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Schiller J, Towne MC, Epstein R, Thornton JK, Suslovitch V. How parents of children with ataxia-telangiectasia use dynamic coping to navigate cyclical uncertainty. J Genet Couns 2024; 33:301-313. [PMID: 37183503 DOI: 10.1002/jgc4.1727] [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: 11/29/2022] [Revised: 04/13/2023] [Accepted: 04/22/2023] [Indexed: 05/16/2023]
Abstract
Ataxia-telangiectasia (A-T) is a rare, childhood-onset, multi-systemic, progressive condition. Parents of children with rare diseases like A-T are emotionally, socially, and psychologically impacted by the diagnosis. To examine the parental perspective of having a child with A-T, and to better understand how parents cope with an A-T diagnosis, we conducted 10 semistructured interviews. Thematic analysis using a phenomenological approach resulted in five themes: (1) Parental responsibilities change as the result of an A-T diagnosis, (2) An A-T diagnosis brings about shifts in identity for all family members, (3) Parental coping changes over time, (4) A-T parents experience continuous uncertainty and a lack of stability, and (5) A-T parents receive support from various people, places, and resources. Many parents fostered resilience by adopting a present-centered and positive mindset about the impacts of the diagnosis. Parents also became A-T experts and used their knowledge to advocate for their children and help mentor other parents. Responses from parents indicated a need for providers to incorporate parental mental well-being check-ins to pediatric rare disease appointments and welcome parents as respected members of their children's care team. Genetic counselors are in a unique position to help coordinate complex care for children with A-T (and other rare diseases) and provide support to family members using the framework of family-centered care. This paper offers suggestions for expanding support and learning to cope with a difficult diagnosis for parents of children with rare diseases, specifically A-T, based on stories from parents of children with A-T.
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Affiliation(s)
- Julia Schiller
- Division of Graduate Medical Sciences, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Meghan C Towne
- Division of Graduate Medical Sciences, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Ambry Genetics, Aliso Viejo, California, USA
| | - Rachel Epstein
- Division of Graduate Medical Sciences, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | | | - Victoria Suslovitch
- Division of Graduate Medical Sciences, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Boston Children's Hospital, Boston, Massachusetts, USA
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Graaf G, Hughes PM, deJong NA, Thomas KC. Family Support Services and Reported Parent Coping Among Caregivers of Children with Emotional, Behavioral, or Developmental Disorders. J Dev Behav Pediatr 2024; 45:e54-e62. [PMID: 38127916 PMCID: PMC10922057 DOI: 10.1097/dbp.0000000000001230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/12/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE Caregivers of children with special health care needs (CSHCN) experience substantial strain caring for their child's special needs because of high needs for health and other support services. Caregivers of CSHCN with emotional, behavioral, or developmental problems (EBDPs) report stress and poor mental health at higher rates than caregivers of other CSHCN. Although family support services are associated with caregiver mental health and well-being among families of CSHCN, the association of these factors with caregiver coping has been underexamined. METHOD Using the Double ABCX Model of Family Adaptation to guide variable selection, this study uses 2016 to 2019 data from the National Survey of Children's Health. Univariate, bivariate, and multivariate logistic analyses examined the association between caregivers' receipt of adequate care coordination and emotional support services and their reported coping with the day-to-day strains of parenting. These relationships are compared between caregivers of CSHCN with and without EBDPs. RESULTS Receipt of adequate care coordination was associated with higher rates of caregiver-reported positive coping for all caregivers of CSHCN who have no source of emotional support. Receipt of emotional support services was associated with increased reports of positive coping for caregivers for all CSHCN as well. Caregivers reporting only informal sources of emotional support, however, also reported higher rates of positive coping when compared with caregivers with no source of emotional support. CONCLUSION Mobilization of resources that can aid caregivers in coordinating care and provide emotional support may play a key role in positive caregiver coping for families of CSHCN.
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Affiliation(s)
- Genevieve Graaf
- School of Social Work, University of Texas at Arlington; 211 South Cooper Street, Box 19129, Arlington, TX 76019
| | - Phillip M Hughes
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill
| | - Neal A deJong
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Kathleen C Thomas
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC
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van de Riet L, Alsem MW, Beijneveld RSI, van Woensel JBM, van Karnebeek CD. Delineating family needs in the transition from hospital to home for children with medical complexity: part 2, a phenomenological study. Orphanet J Rare Dis 2023; 18:387. [PMID: 38082332 PMCID: PMC10714565 DOI: 10.1186/s13023-023-02747-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 05/18/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND A systematic literature review on the transition from hospital-to-home (H2H) of families with a child with medical complexity (CMC), resulted in nine overarching themes. These demonstrated common needs and experiences despite the widely differing CMC diagnoses and family characteristics. However, none of the reported studies was conducted in the Netherlands, which hampers the creation of a tailored H2H care pathway, deemed essential for our recently established Transitional Care Unit in the Netherlands: the 'Jeroen Pit Huis'. Therefore, the aim of this study was to gain a deeper understanding of the needs and experiences of Dutch CMC parents on H2H transition and integrate these insights with the literature review into an evidence-based H2H care pathway for CMC and their families. METHODS A descriptive phenomenological approach was applied. Heterogeneous purposeful sampling methods were used to recruit participants according to the following criteria: parents of CMC from various regions in the Netherlands, who spoke Dutch fluently and who had been discharged home from a tertiary hospital within the previous five years. Semi-structured, open-ended interviews were conducted via video call by two researchers, who transcribed the audio recordings verbatim. Thematic analysis methods were used to identify emerging themes from the individual transcripts, involving a third and fourth researcher to reach consensus. RESULTS Between March and August 2021, 14 mothers and 7 fathers participated in 14 interviews. They elaborated on the H2H transition of 14 CMC with a wide range of underlying diseases: 7 male, 7 female, aged 6 months to 10 years. Eight overarching themes, consistent with the results of the systematic review, represent CMC parental needs and experiences during the H2H process in the Netherlands: (1) autonomy, (2) division of tasks and roles, (3) family emotions, (4) impact on family life, (5) communication, (6) coordination of care, (7) support system and (8) adaptation. CONCLUSIONS The H2H needs and experiences reported by the CMC families in this study align with the results of our systematic review. The H2H transition process is not linear but continuous, and should extend beyond the specific medical needs of the CMC to holistic care for the family as a whole. The overarching care needs and experiences, expressed by all CMC families, regardless of underlying symptoms and diagnoses, inform the H2H care pathway and its future evaluation. Our studies highlight the necessity to focus on the family needs rather than on the specific illness of the child, as well as the value of our interdisciplinary care team partnering with parents in the 'Jeroen Pit Huis' towards a safe and sustainable transition home.
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Affiliation(s)
- L van de Riet
- Department of Pediatric Intensive Care, Amsterdam UMC, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands
- On Behalf of the Transitional Care Unit Consortium, Amsterdam, The Netherlands
| | - M W Alsem
- On Behalf of the Transitional Care Unit Consortium, Amsterdam, The Netherlands
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, Meibergdreef 9, Amsterdam, The Netherlands
| | - R S I Beijneveld
- Department of Pediatric Intensive Care, Amsterdam UMC, Meibergdreef 9, Amsterdam, The Netherlands
| | - J B M van Woensel
- Department of Pediatric Intensive Care, Amsterdam UMC, Meibergdreef 9, Amsterdam, The Netherlands
- On Behalf of the Transitional Care Unit Consortium, Amsterdam, The Netherlands
| | - C D van Karnebeek
- On Behalf of the Transitional Care Unit Consortium, Amsterdam, The Netherlands.
