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Dewan T, Mackay L, Asaad L, Buchanan F, Hayden KA, Montgomery L. Experiences of Inpatient Healthcare Services Among Children With Medical Complexity and Their Families: A Scoping Review. Health Expect 2024; 27:e14178. [PMID: 39229799 PMCID: PMC11372467 DOI: 10.1111/hex.14178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 07/24/2024] [Accepted: 07/25/2024] [Indexed: 09/05/2024] Open
Abstract
BACKGROUND Children with medical complexity (CMC) have high healthcare utilization and face unique challenges during hospital admissions. The evidence describing their experiences of inpatient care is distributed across disciplines. The aim of this scoping review was to map the evidence related to the inpatient experience of care for CMC and their families, particularly related to key aspects and methodological approaches, and identify gaps that warrant further study. METHODS This scoping review was conducted in accordance with JBI methodology and included all studies that reported experiences of acute hospital care for CMC/families. All study designs were included. Databases searched included EMBASE, CINAHL Plus with Full Text, Web of Science, MEDLINE(R) and APA PsycInfo from 2000 to 2022. Details about the participants, concepts, study methods and key findings were abstracted using a data abstraction tool. A thematic analysis was conducted. RESULTS Forty-nine papers were included: 27 qualitative studies, 10 quantitative studies, six mixed methods studies, two descriptive studies and four reviews. Some quantitative studies used validated instruments to measure experience of care, but many used non-validated surveys. There were a few interventional studies with a small sample size. Results of thematic analysis described the importance of negotiating care roles, shared decision-making, common goal setting, relationship-building, communication, sharing expertise and the hospital setting itself. CONCLUSION CMC and families value relational elements of care and partnering through sharing expertise, decision-making and collaborative goal-setting when admitted to hospital. PATIENT OR PUBLIC CONTRIBUTION This review was conducted in alignment with the principles of patient and family engagement. The review was conceptualized, co-designed and conducted with the full engagement of the project's parent-partner. This team member was involved in all stages from constructing the review question, to developing the protocol, screening articles and drafting this manuscript.
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Affiliation(s)
- Tammie Dewan
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Lyndsay Mackay
- College of Nursing, Trinity Western University, Langley, British Columbia, Canada
| | - Lauren Asaad
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Francine Buchanan
- Patient, Family and Community Engagement, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - K Alix Hayden
- Library and Cultural Resources, University of Calgary, Calgary, Alberta, Canada
| | - Lara Montgomery
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
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Howitt L, Jacob G, Zucal G, Smith J, Crocker Ellacott R, Sharkey S. Navigation Support during Transitions in Care for Persons with Complex Care Needs: A Systematic Review. Healthcare (Basel) 2024; 12:1814. [PMID: 39337156 PMCID: PMC11431248 DOI: 10.3390/healthcare12181814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 08/29/2024] [Accepted: 09/01/2024] [Indexed: 09/30/2024] Open
Abstract
Persons with complex care needs that arise due to chronic health conditions, serious illness, or social vulnerability are at increased risk of adverse health outcomes during transitions in care. To inform the development of a best practice guideline, a systematic review was conducted to examine the effect that navigation support has during transitions in care on quality of life, emergency department visits, follow-up visits, patient satisfaction, and readmission rates for persons with complex care needs. Eight databases were searched from 2016 to 2023. Studies were appraised using validated tools and data were extracted and presented narratively. The GRADE approach was used to assess the certainty of the evidence. Seventeen studies were included and the majority focused on transitions from hospital to home. Navigation support was provided for one month to one year following a transition. Results weakly indicate that providing navigation support during transitions in care may increase follow-up visits, reduce readmissions within 30 days, and increase patient satisfaction for persons with complex care needs. There were no important differences for quality of life and emergency department visits within 30 days of a transition. The certainty of the evidence was very low. Providing navigation support during transitions in care may improve outcomes for persons with complex needs; however, there remains uncertainty regarding the effectiveness of this intervention and more high-quality research is needed.
