1
|
Spratling R, Tennant MN, Lee J. Symptom and Technology Management Intervention Usefulness for Caregivers of Children With Tracheostomies and Feeding Tubes. West J Nurs Res 2024; 46:366-373. [PMID: 38545957 DOI: 10.1177/01939459241240422] [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] [Indexed: 04/13/2024]
Abstract
BACKGROUND Caregivers of children who require medical technology of tracheostomies and feeding tubes provide intensive and specialized care at home. They have extensive training in the hospital prior to their child's discharge; however, there is limited education about their child's care once they are at home. The Creating Opportunities for Personal Empowerment: Symptom and Technology Management Resources intervention focused on commonly experienced symptoms and technology used at home by caregivers. OBJECTIVE We present the findings from the intervention exit interviews to gain insight about the intervention from caregiver perspectives, notably their perceptions of usefulness, ease of use, and acceptability. METHODS A qualitative descriptive design was used to examine caregivers' perceptions of the intervention in exit interviews. These interviews were conducted upon completion of the intervention as part of feasibility testing. RESULTS Sixteen caregivers completed the study and participated in exit interviews. Caregivers described the themes of the best that you can do, a reminder that I am doing it the right way, and I wish I had these when my child first had the tracheostomy and feeding tube. Caregivers also provided feedback about the intervention's usefulness and suggestions for further refinement and future adaptations of the intervention. CONCLUSIONS Caregivers provided valuable insights about the intervention, describing its usefulness to them, the potential for usefulness for other caregivers of these children, and their experiences with care of their children at home. Future plans include efficacy testing and modifications to enhance the intervention based on caregiver feedback.
Collapse
Affiliation(s)
- Regena Spratling
- School of Nursing, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA, USA
| | - Monica Nelson Tennant
- School of Nursing, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA, USA
| | - Jiwon Lee
- School of Nursing, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA, USA
| |
Collapse
|
2
|
Song IG, Kim YS, Kim MS, Lee JW, Cho YM, Lim Y, Kwon SK, Suh DI, Park JD. Healthcare service use and medical outcomes of tracheostomy-dependent children: a nationwide study. BMJ Paediatr Open 2024; 8:e002377. [PMID: 38508660 PMCID: PMC10952918 DOI: 10.1136/bmjpo-2023-002377] [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: 11/08/2023] [Accepted: 03/10/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Despite the rising trend of tracheostomies in children, there is a lack of comprehensive resources for families to navigate the challenges of living with a tracheostomy, emphasising the need for evidence-based support in understanding postoperative care and long-term adjustments. This study aimed to examine the pattern of using healthcare services and nationwide medical outcomes in children who underwent a tracheotomy before the age of 2 years. METHODS This retrospective study used the National Health Insurance System database from 2008 to 2016 and included all children codified with tracheotomy procedure codes before their second birthday. Healthcare utilisation, such as medical costs, number of hospital visits, home healthcare nursing and medical diagnoses on readmission, in the first 2 years after tracheotomy was evaluated. Multivariable logistic regression analysis was used to determine the factors affecting mortality. RESULTS In total, 813 patients were included in this study. Their use of healthcare services and the accompanying expenses were higher than the national medians for similar age groups; however, both metrics decreased in the second year. The major causes of admission within 2 years of surgery were respiratory and neurological diseases. The mortality rate within 2 years was 37.8%. Higher risks of mortality were associated with having two or more complex chronic conditions. Use of home healthcare nursing services was associated with a lower mortality risk. CONCLUSION Paediatric patients with more complex chronic conditions tended to have higher mortality rates within 2 years after surgery. However, receiving home healthcare nursing was significantly associated with a reduced risk of death. Many causes of hospitalisation may be preventable with education and supportive care. Therefore, further research for establishing an integrated care system for these patients and their caregivers is required.