- Emma Center for Personalized Medicine, Departments of Pediatrics and Human Genetics, Amsterdam Gastro-Enterology Endocrinology and Metabolism, Amsterdam UMC, Meibergdreef 9, Amsterdam, The Netherlands.
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van de Riet L, Alsem MW, van der Leest EC, van Etten-Jamaludin FS, Maaskant JM, van Woensel JBM, van Karnebeek CD. Delineating family needs in the transition from hospital to home for children with medical complexity: part 1, a meta-aggregation of qualitative studies. Orphanet J Rare Dis 2023; 18:386. [PMID: 38082309 PMCID: PMC10714518 DOI: 10.1186/s13023-023-02942-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 10/02/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Advances in diagnostic and therapeutic interventions for rare diseases result in greater survival rates, with on the flipside an expanding group of children with medical complexity (CMC). When CMC leave the protective hospital environment to be cared for at home, their parents face many challenges as they take on a new role, that of caregiver rather than care-recipient. However, an overview of needs and experiences of parents of CMC during transition from hospital-to-home (H2H) is lacking, which hampers the creation of a tailored H2H care pathway. Here we address this unmet medical need by performing a literature review to systematically identify, assess and synthesize all existing qualitative evidence on H2H transition needs of CMC parents. METHODS An extensive search in Medline, PsychINFO and CINAHL (up to September 2022); selection was performed to include all qualitative studies describing parental needs and experiences during H2H transition of CMC. All papers were assessed by two independent investigators for methodological quality before data (study findings) were extracted and pooled. A meta-aggregation method categorized the study findings into categories and formulated overarching synthesized findings, which were assigned a level of confidence, following the ConQual approach. RESULTS The search yielded 1880 papers of which 25 met eligible criteria. A total of 402 study findings were extracted from the included studies and subsequently aggregated into 50 categories and 9 synthesized findings: (1) parental empowerment: shifting from care recipient to caregiver (2) coordination of care (3) communication and information (4) training skills (5) preparation for discharge (6) access to resources and support system (7) emotional experiences: fatigue, fear, isolation and guilt (8) parent-professional relationship (9) changing perspective: finding new routines and practices. The overall ConQual Score was low for 7 synthesized findings and very low for 2 synthesized findings. CONCLUSIONS Despite the variability in CMC symptoms and underlying (rare disease) diagnoses, overarching themes in parental needs during H2H transition emerged. We will augment this new knowledge with an interview study in the Dutch setting to ultimately translate into an evidence-based tailored care pathway for implementation by our interdisciplinary team in the newly established 'Jeroen Pit Huis', an innovative care unit which aims for a safe and sustainable H2H transition for CMC and their families.
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Affiliation(s)
- L van de Riet
- Department of Pediatric Intensive Care, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
- On Behalf of the Transitional Care Unit Consortium, Amsterdam, The Netherlands
| | - M W Alsem
- On Behalf of the Transitional Care Unit Consortium, Amsterdam, The Netherlands
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - E C van der Leest
- Department of Pediatric Intensive Care, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - F S van Etten-Jamaludin
- Medical Library AMC, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - J M Maaskant
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
- On Behalf of the Transitional Care Unit Consortium, Amsterdam, The Netherlands
- Department of Pediatrics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - J B M van Woensel
- Department of Pediatric Intensive Care, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- On Behalf of the Transitional Care Unit Consortium, Amsterdam, The Netherlands
| | - C D van Karnebeek
- On Behalf of the Transitional Care Unit Consortium, Amsterdam, The Netherlands.
- Emma Center for Personalized Medicine, Departments of Pediatrics and Human Genetics, Amsterdam Gastro-Enterology Endocrinology and Metabolism, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
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Hirt E, Wright A, Kehring A, Wang Y, Toraño V, Boles J. "Fitting the Pieces Together": The Experiences of Caregivers of Children With Medical Complexity. Hosp Pediatr 2023; 13:1056-1066. [PMID: 37916264 DOI: 10.1542/hpeds.2022-007112] [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: 11/03/2023]
Abstract
BACKGROUND AND OBJECTIVES Families of children with medical complexity manage a multitude of care responsibilities that must be carefully coordinated alongside typical family roles and activities. Currently, little is known about this experience from the perspectives of caregivers; therefore, the purpose of this study was to explore the experience of caregiving for a child with medical complexity while identifying unmet medical and psychosocial needs. METHODS Nineteen caregivers were recruited from the pediatric complex care clinic at an academic medical center in the United States. Each participant completed an in-depth, narrative interview that was audio-recorded and transcribed; transcripts were analyzed using an inductive coding approach. RESULTS Participants described their caregiving experiences along 4 themes: (1) the many responsibilities of caregiving, (2) insufficient respite care and skilled support, (3) financial limitations and costs of care, and (4) challenges with mental health and wellbeing. Participants identified unmet needs in 6 dimensions: (1) transition stress, (2) communication across teams, (3) learning to be an advocate, (4) purposefully inclusive environments, (5) finding connections and community, and (6) the challenges of coronavirus disease 2019. CONCLUSIONS Caregivers of children with medical complexity identify a host of experiences and unmet needs that challenge the physical, emotional, and psychosocial wellbeing of themselves and their families. With more attention to the holistic experience of caregiving for this population, providers and teams can better anticipate needs and provide services and programs that enhance caregiver and family wellbeing simultaneously.
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Affiliation(s)
- Elise Hirt
- Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Alyssa Wright
- Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Allysa Kehring
- Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Yinuo Wang
- Vanderbilt University, Nashville, Tennessee
| | | | - Jessika Boles
- Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee
- Vanderbilt University, Nashville, Tennessee
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Bergvoll LM, Fjelldal SS, Clancy A, Martinussen M, Laholt H. How do public health nurses in Norwegian school health services support siblings of children with complex care needs? Scand J Caring Sci 2023; 37:1100-1108. [PMID: 37246570 DOI: 10.1111/scs.13184] [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: 01/19/2023] [Revised: 03/20/2023] [Accepted: 05/12/2023] [Indexed: 05/30/2023]
Abstract
AIMS There is a paucity of data regarding the care and support provided by Norwegian school health services to siblings of children with complex care needs. Public health nurses are an integral part of these universal services, which focus on health promotion and disease prevention in primary and secondary schools. This study aimed to explore health promotion interventions by public health nurses for siblings in Norwegian schools and to identify regional differences. METHODS An online national questionnaire was distributed to Norwegian public health nurses and leaders of public health nursing services (N = 487). The questions were related to how the nurses support siblings of children with complex care needs. The quantitative data were analysed using descriptive statistics. An inductive thematic analysis of free-text comments was conducted. ETHICAL APPROVAL The study was approved by the Norwegian Centre for Research Data. RESULTS The majority of public health nursing leaders (67%) reported that the services in their municipality had no system to identify siblings or to provide them with routine care. However, 26% of public health nurses reported that routine support was provided to siblings. Regional differences were identified. STUDY LIMITATIONS This study included responses from 487 PHNs from all four health regions in Norway. The study design is limited and gives a brief outline of the current situation. Further data are needed to provide in-depth knowledge. CONCLUSIONS This survey provides important knowledge for health authorities and professionals working with siblings, about inadequate support and regional differences in care provided to siblings by school health services.
