be elucidated.
Collapse
Affiliation(s)
- Secahattin Bayav
- Department of Pediatrics, Division of Pediatric Pulmonology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Nazan Çobanoğlu
- Department of Pediatrics, Division of Pediatric Pulmonology, Faculty of Medicine, Ankara University, Ankara, Turkey
| |
Collapse
|
2
|
Straus EJ, Brown H, Howard AF, Teachman G. Composing adult lives with a ventilator at the intersection of developmental and neoliberal discourses of time. Health (London) 2024:13634593241226646. [PMID: 38234164 DOI: 10.1177/13634593241226646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
This paper explores temporalities and experiences of time drawn from an analysis of interview data from a critical narrative inquiry of the experiences of young adults living with home mechanical ventilation (HMV). The analysis centers the ideological effects of dominant discourses that shape understandings of time in the Euro-Western world and the ways in which young adults' stories prompt a rethinking of time in health research and praxis. Data generation involved interviews and photo-elicitation with five young adults (ages 18-40). A critical narrative analysis of participants' stories surfaced the influence of ableist, developmentalist, and neoliberal discourses of time and the creative resistance that points to the potential of crip orientations to time in opening up possibilities for living. Implications for practice and research are offered.
Collapse
|
3
|
Vo HH, Mercer AH, Jabre NA, Henderson CM, Boss RD, Wilfond BS. Parent Perspectives on the Child Experience of Pediatric Home Ventilation via Tracheostomy. Hosp Pediatr 2023; 13:1124-1133. [PMID: 37964652 DOI: 10.1542/hpeds.2023-007217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
BACKGROUND AND OBJECTIVE Parents facing the decision of whether to initiate pediatric mechanical ventilation via tracheostomy ("home ventilation") report wanting information about what to expect for life at home for their child. The study objective is to explore parent descriptions of the child experience of home ventilation to increase awareness for clinicians in the inpatient setting caring for these children. METHODS Semistructured interviews were conducted using purposive sampling of parents with children who initiated home ventilation within the previous 5 years from 3 geographically diverse academic medical centers. RESULTS We interviewed 21 families from 3 geographic regions in the United States. About 75% of children had respiratory failure in the first year of life, 80% had medical complexity, and half had severe neurologic impairment. Five domains emerged regarding parent perceptions of their child's experience of home ventilation: (1) health and well-being; (2) development; (3) adaptation; (4) mobility and travel; and (5) relationships. Within each domain, several themes were identified. For each theme, there was a positive and negative subtheme to illustrate how the child's experience was modified by home ventilation. Parent descriptions were generally positive, however, in all domains and to varying degrees, parents expressed negative aspects of home ventilation. CONCLUSIONS By providing information about the realistic experiences of children using home ventilation, clinicians can support families in the inpatient setting as they face this complex decision. Balanced information about home ventilation is critical to enhancing clinician counseling so that families may benefit from the perspectives of experienced parents.
Collapse
Affiliation(s)
- Holly Hoa Vo
- University of Washington School of Medicine, Seattle, Washington
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington
| | - Amanda H Mercer
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington
| | | | - Carrie M Henderson
- University of Mississippi Medical Center, Jackson, Mississippi
- Center for Bioethics and Medical Humanities, Jackson, Mississippi
| | - Renee D Boss
- Johns Hopkins School of Medicine, Baltimore, Maryland
- Johns Hopkins Berman Institute of Bioethics, Baltimore, Maryland
| | - Benjamin S Wilfond
- University of Washington School of Medicine, Seattle, Washington
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington
| |
Collapse
|
4
|
Özcan G, Çobanoğlu N. Identifying and managing psychosocial problems in children on home invasive mechanical ventilation. Pediatr Pulmonol 2023. [PMID: 37988236 DOI: 10.1002/ppul.26763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/09/2023] [Accepted: 11/06/2023] [Indexed: 11/23/2023]
Abstract
Home invasive mechanical ventilation (HIMV) has allowed children with chronic respiratory failure to be discharged from the hospital, giving them a chance to return to their home life which is more natural for children to grow up. Many technological tools necessary for their survival have also caused restrictions in the social lives of these children. Psychosocial problems will be inevitable in this group of patients, who often have to cope with more than one medical problem. Identifying the impact of HIMV on these problems will enable these children to have a better quality of life. While the most objective method used to determine the psychosocial status of these children is quality of life measurement, more studies are needed to determine the ideal questionnaire. This review deals with psychosocial problems on HIMV.
Collapse
Affiliation(s)
- Gizem Özcan
- Division of Pediatric Pulmonology, Department of Pediatrics, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Nazan Çobanoğlu
- Division of Pediatric Pulmonology, Department of Pediatrics, Faculty of Medicine, Ankara University, Ankara, Turkey
| |
Collapse
|
5
|
Impact of respite care on health-related quality of life in children with medical complexity: A parent proxy evaluation. J Pediatr Nurs 2022; 67:e215-e223. [PMID: 35902354 DOI: 10.1016/j.pedn.2022.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 05/16/2022] [Accepted: 07/08/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE This study examined the impact of respite care received by children with medical complexity (CMC) on their health-related quality of life (HRQOL). We hypothesized that out-of-home respite care would increase both opportunities to engage in activities and participation with non-family members and help with acquiring autonomy and social skills. DESIGN AND METHODS This cross-sectional study of CMC aged between 8 and 18 years living at home used a web-based questionnaire survey that parents living with the target CMC answered for proxy evaluation of CMC's HRQOL (KIDSCREEN-27). We asked 3142 parents to participate in the study through 237 special-needs schools throughout Japan. Path analysis was used to estimate the variation in each aspect of HRQOL with respite care time of in-home care services, day care services, short-stay services, and school time. RESULTS We analyzed the responses from 618 parents of CMC. The results showed that respite care by day care services and special-needs schools increased "physical well-being," "psychological well-being," and "peers and social support," which are components of the HRQOL. Furthermore, respite care at schools had an impact on "school environment." CONCLUSIONS Respite care provided by special-needs schools and day care services has implications not only in terms of relief for caregivers but also in improving the HRQOL of CMC. PRACTICE IMPLICATIONS Nurses can provide respite care that does not require parental accompaniment at school or day care facilities, which can lead to CMC's involvement in fostering autonomy and social skills. (249/250 words).
Collapse
|
6
|
Wiegand-Grefe S, Liedtke A, Morgenstern L, Hoff A, Csengoe-Norris A, Johannsen J, Denecke J, Barkmann C, Grolle B, Daubmann A, Wegscheider K, Boettcher J. Health-Related Quality of Life and mental health of families with children and adolescents affected by rare diseases and high disease burden: the perspective of affected children and their siblings. BMC Pediatr 2022; 22:596. [PMID: 36229869 PMCID: PMC9563162 DOI: 10.1186/s12887-022-03663-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 10/10/2022] [Indexed: 11/16/2022] Open
Abstract
Background Advances in genetic and pharmaceutical technology and pediatric care have enabled treatment options for an increasing number of rare diseases in affected children. However, as current treatment options are primarily of palliative nature, the Health-Related Quality of Life (HRQoL) and mental health of this impaired population and their siblings are of increasing importance. Among children and adolescents with rare diseases, those who are technology-dependent carry a high disease burden and are selected as the target population in our study. In a cross-sectional observational design, the children’s HRQoL was assessed with the DISABKIDS (DCGM-37) as well as KIDSCREEN-27, while mental health was assessed with the Strengths and Difficulties Questionnaire (SDQ) by both the affected children, their parents, and siblings. Results Results of the study sample were compared to normative data. Affected children scored significantly lower than the norm on almost all HRQoL subscales as reported by parent and child. From the parental perspective, more mental health subscales were significantly impaired compared to the child’s perspective. Siblings showed no impairment in HRQoL as well as significantly fewer behavioral problems and higher prosocial behavior regarding their mental health compared to the norm. Conclusion Children and adolescents with rare diseases seem particularly impaired in social and emotional aspects of HRQoL and mental health. Interventions may focus primarily on promoting social skills, fostering prosocial behavior and peer relationships.