Collapse
Affiliation(s)
- In Gyu Song
- Pediatrics, Yonsei University College of Medicine, Seodaemun-gu, Korea (the Republic of)
| | - You Sun Kim
- Department of Paediatrics, National Medical Center, Jung, Korea (the Republic of)
- Department of Paediatrics, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Min Sun Kim
- Department of Paediatrics, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
- Seoul National University Children's Hospital Integrated Care Center, Seoul, Korea (the Republic of)
| | - Ji Weon Lee
- Seoul National University Children's Hospital Integrated Care Center, Seoul, Korea (the Republic of)
| | - Yoon-Min Cho
- National Health Insurance Service, Wonju, Korea (the Republic of)
| | - Youna Lim
- Seoul National University, Gwanak-gu, Korea (the Republic of)
| | - Seong Keun Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Dong In Suh
- Department of Paediatrics, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - June Dong Park
- Department of Paediatrics, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| |
Collapse
|
3
|
Sherman J, Bower KL, Eskandanian K. "100 Things I Wish Someone Would Have Told Me": Everyday Challenges Parents Face While Caring for Their Children With a Tracheostomy. QUALITATIVE HEALTH RESEARCH 2024:10497323231217387. [PMID: 38193439 DOI: 10.1177/10497323231217387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
Equitable access to appropriate care, emergency department services, and in-home support aids are needed to minimize the occurrences of adverse events that have a significant impact on families. However, many families of children with medical complexity (CMC) lack consistent care due to issues of health inequity. We conducted 11 qualitative interviews with primary caregivers who were asked about their experiences of providing care to children who have a tracheostomy and are supported by multiple life-saving machines at home. Guided by ecological systems theory, we identified three themes that contextualize the lived experiences of the participants who expressed needs that arose from poor interactions within the mesosystem. Findings convey participant frustrations that result from insufficient support, ineffective training, and inadequate healthcare coverage. Although each theme is organized systematically to emphasize specific concerns within the mesosystem, together these themes emphasize the inextricable relationship between daily needs with systemic barriers to care. We provide a discussion of these needs with a broader context that also impacts the perceived quality of care among families managing the needs of their children who are supported by life-saving technology. By addressing existing challenges and identifying opportunities for improvement within the healthcare system, we seek to contribute to the collective effort of advocating for ethical systemic change on behalf of CMC and their families.
Collapse
Affiliation(s)
| | - Kyle L Bower
- Department of Human Development & Family Science, The University of Georgia, Athens, GA, USA
| | | |
Collapse
|
4
|
Zhang J, Liu P, Narayanan AM, Chorney SR, Kou Y, Johnson RF. Economic Evaluation of Pediatric Tracheostomy: A Cost of Illness Analysis. OTO Open 2024; 8:e108. [PMID: 38235054 PMCID: PMC10792475 DOI: 10.1002/oto2.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/06/2023] [Accepted: 12/31/2023] [Indexed: 01/19/2024] Open
Abstract
Objective This study aimed to determine the direct costs of pediatric tracheostomy care within a health care system. Study Design Prospective analysis. Setting Academic children's hospital. Methods Costs associated with caring for pediatric tracheostomy patients under 18 years were analyzed between 2015 and 2021. Direct costs were calculated using the Medicare/Medicaid charges-to-costs ratio for various visit types. Costs were estimated using generalized linear equations, accounting for confounders. Results A total of 297 children underwent tracheostomy at a median age of 0.94 years. The median follow-up was 2.5 years, resulting in 13,966 visits (mean = 41). The total cost was $321 million. The initial admission accounted for 72% ($231 million) of costs while other inpatient admissions added 24% ($78 million). Emergency department, observation, and outpatient visits comprised 4% of costs. The length of stay (LOS) was the primary cost driver for inpatient visits. Each additional hospital day increased costs by roughly $1195, and each extra admission added about $130,223 after adjusting for confounders. Respiratory failure and infections were the primary reasons for 67% of subsequent admissions. Conclusion Pediatric tracheostomy care generated over $300 million in direct costs over 5 years. Inpatient stays constituted 96% of these costs, with the LOS being a major factor. To reduce direct health expenditures for these patients, the focus should be on minimizing admissions.