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Affiliation(s)
- Lise-Marie Bergvoll
- Department of Health and Caring Science, UiT - The Arctic University of Norway, Harstad, Norway
| | | | - Anne Clancy
- Department of Health and Caring Science, UiT - The Arctic University of Norway, Harstad, Norway
| | - Monica Martinussen
- Regional Centre for Child and Youth Mental Health and Child Welfare, UiT - The Arctic University of Norway, Harstad, Norway
| | - Hilde Laholt
- Department of Health and Caring Science, UiT - The Arctic University of Norway, Harstad, Norway
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Herbell K, Graaf G. Parents' Perspectives in Accessing Psychiatric Residential Treatment for Children and Youth: Differential Experiences by Funding Source. CHILDREN AND YOUTH SERVICES REVIEW 2023; 154:107148. [PMID: 37841201 PMCID: PMC10569116 DOI: 10.1016/j.childyouth.2023.107148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Objective There are well-documented disparities in access to mental health care for children and youth with significant behavioral health needs. Few studies that explored the differential experiences of families who use private vs public sources of financing (i.e., insurance and funding) in accessing residential treatment (RT) for children and youth. This study aimed to examine the lived experiences of families accessing psychiatric residential treatment (RT) and contextualize these experiences based on source of financing. Methods Twenty parents completed two interviews about their experiences with RT including the process for gaining access, length of stay, and aftercare. Parents were also asked about barriers (e.g., custody relinquishment), and facilitators (e.g., policies in the state) to accessing RT. Data were analyzed using content analysis. Results There were three distinct groups of families in the study. The first group includes lower income families whose children had public health coverage before needing RT. The second group comprises middle-income families whose children had private coverage but lived in states where there were no RTs that accepted private insurance or private payment and who did not have the means to send their child to RT in another state. The final group included higher income families with private insurance and enough private resources to overcome the limitations of insurance and state policies. This study illuminates key barriers and hardships for families accessing RT: 1) waiting long waiting periods and navigating complex systems; 2) inadequate lengths of stay; and 3) inadequate aftercare and support in the community transition. Conclusions This study is among the first to examine how access to RT differs by whether a family has access to public or private resources. Taken together, these findings support the importance of insurance and financing for families accessing RT for their children and the need for systemic changes in policies and practices to reduce disparities in access.
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Affiliation(s)
- Kayla Herbell
- The Ohio State University College of Nursing 1585 Neil Ave Columbus, OH 43210
| | - Genevieve Graaf
- The University of Texas at Arlington 701 S. Nedderman Dr Arlington, TX 76019
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Phillips B, Carpenter R. Community reintegration: Children with special healthcare needs in rural areas. J Pediatr Nurs 2023; 73:e285-e292. [PMID: 37805381 DOI: 10.1016/j.pedn.2023.09.024] [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: 06/30/2023] [Revised: 09/27/2023] [Accepted: 09/27/2023] [Indexed: 10/09/2023]
Abstract
PURPOSE The purpose of this study was to gather descriptions from caregivers and providers of children with special healthcare needs (CSHCN) about their experiences with community reintegration. This study focused on three community support areas: the healthcare structure, community of support, and school systems. The research question was, "How do caregivers and providers of CSHCN describe reintegration into community-based systems?" METHOD This descriptive qualitative study used focus group design to interview caregivers and providers about their experiences. Data were analyzed using conventional content analysis with open coding, clustering into categories, and abstracting into themes. RESULTS Eight themes were found within three categories. 1. Planning life and caregiving while fighting for everything needed, 2. Deciding to seek help while living with stigma, shame, and fear, 3. Coping with caregiving while feeling isolated, stressed, and overwhelmed, 4. Arranging transportation while living far away, 5. Underwhelming support in community and school systems, 6. Managing finances and covering expenses, 7. Improving communication of complex needs, and 8. Building a community, increasing confidence, and providing hope. CONCLUSION Community reintegration was described by caregivers and providers as balancing responsibilities, securing resources, and facilitating collaboration, which offer guidance for future care. IMPLICATIONS Engaging in open dialogue structured by the themes can help nurses understand the unique needs of caregivers of CSHCN. Social policy reform focused on access to care, financial resources, and school support may reduce inequities, and additional research focused on community-based systems, coping, and caregiving may identify needs based on sociodemographics and existing resources.
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Affiliation(s)
- Brad Phillips
- West Virginia University School of Nursing, 64 Medical Center Drive, Morgantown, WV 26506, United States of America.
| | - Roger Carpenter
- West Virginia University School of Nursing, 64 Medical Center Drive, Morgantown, WV 26506, United States of America
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Spitaletta G, Biagioli V, Greco F, Mascolo R, Liburdi A, Manzi G, Gawronski O, Ricci R, Tiozzo E, Vellone E, Grimaldi Capitello T, Salata M, Raponi M, Dall’Oglio I. Self-care in children and young people with complex chronic conditions: a qualitative study using Emotional Text Mining. Front Pediatr 2023; 11:1170268. [PMID: 37576150 PMCID: PMC10420086 DOI: 10.3389/fped.2023.1170268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 07/10/2023] [Indexed: 08/15/2023] Open
Abstract
Objectives To explore: (1) self-care behaviors in children and young people (range: 6 months-24 years) with complex chronic conditions, characterized by the diagnosis of a severe chronic condition, substantial family-identified needs, functional limitations associated with technology dependence, and intensive use of healthcare services; (2) the contribution to self-care of family members and other persons involved in the child's health and daily life context (e.g., health professionals and teachers), and (3) the principal factors that might have influenced the self-care process associated with developmental age. Methods A qualitative descriptive study was conducted in an Italian academic tertiary pediatric hospital between September 2020 and May 2021. Overall, 25 focus groups and 7 online interviews were conducted via videoconferencing. Textual data were analyzed using Emotional Text Mining to identify three levels of communication: the factors, the main themes (clusters), and the sub-themes. Results A total of 104 participants were enrolled, including 27 patients with complex chronic conditions (12 males, mean age = 11.1 ± 4.40), 33 parents, 6 siblings, 33 health professionals, and 5 teachers. Participants described the process of self-care through four main factors: "self-care", "external settings", "family", and "management". Five clusters (themes) were identified: (1) Self-care management (device; consulting); (2) Shift of agency (influencing factors; parents; school); (3) Self-care support (normal life and personal development; multidisciplinary support); (4) Daily self-care maintenance/monitoring; (5) Treatment adherence. Self-care management was mostly relevant for parents of children aged between 6 months and 3 years. Conclusion The self-care process varies according to the needs related to the specific developmental age and the evolution of the clinical condition over time. The contribution of the family, health professionals, and social networks is fundamental for adequate self-care. To help families manage the unstable condition of their children at home, it is necessary to strengthen support networks implement home care, and ensure continuity of care.