Collapse
Affiliation(s)
- Silke Wiegand-Grefe
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany.
| | - Anna Liedtke
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany
| | - Lydia Morgenstern
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany
| | - Antonia Hoff
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany
| | - Anikó Csengoe-Norris
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany
| | - Jessika Johannsen
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jonas Denecke
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Claus Barkmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany
| | - Benjamin Grolle
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Daubmann
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karl Wegscheider
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes Boettcher
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany.
| |
Collapse
|
7
|
Ruta F, Bassola B, Lusignani M. The characteristics of self-care in children with spinal muscular atrophy: an integrative review. Minerva Pediatr (Torino) 2022; 74:349-357. [DOI: 10.23736/s2724-5276.20.05844-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
8
|
Mattson J, Lunnelie J, Löfholm T, Andersson ES, Aune RE, Björling G. Quality Of Life in Children With Home Mechanical Ventilation – A Scoping Review. SAGE Open Nurs 2022; 8:23779608221094522. [PMID: 35493542 PMCID: PMC9047042 DOI: 10.1177/23779608221094522] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 02/20/2022] [Accepted: 03/29/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Home mechanical ventilation is an established method to support children suffering from chronic respiratory insufficiency, still more research is needed regarding mechanically ventilated children's and adolescents’ quality of life (QoL). Therefore, the aim of this scoping review was to explore research regarding QoL and lived experience of children and adolescents with home mechanical ventilation. Methods A scoping review with systematic searches for research studies published between year 2000–2020 was performed in Cinahl, Medline, and PubMed. Studies that met the inclusion criteria were quality assessed and a thematic analysis was performed. Results In total, ten articles were quality assessed and included in the results. Four themes emerged: Children's self-reported QoL, Parents’ perception and parent-proxy report, Differences between the child's and parent's perception, and challenges in daily life. Children with home mechanical ventilation reported a lower QoL than healthy children and children with other chronic diseases. Generally, parents rate their child's QoL lower than the children themselves. Conclusion This is the first literature review focusing on HMV in the paediatric population. It is clear that HMV does not only affect the treated child or adolescent but also the whole family. It is important to regularly measure and evaluate QoL in children and adolescents with HMV to provide person-centered care. More research is needed to improve these children's and adolescents’ QoL.
Collapse
Affiliation(s)
- Janet Mattson
- Department of Health Sciences, Swedish Red Cross University, Sweden
- Department of Learning, Informatics, and Medical Education, Karolinska Institutet, Sweden
| | - Johan Lunnelie
- Department of Health Sciences, Swedish Red Cross University, Sweden
| | - Tim Löfholm
- Department of Health Sciences, Swedish Red Cross University, Sweden
| | | | - Ragnhild E. Aune
- Department of Material Science, Norwegian University of Science and Technology, Norway
| | - Gunilla Björling
- Department of Health Sciences, Swedish Red Cross University, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Sweden
- Kilimanjaro Christian Medical University College, Faculty of Nursing, Tanzania
| |
Collapse
|
9
|
Rahman M, Jeffreys J, Massie J. A narrative review of the experience and decision-making for children on home mechanical ventilation. J Paediatr Child Health 2021; 57:791-796. [PMID: 33881192 DOI: 10.1111/jpc.15506] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 11/30/2022]
Abstract
Technological advances in mechanical ventilation have made home care possible for children requiring long-term ventilation. However, there are ethical and logistical challenges to transitioning home. The aim of this narrative review is to identify the experiences of the children and their families and the decision-making process to embark on home mechanical ventilation. A systematic review of the literature using Medline and OVID databases was conducted. Children <18 years requiring non-invasive ventilation or tracheostomy with ventilation or continuous positive pressure ventilation were included. The initial search yielded 1351 results, 1017 after duplications were removed and 111 after abstracts were reviewed. After applying inclusion and exclusion criteria to full text analysis, 48 references were analysed. The children and families described home ventilation as facilitating better health and functional status. However, they concurrently described social isolation, stigma, financial stress and loss of independence. The decision-making process to embark on home ventilation needs more research.
Collapse
Affiliation(s)
- Mayukh Rahman
- Faculty of Medicine, Dentistry and Health Sciences - University of Melbourne, Melbourne, Victoria, Australia
| | - Juliette Jeffreys
- Faculty of Medicine, Dentistry and Health Sciences - University of Melbourne, Melbourne, Victoria, Australia
| | - John Massie
- Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Children's Bioethics Centre, Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| |
Collapse
|
10
|
Crumpton J, Wray J. Children's and adolescents' experiences of living with respiratory assistance: A systematic review of qualitative studies. Int J Pediatr Otorhinolaryngol 2019; 127:109658. [PMID: 31499262 DOI: 10.1016/j.ijporl.2019.109658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/21/2019] [Accepted: 08/21/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To date, no review has focused exclusively on the child's reported experience of living with respiratory assistance. The objective of this study was to review empirical studies exploring children's experiences and perceptions of living with respiratory assistance. METHODS Literature searches (1980-2017) of databases (PubMed, Web of Science, PsycINFO and CINAHL) resulted in 1,750 references. Studies were included if they used qualitative methods to explore children's (under 18 years) experiences of living with respiratory assistance, such as tracheostomies and/or those who were ventilator dependent. Studies that focused only on parents, carers or other family member's perspectives, included only adults, used only quantitative methods or were not published in the English language were excluded. Reference lists of relevant studies were reviewed. Each study meeting criteria was reviewed and assessed and key themes were extracted and grouped. RESULTS Seven studies were included in this review. Synthesis of the data identified four main themes: children's understanding of respiratory assistance, identity, social experiences and service delivery. Most children recognised the important function of respiratory assistance on their physical health. They spoke of positive social experiences and some of the challenges they had experienced. Children discussed their experiences of healthcare providers in terms of what was helpful to them and provided suggestions, based on their experience, for future service provision. CONCLUSION This review identified the valuable contribution children's perspectives make to the growing evidence-base in this area. Further in-depth explorations are needed to provide greater understanding about children's experiences of living with respiratory assistance. Research exploring the journey of a young person with respiratory assistance is important in developing knowledge and service provision in this field.
Collapse
Affiliation(s)
- Jessica Crumpton
- North Wales Clinical Psychology Programme, Bangor University, 43 College Road, Bangor, Gwynedd, LL57 2DG, Wales, UK.
| | - Jo Wray
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| |
Collapse
|
11
|
Nijhof SL, Vinkers CH, van Geelen SM, Duijff SN, Achterberg EM, van der Net J, Veltkamp RC, Grootenhuis MA, van de Putte EM, Hillegers MH, van der Brug AW, Wierenga CJ, Benders MJ, Engels RC, van der Ent CK, Vanderschuren LJ, Lesscher HM. Healthy play, better coping: The importance of play for the development of children in health and disease. Neurosci Biobehav Rev 2018; 95:421-429. [DOI: 10.1016/j.neubiorev.2018.09.024] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/27/2018] [Accepted: 09/26/2018] [Indexed: 12/20/2022]
|
12
|
Dickson A, Karatzias T, Gullone A, Grandison G, Allan D, Park J, Flowers P. Negotiating boundaries of care: an interpretative phenomenological analysis of the relational conflicts surrounding home mechanical ventilation following traumatic spinal cord injury. Health Psychol Behav Med 2018; 6:120-135. [PMID: 34040825 PMCID: PMC8114355 DOI: 10.1080/21642850.2018.1462708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objectives: The aim of this study is to explore the phenomena of mechanical ventilation following traumatic spinal cord injury from three simultaneous perspectives; patients who require full-time mechanical ventilation (n = 8), their informal family carers (n = 8) and their formal carers (n = 11). We focus upon the intra and inter- personal challenges of establishing boundaries within the triad. Design: Qualitative study. Methods: Semi-structured interviews were transcribed verbatim and analysed using interpretative phenomenological analysis (IPA). In order to encapsulate the inter-subjective, multi-dimensional and relational aspects of the experience, we focussed on recurrent themes which were independently reported across all three participant groups. Results: One major inter-connected recurrent theme was identified: 1) 'Negotiating boundaries of care and finding a "fit"'. It centres around establishing a 'line', or a boundary, which was imperative for retaining a sense of independence (for patients), a sense of home and privacy (for informal carers) and difficulties balancing complex care provision with the needs of family members so as not to cross that 'line' (for formal carers). Conclusions: The findings highlight the need for focussing on a 'fit' within the triad, balancing boundaries of care in order to establish a productive, satisfactory psycho-social environment for all three participant groups to live and/or work within. Recommendations for both future care provision and future research are suggested.