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Affiliation(s)
- Lyndsay Howitt
- Registered Nurses' Association of Ontario, 500-4211 Yonge Street, Toronto, ON M2P 2A9, Canada
| | - Greeshma Jacob
- Registered Nurses' Association of Ontario, 500-4211 Yonge Street, Toronto, ON M2P 2A9, Canada
| | - Giulia Zucal
- Registered Nurses' Association of Ontario, 500-4211 Yonge Street, Toronto, ON M2P 2A9, Canada
| | - Judy Smith
- Independent Researcher, Newmarket, ON L3Y 7T1, Canada
| | - Rhonda Crocker Ellacott
- Thunder Bay Regional Health Sciences Centre, Thunder Bay Regional Health Research Institute, 980 Oliver Road, Thunder Bay, ON P7B 6V4, Canada
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Champagne E, Chénard J, Simard C, Bonanno M, Bogossian A, Roberge V, Olivier-d'Avignon M, Ummel D, Fortin G, Bergeron F, Bonenfant F. Scoping Review on Transitions in the Context of Pediatric Palliative Care. J Palliat Med 2024. [PMID: 39047058 DOI: 10.1089/jpm.2023.0673] [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: 07/27/2024] Open
Abstract
Background: Children with complex and chronic conditions receiving palliative care will likely experience many transitions during their life and their treatments. Transition periods for children with life-limiting conditions and their families can be bewildering and highly anxiety-inducing. However, clinical observations seem to point to a more heterogenous care offer, including a lack or discontinuity of services, at the expense of their quality of life. Objective: This paper aims to establish a portrait of the existing literature and identify research gaps on the multiple transitions experienced by this population. Design: A scoping review is provided, following a PRISMA protocol. MEDLINE, PubMed and CINAHL were consulted. The search strategy is based on three key concepts: (1) palliative care/complex condition, (2) child/adolescent, and (3) transition. Articles were screened with the help of Covidence. Results: A total of 72 articles are included for analysis. The aimed population is either identified by age group or by medical status. Respondents are most often parents rather than the children themselves. Transitions include: reaching adulthood, changes in care environment, changes in medical status, and school integration. Conclusion: The discussion notices a definitional murkiness about transitions and highlights the fact that the multifaceted and complex nature of transition over time is largely ignored. New research should involve a diversity of participants and include children's voices. Recommendations include clearer concept definitions, health care policies that adopt an ecosystemic approach, and professional training in the systemic family approach in palliative care.
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Affiliation(s)
- Elaine Champagne
- Chair of Religion, spirituality and health, Faculty of theology and religious sciences, Université Laval, Québec Canada
| | - Josée Chénard
- Social Work Department, Université du Québec en Outaouais, St-Jérôme Canada
| | - Chantale Simard
- Department of health sciences, Université du Québec à Chicoutimi, Canada
| | | | - Aline Bogossian
- School of Social Work, Université de Montréal, Montréal, Canada
| | - Véronique Roberge
- Department of health sciences, Université du Québec à Chicoutimi, Canada
| | | | - Deborah Ummel
- Faculty of Education, Université de Sherbrooke, Sherbrooke, Canada
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Hodgson S, Noack K, Griffiths A, Hodgins M. Between equilibrium and chaos, with little restitution: a narrative analysis of qualitative interviews with clinicians and parent carers of children with medical complexity. BMC Health Serv Res 2024; 24:504. [PMID: 38654202 DOI: 10.1186/s12913-024-10973-6] [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: 08/23/2023] [Accepted: 04/09/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Children with medical complexity (CMC) comprise 1% of the paediatric population, but account for over 30% of health service costs. Lack of healthcare integration and coordination for CMC is well-documented. To address this, a deep understanding of local contextual factors, experiences, and family-identified needs is crucial. The aim of this research was to investigate the lived experiences of CMC, their families, and healthcare staff, focusing on understanding the dynamics of care coordination and the challenges faced in providing integrated care, in order to inform the development of effective, family-centred models of care. METHODS In April to July 2022, 31 semi-structured interviews were conducted with parents/guardians of CMC and healthcare professionals who care for CMC. Interviews explored complex paediatric care and care coordination barriers. An inductive thematic analysis was undertaken. Themes were then further explored using Frank's narrative approach. RESULTS Through analysis, we identified that the restitution typology was absent from both staff and parent/guardian narratives. However, we uncovered narratives reflective of the chaos and quest typologies, depicting overwhelming challenges in managing complex medical needs, and proactive efforts to overcome barriers. Importantly, a novel typology termed 'equilibrium' was uncovered. Narratives aligning with this typology described medical complexity as a balance of power and a negotiation of roles. Within the equilibrium typology, illness trajectory was described as a series of negotiations or balancing acts between healthcare stakeholders, before finally reaching equilibrium. Participants described seeking a balance, where their expertise is respected, whilst maintaining the ability to rely on professional guidance and support. These insights provide a nuanced understanding of the multifaceted narratives shaping care experiences for CMC and their families. CONCLUSIONS Our research delineates multifaceted challenges within the care landscape for CMC, their families, and healthcare staff. Embracing the equilibrium narrative typology highlights the criticality of tailored, integrated care models. This necessitates prioritising clear role delineation and communication among caregivers, implementing support systems addressing the challenges of continuous caregiving, and integrating parents/guardians as essential members of the care team. These insights advocate for pragmatic and sustainable strategies to address the unique needs of CMC and their families within healthcare systems.
