1
|
Joosten K, Niseteo T. Better understanding of use of blended diets and its benefits. Evid Based Nurs 2024:ebnurs-2023-103859. [PMID: 38307708 DOI: 10.1136/ebnurs-2023-103859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2024] [Indexed: 02/04/2024]
Affiliation(s)
- Koen Joosten
- Department of Neonatal and Paediatric Intensive Care, Division of Paediatric Intensive Care, Erasmus MC, Sophia Children's Hospital, Rotterdam, Zuid-Holland, The Netherlands
| | - Tena Niseteo
- Referral Center for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, Zagreb, Croatia
| |
Collapse
|
2
|
Turnham HL, Bowen SJ, Ramdas S, Smith A, Wilkinson D, Harrop E. As low as reasonably practicable (ALARP): a moral model for clinical risk management in the setting of technology dependence. JOURNAL OF MEDICAL ETHICS 2023:jme-2023-109111. [PMID: 38124197 DOI: 10.1136/jme-2023-109111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 11/19/2023] [Indexed: 12/23/2023]
Abstract
Children dependent on life-prolonging medical technology are often subject to a constant background risk of sudden death or catastrophic complications. Such children can be cared for in hospital, in an intensive care environment with highly trained nurses and doctors able to deliver specialised, life-saving care immediately. However, remaining in hospital, when life expectancy is limited, can considered to be a harm in of itself. Discharge home offers the possibility for an improved quality of life for the child and their family but comes with significant medical risks.When making decisions for children, two ethical models predominate, the promotion of the child's best interests or the avoidance of harm. However, in some circumstances, particularly for children with life-limiting and/or life-threatening illness, all options may be associated with risk. There are no good options, only potentially harmful choices.In this paper, we explore decisions made by one family in such circumstances. We describe a model adopted from risk management programmes beyond medicine, which offers a potential framework for identifying risks to the child that are morally permissible. Some risks and harms to a child, not ordinarily permitted, may be acceptable when undertaken in the pursuit of a specified desired good, so long as they are as low as reasonably practicable.
Collapse
Affiliation(s)
| | | | - Sitara Ramdas
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Dominic Wilkinson
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
| | | |
Collapse
|
3
|
Babayan K, Keilty K, Esufali J, Grajales Iii FJ. An After-Hours Virtual Care Service for Children With Medical Complexity and New Medical Technology: Mixed Methods Feasibility Study. JMIR Pediatr Parent 2023; 6:e41393. [PMID: 37938869 PMCID: PMC10666005 DOI: 10.2196/41393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 01/11/2023] [Accepted: 03/04/2023] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Family caregivers (FCs) of children with medical complexity require specialized support to promote the safe management of new medical technologies (eg, gastrostomy tubes) during hospital-to-home transitions. With limited after-hours services available to families in home and community care, medical device complications that arise often lead to increased FC stress and unplanned emergency department (ED) visits. To improve FC experiences, enable safer patient discharge, and reduce after-hours ED visits, this study explores the feasibility of piloting a 24/7 virtual care service (Connected Care Live) with families to provide real-time support by clinicians expert in the use of pediatric home care technologies. OBJECTIVE This study aims to establish the economic, operational, and technical feasibility of piloting the expansion of an existing nurse-led after-hours virtual care service offered to home and community care providers to FCs of children with newly inserted medical devices after hospital discharge at Toronto's Hospital for Sick Children (SickKids). METHODS This exploratory study, conducted from October 2020 to August 2021, used mixed data sources to inform service expansion feasibility. Semistructured interviews were conducted with FCs, nurses, and hospital leadership to assess the risks, benefits, and technical and operational requirements for sustainable and cost-effective future service operations. Time and travel savings were estimated using ED visit data in SickKids' electronic medical records (Epic) with a chief complaint of "medical device problems," after-hours medical device inquiries from clinician emails and voicemails, and existing service operational data. RESULTS A total of 30 stakeholders were interviewed and voiced the need for the proposed service. Safer and more timely management of medical device complications, improved caregiver and provider experiences, and strengthened partnerships were identified as expected benefits, while service demand, nursing practice, and privacy and security were identified as potential risks. A total of 47 inquiries were recorded over 2 weeks from March 26, 2021, to April 8, 2021, with 51% (24/47) assessed as manageable via service expansion. This study forecasted annual time and travel savings of 558 hours for SickKids and 904 hours and 22,740 km for families. Minimal technical and operational requirements were needed to support service expansion by leveraging an existing platform and clinical staff. Of the 212 ED visits related to "medical device problems" over 6 months from September 1, 2020, to February 28, 2021, enteral feeding tubes accounted for nearly two-thirds (n=137, 64.6%), with 41.6% (57/137) assessed as virtually manageable. CONCLUSIONS Our findings indicate that it is feasible to pilot the expansion of Connected Care Live to FCs of children with newly inserted enteral feeding tubes. This nurse-led virtual caregiver service is a promising tool to promote safe hospital-to-home transitions, improve FC experiences, and reduce after-hours ED visits.
