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Diaczun T, Miller MK. Nurse practitioner affecting systems change in the context of a LEADS leadership framework: Experience from the field. Int Nurs Rev 2024; 71:413-418. [PMID: 37822057 DOI: 10.1111/inr.12891] [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: 01/01/2023] [Accepted: 09/18/2023] [Indexed: 10/13/2023]
Abstract
AIM This paper highlights a new role of Advanced Practice Nurse/Nurse Practitioner as the clinical planning lead in the development of a unique model of care and service delivery for children living with health complexity, in the context of a LEADS leadership framework and related capabilities. BACKGROUND The LEADS in a Caring Environment Framework is an effective tool for leadership development and systems change. An experienced Advanced Practice Nurse/Nurse Practitioner hired into a leadership role contributes to system change for a complex population across a large geographic area. SOURCES OF EVIDENCE World Health Organization, Canadian Nurses Association and other websites, academic databases (PubMed and CINAHL) and relevant books were explored, and the expertise and knowledge of the authors and the redevelopment project team were utilized. DISCUSSION The Advanced Practice Nurse/Nurse Practitioner (first author) shares and reflects on her own lived experience as a leader in the planning for programmes and services at the new centre utilizing the five LEADS domains and related capabilities. CONCLUSION The utilization of the LEADS in a Caring Environment Capabilities Framework showcases the strengths and skills of an Advanced Practice Nurse/Nurse Practitioner shifting from direct clinical care to successfully leading system-level change. By incorporating the LEADS framework into practice, in any setting or role, Advanced Practice Nurse/Nurse Practitioners can both evaluate and develop their leadership skills while positively effecting system transformation. IMPLICATIONS FOR NURSING PRACTICE The LEADS framework fosters ongoing professional development and can be used to measure the added value of Advanced Practice Nurses within an organization. IMPLICATIONS FOR NURSING POLICY Advanced Practice Nurses improve outcomes within the health care system. Leaders must consider this evidence in health workforce planning, ensuring that Advanced Practice Nursing roles become fully integrated and are supported in the context of national and regional health systems.
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Affiliation(s)
- Tessa Diaczun
- Clinical Planning Lead, Slocan Site Redevelopment Project, Provincial Health Services Authority; Nurse Practitioner, NP Child and Youth Primary Care Clinic, Department of Pediatrics, Specialty Medicine, BC Children's Hospital; Adjunct Professor, University of British Columbia School of Nursing, Vancouver, Canada
| | - Minna K Miller
- Nurse Practitioner, Department of Pediatrics, Division of Respiratory Medicine, BC Children's Hospital; Adjunct Professor, University of British Columbia School of Nursing; Adjunct Professor, Thompson Rivers University School of Nursing; Affiliate Faculty, McMaster University, Canadian Centre for Advanced Practice Nursing Research, Vancouver, Canada
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Loura D, Ferreira AM, Romeiro J, Charepe Z. Health-illness transition processes in children with complex chronic conditions and their parents: a scoping review. BMC Pediatr 2024; 24:446. [PMID: 38992610 PMCID: PMC11238377 DOI: 10.1186/s12887-024-04919-4] [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: 03/28/2024] [Accepted: 07/01/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND The prevalence of complex chronic conditions (CCC), which cause serious limitations and require specialized care, is increasing. The diagnosis of a CCC is a health-illness transition for children and their parents, representing a long-term change leading to greater vulnerability. Knowing the characteristics of these transitional processes is important for promoting safe transitions in this population. This scoping review aimed to map the available evidence on health-illness transition processes in children with complex chronic conditions and their parents in the context of healthcare. METHODS Six databases were searched for studies focusing on children aged 0-21 years with CCC and their parents experiencing health-illness transition processes, particularly concerning adaptation to illness and continuity of care, in the context of healthcare. Studies within this scope carried out between 2013 and 2023 and written in Portuguese or English were identified. The articles were selected using the PRISMA methodology. The data were extracted to an instrument and then presented with a synthesizing approach supporting the interpretation of the results. RESULTS Ninety-eight methodologically broad but predominantly qualitative articles were included in this review. Children with CCC have specific needs associated with complex and dynamic health-illness transitions with a multiple influence in their daily lives. Several facilitating factors (p.e. positive communication and a supportive therapeutic relationship with parents and professionals, as well as involvement in a collaborative approach to care), inhibiting factors (p.e. the complexity of the disease and therapeutic regime, as well as the inefficient organization and coordination of teams) and both positive (p.e. well-being and better quality of life) and negative response patterns (p.e. negative feelings about the chronic illness) were identified. Some interventions to support the transitional process also emerged from the literature. Pediatric palliative care is seen as a good practice and an integrative approach for these children and families. CONCLUSION Health professionals play a fundamental role in supporting the transitional process and promoting positive response patterns. More significant investment is needed at the clinical and academic levels regarding production and dissemination of knowledge in this area to ensure the awareness of children with CCC and that their needs are fully enhanced. REVIEW REGISTRATION https://doi.org/10.17605/OSF.IO/QRZC8 .