Collapse
Affiliation(s)
- Jinghan Zhang
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Palmila Liu
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Ajay M. Narayanan
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Stephen R. Chorney
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Children's Health Airway Management ProgramChildren's Medical Center DallasDallasTexasUSA
| | - Yann‐Fuu Kou
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Children's Health Airway Management ProgramChildren's Medical Center DallasDallasTexasUSA
| | - Romaine F. Johnson
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Children's Health Airway Management ProgramChildren's Medical Center DallasDallasTexasUSA
| |
Collapse
|
5
|
Boyi T, Raghavan M, Antongiovanni J, DeGiovanni JC, Carr MM. Tracheotomy in children older than two years: Analysis of discharge trends from 2015 to 2020. Int J Pediatr Otorhinolaryngol 2024; 176:111815. [PMID: 38048732 DOI: 10.1016/j.ijporl.2023.111815] [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: 09/24/2023] [Revised: 11/20/2023] [Accepted: 11/29/2023] [Indexed: 12/06/2023]
Abstract
OBJECTIVE In light of increasingly complex patients being discharged with tracheostomies, we aimed to evaluate discharge trends over time in pediatric tracheotomy patients. We hypothesized that there would be delays in discharge from increased focus on preparing families for at-home care of critically ill pediatric patients. MATERIALS AND METHODS We conducted a cross-sectional analysis of pediatric patients who underwent tracheotomy (Current Procedural Terminology code 31600) between 2015 and 2020 using the American College of Surgeons National Surgical Quality Improvement Program Pediatric database (ACS NSQIP-P). Univariate and multivariate regression analyses were performed to assess patient demographics, comorbidities, perioperative factors, postoperative complications, and discharge information. Data were analyzed using Stata 15. RESULTS A total of 1552 patients were identified. There were 868 (56 %) males and 684 (44 %) females with a mean age of 7.3 ± 5.7 years. At least one comorbidity was seen in 1282 (83 %) patients, with 907 (58 %) having impaired cognitive status or developmental delay. Thirty-six (2.3 %) patients experienced mortality within 30 days, while 710 (46 %) were still in the hospital at 30 days. The odds of remaining in the hospital after 30 days were positively correlated with the year (p=.001). Other factors associated with an increased likelihood of remaining in the hospital after 30 days included younger patient age (p <.001), any complication (p <.001), and a higher American Society of Anesthesiologists classification (p <.001). CONCLUSION As years have progressed, fewer children were discharged from the hospital after 30 days following tracheotomy. Further research may identify socioeconomic factors contributing to the increasing length of hospital stays associated with a need for tracheotomy.
Collapse
Affiliation(s)
- Trinithas Boyi
- Department of Otolaryngology, University at Buffalo, Buffalo, NY, USA
| | - Maya Raghavan
- Department of Otolaryngology, University at Buffalo, Buffalo, NY, USA
| | - James Antongiovanni
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | | | - Michele M Carr
- Department of Otolaryngology, University at Buffalo, Buffalo, NY, USA.
| |
Collapse
|
6
|
Acorda DE, Brown JN, Lambert EM, Gibbs KD. Psychosocial Measures and Outcomes Among Caregivers of Children With Tracheostomies: A Systematic Review. Otolaryngol Head Neck Surg 2023; 168:979-987. [PMID: 36939578 DOI: 10.1002/ohn.202] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/26/2022] [Accepted: 10/30/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Children with tracheostomies have complex medical issues that require long-term technology dependence and continuous medical care at home. Parents of tracheostomy-dependent children often assume the majority of their child's home care leading to a shift in family dynamics and a decrease in caregiver quality of life. This systematic review sought to identify instruments to measure caregiver psychosocial outcomes after their child's tracheostomy and report on the findings. DATA SOURCES A systematic review was performed using Medline, CINAHL, and EMBASE. REVIEW METHODS Studies that evaluated psychosocial outcomes in caregivers of tracheostomy-dependent children were included. RESULTS We screened a total of 1286 nonduplicate records to include a total of 12 studies assessing the psychosocial outcomes of parents of tracheostomy-dependent children. Fourteen instruments were identified. Caregivers reported lower quality of life when compared to other chronic caregiver groups. They experienced high degrees of stress, struggled to cope individually and as a family unit, and experienced decision regret and conflict. CONCLUSION Findings from this review suggest a significant impact on caregiver psychosocial well-being, but few quantitative studies investigated this dynamic with measures validated in this caregiver population. This review demonstrates the need for longitudinal studies using validated tools to assess the long-term impacts and outcomes of caregivers of the tracheostomy-dependent child.