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Affiliation(s)
- Giuseppina Spitaletta
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Valentina Biagioli
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Francesca Greco
- Department of Languages and Literatures, Communication, Education and Society, University of Udine, Udine, Italy
| | - Rachele Mascolo
- Pediatric Semi-Intensive Care Area/Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Annachiara Liburdi
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Giulia Manzi
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Orsola Gawronski
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Riccardo Ricci
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Emanuela Tiozzo
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Rome, Italy
| | | | - Michele Salata
- Paediatric Palliative Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | | | - Immacolata Dall’Oglio
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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Holmström Rising M, Söderberg S. Experiences of transitions in daily life for parents of children with type 1 diabetes: An interpretive description. Res Nurs Health 2023; 46:313-322. [PMID: 36815583 DOI: 10.1002/nur.22303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 02/03/2023] [Accepted: 02/11/2023] [Indexed: 02/24/2023]
Abstract
In this study, we aimed to explore and describe the experiences of parents whose children have been diagnosed with type 1 diabetes (T1D) and the transitions of daily life. T1D is a long-term illness, and parents of children with T1D often become informal caregivers and face many challenges in their daily lives. A qualitative study design, in line with interpretive description, was used, and a sample of 10 parents of children with T1D participated in individual interviews. The COnsolidated criteria for REporting Qualitative Research (COREQ) checklist was used. The interviews were analyzed using interpretive descriptions. The analysis resulted in one main theme: "The realization of having taken 'daily life' for granted and having to accept a new reality," with six themes showing different transitions in the parents' daily lives, including transitions in daily life patterns, parenthood, in relationships with family and friends, relationships with school personnel, relationships with healthcare personnel, and in knowledge and learning about the illness. Parents experienced multifaceted changes that affected their lives, as shown by the six identified transitions. Being the parent of a child with T1D implies a new reality with complex, irreversible life changes that may be unknown and unspoken to healthcare professionals and society. Healthcare systems, school personnel, and society at large need to improve their knowledge regarding parents' situations to better support them in embracing a new reality for themselves and their children long after the onset of T1D.
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Affiliation(s)
| | - Siv Söderberg
- Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden
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Milde N, Rasmussen A, Nissen K, Kessel L. Support needs around the time of diagnosis of parents caring for an infant with visual impairment or blindness in Denmark: a qualitative study. BMJ Open 2023; 13:e067805. [PMID: 36810175 PMCID: PMC9945031 DOI: 10.1136/bmjopen-2022-067805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
OBJECTIVE The whole family is affected when an infant is diagnosed with visual impairment or blindness. We aimed to describe the support needs of parents around the time of diagnosis. DESIGN We used a descriptive qualitative method based on the theory of critical psychology and conducted five semistructured interviews with a total of eight parents of children under the age of 2 years who had been diagnosed with blindness or visual impairment before the age of 1 year. Thematic analysis was used to extract primary themes. SETTING The study was initiated by a tertiary hospital centre specialised in the ophthalmic management of children and adults with visual impairment. PARTICIPANTS Eight parents representing five families caring for a child under the age of 2 years with visual impairment or blindness participated in the study. The parents were recruited from the Department of Ophthalmology at Rigshospitalet, Denmark in relation to appointments in the clinic or by phone or email. RESULTS We identified three themes: (1) recognition and reactions during the time of diagnosis; (2) family, network and struggles; and (3) interaction with healthcare professionals. CONCLUSION The main lesson for healthcare professionals is to bring hope at a time when all hope may seem to be lost. Second, a need to direct attention to families with no or sparse supportive networks. Third, coordinating appointments between hospital departments and at-home therapies and reducing the number of appointments to allow parents time to establish a family relation with their child. Parents respond well to competent healthcare professionals who keep them informed and who see their child as an individual rather than as a diagnosis.
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Affiliation(s)
- Nina Milde
- Department of Ophthalmology, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark
| | - Annette Rasmussen
- Department of Ophthalmology, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark
| | - Kamilla Nissen
- Department of Ophthalmology, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark
- Department of Ophthalmology, Copenhagen University Hospital - Rigshospitalet - KennedyCenter, Glostrup, Denmark
| | - Line Kessel
- Department of Ophthalmology, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Baker K, Claridge AM. "I have a Ph.D. in my daughter": Mother and Child Experiences of Living with Childhood Chronic Illness. JOURNAL OF CHILD AND FAMILY STUDIES 2022; 32:1-12. [PMID: 36530562 PMCID: PMC9743100 DOI: 10.1007/s10826-022-02506-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/30/2022] [Indexed: 06/17/2023]
Abstract
Children in the United States are increasingly living with chronic illnesses. Existing literature has focused on adolescent children's experiences. The current study involved interviews with 10 families: children (ages 6-11) diagnosed with chronic illnesses and their mothers to better understand the experience of living with chronic illness. Using grounded theory, participants' responses fell into several themes: impact on family dynamics, parental advocacy, initial difficulty followed by resilience, unique stressors, and areas of social support. Overall, both mothers and children reported unique challenges related to living with childhood chronic illness, especially in terms of family dynamics, sibling relationships, and the mother-child relationship. However, almost all families also emphasized their ability to be resilient. The results have implications for medical practitioners and teachers who work with school-age children with chronic illnesses. Mothers need to feel supported and understood by professionals. Families need support to cope with stressors and strengthen couple, sibling, and parent-child relationships.
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Affiliation(s)
- Kendall Baker
- Mary Bridge Children’s Hospital, MultiCare, 317 Martin Luther King Jr Way, Tacoma, WA 98405 USA
| | - Amy M. Claridge
- Child Development and Family Science, Department of Family and Consumer Sciences, College of Education and Professional Studies, Central Washington University, 400 E University Way, MS: 7565, Ellensburg, WA USA
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13
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Flankegård G, Mörelius E, Rytterström P. Everyday life with childhood functional constipation: A qualitative phenomenological study of parents' experiences. J Pediatr Nurs 2022; 67:e165-e171. [PMID: 35931621 DOI: 10.1016/j.pedn.2022.07.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/08/2022] [Accepted: 07/19/2022] [Indexed: 10/16/2022]
Abstract
UNLABELLED Childhood functional constipation (FC) is a worldwide problem with treatment regiments affecting everyday life. AIM To explore parents´ experiences of living with a child with FC and its impact on everyday family life. METHOD A qualitative phenomenological interview study using a reflective lifeworld research approach. Interviews with 15 parents of otherwise healthy children aged 1-14 years affected by FC. FINDINGS Shame is the driving force making parents put everyday life on hold. The quest for control, self-imposed loneliness, guilt, inadequacy, and frustrating battles become essential parts of everyday life to protect it from FC-related shame. CONCLUSION FC has as great an impact on everyday life as any childhood illness. Every part of family life is affected by FC. Continuously family support and guidance are needed. PRACTICE IMPLICATIONS Healthcare professionals need to take FC more seriously, listen to the parents and try to understand their experiences of everyday life to enable custom made care plans with the family-unit in focus. Care with clinical sensitivity might help parents deal with the attendant shame and stigmatization that stem from illness beliefs about FC.
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Affiliation(s)
- Gunilla Flankegård
- Linköping University, Department of Health, Medicine and Caring Sciences, Sweden.
| | - Evalotte Mörelius
- Linköping University, Department of Health, Medicine and Caring Sciences, Sweden; School of Nursing and Midwifery, Edith Cowan University, Australia.
| | - Patrik Rytterström
- Linköping University, Department of Health, Medicine and Caring Sciences, Sweden.