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Affiliation(s)
- David Loura
- Local Health Unit of São José, Dona Estefânia Hospital, St. Jacinta Marto, N. 8A, 1150-192, Lisbon, Portugal.
- Faculty of Health Sciences and Nursing, Catholic University of Portugal, Lisbon, Portugal.
| | - Ana Margarida Ferreira
- Faculty of Health Sciences and Nursing, Catholic University of Portugal, Lisbon, Portugal
- Local Health Unit of Arco Ribeirinho, Nossa Senhora Do Rosário Hospital, Setúbal, Portugal
| | - Joana Romeiro
- Faculty of Health Sciences and Nursing, Catholic University of Portugal, Lisbon, Portugal
- Center for Interdisciplinary Health Research (CIIS), Lisbon, Portugal
- Catholic University of Portugal, Postdoc-Fellowship Program in Integral Human Development (IHD), CADOS, Lisbon, Portugal
| | - Zaida Charepe
- Faculty of Health Sciences and Nursing, Catholic University of Portugal, Lisbon, Portugal
- Center for Interdisciplinary Health Research (CIIS), Lisbon, Portugal
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Pérez-Ardanaz B, Gutiérrez-Rodríguez L, Pelaez-Cantero MJ, Morales-Asencio JM, Gómez-González A, García-Piñero JM, Lupiañez-Perez I. Healthcare service use for children with chronic complex diseases: A longitudinal six-year follow-up study. J Pediatr Nurs 2024; 77:e132-e138. [PMID: 38594165 DOI: 10.1016/j.pedn.2024.04.001] [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: 01/19/2023] [Revised: 04/01/2024] [Accepted: 04/01/2024] [Indexed: 04/11/2024]
Abstract
PURPOSE The objective was analysed the patterns use of healthcare services of this population and the influence of their clinical and sociodemographic characteristics. DESIGN AND METHODS A six-year longitudinal follow-up study was performed to evaluate the annual healthcare resources use and clinical data among children with complex chronic diseases in Spain between 2015 and 2021. The sample trends in healthcare usage and the associated factors were analysed using ANCOVA and multivariable linear regression models. RESULTS Patients had high attendance during the follow-up period, with >15 episodes year. This trend decreased over time, especially in children with oncological diseases compared with other diseases (F (16.75; 825.4) = 32.457; p < 0.001). A multivariable model showed that children with a greater number of comorbidities (β = 0.17), shorter survival time (β = -0.23), who had contact with the palliative care unit (β = 0.16), and whose mothers had a higher professional occupation (β = 0.14), had a greater use of the healthcare system. CONCLUSIONS Children with a higher number of comorbidities and the use of medical devices made a greater frequentation of health services, showing a trend of decreasing use over time. Socioeconomic factors such as mothers' occupational status determine healthcare frequentation. These results suggest the existence of persistent gaps in care coordination sustained over time. PRACTICAL IMPLICATIONS Systematized and coordinated models of care for this population should consider the presence of inequalities in health care use.