Collapse
Affiliation(s)
- Darlene E Acorda
- Department of Nursing, Texas Children's Hospital, Texas, Houston, USA
| | - Jennifer N Brown
- Department of Nursing, Texas Children's Hospital, Texas, Houston, USA
| | - Elton M Lambert
- Department of Nursing, Texas Children's Hospital, Texas, Houston, USA.,Section of Otorhinolaryngology, Baylor College of Medicine, Section of Otorhinolaryngology, Texas, Houston, USA
| | | |
Collapse
|
7
|
Acorda DE, Jackson A, Lam AK, Molchen W. Overwhelmed to ownership: The lived experience of parents learning to become caregivers of children with tracheostomies. Int J Pediatr Otorhinolaryngol 2022; 163:111364. [PMID: 36330951 DOI: 10.1016/j.ijporl.2022.111364] [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: 06/13/2022] [Revised: 10/06/2022] [Accepted: 10/14/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Caring for a child with a tracheostomy is challenging and requires parents to master advanced medical skills, often without prior medical training. Tracheostomy education programs are well-established, yet the experience of parents becoming competent caregivers is unexplored. Providing effective education may impact long-term child and caregiver outcomes and mitigates preventable hospital readmissions. OBJECTIVE This study aimed to explore parents' experience completing tracheostomy education within a children's hospital and understand the factors that promote or hinder learning. METHODS We conducted a qualitative descriptive study on twenty-three purposively sampled parents of children with new tracheostomies from 2020 to 2021 who were admitted to the Transitional Intensive Care Unit (TICU) at a quaternary pediatric hospital. Semi-structured interviews were conducted after parents completed tracheostomy education and before discharge. Inductive thematic analysis was employed to identify themes and subthemes. RESULTS Five major themes emerged: decision making, balancing benefits, becoming a caregiver, healthcare providers (HCPs) as barriers and facilitators for learning, and recommendations for tracheostomy education programs. Parents described becoming a caregiver in four stages: initial realization, overwhelmed, owning care, and role transition. Learning tracheostomy management in a positive, collaborative, supportive environment helped parents be more confident in their skills and eased their transition to home. Previous life experience, learning style, and healthcare professional behaviors influenced parents' transition into the caregiver role. CONCLUSIONS Findings will inform interventions for improving pediatric tracheostomy education programs, including the HCP's role in supporting families. Equipping caregivers with the skills to provide tracheostomy interventions in the home could decrease preventable readmissions and improve outcomes in this medically fragile, high-risk pediatric population.
Collapse
Affiliation(s)
| | | | - Anne K Lam
- Texas Children's Hospital, Houston, TX, USA
| | - Wallis Molchen
- Texas Children's Hospital, Houston, TX, USA; Section of Critical Care, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
8
|
A parent first: Exploring the support needs of parents caring for a child with medical complexity in Australia. J Pediatr Nurs 2022; 67:e48-e57. [PMID: 36192287 DOI: 10.1016/j.pedn.2022.09.018] [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: 05/09/2022] [Revised: 09/20/2022] [Accepted: 09/20/2022] [Indexed: 11/20/2022]
Abstract
PURPOSE In a recent paediatric nursing research priority setting study, youth, parents and healthcare professionals included 'practical and emotional support' among the top ten areas to focus on. The aim of this study was to explore the support needs of parents who have a child with medical complexity living in the family home. DESIGN Exploratory with a qualitative inductive approach. METHODS Semi-structured interviews with 12 mothers of children living with heterogenous medical complexity. Interviews were recorded, transcribed and analysed using thematic analysis. The COREQ checklist was used as a reporting guide. RESULTS Three themes were tied together by the finding that participants identified as 'a parent first'. The first theme represents the early days where participants desired emotional and practical support for becoming a parent of a child with medical complexity. In the second theme, participants desired more support for the discharge home from the hospital. In the last theme, participants described high levels of knowledge and expertise in relation to their child's unique needs and desired highly accessible support for keeping their child out of hospital. CONCLUSION Parents' support needs change over time and are similar despite the heterogeneity of their children's medical complexity. Parents seek services that support an independent family life and are responsive to their confidence and competence in caring for their child at home. PRACTICE IMPLICATIONS Interventions should be tailored to the changing support needs of parents over time.