Collapse
Affiliation(s)
- A Dickson
- School of Health & Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - T Karatzias
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - A Gullone
- School of Health and Social Sciences, University of Edinburgh, Edinburgh, UK
| | - G Grandison
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - D Allan
- Queen Elizabeth National Spinal Injuries for Scotland, Southern General Hospital, Glasgow, UK
| | - J Park
- School of Health & Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - P Flowers
- School of Health & Life Sciences, Glasgow Caledonian University, Glasgow, UK
| |
Collapse
|
13
|
Israelsson-Skogsberg Å, Hedén L, Lindahl B, Laakso K. 'I'm almost never sick': Everyday life experiences of children and young people with home mechanical ventilation. J Child Health Care 2018; 22:6-18. [PMID: 29298495 DOI: 10.1177/1367493517749328] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Developments in medical technology and treatment have increased the survival rates of children with serious illnesses or injuries, including those receiving home mechanical ventilation, which is a small but growing group. The aim of this study was to explore everyday life experiences of children and young people living with home mechanical ventilation (HMV). Data were obtained through interviews with nine participants. The interviews were supported by photovoice methodology: photographs taken by the participants before or during the interviews were used to facilitate conversation. Interview data were analyzed using qualitative content analysis. The findings revealed that everyday life on a ventilator can be described as including power but simultaneously as characterized by vulnerability to the outside world, comparable to balancing on a tightrope. Various types of technology, both information and communication technology (ICT) and vital medical technology, enabled the participants to engage with the world around them. This study contributes knowledge about the experiences of children and young people with HMV, who depict their lives as good and valuable. The study also underscores, when designing plans and home support, it is necessary to take a sensible approach to personal experiences of what a good life is and what resources are needed to attain and maintain health.
Collapse
Affiliation(s)
| | - Lena Hedén
- 1 Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Berit Lindahl
- 1 Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Katja Laakso
- 2 Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
14
|
González R, Bustinza A, Fernandez SN, García M, Rodriguez S, García-Teresa MÁ, Gaboli M, García S, Sardón O, García D, Salcedo A, Rodríguez A, Luna MC, Hernández A, González C, Medina A, Pérez E, Callejón A, Toledo JD, Herranz M, López-Herce J. Quality of life in home-ventilated children and their families. Eur J Pediatr 2017; 176:1307-1317. [PMID: 28803432 DOI: 10.1007/s00431-017-2983-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 07/23/2017] [Accepted: 08/03/2017] [Indexed: 11/30/2022]
Abstract
UNLABELLED HMV (home mechanical ventilation) in children has increased over the last years. The aim of the study was to assess perceived quality of life (QOL) of these children and their families as well as the problems they face in their daily life.We performed a multicentric cross-sectional study using a semi-structured interview about the impact of HMV on families and an evaluation questionnaire about perceived QOL by the patient and their families (pediatric quality of life questionnaire (PedsQL4.0)). We studied 41 subjects (mean age 8.2 years). Global scores in PedsQL questionnaire for subjects (median 61.4), and their parents (median 52.2) were below those of healthy children. 24.4% received medical follow-up at home and 71.8% attended school. Mothers were the main caregivers (75.6%), 48.8% of which were fully dedicated to the care of their child. 71.1% consider economic and healthcare resources insufficient. All families were satisfied with the care they provide to their children, even though it was considered emotionally overwhelming (65.9%). Marital conflict and neglect of siblings appeared in 42.1 and 36% of families, respectively. CONCLUSIONS Perceived QOL by children with HMV and their families is lower than that of healthy children. Parents are happy to care for their children at home, even though it negatively affects family life. What is Known: • The use of home mechanical ventilation (HMV) in children has increased over the last years. • Normal family functioning is usually disrupted by HMV. What is New: • The aim of HMV is to provide a lifestyle similar to that of healthy children, but perceived quality of life by these patients and their parents is low. • Most of the families caring for children on HMV agree that support and resources provided by national health institutions is insufficient.
Collapse
Affiliation(s)
- Rafael González
- Pediatric Intensive Care Unit, Hospital General Universitario Gregorio Marañón, Calle Doctor Castelo 47, Madrid, 28009, Spain
- Gregorio Marañón Health Research Institute, Madrid, Spain
- RETICS funded by the PN I+D+I 2013-2016 (Spain), ISCIII- Sub-Directorate General for Research Assessment and Promotion and the European Regional Development Fund (ERDF), ref. RD16/0022, Madrid, Spain
| | - Amaya Bustinza
- Pediatric Intensive Care Unit, Hospital General Universitario Gregorio Marañón, Calle Doctor Castelo 47, Madrid, 28009, Spain
- Gregorio Marañón Health Research Institute, Madrid, Spain
| | - Sarah N Fernandez
- Pediatric Intensive Care Unit, Hospital General Universitario Gregorio Marañón, Calle Doctor Castelo 47, Madrid, 28009, Spain
- Gregorio Marañón Health Research Institute, Madrid, Spain
| | - Miriam García
- Pediatric Intensive Care Unit, Hospital General Universitario Gregorio Marañón, Calle Doctor Castelo 47, Madrid, 28009, Spain
| | - Silvia Rodriguez
- Pediatric Intensive Care Unit, Hospital Sant Joan De Deu, Barcelona, Spain
| | | | - Mirella Gaboli
- Pediatric Intensive Care Unit, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Silvia García
- Pediatric Intensive Care Unit and Home Care Unit, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Olaia Sardón
- Pediatric Pneumology Department, Hospital Universitario Donostia-Osakidetza, San Sebastián, Spain
| | - Diego García
- Pediatric Intensive Care Unit, Hospital de Cruces, Bilbao, Spain
| | - Antonio Salcedo
- Pediatric Pneumology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Antonio Rodríguez
- Pediatric Intensive Care Unit, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Ma Carmen Luna
- Pediatric Pneumology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Arturo Hernández
- Pediatric Intensive Care Unit, Hospital Universitario Puerta del Mar, Cadiz, Spain
| | - Catalina González
- Pediatric Intensive Care Unit, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Alberto Medina
- Pediatric Intensive Care Unit, Hospital Central de Asturias, Oviedo, Spain
| | - Estela Pérez
- Pediatric Pneumology Department, Hospital Materno Infantil Carlos Haya, Malaga, Spain
| | - Alicia Callejón
- Pediatric Pneumology Department, Hospital Universitario Nuestra Señora de la Candelaria, Tenerife, Spain
| | - Juan D Toledo
- Pediatric Department, Hospital General de Castelló, Castellón, Spain
| | - Mercedes Herranz
- Pediatric Pneumology Department, Hospital Virgen del Camino, Pamplona, Spain
| | - Jesús López-Herce
- Pediatric Intensive Care Unit, Hospital General Universitario Gregorio Marañón, Calle Doctor Castelo 47, Madrid, 28009, Spain.
- Gregorio Marañón Health Research Institute, Madrid, Spain.
- RETICS funded by the PN I+D+I 2013-2016 (Spain), ISCIII- Sub-Directorate General for Research Assessment and Promotion and the European Regional Development Fund (ERDF), ref. RD16/0022, Madrid, Spain.
- Pediatrics Department, Complutense University of Madrid, Madrid, Spain.
| |
Collapse
|
15
|
Taylor MJ, Fornusek C, Ruys AJ, Bijak M, Bauman AE. The Vienna FES Interview Protocol - A mixed-methods protocol to elucidate the opinions of various individuals responsible for the provision of FES exercise. Eur J Transl Myol 2017; 27:6604. [PMID: 29118956 PMCID: PMC5656807 DOI: 10.4081/ejtm.2017.6604] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 08/23/2017] [Accepted: 08/25/2017] [Indexed: 02/08/2023] Open
Abstract
Functional Electrical Stimulation (FES) is the production of electrically elicited muscle contractions to perform a function or task. It has been used as a method to regain lost body functions or support weak body functions, and as such, has been clinically available since the early seventies. Some methods are applied routinely while others have not been translated to the bedside, or are still largely restricted to laboratory use. Progress in this field might be achieved by a strong cooperation of patients, clinicians, therapists and engineers. A better insight into multiple perspectives may help in understanding the shortcomings of current FES technology. This will help direct future research efforts into design of systems and potential application in relevant populations. In addition, these findings can assist with the translation of FES technology into a community context. We outline an interview protocol designed for use at the 12th Vienna International Workshop on Functional Electrical Stimulation where the mentioned experts from the field of FES met.