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Affiliation(s)
- Bibiana Pérez-Ardanaz
- Universidad de Málaga, Faculty of Health Sciences, Department of Nursing, Spain; Instituto de Investigación Biomédica de Málaga-Bionand (IBIMA), Spain.
| | - Laura Gutiérrez-Rodríguez
- Universidad de Málaga, Faculty of Health Sciences, Department of Nursing, Spain; Instituto de Investigación Biomédica de Málaga-Bionand (IBIMA), Spain.
| | | | - José Miguel Morales-Asencio
- Universidad de Málaga, Faculty of Health Sciences, Department of Nursing, Spain; Instituto de Investigación Biomédica de Málaga-Bionand (IBIMA), Spain.
| | - Alberto Gómez-González
- Universidad de Málaga, Faculty of Health Sciences, Department of Nursing, Spain; Instituto de Investigación Biomédica de Málaga-Bionand (IBIMA), Spain.
| | - José Miguel García-Piñero
- Universidad de Málaga, Faculty of Health Sciences, Department of Nursing, Spain; Pediatric Intensive Care Unit, Hospital Materno-Infantil, Málaga, Spain
| | - Inmaculada Lupiañez-Perez
- Universidad de Málaga, Faculty of Health Sciences, Department of Nursing, Spain; Instituto de Investigación Biomédica de Málaga-Bionand (IBIMA), Spain.
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Geyer D, Vessey JA. Caring for children with medical complexity at home: An integrative review. J Pediatr Nurs 2024; 76:167-175. [PMID: 38412708 DOI: 10.1016/j.pedn.2024.02.018] [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: 10/01/2023] [Revised: 12/28/2023] [Accepted: 02/19/2024] [Indexed: 02/29/2024]
Abstract
PROBLEM Despite reporting significant systemic barriers to providing care, burden among parental caregivers of children with medical complexity (CMC) is often attributed to stressors related to disease management. The relationship between parental caregiver burden and systemic barriers within the healthcare bureaucracy, as defined by Ray's Theory of Bureaucratic Caring (BCT), has not been explored. The purpose of this integrative review was to examine which elements of the bureaucratic healthcare system are contributing to burden among parental caregivers of CMC living at home. ELIGIBILITY CRITERIA Refereed research articles related to the experiences of parental caregivers of CMC living in the United States published after 2014. SAMPLE 1967 articles were obtained on initial literature search. Using the PRISMA algorithm, ten articles published between 2018 and 2022 were ultimately selected for appraisal. RESULTS Parental caregiver burden was consistently attributed to barriers and gaps among social-cultural, physical, political, legal, economic, technological, and educational elements of the bureaucratic healthcare system. CONCLUSIONS Weaknesses across the bureaucratic elements of the healthcare system prevent CMC from consistently receiving necessary care which in turn, contribute to feelings of burden among their parental caregivers. Efforts to alleviate burden experienced by parental caregivers should focus on addressing gaps within the healthcare bureaucracy. IMPLICATIONS Nurses are well-positioned to address these gaps through clinical work, advocacy, and research. Future research should further examine the appropriateness of using BCT to better understand the implications of systems-level weaknesses on parental caregiver burden. Parental caregivers of CMC should be closely involved in this process.
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Affiliation(s)
- David Geyer
- William F. Connell School of Nursing, Boston College, MA, USA.