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14
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Oral Care for Children with Special Healthcare Needs in Dentistry: A Literature Review. J Clin Med 2022; 11:jcm11195557. [PMID: 36233425 PMCID: PMC9573545 DOI: 10.3390/jcm11195557] [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: 07/21/2022] [Revised: 08/16/2022] [Accepted: 09/08/2022] [Indexed: 11/17/2022] Open
Abstract
Oral health is a very important aspect of general health, especially for vulnerable groups such as children with special healthcare needs. It is important to provide appropriate oral care in order to promote quality of life and good health for everyone, especially for children with special healthcare needs. Method: We reviewed the recent literature to collect knowledge regarding the delivery of quality oral care to children with special healthcare needs. We also explored some of the treatment management options that could address the needs of these children when attending dental clinics. Result: Unfortunately, we noted significant inequalities with issues related to oral health among those children. This situation often results in limitations to the activities of daily living for these children. There is therefore a need for much-needed advancements and refinements in oral healthcare to address the needs of children who have special healthcare needs. Conclusions: Providing children with special healthcare needs with high-quality dental care may necessitate active liaisons with healthcare facilitators and will require work across professions to make certain that these children’s oral health is also prioritized. Coordinated efforts by dental professionals are needed to provide dental health education and preventive interventions for these children.
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15
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Pollock MD, Ming D, Chung RJ, Maslow G. Parent-to-parent peer support for children and youth with special health care needs: Preliminary evaluation of a family partner program in a healthcare system. J Pediatr Nurs 2022; 66:6-14. [PMID: 35597132 DOI: 10.1016/j.pedn.2022.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 04/16/2022] [Accepted: 05/06/2022] [Indexed: 12/22/2022]
Abstract
PURPOSE Children and youth with special health care needs (CYSHCN) have complex care and coordination needs that are often managed by parents or primary caregivers. This study describes a parent-to-parent peer support pilot program for parents of CYSHCN implemented in both outpatient and inpatient settings across a large health system. DESIGN & METHODS Retrospective data from the Family Partner Program documentation in patient health records are described. Descriptions about the encounters and types of support provided are also reviewed using qualitative descriptive analysis. RESULTS Three Family Partners conducted 203 encounters with parents of 90 CYSHCN over six months. Family Partners provided both emotional and tangible support. Primary themes discussed included the persistent care, coordination and management needs related to parenting a child with complex care needs, the subsequent worry and stress about their child and family, and the need for stress management and self-care. CONCLUSION This study provides early evidence that implementation of a parent-to-parent peer support program for parents of CYSHCN in a large, academic medical center is feasible. Family Partners enhanced their healthcare team's ability to provide patient- and family-centered support for pediatric patients and their families through the provision of emotional and tangible support. PRACTICE IMPLICATIONS Family Partners, who are trained in effective use of the shared experience, the health coach model, and healthcare systems, and who are supported by a strong supervisory team, are ideally suited to support families and patients as they address their concerns and unmet needs and navigate complex health circumstances.
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Affiliation(s)
- McLean D Pollock
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States of America.
| | - David Ming
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States of America
| | - Richard J Chung
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States of America
| | - Gary Maslow
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States of America; Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States of America
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16
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Graaf G, Baiden P, Boyd G, Keyes L. Barriers to Respite Care for Children with Special Health Care Needs. J Dev Behav Pediatr 2022; 43:117-129. [PMID: 34310466 DOI: 10.1097/dbp.0000000000000992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 06/01/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to estimate time-specific, population-based prevalence of 14 specific barriers to respite services, as reported by parents of children with special health care needs (CSHCN) with and without emotional, behavioral, or developmental problems (EBDPs), and to identify individual, family, and environmental characteristics associated with the most common barriers to respite care for families of CSHCN. METHODS Descriptive, bivariate, and multivariable logistic regression analyses were used to examine data from the National Survey of Children with Special Health Care Needs for 2005/2006 and 2009/2010. RESULTS Among families reporting unmet need for respite care services, service availability or transportation barriers (23.8%) and cost barriers (19.8%) were the most commonly reported obstacles among all CSHCN, followed by lack of knowledge about where to obtain respite services (12.1%) and inconvenient service times (11.3%). Reports of location or availability barriers decreased significantly from 2005 to 2009, but service time barriers increased simultaneously. All types of barriers to respite services were reported significantly more frequently by CSHCN with EBDPs than those without, even when other demographic factors were controlled for. CSHCN conditional severity and discontinuity in insurance were positively associated with cost barriers, whereas CSHCN public health coverage was associated with reduced rates of reported cost and information barriers to respite care. CONCLUSION Increased understanding of parent-reported barriers to respite care for families of CSHCN is critical to creating structural and practice-oriented solutions that address obstacles and increase access to respite care for these vulnerable families.
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Affiliation(s)
- Genevieve Graaf
- School of Social Work, University of Texas at Arlington, Arlington, TX
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17
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Chow AJ, Iverson R, Lamoureux M, Tingley K, Jordan I, Pallone N, Smith M, Al-Baldawi Z, Chakraborty P, Brehaut J, Chan A, Cohen E, Dyack S, Gillis LJ, Goobie S, Graham ID, Greenberg CR, Grimshaw JM, Hayeems RZ, Jain-Ghai S, Jolly A, Khangura S, MacKenzie JJ, Major N, Mitchell JJ, Nicholls SG, Pender A, Potter M, Prasad C, Prosser LA, Schulze A, Siriwardena K, Sparkes R, Speechley K, Stockler S, Taljaard M, Teitelbaum M, Trakadis Y, van Karnebeek C, Walia JS, Wilson BJ, Wilson K, Potter BK. Families' healthcare experiences for children with inherited metabolic diseases: protocol for a mixed methods cohort study. BMJ Open 2022; 12:e055664. [PMID: 35193919 PMCID: PMC8867352 DOI: 10.1136/bmjopen-2021-055664] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 12/02/2022] Open
Abstract
INTRODUCTION Children with inherited metabolic diseases (IMDs) often have complex and intensive healthcare needs and their families face challenges in receiving high-quality, family centred health services. Improvement in care requires complex interventions involving multiple components and stakeholders, customised to specific care contexts. This study aims to comprehensively understand the healthcare experiences of children with IMDs and their families across Canada. METHODS AND ANALYSIS A two-stage explanatory sequential mixed methods design will be used. Stage 1: quantitative data on healthcare networks and encounter experiences will be collected from 100 parent/guardians through a care map, 2 baseline questionnaires and 17 weekly diaries over 5-7 months. Care networks will be analysed using social network analysis. Relationships between demographic or clinical variables and ratings of healthcare experiences across a range of family centred care dimensions will be analysed using generalised linear regression. Other quantitative data related to family experiences and healthcare experiences will be summarised descriptively. Ongoing analysis of quantitative data and purposive, maximum variation sampling will inform sample selection for stage 2: a subset of stage 1 participants will participate in one-on-one videoconference interviews to elaborate on the quantitative data regarding care networks and healthcare experiences. Interview data will be analysed thematically. Qualitative and quantitative data will be merged during analysis to arrive at an enhanced understanding of care experiences. Quantitative and qualitative data will be combined and presented narratively using a weaving approach (jointly on a theme-by-theme basis) and visually in a side-by-side joint display. ETHICS AND DISSEMINATION The study protocol and procedures were approved by the Children's Hospital of Eastern Ontario's Research Ethics Board, the University of Ottawa Research Ethics Board and the research ethics boards of each participating study centre. Findings will be published in peer-reviewed journals and presented at scientific conferences.