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Affiliation(s)
| | - Kirsten Noack
- Hunter New England Local Health District, Newcastle, Australia
| | | | - Michael Hodgins
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia
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Glick AF, Farkas JS, Magro J, Shah AV, Taye M, Zavodovsky V, Rodriguez RH, Modi AC, Dreyer BP, Famiglietti H, Yin HS. Management of Discharge Instructions for Children With Medical Complexity: A Systematic Review. Pediatrics 2023; 152:e2023061572. [PMID: 37846504 PMCID: PMC10598634 DOI: 10.1542/peds.2023-061572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/25/2023] [Indexed: 10/18/2023] Open
Abstract
CONTEXT Children with medical complexity (CMC) are at risk for adverse outcomes after discharge. Difficulties with comprehension of and adherence to discharge instructions contribute to these errors. Comprehensive reviews of patient-, caregiver-, provider-, and system-level characteristics and interventions associated with discharge instruction comprehension and adherence for CMC are lacking. OBJECTIVE To systematically review the literature related to factors associated with comprehension of and adherence to discharge instructions for CMC. DATA SOURCES PubMed/Medline, Embase, Cochrane Central Register of Controlled Trials, PsycInfo, Cumulative Index to Nursing and Allied Health Literature, Web of Science (database initiation until March 2023), and OAIster (gray literature) were searched. STUDY SELECTION Original studies examining caregiver comprehension of and adherence to discharge instructions for CMC (Patient Medical Complexity Algorithm) were evaluated. DATA EXTRACTION Two authors independently screened titles/abstracts and reviewed full-text articles. Two authors extracted data related to study characteristics, methodology, subjects, and results. RESULTS Fifty-one studies were included. More than half were qualitative or mixed methods studies. Few interventional studies examined objective outcomes. More than half of studies examined instructions for equipment (eg, tracheostomies). Common issues related to access, care coordination, and stress/anxiety. Facilitators included accounting for family context and using health literacy-informed strategies. LIMITATIONS No randomized trials met inclusion criteria. Several groups (eg, oncologic diagnoses, NICU patients) were not examined in this review. CONCLUSIONS Multiple factors affect comprehension of and adherence to discharge instructions for CMC. Several areas (eg, appointments, feeding tubes) were understudied. Future work should focus on design of interventions to optimize transitions.