| | - Judith A Vessey
- William F. Connell School of Nursing, Boston College, MA, USA; Medical, Surgical and Behavioral Health Programs, Boston Children's Hospital, MA, USA
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Fardell JE, Hu N, Wakefield CE, Marshall G, Bell J, Lingam R, Nassar N. Impact of Hospitalizations due to Chronic Health Conditions on Early Child Development. J Pediatr Psychol 2023; 48:799-811. [PMID: 37105227 DOI: 10.1093/jpepsy/jsad025] [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: 02/01/2022] [Revised: 04/10/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
OBJECTIVE To assess the impact of hospitalization for chronic health conditions on early child development and wellbeing at school start. METHODS We conducted a longitudinal cohort study of children starting school using population-based record linkage of routinely collected admitted hospital data and standardized assessment of early childhood development (Australian Early Developmental Census: AEDC). Developmental vulnerability (DV) was defined as children scoring <10th centile in any one of five developmental domains. Children scoring <10th centile on two or more domains were considered developmentally high-risk (DHR). Children hospitalized with chronic health conditions were compared to children without hospitalizations prior to school start. RESULTS Among 152,851 children with an AEDC record, 22,271 (14·6%) were hospitalized with a chronic condition. Children hospitalized with chronic health conditions were more likely to be DHR (adjusted odds ratio 1.25, 95% CI: 1.18-1.31) compared to children without hospitalizations. Children hospitalized more frequently (>7 times) or with longer duration (>2 weeks) had a 40% increased risk of being DHR (1.40, 95% CI: 1.05-1.88 and 1.40, 95% CI: 1.13-1.74, respectively). Children hospitalized with mental health/behavioral/developmental conditions had the highest risk of DHR (2.23, 95% CI: 1.72-2.90). Developmental vulnerability was increased for physical health (1.37, 95% CI: 1.30-1.45), language (1.28, 95% CI: 1.19-1.38), social competence (1.22, 95% CI: 1.16-1.29), communication (1.17, 95% CI: 1.10-1.23), and emotional maturity (1.16, 95% CI: 1.09-1.23). CONCLUSIONS Frequent and longer duration hospitalizations for chronic health conditions can impact early childhood development. Research and interventions are required to support future development and well-being of children with chronic health conditions who are hospitalized.
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Affiliation(s)
- Joanna E Fardell
- Behavioural Sciences Unit, School of Women's and Children's Health, UNSW Sydney, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Australia
| | - Nan Hu
- Population Child Health Research Group, School of Women's and Children's Health, University of New South Wales, Australia
| | - Claire E Wakefield
- Behavioural Sciences Unit, School of Women's and Children's Health, UNSW Sydney, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Australia
| | - Glenn Marshall
- Kids Cancer Centre, Sydney Children's Hospital, Australia
| | - Jane Bell
- Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, University of Sydney, Australia
| | - Raghu Lingam
- Population Child Health Research Group, School of Women's and Children's Health, University of New South Wales, Australia
| | - Natasha Nassar
- Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, University of Sydney, Australia
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Godoy-Molina E, Vázquez-Pareja M, Pérez-Frías J, Navas-López VM, Nuñez-Cuadros E. Identification of the complex chronic patient: PedCom Scale validation and English translation. An Pediatr (Barc) 2023; 99:271-275. [PMID: 37735026 DOI: 10.1016/j.anpede.2023.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 06/16/2023] [Indexed: 09/23/2023] Open
Affiliation(s)
- Elena Godoy-Molina
- Unidad de Paciente Crónico Complejo y Cuidados Paliativos Pediátricos, UGC Pediatría y Áreas Específicas, Hospital Regional Universitario Málaga, Malaga, Spain; Programa de Doctorado en Biomedicina, Investigación Traslacional y Nuevas Tecnologías en Salud, Facultad de Medicina Universidad de Málaga, Malaga, Spain.
| | - María Vázquez-Pareja
- Servicio de Pediatría, UGC Pediatría y Áreas Específicas, Hospital Regional Universitario Málaga, Malaga, Spain
| | - Javier Pérez-Frías
- Programa de Doctorado en Biomedicina, Investigación Traslacional y Nuevas Tecnologías en Salud, Facultad de Medicina Universidad de Málaga, Malaga, Spain; Catedrático del Departamento, Facultad de Medicina, Universidad de Málaga, Malaga, Spain
| | - Víctor Manuel Navas-López
- Servicio de Pediatría, UGC Pediatría y Áreas Específicas, Hospital Regional Universitario Málaga, Malaga, Spain
| | - Esmeralda Nuñez-Cuadros
- Jefa de Sección, Sección UGC Pediatría y Áreas Específicas, Hospital Regional Universitario Málaga, Malaga, Spain