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Affiliation(s)
- Andrea J Chow
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Ryan Iverson
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | | | - Kylie Tingley
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Nicole Pallone
- Patient Partner, Canadian PKU & Allied Disorders Inc, Toronto, Ontario, Canada
| | - Maureen Smith
- Patient Partner, Canadian Organization for Rare Disorders, Toronto, Ontario, Canada
| | - Zobaida Al-Baldawi
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Pranesh Chakraborty
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Jamie Brehaut
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Alicia Chan
- Department of Medical Genetics, University of Alberta, Edmonton, Alberta, Canada
| | - Eyal Cohen
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sarah Dyack
- Division of Medical Genetics, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lisa Jane Gillis
- Department of Medicine, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
| | - Sharan Goobie
- Division of Medical Genetics, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ian D Graham
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Cheryl R Greenberg
- Rady Faculty of Health Sciences, Max Rady College of Medicine, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Robin Z Hayeems
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Shailly Jain-Ghai
- Department of Medical Genetics, University of Alberta, Edmonton, Alberta, Canada
| | - Ann Jolly
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Contagion Consulting Group, Ottawa, Ontario, Canada
| | - Sara Khangura
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Jennifer J MacKenzie
- Hamilton Health Sciences, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Nathalie Major
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - John J Mitchell
- Division of Pediatric Endocrinology, Department of Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Stuart G Nicholls
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Ottawa Methods Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Amy Pender
- Hamilton Health Sciences, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Murray Potter
- Hamilton Health Sciences, McMaster Children's Hospital, Hamilton, Ontario, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Chitra Prasad
- Department of Pediatrics, Western University, London, Ontario, Canada
| | - Lisa A Prosser
- Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Andreas Schulze
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Department of Biochemistry, University of Toronto, Toronto, ON, Canada
- Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Komudi Siriwardena
- Department of Medical Genetics, University of Alberta, Edmonton, Alberta, Canada
| | - Rebecca Sparkes
- Departments of Medical Genetics and Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Kathy Speechley
- Department of Pediatrics, Western University, London, Ontario, Canada
| | - Sylvia Stockler
- Department of Pediatrics, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Monica Taljaard
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Mari Teitelbaum
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Yannis Trakadis
- Department of Specialized Medicine, Division of Medical Genetics, McGill University Health Centre, Montreal, Quebec, Canada
| | - Clara van Karnebeek
- Department of Pediatrics, Radboud University Medical Center, Nijmegen, Gelderland, The Netherlands
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Jagdeep S Walia
- Medical Genetics, Department of Pediatrics, Kingston Health Sciences Centre, Kingston, Ontario, Canada
- Department of Pediatrics, Queen's University, Kingston, Ontario, Canada
| | - Brenda J Wilson
- Faculty of Medicine Division of Community Health and Humanities, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Kumanan Wilson
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Bruyere Research Institute, Ottawa, Ontario, Canada
| | - Beth K Potter
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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Lawrence PR, Spratling R. A Theory for Understanding Parental Workload and Capacity to Care for Children With Medical Complexity. Res Theory Nurs Pract 2022; 36:34-46. [PMID: 35173026 DOI: 10.1891/rtnp-2022-0026] [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: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Children with medical complexity (CMC) experience poor health outcomes despite the high cost of care, and their parents face challenges in providing complex care. Poor health outcomes may be related to an imbalance between parental demands to manage care and their ability to meet the demands needed to provide complex care. However, this phenomenon has not been explored. In addition, much of the existing research focused on CMC lacks an overarching theoretical framework. The purpose of this article is to outline factors that impact families of CMC described in the literature. This article proposes a modified framework using theory derivation, which highlights the concepts of parental workload and capacity and demonstrates how they are related to CMC health. METHODS A revised theoretical framework using theory derivation by Walker and Avant is presented using findings from the CMC literature that most affect the parents of these children. RESULTS Applying content from two existing theories using concepts of relevance results in a framework that provides richer insight into the relationship between parental workload and parental capacity, particularly when parental workload outweighs parental capacity. This framework allows for the examination of how an imbalance between workload and capacity impacts CMC health outcomes. IMPLICATIONS FOR PRACTICE Although further study is needed to test the proposed theory, the framework can be used to examine these relationships with hopes of developing interventions to decrease parental workload and enhance parental ability.
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Affiliation(s)
- Patricia R Lawrence
- Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, USA
| | - Regena Spratling
- Associate Dean Chief Academic Officer for Nursing, Associate Professor, School of Nursing, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, USA
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Graaf G, Baiden P, Keyes L, Boyd G. Barriers to Mental Health Services for Parents and Siblings of Children with Special Health Care Needs. JOURNAL OF CHILD AND FAMILY STUDIES 2022; 31:881-895. [PMID: 35039741 PMCID: PMC8754365 DOI: 10.1007/s10826-022-02228-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/03/2022] [Indexed: 06/14/2023]
Abstract
Caregivers of children with special health care needs (CSHCNs), especially those whose children have emotional, behavioral, or developmental problems (EBDPs), experience considerable strain and stress related to caring for their child's special needs. The enormous burden of caregiving can decrease a parent's ability to provide care, impacting the health of the child, the parents, and overall family functioning. To manage these challenges, these parents report the need for mental health care for themselves or their children, but many families with need go without care. Comprehensive knowledge about barriers to family mental health care for families of CSHCN is lacking. This study examines data from the National Survey of Children with Special Health Care Needs (2005/2006 and 2009/2010) to estimate time-specific, population-based prevalence of fourteen specific barriers to family mental health services and identifies risk factors for experiencing barriers to care for families of CSHCN. Among all CSHCN, cost barriers (33.5%) and lack of insurance (15.9%) were the most commonly reported obstacles to service access in 2005 and 2009, followed by inconvenient service times (12.3%), and locations (8.7%). Reports of these barriers increased significantly from 2005 to 2009. All types of barriers to family mental health services were reported significantly more frequently by CSHCN with EBDPs than by those without. CSHCN's race, insurance, and parent education and income levels were factors associated with cost barriers to family mental health care. Understanding barriers to mental health care for families of CSHCN is critical to creating policy and practice solutions that increase access to mental health care for these families.