Collapse
Affiliation(s)
- Katherine Babayan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Krista Keilty
- Connected Care Program, Hospital for Sick Children, Toronto, ON, Canada
- Child Health Evaluative Studies, SickKids Research Institute, Toronto, ON, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Jessica Esufali
- Connected Care Program, Hospital for Sick Children, Toronto, ON, Canada
| | - Francisco J Grajales Iii
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
4
|
Özer Özlü NG, Vural F, Dökümcü ÜZ, Özcan C, Erdener HA. Nutritional Experiences of Parents of Children Who Had Gastric Transposition Surgery. Clin Nurs Res 2023; 32:138-148. [PMID: 35193414 DOI: 10.1177/10547738221078896] [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: 12/15/2022]
Abstract
This study aimed to understand the postoperative nutritional experiences of parents of children who had undergone gastric transposition surgery after corrosive esophageal injury. The study had a descriptive qualitative research design, and used a structured interview form as a result of the COVID-19 pandemic. The population of the study consisted of the parents of 12 children who had undergone gastric transposition surgery at the pediatric surgery clinic of a university hospital in an urban area in Turkey. Thematic analysis was conducted on the transcripts using the MAXQDA program. Four main themes emerged and five supporting sub-themes were identified. The main themes were what we experienced in the postoperative nutrition process, coping with how we live, what we want to know, and our recommendations to healthcare professionals. Family-centered care should be a main focus when caring children who have had gastric transposition surgery, and children and their parents should be supported by a multidisciplinary team.
Collapse
Affiliation(s)
- Nazife Gamze Özer Özlü
- Faculty of Nursing, Department of Surgery Nursing, Dokuz Eylül University Institute of Health Sciences, Inciralti, Izmir, Turkey
| | - Fatma Vural
- Faculty of Nursing, Department of Surgical Nursing, Dokuz Eylül University, Inciralti, Izmir, Turkey
| | - Ülküm Zafer Dökümcü
- Department of Pediatric Surgery, Ege University Health and Research Hospital, Bornova, Izmir, Turkey
| | - Coşkun Özcan
- Department of Pediatric Surgery, Ege University Health and Research Hospital, Bornova, Izmir, Turkey
| | - Hakkı Ata Erdener
- Department of Pediatric Surgery, Ege University Health and Research Hospital, Bornova, Izmir, Turkey
| |
Collapse
|
5
|
Page B, Harrop E, Beale T, Boyce K, Smith C, Butler S, Sharrard A, Vincent C, Lee ACH. Coproduced resources to support parents caring for children with gastrostomies. Frontline Gastroenterol 2022; 14:144-148. [PMID: 36818798 PMCID: PMC9933587 DOI: 10.1136/flgastro-2022-102181] [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: 03/28/2022] [Accepted: 07/29/2022] [Indexed: 02/24/2023] Open
Abstract
Objective To describe and disseminate a package of support for parents who care for children with gastrostomies, consisting of a library of videos and resources to support families from referral for gastrostomy surgery, to long-term support at home. Methods The resources were systematically developed and evaluated by parents, hospital and community-based nurses, paediatricians, a surgeon and researchers. Results The videos empower families, reduce their anxiety and increase their confidence, providing support throughout the families' journey. Surveys and feedback from parents and clinicians show that the video library is seen as providing clear and comprehensive guidance and is suitable for integration into routine practice. To effectively disseminate these resources across a region, the videos need to be shared widely with relevant community and hospital-based teams, and shared through parent networks. The videos should be viewed as one part of a wider package of training and support, in combination with hands-on-practice and clinical support. Conclusions The resources described have been developed with and for families. Critically the videos are founded in the lived-experience of families, as well as the expertise of clinicians from community and hospital services. Similar resources are needed to support families performing other types of specialist care. The resources are freely available to any parent or clinical team.