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Miyatake H, Onishi T, Kaneda Y, Ozaki A, Tanimoto T, Beniya H. Possibility for Children with Medical Complexities to Reach a 3000-m Peak: A Report of 2 Cases. Wilderness Environ Med 2023; 34:383-387. [PMID: 37438154 DOI: 10.1016/j.wem.2023.05.008] [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: 01/02/2023] [Revised: 05/13/2023] [Accepted: 05/16/2023] [Indexed: 07/14/2023]
Abstract
With the recent development of neonatal medicine, the number of children with medical complexities (CMCs) is increasing. Outdoor activities are important for their psychosocial development, and the principles of accessibility should be addressed. We report the experience of 2 CMCs' high-altitude mountaineering with the necessary support. The participants were a 3-y-old girl with cerebral palsy, symptomatic epilepsy, and a ventriculoperitoneal shunt (Child A) and a 6-y-old girl who underwent bilateral Glenn operations at 11 mo for hypoplastic left heart syndrome (Child B). The support staff consisted of 4 doctors, 1 nurse, 5 nonmedical staff , 3 members from a mountaineering association, and 2 people from an oxygen company. The climbing schedule was 2 days. On the first day, we took a bus to a hut at an altitude of 2450 m and stayed overnight to acclimatize to the altitude. On the second day, we took the beginner's route, which took 3 h to climb 500 m, and our team made an attempt on the summit. During the attempt, Child B panicked. Although her lung sounds did not raise suspicions of pulmonary edema, we decided to leave the mountain with her because her transcutaneous oxygen saturation decreased. Child A had no apparent health problems and made it to the summit. Although CMCs' alpine climbing requires careful planning and staffing considering the risk of high-altitude sickness, our case suggests the feasibility of such activities with CMCs as part of accessibility.
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Affiliation(s)
| | - Toya Onishi
- School of Medicine, Shiga University of Medical Science, Otsu City, Shiga Prefecture, Japan
| | - Yudai Kaneda
- School of Medicine, Hokkaido University, Sapporo City, Hokkaido, Japan
| | - Akihiko Ozaki
- Department of Breast and Thyroid Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki City, Fukushima Prefecture, Japan
| | - Tetsuya Tanimoto
- Medical Governance Research Institute, Minato City, Tokyo, Japan
| | - Hiroyuki Beniya
- Orange Home-Care Clinic, Fukui City, Fukui Prefecture, Japan
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Godoy-Molina E, Fernández-Ferrández T, Ruiz-Sánchez JM, Cordón-Martínez A, Pérez-Frías J, Navas-López VM, Nuñez-Cuadros E. Escala para la identificación del paciente pediátrico crónico complejo (Escala PedCom). Estudio piloto. An Pediatr (Barc) 2022. [DOI: 10.1016/j.anpedi.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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A scale for the identification of the complex chronic pediatric patient (PedCom Scale): A pilot study. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2022; 97:155-160. [PMID: 35871152 DOI: 10.1016/j.anpede.2021.10.004] [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: 04/26/2021] [Accepted: 10/11/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES The complex chronic condition (CCC) is an increasingly prevalent reality in pediatrics. However, having a CCC does not necessarily mean being a complex chronic patient (CCP). From this perspective, we developed an instrument (PedCom Scale) that would facilitate the identification of the CCP. MATERIAL AND METHODS Initially, general aspects for the classification of patients as CCP were defined. Subsequently, the items of the scale were developed, scoring them from 0.5 to 4 points. We performed a confirmatory factor analysis (CFA) and the internal consistency was studied using alpha-Cronbach. Concordance was evaluated by intra- and inter-observer study. The gold standard was the classification performed by two evaluators after assessing the patient's medical history. The cut-off point for considering the patient as a CCP was established using the ROC curve. RESULTS The initial version included 43 items with a global content validity index (CVI) of 0.94. A total of 180 patients were included. After the CFA, one item was eliminated, so the final version consists of 42 items with an CVI of 0.95. The alpha-Cronbach value was 0.723. The intraclass correlation coefficient of the test-retest analysis was 0.998 and 0.996 for the inter-observer study. The cut-off point for considering a patient as a CCP was established at 6.5 points, with this results we obtained a sensitivity of 98% and specificity of 94%. CONCLUSIONS The PedCom Scale is an easy-to-use tool focused on the identification of the CCP. In our sample, it presented satisfactory levels of internal consistency and adequate levels of intra- and inter-observer agreement, with good sensitivity and specificity for the identification of the CCP.
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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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