Collapse
Affiliation(s)
| | - Ché Fornusek
- Faculty of Health Sciences, University of Sydney, Lidcombe, Australia
| | - Andrew J Ruys
- Faculty of Engineering and IT, University of Sydney, Camperdown, Australia
| | - Manfred Bijak
- Centre for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | | |
Collapse
|
16
|
Falkson S, Knecht C, Hellmers C, Metzing S. The Perspective of Families With a Ventilator-Dependent Child at Home. A Literature Review. J Pediatr Nurs 2017; 36:213-224. [PMID: 28888506 DOI: 10.1016/j.pedn.2017.06.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 06/30/2017] [Accepted: 06/30/2017] [Indexed: 11/26/2022]
Abstract
This literature review gives an overview about the existing research concerning the experiences of families with a child with ventilation at home. The number of children with home-ventilation is increasing. Children who receive homecare have the possibility of growing up in their familiar environment and participate in social life. In comparison to children living in institutions, children at home show advantages in their physical, psychological, emotional, social and cognitive development. However, homecare of a child with ventilation places high demands on all family members. Parents assume divergent roles and live with losses. Especially mothers feel isolated, partially through self-imposed isolation. While parents are concerned about this dilemma, talk about their anxieties and strive for stability, children focus on other aspects of their life. They see the ventilator as a positive technique that helps them breathe. The children underline the importance of friends and would like to meet them without nurses in attendance. They strive for normalcy and independence like healthy children, asking for acceptance of themselves and their wishes. There are only few studies about the experience of families with a child with ventilator. Most studies are from the mother's perspective. Parents and children ascribe different importance to the ventilation. Further research should usefully explore the experiences of families with children using home-ventilation. The different perspectives of all family members have to be taken into consideration.
Collapse
Affiliation(s)
- Sandra Falkson
- Department of Nursing Science, University of Witten/Herdecke, Witten, Germany; Research group 'FamiLe' - 'Family Health in Life Course'.
| | - Christiane Knecht
- Department of Nursing Science, University of Witten/Herdecke, Witten, Germany; Research group 'FamiLe' - 'Family Health in Life Course'
| | - Claudia Hellmers
- Faculty of Business Management and Social Sciences, University of Applied Sciences Osnabrück, Osnabrück, Germany; Research group 'FamiLe' - 'Family Health in Life Course'
| | - Sabine Metzing
- Department of Nursing Science, University of Witten/Herdecke, Witten, Germany; Research group 'FamiLe' - 'Family Health in Life Course'
| |
Collapse
|
17
|
Manning JC, Hemingway P, Redsell SA. Stories of survival: Children's narratives of psychosocial well-being following paediatric critical illness or injury. J Child Health Care 2017; 21:236-252. [PMID: 29119819 DOI: 10.1177/1367493517717078] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Survival from critical illness can expose children to an array of negative physical and psychological problems. While the perspective of parents and professionals have been well documented, there is limited understanding of how childhood critical care survivors make sense of their experiences in relation to psychosocial well-being. We aimed to explore long-term psychosocial well-being of childhood survivors of critical illness through their stories. A qualitative, exploratory study using serial in-depth interviews was employed. Nine children (aged 6-15 years) were recruited to the study, 6-14 months post-discharge from a paediatric intensive care unit. Qualitative art-based methods were used with a responsive interviewing technique and data were analysed using narrative psychological analysis. Four themes emerged: disrupted lives and stories; survivors revealed uncertainties in their stories as they recalled their critical care event, exposure to death and dying; talking about extreme physical vulnerability provoked anxieties, mediating between different social worlds and identities; revealed the dynamic nature of survival and getting on with life; the prospective outlook survivors had on their existence despite newly manifesting adversities. Childhood survivors' stories identify challenges and adversities that are faced when attempting to readjust to life following critical illness that both enhance and impair psychosocial well-being.
Collapse
Affiliation(s)
- Joseph C Manning
- 1 School of Health Sciences, Faculty of Medicine and Health Sciences, The University of Nottingham, Nottingham, UK.,2 Children's and Families Research, Faculty of Health and Life Sciences, Coventry University, Switzerland, UK.,3 Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Pippa Hemingway
- 1 School of Health Sciences, Faculty of Medicine and Health Sciences, The University of Nottingham, Nottingham, UK
| | - Sarah A Redsell
- 4 Faculty of Health, Social Care and Education, Anglia Ruskin University, Cambridge, UK
| |
Collapse
|
18
|
Akangire G, Manimtim W, Nyp M, Townley N, Dai H, Norberg M, Taylor JB. Factors leading to rehospitalization for tracheostomized and ventilator-dependent infants through 2 years of age. J Perinatol 2017; 37:857-863. [PMID: 28425979 DOI: 10.1038/jp.2017.54] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 03/07/2017] [Accepted: 03/22/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To identify factors leading to readmission for tracheostomized, ventilator-dependent infants <2 years of age. STUDY DESIGN Retrospective cohort study of 117 tracheostomized, ventilator-dependent infants followed through 2 years of age. RESULTS Home ventilator use (at hospital discharge, 6 and 12 months of age), inhaled steroid use (at 12 and 24 months of age), oxygen dependence (at 6 and 12 months of age) and tracheostomy (at discharge, 6 and 12 months of age) were increased risks for rehospitalization. Equipment malfunction throughout the first 2 years also contributed to readmissions. Viral infection, with rhinovirus/enterovirus the most commonly identified pathogen, was the most common etiology for rehospitalization. Diuretic use and initial comorbid diagnoses were not associated with increased risk of rehospitalization. CONCLUSION The risk for rehospitalization for infants requiring tracheostomy and ventilator support was affected by prolonged oxygen use, prolonged ventilator dependence, inhaled steroid use and equipment malfunction, and was equally distributed throughout the first 2 years of life.
Collapse
Affiliation(s)
- G Akangire
- Center for Infant Pulmonary Disorders, Children's Mercy Hospitals and Clinics, Kansas City, MO, USA.,Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - W Manimtim
- Center for Infant Pulmonary Disorders, Children's Mercy Hospitals and Clinics, Kansas City, MO, USA.,Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - M Nyp
- Center for Infant Pulmonary Disorders, Children's Mercy Hospitals and Clinics, Kansas City, MO, USA.,Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - N Townley
- Center for Infant Pulmonary Disorders, Children's Mercy Hospitals and Clinics, Kansas City, MO, USA.,Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - H Dai
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - M Norberg
- Center for Infant Pulmonary Disorders, Children's Mercy Hospitals and Clinics, Kansas City, MO, USA
| | - J B Taylor
- Center for Infant Pulmonary Disorders, Children's Mercy Hospitals and Clinics, Kansas City, MO, USA.,Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| |
Collapse
|
19
|
Seear M, Kapur A, Wensley D, Morrison K, Behroozi A. The quality of life of home-ventilated children and their primary caregivers plus the associated social and economic burdens: a prospective study. Arch Dis Child 2016; 101:620-7. [PMID: 26940814 DOI: 10.1136/archdischild-2015-309796] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 02/14/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND Despite the obvious challenges faced by families caring for children on home ventilation, there is surprisingly little research into the details of their daily lives. In particular, little is known about the quality of life of the child and caregiver plus the associated social and economic burdens of care. METHODS We prospectively studied 90 families enrolled in a paediatric home ventilation service in British Columbia. In the clinic, we recorded demographic information, patient acuity score and quality of life for patient and caregiver using standardised questionnaires. Parents then monitored social and financial costs of care at home over the subsequent 8 weeks. These data were collected by telephone at 1 and 2 months. RESULTS Most children led rich active lives. Camping trips, wheelchair sports and foreign travel were the norm, not the exception. Over 90% assessed the burden of care as mild or moderate. Government support covers medical expenses and home nursing (median 32 h/week, IQR 0-62.5 h). Monthly unreimbursed family expenses were low (median $87.7, IQR $15.3-$472). Despite this, nearly 25% of primary caregivers assessed burden of care as severe and over 50% had chronic illnesses requiring daily medication (principally depression, anxiety and arthritis). Quality of life for children or caregivers did not correlate with income or education. INTERPRETATION Home ventilation of complex children is a successful strategy but it places significant strain on the primary caregiver. Specific attention to the physical and mental health of the caregiver should be an integral part of the management of home-ventilated children. TRIAL REGISTRATION NUMBER NCT01863992.