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Affiliation(s)
| | | | - Juliana Magro
- Health Sciences Libraries, NYU Langone Health, New York, New York
| | | | | | | | | | - Avani C. Modi
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | | | | | - H. Shonna Yin
- Department of Pediatrics
- Department of Population Health, NYU Langone Health, New York, New York
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Lee DG, Choi MY. [Effects of Emotional Intelligence on Job Satisfaction of Pediatric Nurses: The Mediating Effect of Communication Skills and Pediatric Nurse-Parent Partnership]. J Korean Acad Nurs 2023; 53:514-524. [PMID: 37977562 DOI: 10.4040/jkan.23044] [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: 03/14/2023] [Revised: 06/19/2023] [Accepted: 08/07/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE This study aimed to identify the mediating effects of communication skills and pediatric nurse-parent partnership on the relationship between emotional intelligence and job satisfaction among pediatric nurses. METHODS A survey was administered to 205 pediatric nurses working in children's, general, and tertiary hospitals situated in Chungcheong province and Seoul. Data were collected in August and September 2022. The collected data were analyzed using SPSS Statistics version 26.0 along with the PROCESS macro program. RESULTS Emotional intelligence had a significant effect, and was a critical factor affecting the job satisfaction of pediatric nurses. Furthermore, communication skills and nurse-parent partnership had a serial double mediating effect. CONCLUSION These findings underscore the significance of conducting job satisfaction improvement programs, including strategies for augmenting emotional intelligence, bolstering communication skills, and fostering nurse-parent partnership.
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Affiliation(s)
- Da Gyeon Lee
- Department of Nursing Science, Chungbuk National University, Cheongju, Korea
| | - Mi-Young Choi
- Department of Nursing Science, Chungbuk National University, Cheongju, Korea.
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Wilson N, Whittaker K, Arnott J, Burke L, Beresford MW, Peak M. Stuck in transit: A qualitative study of the transitional care needs of young people with epilepsy and juvenile idiopathic arthritis. J Child Health Care 2023; 27:435-449. [PMID: 35235476 PMCID: PMC10472714 DOI: 10.1177/13674935221074777] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Transition services for young people with long-term conditions often fall short. This qualitative study explored perspectives on service features that enable effective transition in epilepsy and juvenile idiopathic arthritis. Patients, parents, clinicians and service commissioners took part in semi-structured interviews (n = 18). Thematic analysis was used to identify key features, barriers and facilitators of effective transition across participant groups. Analysis led to the development of nine sub-themes which mapped to overarching domains of communication, capability, continuity and capacity. Findings include the need for age appropriate communication, the link between parental dependence, self-care and patient knowledge, the value of service integration for continuity and the impact of capacity on flexible and age appropriate transition services.
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Affiliation(s)
- Neil Wilson
- Faculty of Health and Care, University of Central Lancashire, Preston, UK
| | - Karen Whittaker
- Visiting Fellow, School of Nursing, University of Central Lancashire, Preston, UK
| | - Janine Arnott
- Faculty of Health and Care, University of Central Lancashire, Preston, UK
| | - Lauren Burke
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Michael W Beresford
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
- Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Matthew Peak
- Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
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Loureiro FM, Ribeiro SE. On 'how Children's participation ought to be practiced: A preliminary ethical framework to optimise the participation of children with osteogenesis imperfecta in health care?'. J Clin Nurs 2022. [PMID: 36564890 DOI: 10.1111/jocn.16609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 10/06/2022] [Indexed: 12/25/2022]
Affiliation(s)
- Fernanda Manuela Loureiro
- Egas Moniz School of Health & Science, Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Caparica, Portugal
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Vaz LE, Jungbauer RM, Jenisch C, Austin JP, Wagner DV, Everest SJ, Libak AJ, Harris MA, Zuckerman KE. Caregiver Experiences in Pediatric Hospitalizations: Challenges and Opportunities for Improvement. Hosp Pediatr 2022; 12:1073-1080. [PMID: 36412061 DOI: 10.1542/hpeds.2022-006645] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND There are limited qualitative data describing general pediatric hospitalizations through the caregivers' lens, and most focus on one particular challenge or time during the hospitalization. This qualitative study aimed to address a gap in the description of the breadth and depth of personal challenges caregivers may face during the entire hospitalization, irrespective of severity of patient illness or diagnosis, and explored caregiver-suggested interventions. METHODS Caregivers of pediatric patients on the hospitalist service at a Pacific Northwest children's hospital were interviewed to explore their hospitalization experience and solicit feedback for potential interventions. Content was coded iteratively using a framework analysis until thematic saturation was met. Findings were triangulated through 2 focus groups, 1 with parent advisors and the other with hospital physicians and nurses. RESULTS Among 14 caregivers (7 each of readmitted and newly admitted patients) and focus group participants, emergent domains on difficulties faced with their child's hospitalization were anchored on physiologic (sleep, personal hygiene, and food), psychosocial (feelings of isolation, mental stress), and communication challenges (information flow between families and the medical teams). Caregivers recognized that addressing physiologic and psychosocial needs better enabled them to advocate for their child and suggested interventions to ameliorate hospital challenges. CONCLUSIONS Addressing physiologic and psychosocial needs may reduce barriers to caregivers optimally caring and advocating for their child. Downstream consequences of unaddressed caregiver challenges should be explored in relation to participation in hospital care and confidence in shared decision-making, both vital components for optimization of family-centered care.