Collapse
|
9
|
Li L, Jo S, Kawai K, Yacovone L, Jackmin M, Nuss RC. Utility of telemedicine in tracheostomy-dependent children. Laryngoscope Investig Otolaryngol 2022; 7:1751-1755. [PMID: 36544973 PMCID: PMC9764762 DOI: 10.1002/lio2.937] [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: 06/15/2022] [Revised: 08/31/2022] [Accepted: 09/02/2022] [Indexed: 12/24/2022] Open
Abstract
Objectives Telemedicine can improve access to pediatric otolaryngology care by decreasing travel time and cost, and lowering the risk of viral transmission during the SARS-CoV-2 (COVID-19) pandemic. This study aims to identify the clinical role and outcomes of telemedicine for tracheostomy-dependent children before and during the COVID-19 pandemic. Methods Retrospective chart review of 42 tracheostomy-dependent pediatric patients who utilized telemedicine between October 2013 and April 2020 (pre-COVID-19), and 111 patients who utilized telemedicine between May 2020 and July 2021 (during COVID-19) at a tertiary free-standing children's hospital outpatient clinic. Results The majority of pre-COVID-19 telecommunication solely addressed tracheostomy stomal concerns as compared with during COVID-19 (99% vs. 3%, p < .001), while telecommunication during COVID-19 was mainly used for routine follow-up as compared with pre-COVID-19 (99% vs. 0%, p < .001). Telemedicine visits during COVID-19 were significantly less likely to result in the need for in-person office visits as compared with those pre-COVID-19 (4% vs. 22%; p < .001). There was no significant difference in urgent emergency department (ED) evaluation following telemedicine pre- and during COVID-19 (16% vs. 11%). The most common reasons for ED presentation both pre- and during COVID-19 following telemedicine visit included respiratory distress, dislodged tracheostomy tube, and tracheostomy bleeding. Conclusion The clinical role of telemedicine has evolved from problem-based evaluation to routine follow-up during the COVID-19 pandemic. Although telemedicine can decrease the need for in-person office evaluation of routine tracheostomy concerns, respiratory complications and tracheostomy bleeding still require urgent in-person ED evaluation. Level of evidence Level 4.
Collapse
Affiliation(s)
- Lilun Li
- Department of Otolaryngology and Communication EnhancementBoston Children's HospitalBostonMassachusettsUSA
| | - Stacy Jo
- Department of Otolaryngology and Communication EnhancementBoston Children's HospitalBostonMassachusettsUSA
| | - Kosuke Kawai
- Department of Otolaryngology and Communication EnhancementBoston Children's HospitalBostonMassachusettsUSA
| | - Laura Yacovone
- Department of Otolaryngology and Communication EnhancementBoston Children's HospitalBostonMassachusettsUSA
| | - Mary Jackmin
- Department of Otolaryngology and Communication EnhancementBoston Children's HospitalBostonMassachusettsUSA
| | - Roger C. Nuss
- Department of Otolaryngology and Communication EnhancementBoston Children's HospitalBostonMassachusettsUSA,Department of Otolaryngology – Head and Neck SurgeryHarvard Medical SchoolBostonMassachusettsUSA
| |
Collapse
|
10
|
High MS, Julion W, Heigel S, Fawcett A, Sobotka SA. Parent education programs for children assisted by invasive mechanical ventilation: A scoping review. J Pediatr Nurs 2022; 66:160-170. [PMID: 35797806 PMCID: PMC10767751 DOI: 10.1016/j.pedn.2022.06.009] [Citation(s) in RCA: 2] [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] [Received: 02/18/2022] [Revised: 05/22/2022] [Accepted: 06/17/2022] [Indexed: 11/23/2022]
Abstract
PROBLEM The population of children assisted by invasive mechanical ventilation (IMV) and living at home is growing. Although parent education is essential for safe transitions from hospital-to-home, little is known about how this education is delivered. The aim of this review is to identify existing literature about parent education programs, synthesize the evidence, and identify gaps in the literature for future inquiry. ELIGIBILITY CRITERIA This scoping review was conducted in accordance with the Joanna Briggs Institute methodology. Full-text publications in the English language focused on describing parent education programs for children assisted by IMV, indexed in CINAHL, PubMed, OVID, and PsycINFO and published from 2010 to 2021 were included. Reference lists of relevant articles were reviewed, and a hand search was completed to locate any additional literature outside the original search. SAMPLE A total of 2472 citations were identified. After screening titles and abstracts, 37 full-text articles were retrieved and assessed for eligibility. Two independent reviewers completed the screening process. A hand search located one additional article. A final sample of 18 articles were included in the review. RESULTS The parent education programs described in the final sample included standardized discharge education programs, simulation training, resourcefulness training, patient-specific action plans, disaster preparedness, and symptom and technology management. CONCLUSION Although most parent education programs identified in this review focused on teaching caregiver skills, program characteristics and outcome measures varied widely. IMPLICATIONS This review recommends directions for future research to optimize parent education for children assisted by IMV.