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Affiliation(s)
- Genevieve Graaf
- School of Social Work, University of Texas at Arlington 211 South Cooper Street, Box 19129, Arlington, TX 76019 USA
| | - Philip Baiden
- School of Social Work, University of Texas at Arlington 211 South Cooper Street, Box 19129, Arlington, TX 76019 USA
| | - Latocia Keyes
- Department of Social Work, Tarleton State University, 1333 W. Washington, Stephenville, TX 76402 USA
| | - George Boyd
- School of Social Work, University of Texas at Arlington 211 South Cooper Street, Box 19129, Arlington, TX 76019 USA
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Bristow S, Usher K, Power T, Jackson D. Understanding maternal resilience; Lesson learnt from rural mothers caring for a child with a chronic health condition. J Clin Nurs 2021; 31:2593-2604. [PMID: 34693563 DOI: 10.1111/jocn.16081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/14/2021] [Accepted: 09/30/2021] [Indexed: 11/30/2022]
Abstract
AIM This study aimed to understand the lived experience of rural mothers caring for a child with a chronic health condition and to understand their perspectives on the support, services and resources they identify as necessary to effectively manage caregiving. BACKGROUND Maternal caregivers in rural areas experience difficulty accessing specialist health care for their child and can also experience geographical and social isolation. Understanding the factors that enable these maternal caregivers to overcome the challenges and adversities faced is crucial to help nurses identify and facilitate avenues for support and resources. DESIGN This study employed a phenomenological design. The study is reported in line with Consolidated criteria for reporting qualitative research guidelines (COREQ). METHODS Semi-structured interviews were conducted with 17 maternal caregivers in rural New South Wales, Australia, who had at least one child with a chronic health condition aged between 2-18 years. Data were collected from March to June 2018. Thematic analysis was used to develop a thematic framework. This paper reports on one of the major themes identified in this research, specifically maternal resilience. RESULTS Participants demonstrated maternal resilience by creating meaningful social connections, cultivating networks, developing problem-solving skills, enhancing their self-efficacy and finding a sense of purpose through hope and optimism. These strategies provide nurses insight into how some rural women overcome adversities associated with their maternal labour required in caring for a child with a chronic health condition. CONCLUSION This study found that participants overcame the challenges related to their caregiving work, emerging as resilient caregivers. Understanding maternal resilience assists nurses to provide the services rural mothers in Australia need to care for their child with a CHC. RELEVANCE TO CLINICAL PRACTICE Findings from this study provide insight into the experiences of rural maternal caregivers of children with a chronic health condition and identify the strategies they adopt to overcome caregiver challenges. Understanding these strategies allows nurses to improve care and support for rural mothers using a strength-based approach to build maternal resilience.
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Affiliation(s)
- Sally Bristow
- School of Health, University of New England, Armidale, Australia
| | - Kim Usher
- School of Health, University of New England, Armidale, Australia
| | - Tamara Power
- Susan Wakil School of Nursing, University of Sydney, Sydney, New South Wales, Australia
| | - Debra Jackson
- Susan Wakil School of Nursing, University of Sydney, Sydney, New South Wales, Australia
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21
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Graaf G, Annis I, Martinez R, Thomas KC. Predictors of Unmet Family Support Service Needs in Families of Children with Special Health Care Needs. Matern Child Health J 2021; 25:1274-1284. [PMID: 33942229 DOI: 10.1007/s10995-021-03156-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study describes rates of perceived and unmet need for family support services (care coordination, respite care, and family mental health care) among a national sample of children with special health care needs (CSHCN), distinguishing children with emotional, behavioral, or developmental problems (EBDPs) from children with primarily physical chronic conditions. It also examines if a child having EBDPs is associated with perceived and unmet family support service needs and investigates public versus private health insurance's moderating effect on this association. METHODS Using data from the National Survey of Children with Special Health Care Needs (2005/2006 and 2009/2010), this cross-sectional study uses multi-level, fixed effects logistic regression. RESULTS When compared to CSHCN with no EBDPs, parents of CSHCN with EBDPs report greater need for all family support services and greater rates of unmet need for all support services. This pattern of greater need for CSHCN with EBDPs versus those without is similar among those with public and private health insurance. Among CSHCN with family support needs, however, the pattern differs. For CSHCN with EBDPs, having public insurance is associated with lower probabilities of unmet needs compared to private insurance. For CSHCN without EBDPs, having public insurance has a mixed effect on probability of reporting unmet need. CONCLUSION Having EBDPs and public insurance is associated with increased perceived need, but public insurance also confers particular benefit for children with EBDPs.
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Affiliation(s)
- Genevieve Graaf
- School of Social Work, University of Texas At Arlington, Social Work Complex-A, 112D 211 South Cooper Street, Box 19129, Arlington, TX, 76019, USA.
| | - Izabela Annis
- Eshelman School of Pharmacy, University of North Carolina At Chapel Hill, Chapel Hill, USA
| | - Regina Martinez
- School of Social Work, University of Texas At Arlington, Social Work Complex-A, 112D 211 South Cooper Street, Box 19129, Arlington, TX, 76019, USA
| | - Kathleen C Thomas
- Eshelman School of Pharmacy, University of North Carolina At Chapel Hill, Chapel Hill, USA
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22
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Clancy A, Olaso EM, Larkin P, Brenner M. Education on childrens complex care needs in general nursing curricula in Europe: An inductive content analysis. Nurse Educ Pract 2021; 52:103034. [PMID: 33799094 DOI: 10.1016/j.nepr.2021.103034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 02/06/2021] [Accepted: 03/13/2021] [Indexed: 11/16/2022]
Abstract
Nursing programmes must prepare children's nurses to respond effectively to the health needs of children and young people. The aim of this study was to examine general nursing curricula for child-related content. A non-experimental descriptive study design was used. Curricular plans from 18 countries where general nursing education was the only requirement to care for children with complex care needs in the community were analysed. Curricula were obtained from institutions who educated the largest number of student nurses in each country. An inductive analysis of the curricula was carried out. Almost three-quarters of the curricula (n = 13) offered one or more compulsory core modules on children. The content varied from one to sixteen ECTS credits showing a wide variation in the focus on children in these curricula. In 12 of the 18 countries most of the child-related content was in other modules. The sample curricula from five countries had no compulsory modules on children. Child-related curricular content varied considerably across countries, with little content focused on children with complex care needs. This can illustrate that nurses are not always adequately prepared to meet the needs of sick children.
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Affiliation(s)
- Anne Clancy
- Department of Health and Care Sciences, UiT the Norwegian University of the Arctic, Campus Harstad, Havnegata 5, 9480, Harstad, Norway.
| | - Elena Montañana Olaso
- Postdoctoral Research Fellow, Models of Child Health Appraised (MOCHA) Study, School of Nursing and Midwifery, Trinity College Dublin, Room 6.23, Institute of Population Health, Russell Centre, Tallaght Cross, Dublin 24., Ireland.
| | - Philip Larkin
- Directeur Académique, UNIL
- Université de Lausanne, CHUV
- Centre Hospitalier Universitaire Vaudois, Faculté de Biologie et de Médecine - FBM, Institut Universitaire de Formation et de Recherche en Soins - IUFRS, Bureau -01/157 - SV-A Secteur Vennes - Rte de La Corniche 10, CH-1010, Lausanne, Switzerland.
| | - Maria Brenner
- Head of Discipline for Children's Nursing School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, 24 D'Olier Street, Dublin, Ireland.
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23
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Matthews EJ, Puplampu V, Gelech JM. Tactics and Strategies of Family Adaptation among Parents Caring for Children and Youth with Developmental Disabilities. Glob Qual Nurs Res 2021; 8:23333936211028184. [PMID: 34263013 PMCID: PMC8246494 DOI: 10.1177/23333936211028184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 06/06/2021] [Accepted: 06/07/2021] [Indexed: 12/14/2022] Open
Abstract
The stressors experienced by families caring for children and youth with developmental disabilities (DD) impact quality of life for all family members. Families employ creative practices to cope and thrive in the midst of such challenges. This study sought to understand the adaptive practices, tactics, and strategies engaged in by parents. We interviewed 39 parents of 46 children and youth with DD in Canada. Thematic analysis elucidated three categories of adaptations and twelve tactics and strategic actions at three ecological levels: within the system-adapting with everyday tactics and strategies; within our family-constructing spaces of care; within myself-adjusting perceptions of adversity. Our critical interpretation highlights an ecology of parental labor across varying psychosocial and health care service contexts in which parents strive to make a good life for their children and families. Nurses can empower and enhance their well-being by conducting holistic assessments and targeted family nursing interventions.