Collapse
Affiliation(s)
- Michael Seear
- Division of Respiratory Medicine, BC's Children's Hospital, Vancouver, Canada
| | - Akshat Kapur
- Division of Respiratory Medicine, BC's Children's Hospital, Vancouver, Canada
| | - David Wensley
- Division of Respiratory Medicine, BC's Children's Hospital, Vancouver, Canada
| | - Kelly Morrison
- Division of Respiratory Medicine, BC's Children's Hospital, Vancouver, Canada
| | - Ariana Behroozi
- Division of Respiratory Medicine, BC's Children's Hospital, Vancouver, Canada
| |
Collapse
|
20
|
Israelsson-Skogsberg Å, Lindahl B. Personal care assistants' experiences of caring for people on home mechanical ventilation. Scand J Caring Sci 2016; 31:27-36. [PMID: 27126367 DOI: 10.1111/scs.12326] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 12/06/2015] [Indexed: 11/29/2022]
Abstract
AIM The aim of this study was to describe personal care assistants' (PCA) experiences of working with a ventilator-assisted person at home. METHODS Data were collected from fifteen audiotaped semistructured interviews with PCAs supporting a child or adult using home mechanical ventilation (HMV). Thirteen women and two men participated; their working experience with HMV users ranged from one to 17 years (median 6 years). Data were subjected to qualitative content analysis in an inductive and interpretive manner. FINDINGS Five categories emerged from the data: Being part of a complex work situation; Taking on a multidimensional responsibility; Caring carried out in someone's home; Creating boundaries in an environment with indistinct limits; and Being close to another's body and soul. CONCLUSIONS The participants felt very close to the person they worked with, both physically and emotionally. They had a great responsibility and therefore a commensurate need for support, guidance and a well-functioning organisation around the HMV user. There is international consensus that advanced home care will continue to expand and personal care assistance is key in this development. We suggest that one way to move forward for PCAs working with HMV users is to create multiprofessional teams led by a key-person who coordinates the individual needs. More research is needed within this area from a broad perspective including the HMV-assisted persons, relatives, personal care assistants and management organisations.
Collapse
Affiliation(s)
| | - Berit Lindahl
- Borås University College, Faculty of Caring Sciences, Work Life & Social Welfare, Borås, Sweden
| |
Collapse
|
21
|
Soto C, Tarrant C, Dixon-Woods M. What is the right approach to infection prevention and control for children living at home with invasive devices? J Hosp Infect 2016; 93:89-91. [PMID: 26944898 DOI: 10.1016/j.jhin.2015.12.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 12/23/2015] [Indexed: 11/16/2022]
Affiliation(s)
- C Soto
- Social Science Applied to Healthcare Improvement Research (SAPPHIRE) Group, Department of Health Sciences, University of Leicester, Leicester, UK
| | - C Tarrant
- Social Science Applied to Healthcare Improvement Research (SAPPHIRE) Group, Department of Health Sciences, University of Leicester, Leicester, UK.
| | - M Dixon-Woods
- Social Science Applied to Healthcare Improvement Research (SAPPHIRE) Group, Department of Health Sciences, University of Leicester, Leicester, UK
| |
Collapse
|
22
|
MacLusky I. Chronic Ventilator Support in Children: Why, Who, and When. Respir Med 2016. [DOI: 10.1007/978-1-4939-3749-3_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
23
|
Smith BK, Renno MS, Martin AD, Corti M, Byrne BJ. Reply: Respiratory motor function in centronuclear myopathy. Muscle Nerve 2015; 53:660-1. [DOI: 10.1002/mus.24961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 11/06/2015] [Indexed: 11/12/2022]
Affiliation(s)
- Barbara K. Smith
- Department of Physical Therapy; University of Florida; Gainesville Florida USA
- Department of Pediatrics; University of Florida; Gainesville Florida USA
| | - Markus S. Renno
- Department of Pediatrics; Vanderbilt University; Nashville Tennessee USA
| | - Anatole D. Martin
- Department of Physical Therapy; University of Florida; Gainesville Florida USA
| | - Manuela Corti
- Department of Pediatrics; University of Florida; Gainesville Florida USA
| | - Barry J. Byrne
- Department of Pediatrics; University of Florida; Gainesville Florida USA
| |
Collapse
|
24
|
Agarwal A, Willis D, Tang X, Bauer M, Berlinski A, Com G, Ward WL, Carroll JL. Transition of respiratory technology dependent patients from pediatric to adult pulmonology care. Pediatr Pulmonol 2015; 50:1294-300. [PMID: 25652000 DOI: 10.1002/ppul.23155] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 11/19/2014] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Recent advances in medicine have allowed children with chronic life-threatening disorders to survive longer than ever before with the use of complex medical device technology (e.g., mechanical ventilation, dialysis, etc.). The care of children with chronic pulmonary disorders and respiratory-technology dependence is often complex, involving a high level of ongoing interaction between caregivers and the health care team. Unmanaged, non-standardized transition of respiratory technology dependent (RTD) patients to adult care potentially increases the risk of adverse outcomes. Pediatric Pulmonary programs at US children's hospitals were surveyed to ascertain whether a standardized process is utilized for transitioning RTD patients from pediatric to adult subspecialty pulmonology care. METHODOLOGY Pediatric pulmonology programs with Accreditation Council for Graduate Medical Education certification were invited to participate in an electronic survey inquiring about practices and processes used to transition RTD patients from pediatric to adult pulmonology. RESULTS The majority of respondents, 78.1% (25/32), reported that they do not utilize a standard protocol for transition while 41.4% (12/29) have no process in place. No program surveyed uses a designated transition leader. Referral to an adult pulmonologist within the same health system occurs more frequently than referral to private practice. Forty-three percent are not satisfied with involvement from the adult pulmonology care team. Coordination of care with other specialty services such as adult otolaryngology is provided by 31% of respondents. Of respondents, 13.8% assessed "readiness to transition" to adult pulmonary for RTD patients. Pediatric pulmonary providers are not satisfied with their current practices or involvement from the adult team, and only 24% track the transition process until the first visit with the adult pulmonologist. CONCLUSION The survey results highlight a lack of standardized transition programs at US children's hospitals for the transfer of RTD patients from a pediatric to an adult care setting. Improvement in the standardized management of transitions of complex RTD patients from pediatric to adult care may decrease the risk for adverse health outcomes and the stresses associated with changing the health care setting.
Collapse
Affiliation(s)
- Amit Agarwal
- Division of Pediatric Pulmonary and Sleep Medicine, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Denise Willis
- Respiratory Care Department, Arkansas Children's Hospital, Little Rock, Arkansas
| | - Xinyu Tang
- Division of Biostatistics, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Martin Bauer
- Division of Pediatric Pulmonary and Sleep Medicine, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Ariel Berlinski
- Division of Pediatric Pulmonary and Sleep Medicine, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Gulnur Com
- Division of Pediatric Pulmonary and Sleep Medicine, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Wendy L Ward
- Division of Psychology, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - John L Carroll
- Division of Pediatric Pulmonary and Sleep Medicine, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| |
Collapse
|
25
|
Antommaria AHM, Collura CA, Antiel RM, Lantos JD. Two infants, same prognosis, different parental preferences. Pediatrics 2015; 135:918-23. [PMID: 25847802 DOI: 10.1542/peds.2013-4044] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/12/2014] [Indexed: 11/24/2022] Open
Abstract
A central principle of justice is that similar cases should be decided in similar ways. In pediatrics, however, there are cases in which 2 infants have similar diagnoses and prognoses, but their parents request different treatments. In this Ethics Rounds, we present such a situation that occurred in a single NICU. Three physician-ethicists analyze the issues.