Collapse
Affiliation(s)
- Michelle S High
- College of Nursing, Rush University, Chicago, IL, USA; Department of Nursing, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Lurie Children's Pediatric Research & Evidence Synthesis Center (PRECIISE): A JBI Affiliated Group, Chicago, IL, USA.
| | | | - Sarah Heigel
- Department of Nursing, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Andrea Fawcett
- Lurie Children's Pediatric Research & Evidence Synthesis Center (PRECIISE): A JBI Affiliated Group, Chicago, IL, USA; Department of Clinical and Organizational Development, Ann & Robert H. Lurie Children's Hospital of Chicago, IL, USA
| | - Sarah A Sobotka
- Section of Developmental and Behavioral Pediatrics, Department of Pediatrics, University of Chicago, Chicago, IL, USA
| |
Collapse
|
11
|
Nageswaran S, Gower WA, King NM, Golden SL. Tracheostomy decision-making for children with medical complexity: What supports and resources do caregivers need? Palliat Support Care 2022:1-7. [PMID: 36000170 PMCID: PMC9950280 DOI: 10.1017/s1478951522001122] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Caregivers of children with medical complexity (CMC) face decisions about life-sustaining interventions, such as tracheostomy. Our objective is to describe the support needs of caregivers of CMC and the resources they use surrounding tracheostomy decision-making (TDM) for their children. METHODS This qualitative study, conducted between 2013 and 2015, consisted of semi-structured interviews with 56 caregivers of 41 CMC who had tracheostomies, and 5 focus groups of 33 clinicians at a tertiary care children's hospital. Participants were asked about their perspectives on the TDM process. Qualitative data were transcribed, coded, and organized into themes. RESULTS Caregivers used five domains of resources surrounding TDM: (1) social network including extended family members, friends, and clergy; (2) healthcare providers including physicians and nurses; (3) other parents of children with tracheostomy; (4) tangible materials such as print materials, videos, tracheostomy tubes, mannequins, and simulation labs; and (5) internet including websites, social media, and online health communities. Caregivers used these resources for (1) decision-making, (2) becoming knowledgeable and skillful about child's diagnosis, tracheostomy, and home care, and (3) emotional and spiritual well-being. Caregivers agreed that they received enough support, but there were gaps. Clinicians were knowledgeable about these resources, discussed social network and internet less often than the other domains, and identified gaps in supporting caregivers. SIGNIFICANCE OF RESULTS Caregivers' need for support and use of resources surrounding tracheostomy placement for CMC extended beyond decision-making, and included becoming knowledgeable and getting emotional/spiritual support. Healthcare providers exploring these resources with caregivers could improve the quality of TDM communication.