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24
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Rothwell DW, Lach LM, Kohen DE, Findlay LC, Arim RG. Income trajectories of families raising a child with a neurodisability. Disabil Rehabil 2020; 44:1923-1932. [PMID: 32898428 DOI: 10.1080/09638288.2020.1811782] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE To examine household income trajectories of children with and without neurodisability over a period of 6 years. METHOD We used four cycles of the Canadian National Longitudinal Survey of Children and Youth, a longitudinal study of the development and well-being of Canadian children from birth into adulthood. RESULTS While household income increased over time for both groups, families of children with neurodisability had consistently lower household income compared to families of children without neurodisability even after controlling for child and family socio-demographic characteristics. The presence of an interaction effect between parent work status and child with neurodisability at baseline indicated that among children whose parent(s) were not working at baseline, household incomes did not differ between children with and without neurodisability. CONCLUSIONS The association between child with neurodisability and lower household income may not hold for all types of parents', working status is an important consideration.Implications for RehabilitationFindings support the health selection hypothesis that health status shapes diverging economic conditions over time: children with a ND have lower household incomes than children without a ND child across all waves of the Canadian National Longitudinal Survey of Youth.Income gaps did not increase or decrease over time; rehabilitation services and policies must consider the lower average incomes associated with raising a child with a ND.Social assistance support likely plays a key role in closing the gap, especially for non-working families.
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Affiliation(s)
- David W Rothwell
- Oregon State University, Human Development and Family Sciences, Corvallis, OR, USA
| | - Lucyna M Lach
- McGill University, School of Social Work, Montreal, Canada
| | - Dafna E Kohen
- Health Analysis Division, Statistics Canada, Ottawa, Canada
| | | | - Rubab G Arim
- Health Analysis Division, Statistics Canada, Ottawa, Canada
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25
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Clancy A, Simonsen N, Lind J, Liveng A, Johannessen A. The meaning of dignity for older adults: A meta-synthesis. Nurs Ethics 2020; 28:878-894. [PMID: 32613895 PMCID: PMC8408827 DOI: 10.1177/0969733020928134] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Dignified care is a central issue in the nursing care of older adults. Nurses are expected to treat older adults with dignity, and older adults wish to be treated in a dignified manner. Researchers have recommended investigating the concept of dignity based on specific contexts and population groups. This meta-synthesis study aims to explore the understandings of dignity from the perspective of older adults in the Nordic countries. Synthesising findings from qualitative studies on older adults’ experiences of dignity has provided important insight into what can be essential for dignified care in a Nordic context. The importance of visibility and recognition for the experience of dignity is an overarching theme in all the studies. The participants’ descriptions mostly implicated an existence dominated by a lack of recognition. The older adults do not feel valued as people or for their contribution to society and strive to tone down their illnesses in an attempt to become more visible and acknowledged as people. Toning down their illnesses and masking their needs can protect their independence. At the same time, becoming less visible can leave them without a voice. The metaphorical phrase protected and exposed by a cloak of invisibility is used to express the authors’ overall interpretation of the findings. Lack of recognition and being socially invisible is a genuine threat to older adults’ dignity.
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Affiliation(s)
- Anne Clancy
- 87560UiT Norges Arktiske Universitet, Norway
| | - Nina Simonsen
- Folkhälsan Research Center, Finland; 3855University of Helsinki, Finland
| | | | | | - Aud Johannessen
- Vestfold Hospital Trust, Norway; 11310University of South-Eastern Norway, Norway
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26
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Bristow S, Power T, Jackson D, Usher K. Conquering the great divide: Rural mothers of children with chronic health conditions accessing specialist medical care for their children. Collegian 2020. [DOI: 10.1016/j.colegn.2019.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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27
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DiFusco LA, Saylor JL, Schell KA. Maternal experiences of caring for a child with a ventricular assist device. Pediatr Transplant 2020; 24:e13620. [PMID: 31815350 DOI: 10.1111/petr.13620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 10/19/2019] [Accepted: 11/08/2019] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to gain a deeper understanding of maternal experiences of caring for their child with a VAD at home as a bridge to transplant. A descriptive, qualitative study was conducted via telephone-recorded guided interviews. Participants were caring for or had a child with a VAD between 4 and 16 years old. Data collection occurred over a 12-month period. Using the snowball sampling technique, a purposeful sample of mothers (n = 6) was consented and completed the interview. The data were analyzed using an iterative process of thematic analysis. Five themes emerged: physical modifications, the loss of independence, the emotional rollercoaster, support from others, and transitions on and off the device. We introduced new evidence about sleep, contraception, and heart transplantation, and how VAD therapy impacts childhood development. The mean duration of VAD support was 263 ± 170 days. Five children had heart transplants by the time of interview. To the best of our knowledge, this is the first qualitative study in the US that explores maternal experiences of caring for a child who is living at home with a VAD. VAD therapy is a novel approach to managing advanced heart failure among children and presents unique challenges when caring for them at home. Results provide insight into the education, physical environment, and support needed by parents.
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Affiliation(s)
- Leigh Ann DiFusco
- The University of Delaware School of Nursing, Newark, DE, USA.,The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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28
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Parrish II RH, Casher D, van den Anker J, Benavides S. Creating a Pharmacotherapy Collaborative Practice Network to Manage Medications for Children and Youth: A Population Health Perspective. CHILDREN (BASEL, SWITZERLAND) 2019; 6:E58. [PMID: 30970616 PMCID: PMC6518168 DOI: 10.3390/children6040058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 04/02/2019] [Accepted: 04/03/2019] [Indexed: 02/07/2023]
Abstract
Children with special health care needs (CSHCN) use relatively high quantities of healthcare resources and have overall higher morbidity than the general pediatric population. Embedding clinical pharmacists into the Patient-Centered Medical Home (PCMH) to provide comprehensive medication management (CMM) through collaborative practice agreements (CPAs) for children, especially for CSHCN, can improve outcomes, enhance the experience of care for families, and reduce the cost of care. Potential network infrastructures for collaborative practice focused on CSHCN populations, common language and terminology for CMM, and clinical pharmacist workforce estimates are provided. Applying the results from the CMM in Primary Care grant, this paper outlines the following: (1) setting up collaborative practices for CMM between clinical pharmacists and pediatricians (primary care pediatricians and sub-specialties, such as pediatric clinical pharmacology); (2) proposing various models, organizational structures, design requirements, and shared electronic health record (EHR) needs; and (3) outlining consistent documentation of CMM by clinical pharmacists in CSHCN populations.
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Affiliation(s)
- Richard H Parrish II
- Department of Pharmacy Services, St. Christopher's Hospital for Children ⁻ American Academic Health System, 160 East Erie Avenue, Philadelphia, PA 19134, USA.
- School of Pharmacy, Virginia Commonwealth University, Richmond, VA 23298, USA.
| | - Danielle Casher
- Department of Pediatrics, Drexel University College of Medicine, Philadelphia, PA 19134, USA.
| | - Johannes van den Anker
- Universitäts-Kinderspital beider Basel (UKBB), Spitalstrasse 33, CH-4031 Basel, Switzerland.
- Children's National Health System, 111 Michigan Avenue, Washington, DC 20010, USA.
- Erasmus Medical Center-Sophia Children's Hospital, s-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
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