Collapse
Affiliation(s)
- Armand H Matheny Antommaria
- Ethics Center and Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Christopher A Collura
- Departments of Pediatric and Adolescent Medicine, and Palliative Care Fellow, Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Medicine, Boston Children's Hospital, Boston, Massachusetts; Center for Bioethics, University of Minnesota, Minneapolis, Minnesota
| | | | - John D Lantos
- Department of Pediatrics, University of Missouri, Kansas City, Missouri; and Children's Mercy Hospital Bioethics Center, Kansas City, Missouri
| |
Collapse
|
26
|
Home mechanical ventilation in childhood-onset hereditary neuromuscular diseases: 13 years' experience at a single center in Korea. PLoS One 2015; 10:e0122346. [PMID: 25822836 PMCID: PMC4379105 DOI: 10.1371/journal.pone.0122346] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 02/15/2015] [Indexed: 01/05/2023] Open
Abstract
Introduction Children with hereditary neuromuscular diseases (NMDs) are at a high risk of morbidity and mortality related to respiratory failure. The use of home mechanical ventilation (HMV) has saved the lives of many children with NMD but, due to a lack of studies, dependable guidelines are not available. We drew upon our experience to compare the various underlying NMDs and to evaluate HMV with regard to respiratory morbidity, the proper indications and timing for its use, and to develop a policy to improve the quality of home noninvasive ventilation (NIV). Methods We retrospectively analyzed the medical records of 57 children with childhood-onset hereditary NMDs in whom HMV was initiated between January 2000 and May 2013 at Seoul National University Children's Hospital. The degree of respiratory morbidity was estimated by the frequency and duration of hospitalizations caused by respiratory distress. Results The most common NMD was spinal muscular atrophy (SMA, n = 33). Emergent mechanical ventilation was initiated in 44% of the patients before the confirmed diagnosis, and the indicators of pre-HMV respiratory morbidity (e.g., extubation trials, hypoxia, hospitalizations, and intensive care unit stay) were greater in these patients than in others. The proportion of post-HMV hospitalizations (range, 0.00−0.52; median, 0.01) was lower than that of pre-HMV hospitalizations (0.02−1.00; 0.99) (P < 0.001). Eight patients were able to maintain home NIV. The main causes of NIV failure were air leakage and a large amount of airway secretions. Conclusions The application of HMV helped reduce respiratory morbidity in children with childhood-onset hereditary NMD. Patients with SMA type I can benefit from an early diagnosis and the timely application of HMV. The choice between invasive and noninvasive HMV should be based on the patient’s age and NIV trial tolerance. Systematic follow-up guidelines provided by a multidisciplinary team are needed.
Collapse
|
27
|
Smith BK, Goddard M, Childers MK. Respiratory assessment in centronuclear myopathies. Muscle Nerve 2014; 50:315-26. [PMID: 24668768 DOI: 10.1002/mus.24249] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2014] [Indexed: 12/23/2022]
Abstract
The centronuclear myopathies (CNMs) are a group of inherited neuromuscular disorders classified as congenital myopathies. While several causative genes have been identified, some patients do not harbor any of the currently known mutations. These diverse disorders have common histological features, which include a high proportion of centrally nucleated muscle fibers, and clinical attributes of muscle weakness and respiratory insufficiency. Respiratory problems in CNMs may manifest initially during sleep, but daytime symptoms, ineffective airway clearance, and hypoventilation predominate as more severe respiratory muscle dysfunction evolves. Respiratory muscle capacity can be evaluated using a variety of clinical tests selected with consideration for the age and baseline motor function of the patient. Similar clinical tests of respiratory function can also be incorporated into preclinical CNM canine models to offer insight for clinical trials. Because respiratory problems account for significant morbidity in patients, routine assessments of respiratory muscle function are discussed.
Collapse
Affiliation(s)
- Barbara K Smith
- Department of Physical Therapy, University of Florida, Gainesville, Florida, USA
| | | | | |
Collapse
|
28
|
Graham RJ, Rodday AM, Parsons SK. Family-centered assessment and function for children with chronic mechanical respiratory support. J Pediatr Health Care 2014; 28:295-304. [PMID: 23942254 DOI: 10.1016/j.pedhc.2013.06.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 06/18/2013] [Accepted: 06/29/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The purpose of this study was to assess health-related quality of life (HRQL) when managing severe, chronic respiratory insufficiency (CRI) at home. METHODS Families enrolled in a comprehensive program for CRI completed the Child Health Ratings Inventories with (a) parent-proxy ratings of the child's HRQL and (b) the parent's own HRQL. Psychometrics and known groups comparisons were reported. Linear regressions models assessed the effect of the parent's HRQL on proxy ratings. RESULTS Eighty-six parents (67%) completed the measures. The child global HRQL score was low (63.1, SD = 24.9), although ratings of "family life" were higher (73.8, SD = 26.5). The parent global HRQL and emotional functioning (EF) scores were low, despite preserved physical and role function. Having a child with a congenital versus an acquired disability was associated with higher parental EF (p = .004). Higher parental EF correlated with a higher global child HRQL (p < .001). DISCUSSION Families of children with CRI experience reduced HRQL. The Child Health Ratings Inventories is a valid tool for this assessment, identifying emotional distress and potential gaps in support.
Collapse
|
29
|
Wilfond BS. Tracheostomies and assisted ventilation in children with profound disabilities: navigating family and professional values. Pediatrics 2014; 133 Suppl 1:S44-9. [PMID: 24488540 DOI: 10.1542/peds.2013-3608h] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Parental requests for gastrostomies, tracheostomies, or assisted ventilation in children with profound disabilities raise ethical concerns about children's interests, parental decision-making, and health care costs. The underlying concern for many relates to the perceived value of these children. Clinicians should make efforts to appreciate the family's perspective regarding children with profound disabilities who require respiratory and nutritional medical support. Finding opportunities to learn about the family members' lives outside of the health care setting may facilitate a deeper understanding of what it means to live with a child who has profound disabilities. In conversations with families, referring to interventions as futile and conditions as lethal will obscure the value-based nature of these decisions. Respiratory and nutritional interventions are not clearly against the interests of most children. Even for children with a limited life span, life-sustaining interventions may be important for the child and family. Health care costs are a serious societal issue; however, the costs associated with profound disabilities are not the most significant contributor. Societal decisions not to provide life-sustaining health care to children with profound disabilities would require a public process. Clinicians may have personal views regarding decisions for their own family or for their vision for society. However, clinicians have professional obligations to families who have different values. It is important to present balanced information and support parental decision-making so parents may decide to forgo or use life-sustaining interventions according to their values and goals.
Collapse
Affiliation(s)
- Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, and Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| |
Collapse
|
30
|
Lindahl B, Lindblad BM. Being the parent of a ventilator-assisted child: perceptions of the family-health care provider relationship when care is offered in the family home. JOURNAL OF FAMILY NURSING 2013; 19:489-508. [PMID: 24122580 DOI: 10.1177/1074840713506786] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The number of medically fragile children cared for at home is increasing; however, there are few studies about the professional support these families receive in their homes. The aim of the study was to understand the meanings that parents had about the support they received from health care professionals who offered care for their ventilator-assisted child in the family home. A phenomenological-hermeneutic method was used. Data included the narratives of five mother-father couples living in Sweden who were receiving professional support for their ventilator-assisted child. The findings indicate that receiving professional support meant being at risk of and/or exposed to the exercise of control over family privacy. The professional support system in the families' homes worked more by chance than by competent and sensible planning. In good cases, caring encounters were characterized by a mutual relationship where various occupational groups were embraced as a part of family life. The findings are discussed in light of compassionate care, exercise of power, and the importance of holistic educational programs.
Collapse
|
31
|
The impact of technology dependence on children and their families. J Pediatr Health Care 2013; 27:451-9. [PMID: 22742822 DOI: 10.1016/j.pedhc.2012.05.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Accepted: 05/10/2012] [Indexed: 11/20/2022]
Abstract
Advances in medical care and technologies have prolonged life for many children with medical complexity. These advances and their effects reinforce the need for further research to determine how children and their families are being affected by technology dependence and their quality of life. A review of the literature suggests that children, as well as their family members, are negatively affected by technology dependence in a variety of psychosocial domains. Implications for clinical care and future research of this population are discussed.