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Affiliation(s)
- Louise E Vaz
- Department of Pediatrics, Doernbecher Children's Hospital
| | - Rebecca M Jungbauer
- Pacific Northwest Evidence-Based Practice Center, Oregon Health and Science University, Portland, Oregon
| | - Celeste Jenisch
- Department of Pediatrics, Doernbecher Children's Hospital.,Build Exito Program, Portland State University, Portland, Oregon
| | - Jared P Austin
- Department of Pediatrics, Doernbecher Children's Hospital
| | - David V Wagner
- Department of Pediatrics, Doernbecher Children's Hospital
| | - Steven J Everest
- Build Exito Program, Portland State University, Portland, Oregon
| | - Alyssa J Libak
- Build Exito Program, Portland State University, Portland, Oregon
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Brenner M, Greene J, Doyle C, Koletzko B, Del Torso S, Bambir I, De Guchtenaere A, Polychronakis T, Reali L, Hadjipanayis AA. Increasing the Focus on Children's Complex and Integrated Care Needs: A Position Paper of the European Academy of Pediatrics. Front Pediatr 2021; 9:758415. [PMID: 34926344 PMCID: PMC8671931 DOI: 10.3389/fped.2021.758415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 11/09/2021] [Indexed: 12/04/2022] Open
Abstract
There is wide variation in terminology used to refer to children living with complex needs, across clinical, research and policy settings. It is important to seek to reconcile this variation to support the effective development of programmes of care for this group of children and their families. The European Academy of Pediatrics (EAP) established a multidisciplinary Working Group on Complex Care and the initial work of this group examined how complex care is defined in the literature. A scoping review was conducted which yielded 87 papers with multiple terms found that refer to children living with complex needs. We found that elements of integrated care, an essential component of care delivery to these children, were repeatedly referred to, though it was never specifically incorporated into a term to describe complex care needs. This is essential for practice and policy, to continuously assert the need for integrated care where a complex care need exists. We propose the use of the term Complex and Integrated Care Needs as a suitable term to refer to children with varying levels of complexity who require continuity of care across a variety of health and social care settings.
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Affiliation(s)
- Maria Brenner
- European Academy of Paediatrics (EAP), Brussels, Belgium.,School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Josephine Greene
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Carmel Doyle
- European Academy of Paediatrics (EAP), Brussels, Belgium.,School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Berthold Koletzko
- European Academy of Paediatrics (EAP), Brussels, Belgium.,Dr. Von Hauner Children's Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Stefano Del Torso
- European Academy of Paediatrics (EAP), Brussels, Belgium.,ChildCare WorldWide, Padova, Italy
| | - Ivan Bambir
- European Academy of Paediatrics (EAP), Brussels, Belgium.,Department of Pediatrics, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Ann De Guchtenaere
- European Academy of Paediatrics (EAP), Brussels, Belgium.,Department of Pediatrics, Ghent University Hospital, Ghent, Belgium
| | - Theofilos Polychronakis
- European Academy of Paediatrics (EAP), Brussels, Belgium.,Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Laura Reali
- European Academy of Paediatrics (EAP), Brussels, Belgium.,Studio Pediatrico, Rome, Italy
| | - Adamos A Hadjipanayis
- European Academy of Paediatrics (EAP), Brussels, Belgium.,Paediatric Department, Larnaca General Hospital, Larnaca, Cyprus.,School of Medicine, European University Cyprus, Nicosia, Cyprus
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