Collapse
Affiliation(s)
- Bethan Page
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | | | | | | | - Colette Smith
- Community Children's Nursing, Oxford Health NHS Foundation Trust, Oxford, UK
| | | | - Alison Sharrard
- Department of Paediatrics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Charles Vincent
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Alex CH Lee
- Department of Paediatrics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| |
Collapse
|
6
|
Page B, Lee ACH, Harrop EJ, Beale T, Sharrard A, Yeung N, Vincent CA. Coproducing a library of videos to support families caring for children with gastrostomies: A mixed-methods evaluation with family carers and clinicians. Health Expect 2022; 25:1038-1047. [PMID: 35141999 PMCID: PMC9122434 DOI: 10.1111/hex.13449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/13/2022] [Accepted: 01/18/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction Many families now perform specialist medical procedures at home. Families need appropriate training and support to do this. The aim of this study was to evaluate a library of videos, coproduced with parents and healthcare professionals, to support and educate families caring for a child with a gastrostomy. Methods A mixed‐methods online survey evaluating the videos was completed by 43 family carers who care for children with gastrostomies and 33 healthcare professionals (community‐based nurses [n = 16], paediatricians [n = 6], dieticians [n = 6], hospital‐based nurses [n = 4], paediatric surgeon [n = 1]) from the United Kingdom. Participants watched a sample of videos, rated statements on the videos and reflected on how the videos could be best used in practice. Results Both family carers and healthcare professionals perceived the video library as a valuable resource for parents and strongly supported the use of videos in practice. All healthcare professionals and 98% (n = 42) of family carers agreed they would recommend the videos to other families. Family carers found the videos empowering and easy to follow and valued the mixture of healthcare professionals and families featured in the videos. Participants gave clear recommendations for how different video topics should fit within the existing patient pathway. Discussion Families and healthcare professionals perceived the videos to be an extremely useful resource for parents, supporting them practically and emotionally. Similar coproduced educational materials are needed to support families who perform other medical procedures at home. Patient or Public Contribution Two parent representatives attended the research meetings from conception of the project and were involved in the design, conduct and dissemination of the surveys. The videos themselves were coproduced with several different families.
Collapse
Affiliation(s)
- Bethan Page
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Alex C H Lee
- Department of Paediatrics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | | | - Alison Sharrard
- Department of Paediatrics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Nick Yeung
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Charles A Vincent
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| |
Collapse
|
7
|
Campagna S, Borraccino A, Politano G, Dalmasso M, Ravaglia A, Dimonte V, Gianino MM. Emergency-department accesses in home care paediatric patients: Occurrence and risks of use in a six-year retrospective investigation in Northern Italy. PLoS One 2022; 16:e0262085. [PMID: 34972170 PMCID: PMC8719707 DOI: 10.1371/journal.pone.0262085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 12/18/2021] [Indexed: 11/30/2022] Open
Abstract
Objective To assess the determinants of ED use in paediatric patients enrolled in an Integrated Paediatric Home Care (IPHC) program. Methods A retrospective study was conducted using administrative databases on a cohort of patients enrolled in an IPHC program between January 1st, 2012, and December 31st, 2017, in Northern Italy. ED visits that occurred during the IPHC program were considered. Data were collected considering sociodemographic, clinical and organizational variables. A multivariable stepwise logistic regression analysis was performed. The dependent variable to identify possible associations was ED visit. Results A total of 463 ED visits occurred in 465 children, with an incidence rate of 1. The risk of ED visits significantly increased among children involved in the IPHC program after hospital discharge (OR 1.94). Additionally, the risk of ED visits increased significantly as the duration of IPHC increased (OR 5.80 between 101 and 200 days, to OR 7.84 between 201 and 300 days, OR 12.54 between 301 and 400 days and OR 18.67 to more than 400 days). Conclusion The overall results represent a practical perspective to contribute improving both the service quality of IPHC and reducing low acuity and improper ED use.
Collapse
Affiliation(s)
- Sara Campagna
- Department of Public Health and Paediatrics, University of Torino, Torino, Italy
| | - Alberto Borraccino
- Department of Public Health and Paediatrics, University of Torino, Torino, Italy
- * E-mail:
| | - Gianfranco Politano
- Department of Control and Computer Engineering, Politecnico of Torino, Torino, Italy
| | - Marco Dalmasso
- Epidemiology Unit, Local Health Unit TO3, Piedmont Region, Italy
| | - Aldo Ravaglia
- Paediatric General Pratictioner, Local Health Unit TO4, Piedmont Region, Italy
| | - Valerio Dimonte
- Department of Public Health and Paediatrics, University of Torino, Torino, Italy
| | | |
Collapse
|
8
|
Mohamed Elfadil O, Ewy M, Patel J, Patel I, Mundi MS. Growing use of home enteral nutrition: a great tool in nutrition practice toolbox. Curr Opin Clin Nutr Metab Care 2021; 24:446-452. [PMID: 34148970 DOI: 10.1097/mco.0000000000000777] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Home enteral nutrition (HEN) is a well-established practical nutrition therapy tool that is typically managed by an interdisciplinary team. Prevalence of HEN is increasing across the globe given significant evidence for utility, feasibility, efficacy, safety, and reliability of HEN in helping patients meeting their nutrition needs. The current review highlights the growing use of HEN in the context of what is novel in the field including trends in HEN practice with regards to tubes and connectors, feeding formula and real food blends, and common complications. The review also highlights that the use of HEN is expected to expand further over coming years emphasizing the need for national consensus recommendations and guidelines for HEN management. RECENT FINDINGS The growing use of HEN has always been parallel to adoption of holistic definitions and concept of malnutrition in clinical nutrition practice and more understanding of the need for malnutrition risk stratification, meeting unmet needs in practice and addressing challenges that lead to suboptimal enteral nutrition. SUMMARY Research and advancements in technology as well as in tube feeding formula industry have led to the development of more solutions and have helped identify and implement best HEN practices.