Collapse
|
32
|
Manning JC, Hemingway P, Redsell SA. Long-term psychosocial impact reported by childhood critical illness survivors: a systematic review. Nurs Crit Care 2013; 19:145-56. [PMID: 24147805 PMCID: PMC4285805 DOI: 10.1111/nicc.12049] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 07/25/2013] [Accepted: 07/29/2013] [Indexed: 12/02/2022]
Abstract
Aim To undertake a qualitative systematic review that explores psychological and social impact, reported directly from children and adolescents at least 6 months after their critical illness. Background Significant advances in critical care have reduced mortality from childhood critical illness, with the majority of patients being discharged alive. However, it is widely reported that surviving critical illness can be traumatic for both children and their family. Despite a growing body of literature in this field, the psychological and social impact of life threatening critical illness on child and adolescent survivors, more than 6 months post event, remains under-reported. Data sources Searches of six online databases were conducted up to February 2012. Review methods Predetermined criteria were used to select studies. Methodological quality was assessed using a standardized checklist. An adapted version of the thematic synthesis approach was applied to extract, code and synthesize data. Findings Three studies met the inclusion criteria, which were all of moderate methodological quality. Initial coding and synthesis of data resulted in five descriptive themes: confusion and uncertainty, other people's narratives, focus on former self and normality, social isolation and loss of identity, and transition and transformation. Further synthesis culminated in three analytical themes that conceptualize the childhood survivors' psychological and social journey following critical illness. Conclusions Critical illness in childhood can expose survivors to a complex trajectory of recovery, with enduring psychosocial adversity manifesting in the long term. Nurses and other health professionals must be aware and support the potential multifaceted psychosocial needs that may arise. Parents and families are identified as fundamental in shaping psychological and social well-being of survivors. Therefore intensive care nurses must take opportunities to raise parents' awareness of the journey of survival and provide appropriate support. Further empirical research is warranted to explore the deficits identified with the existing literature.
Collapse
Affiliation(s)
- Joseph C Manning
- JC Manning, RN (Child), PGCert Paediatric Critical Care, MNursSci (Hons), Research Fellow, School of Health Sciences, Faculty of Medicine & Health Sciences, The University of Nottingham, Nottingham, UK
| | | | | |
Collapse
|
33
|
Maddox C, Pontin D. Paid carers' experiences of caring for mechanically ventilated children at home: implications for services and training. J Child Health Care 2013; 17:153-63. [PMID: 23711491 DOI: 10.1177/1367493512456113] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
UK survival rates for long-term mechanically ventilated children have increased and paid carers are trained to care for them at home, however there is limited literature on carers' training needs and experience of sharing care. Using a qualitative abductive design, we purposively sampled experienced carers to generate data via diaries, semi-structured interviews, and researcher reflexive notes. Research ethics approval was granted from NHS and University committees. Five analytical themes emerged - Parent as expert; Role definition tensions; Training and Continuing Learning Needs; Mixed Emotions; Support Mechanisms highlighting the challenges of working in family homes for carers and their associated learning needs. Further work on preparing carers to share feelings with parents, using burnout prevention techniques, and building confidence is suggested. Carers highlight the lack of clinical supervision during their night-working hours. One solution may be to provide access to registered nurse support when working out-of-office hours.
Collapse
Affiliation(s)
- Christina Maddox
- Department of Nursing & Midwifery, Children's Nursing, Faculty of Health & Life Sciences, University of the West of England, UK
| | | |
Collapse
|
34
|
van Huijzen S, van Staa A. Chronic ventilation and social participation: experiences of men with neuromuscular disorders. Scand J Occup Ther 2013; 20:209-16. [DOI: 10.3109/11038128.2013.765033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
35
|
Sovtic A, Minic P, Vukcevic M, Markovic-Sovtic G, Rodic M, Gajic M. Home mechanical ventilation in children is feasible in developing countries. Pediatr Int 2012; 54:676-81. [PMID: 22462757 DOI: 10.1111/j.1442-200x.2012.03634.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The results of many national surveys on pediatric home mechanical ventilation (HMV) in developed countries have been presented elsewhere, but data from developing countries with low national incomes are scarce. METHODS Twenty-nine pediatric patients, treated in the Mother and Child Institute of Serbia, who had been receiving long-term ventilatory support at home, were surveyed. The major criterion for initiating HMV was hypercapnia, diagnosed by blood gas analysis, performed in the morning, after awakening. Other criteria were either symptoms of hypoventilation during the night associated with an apnea index of >5, or apnoea-hypopnoea index of >15, or nocturnal hypoxemia, defined as an oxygen saturation rate of <90% for >5% of total sleep time. RESULTS The mean age at initiation of HMV was 9.3 years (range 0.5-17.8 years). Patients waited for HMV initiation either in hospital or at home; the mean period was 6.3 months (range 1-18 months). The subjects received HMV for a mean of 25.06 months (range 3-119 months). There was a significant difference in the duration of HMV for different underlying diseases (P= 0.046), and mechanical malfunction was strongly dependent on the duration of HMV (P= 0.011). Eleven patients underwent invasive HMV via a tracheostomy, and 18 others received non-invasive ventilation, via nasal and full-face masks. CONCLUSION HMV is feasible in developing countries. Valuable reimbursement policies as well as an organized and functional network are essential for its implementation, as a standard of care in leading national pediatric hospitals.
Collapse
Affiliation(s)
- Aleksandar Sovtic
- Department of Pulmonology, Mother and Child Institute, Belgrade, Serbia.
| | | | | | | | | | | |
Collapse
|
36
|
Spratling R. The experiences of medically fragile adolescents who require respiratory assistance. J Adv Nurs 2012; 68:2740-9. [PMID: 22416944 DOI: 10.1111/j.1365-2648.2012.05979.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS To report a study of the experiences of medically fragile adolescents who require respiratory assistance. BACKGROUND The population of medically fragile adolescents has grown in recent decades because of the sequelae of prematurity, injuries and chronic or terminal illnesses. Medically fragile adolescents who require respiratory assistance are part of this unique population, yet as nurses, we know little about their experiences and the best approaches to use in caring for them. DESIGN A qualitative design, interpretive phenomenology was used in this study. METHODS Interpretive phenomenology was used to describe and interpret the experience of 11 medically fragile adolescents (ages 13-18 years old) who required respiratory assistances of tracheostomies, ventilator support and Bi-level positive airway pressure. Between April 2010-September 2010, audiotaped semi-structured interviews were conducted with the adolescents. Data analysis was completed using a stepped approach to identify themes. FINDINGS Five themes were identified from the interviews with the adolescents: 'Get to know me', 'Allow me to be myself', 'Being there for me', 'No matter what, technology helps' and 'I am an independent person'. CONCLUSIONS Medically fragile adolescents have a clear view of who they are as a person. They want nurses to view them as a person, not just a patient. The adolescents said that friends were there for them when they needed support. Technology had meanings that enhanced daily living and existed as a part of their day, not their whole day. The adolescents were actively engaging in activities and strategies to achieve their goals of independence.
Collapse
Affiliation(s)
- Regena Spratling
- North Georgia College and State University, Dahlonega, Georgia, USA.
| |
Collapse
|
37
|
Costa MTFD, Gomes MA, Pinto M. [Chronic dependence on mechanical pulmonary ventilation in pediatric care: a necessary debate for Brazil's Unified Health System]. CIENCIA & SAUDE COLETIVA 2012; 16:4147-59. [PMID: 22031144 DOI: 10.1590/s1413-81232011001100020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Accepted: 12/01/2010] [Indexed: 11/22/2022] Open
Abstract
People with prolonged dependence on mechanical ventilation require permanent care and the use of equipment that can result in longer term hospital internment. This can lead to difficulty of access for patients with acute injuries, as well as personal difficulties and stress with reduced quality of life for their families or caregivers due to such longer hospital internment. This critical review of publications dealing with dependence on mechanical ventilation among children and adolescents aimed at making information organized in a systematic manner available in order to support discussion on the subject. It should be borne in mind that changes in epidemiological profile and growing technological access determine needs such as intensive therapy hospital beds and complex home care for chronic patients, which still have limits of supply and regulatory restrictions in the Brazilian public health system.
Collapse
|
38
|
Dybwik K, Nielsen EW, Brinchmann BS. Ethical challenges in home mechanical ventilation: a secondary analysis. Nurs Ethics 2011; 19:233-44. [PMID: 22183963 PMCID: PMC3573680 DOI: 10.1177/0969733011414967] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to explore the ethical challenges in home mechanical ventilation based on a secondary analysis of qualitative empirical data. The data included perceptions of healthcare professionals in hospitals and community health services and family members of children and adults using home mechanical ventilation. The findings show that a number of ethical challenges, or dilemmas, arise at all levels in the course of treatment: deciding who should be offered home mechanical ventilation, respect for patient and family wishes, quality of life, dignity and equal access to home mechanical ventilation. Other challenges were the impacts home mechanical ventilation had on the patient, the family, the healthcare services and the allocation of resources. A better and broader understanding of these issues is crucial in order to improve the quality of care for both patient and family and assist healthcare professionals involved in home mechanical ventilation to make decisions for the good of the patient and his or her family.
Collapse
Affiliation(s)
- Knut Dybwik
- Department of Anesthesiology, Nordland Hospital, Bodoe, Norway.
| | | | | |
Collapse
|
39
|
|
40
|
Lindahl B, Lindblad BM. Family members' experiences of everyday life when a child is dependent on a ventilator: a metasynthesis study. JOURNAL OF FAMILY NURSING 2011; 17:241-269. [PMID: 21531859 DOI: 10.1177/1074840711405392] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Children using mechanical ventilation for survival represent a small, but growing, vulnerable population in society. The aim of this study was to describe the existing qualitative research that examined family members' experiences when a child is dependent on ventilator at home. A metasynthesis is an interpretative integration of qualitative research findings based on a systematic literature search. Twelve original research reports focusing on the life situation of ventilator- and technology-dependent children and their families published between 1998 and 2006 were selected as data. Themes from the metasynthesis included experiences of the ill child, siblings, and parents and the meaning of space and place. These findings provide an understanding of the family members' experiences when a child is dependent on a ventilator for survival. Recommendations for future research with this population of families include a greater focus on professional support systems and family strengths and the use of longitudinal research methods using observation and interviews.
Collapse
|
41
|
|
42
|
The quality of life of young children and infants with chronic medical problems: review of the literature. Curr Probl Pediatr Adolesc Health Care 2011; 41:91-101. [PMID: 21440223 DOI: 10.1016/j.cppeds.2010.10.008] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The question "what makes a good quality of life?" is a philosophical one which could be thought immune to scientific investigations. However, over the last few decades there has been great progress in developing tools to quantify quality of life (QoL) to make comparisons between different health states, evaluate the effectiveness of medical interventions, and describe the life trajectories of individuals or groups. Using a series of vignettes, we explore and review the biomedical literature to demonstrate how QoL is affected by chronic health conditions in childhood, and how it evolves as individuals pass into adulthood. Individuals experiencing serious chronic illnesses generally have reduced health-related QoL: their health status has significant repercussions of their everyday life, but scores are usually much better than healthy individuals expect, and better than physicians predict. Global QoL is more than a health status concept. QoL is a complex relationship between objectivity and subjectivity; it requires substantial and valid facts, and it defines itself by an interpretation of health within different schemes of values: societal, medical, and those of the subject themselves. QoL is dynamic; purely physical influences diminish as individuals age, and psychosocial factors become much more important. Resilience frequently allows adaptation to adverse health states, leading to acceptable QoL for most children with disabilities.
Collapse
|
43
|
Noyes J. Ventilator-dependent children in the United Kingdom: Increasing numbers, increasing expectations, and remaining challenges. Aust Crit Care 2011; 24:1-3. [DOI: 10.1016/j.aucc.2010.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Accepted: 11/02/2010] [Indexed: 10/18/2022] Open
|
44
|
Kirk S. How children and young people construct and negotiate living with medical technology. Soc Sci Med 2010; 71:1796-803. [DOI: 10.1016/j.socscimed.2010.07.044] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2009] [Revised: 07/27/2010] [Accepted: 07/30/2010] [Indexed: 11/26/2022]
|
45
|
|
46
|
Graham RJ, Pemstein DM, Palfrey JS. Included but isolated: early intervention programmes provision for children and families with chronic respiratory support needs. Child Care Health Dev 2008; 34:373-9. [PMID: 18410643 DOI: 10.1111/j.1365-2214.2008.00823.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To measure enrollment of children with mechanical respiratory support needs within the Massachusetts early intervention programmes (EIP) and describe challenges in execution of individual family service plans (IFSPs). METHODS Mixed methods provided a complementary assessment. Quantitative data were collected in 2005 from the Commonwealth of Massachusetts EIP administrative database as part of a cross-sectional state census. Qualitative data were retrieved from EIP regional coordinators in a key informant focus group. Descriptive statistics were used for quantitative survey data. Audio-recordings were transcribed verbatim and a qualitative, thematic analysis was undertaken. RESULTS Four hundred and eighty children requiring mechanical respiratory support at the time of EIP enrollment were identified between 1 July 1997 and 1 January 2005. Focus group analysis revealed themes including: (1) barriers to community transition; (2) community expertise and training; (3) interface with medical providers; and (4) the role of web-based resources. Isolation of families emerged as a recurrent and resounding concept, relating to all of the themes. CONCLUSIONS Findings support the assumption that implementation of IFSPs for the cohort of children with chronic mechanical respiratory support needs in EIPs is challenging. Barriers reflect inconsistent care coordination and practical encumbrances, contributing to the physical and social isolation of these children and their families.
Collapse
Affiliation(s)
- R J Graham
- Children's Hospital Boston, Department of Anaesthesiology, Perioperative and Pain Medicine, Division of Critical Care, Boston, MA 02115-5724, USA.
| | | | | |
Collapse
|
47
|
de Oliveira Rios dos Santos M, Landín G, Redondo Collazo L, Oreiro Vilacoba M, Rodríguez Núñez A. Ventilación domiciliaria invasiva. La perspectiva de los padres. An Pediatr (Barc) 2007; 67:613-4. [DOI: 10.1016/s1695-4033(07)70819-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
48
|
Noyes J. Comparison of ventilator-dependent child reports of health-related quality of life with parent reports and normative populations. J Adv Nurs 2007; 58:1-10. [PMID: 17394611 DOI: 10.1111/j.1365-2648.2006.04191.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS This paper is a report of the first study of ventilator-dependent child and parent ratings of health-related quality of life using a validated instrument, which was undertaken as part of a case study of costs and consequences. BACKGROUND Advances in medical care and technologies such as the ventilator have extended childhood illness trajectories beyond our current range of knowledge and experience. These advances and their effects reinforce the need for further research to determine health-related quality of life as an outcome of ventilator-dependency in childhood. METHODS The KINDL was administered to ventilator-dependent children aged 4-18 years and parents as part of an in-depth case study. Twenty-seven parents and 17 children (including 17 child-parent pairs) completed questionnaires. Data were collected between 2001 and 2004. Findings were compared with normative values derived from a representative sample of children of a similar age in the general population. RESULTS Ventilator-dependent children reported significantly lower overall health-related quality of life, and significantly lower scores on all domains except about their friends, compared with school children, and chronically ill children in respect of their disease. Parents and children rated children's overall health-related quality of life the same but parents reported significantly lower scores for their child's disease and relationships with friends. There was a positive correlation between children and parents in all areas apart from self-esteem and school. CONCLUSIONS Both child and parent perspectives are needed to understand the impact of ventilator-dependency and associated co-morbidity on the child. As new interventions and models of service delivery emerge it will be important for nurses to understand the impact on the child by evaluating physical, emotional and social consequences.
Collapse
Affiliation(s)
- Jane Noyes
- College of Health and Behavioural Sciences, School of Healthcare Sciences, University of Wales, Bangor, UK.
| |
Collapse
|