Collapse
Affiliation(s)
| | - Matthew Ewy
- Division of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jalpan Patel
- Division of Endocrinology, Diabetes, Metabolism and Nutrition
| | - Ishani Patel
- Division of Endocrinology, Diabetes, Metabolism and Nutrition
| | | |
Collapse
|
9
|
Page B, Butler S, Smith C, Lee AC, Vincent CA. Training and support for caring for a child's gastrostomy: a survey with family carers. BMJ Paediatr Open 2021; 5:e001068. [PMID: 34395927 PMCID: PMC8317118 DOI: 10.1136/bmjpo-2021-001068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 07/17/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The aim of this study was to explore family carers' experiences of training and ongoing support for caring for their child's gastrostomy, and to get their views on how this could be improved. METHODS A mixed-methods online survey with 146 family carers (eg, parents, grandparents) who care for a child with a gastrostomy. Family carers rated their own experience of training and support and made recommendations for how training and support could be improved for future families. RESULTS The nature and extent of the training family carers reported receiving varied considerably. Many felt that the demonstrations they received in hospital were too brief. Two in five family carers rated their confidence caring for their child's gastrostomy as very low in the first few weeks after surgery. Parents valued ongoing learning and support from other parents and support from community nurses. Videos and simulation practice were rated as useful formats of training, in addition to face-to-face supervised practice with a clinician. Parents liked how real life the example video shown was, and rated nearly all suggested video topics as 'very helpful', especially troubleshooting topics. CONCLUSIONS Our study found substantial variability in family carers' descriptions of the training and support they received to care for their child's gastrostomy. Training often did not meet family carers' needs. We need to invest in better training and support for families and learn from their recommendations. Improvements to training and support for families (eg, through instructional videos) have the potential to improve family carers' confidence and competence, and reduce the risk of problems and complications which cause harm to children and increase demand on National Health Service (NHS) resources.
Collapse
Affiliation(s)
- Bethan Page
- Experimental Psychology, University of Oxford, Oxford, Oxfordshire, UK
| | | | | | - Alex Ch Lee
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Charles A Vincent
- Experimental Psychology, University of Oxford, Oxford, Oxfordshire, UK
| |
Collapse
|
10
|
Nawaz RF, Page B, Harrop E, Vincent CA. Analysis of paediatric long-term ventilation incidents in the community. Arch Dis Child 2020; 105:446-451. [PMID: 31848150 PMCID: PMC7212935 DOI: 10.1136/archdischild-2019-317965] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/30/2019] [Accepted: 10/31/2019] [Indexed: 01/16/2023]
Abstract
AIM To describe the nature and causes of reported patient safety incidents relating to care in the community for children dependent on long-term ventilation with the further aim of improving safety. METHODS We undertook an analysis of patient safety incident data relating to long-term ventilation in the community using incident reports from England and Wales' National Reporting and Learning System occurring between January 2013 and December 2017. Manual screening by two authors identified 220 incidents which met the inclusion criteria. The free text for each report was descriptively analysed to identify the problems in the delivery of care, the contributory factors and the patient outcome. RESULTS Common problems in the delivery of care included issues with faulty equipment and the availability of equipment, and concerns around staff competency. There was a clearly stated harm to the child in 89 incidents (40%). Contributory factors included staff shortages, out of hours care, and issues with packaging and instructions for equipment. CONCLUSIONS This study identifies a range of problems relating to long-term ventilation in the community, some of which raise serious safety concerns. The provision of services to support children on long-term ventilation and their families needs to improve. Priorities include training of staff, maintenance and availability of equipment, support for families and coordination of care.
Collapse
Affiliation(s)
- Rasanat Fatima Nawaz
- Department of Experimental Psychology, University of Oxford, Oxford, UK,Patient Safety Collaborative, Oxford Academic Health Science Network, Oxford, UK
| | - Bethan Page
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | | | - Charles A Vincent
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| |
Collapse
|