Collapse
Affiliation(s)
- Savithri Nageswaran
- Department of Pediatrics, Wake Forest School of Medicine
- Department of Social Science and Health Policy, Wake Forest University
| | - William A. Gower
- Department of Pediatrics, Wake Forest School of Medicine
- Department of Pediatrics, University of North Carolina School of Medicine (current affiliation)
| | - Nancy M.P. King
- Department of Social Science and Health Policy, Wake Forest University
| | | |
Collapse
|
12
|
Hofmann M, Yonkaitis C. Lessons Learned from Caregivers of Children with Medical Complexity: Implications for Policy & Providers. Home Healthc Now 2022; 40:196-201. [PMID: 35777940 DOI: 10.1097/nhh.0000000000001083] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
As the number of children with medical complexity living at home continues to grow, so do their care needs. Feedback from parent/guardian caregivers of children with medical complexity provides insight that can help policy makers and healthcare providers to understand more about the care provided in the home. Focus groups, a qualitative study approach, were used to more fully understand the challenges faced by parents/guardian caregivers of children with medical complexity residing in Illinois. Focus groups were conducted in the spring of 2021 to examine the issues from the parent/guardian caregiver perspective. Three main themes emerged from the focus group discussions: navigation of the system is confusing; quality of care in the home needs improvement; and caregivers need more help in providing care. Review of the discussions provided an understanding of the experiences of parent/guardian caregivers of children with medical complexity. These findings have important implications for policy makers, public health and Title V Programs, home nursing agencies, and home nurses. It is imperative that systems level upstream solutions be implemented to address the systemic challenges related to care for the child with medical complexity at home.
Collapse
|
13
|
Hall N, Rousseau N, Hamilton DW, Simpson AJ, Powell S, Brodlie M, Powell J. Impact of COVID-19 on carers of children with tracheostomies. Arch Dis Child 2022; 107:e23. [PMID: 34887248 PMCID: PMC8668410 DOI: 10.1136/archdischild-2021-322979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 11/24/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To explore the impact of the COVID-19 pandemic on the experiences of caregivers of children with tracheostomies. DESIGN Qualitative semistructured interviews. SETTING All participants were currently, or had previously cared for, a tracheostomised child who had attended a tertiary care centre in the North of England. Health professionals were purposively sampled to include accounts from a range of professions from primary, community, secondary and tertiary care. PARTICIPANTS Carers of children with tracheostomies (n=34), including health professionals (n=17) and parents (n=17). INTERVENTIONS Interviews were undertaken between July 2020 and February 2021 by telephone or video link. MAIN OUTCOME MEASURE Qualitative reflexive thematic analysis with QSR NVivo V.12. RESULTS The pandemic has presented an additional and, for some, substantial challenge when caring for tracheostomised children, but this was not always felt to be the most overriding concern. Interviews demonstrated rapid adaptation, normalisation and varying degrees of stoicism and citizenship around constantly changing pandemic-related requirements, rules and regulations. This paper focuses on four key themes: 'reconceptualising safe care and safe places'; 'disrupted support and isolation'; 'relationships, trust and communication'; and 'coping with uncertainty and shifting boundaries of responsibility'. These are described within the context of the impact on the child, the emotional and physical well-being of carers and the challenges to maintaining the values of family-centred care. CONCLUSIONS As we move to the next phase of the pandemic, we need to understand the impact on vulnerable groups so that their needs can be prioritised.
Collapse
Affiliation(s)
- Nicola Hall
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Nikki Rousseau
- Surgical, Diagnostic and Devices Division, University of Leeds, Leeds, UK
| | - David W Hamilton
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - A John Simpson
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Steven Powell
- Department of Paediatric Otolaryngology, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Malcolm Brodlie
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Department of Paediatric Respiratory Medicine, Great North Children's Hospital, Newcastle Upon Tyne, UK
| | - Jason Powell
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Department of Paediatric Otolaryngology, Great North Children's Hospital, Newcastle upon Tyne, UK
| |
Collapse
|
14
|
Hoover CG, Coller RJ, Houtrow A, Harris D, Agrawal R, Turchi R. Understanding Caregiving and Caregivers: Supporting Children and Youth With Special Health Care Needs at Home. Acad Pediatr 2022; 22:S14-S21. [PMID: 35248243 DOI: 10.1016/j.acap.2021.10.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 10/15/2021] [Accepted: 10/22/2021] [Indexed: 02/07/2023]
Abstract
Caregiving encompasses the nurturing, tasks, resources, and services that meet the day-to-day needs of children and youth with special health care needs (CYSHCN) at home. Many gaps exist in the strategies currently offered by the health care system to meet the caregiving needs of CYSHCN. The work of family caregivers of CYSHCN is known to be extensive, but it is so poorly understood that it has been described as "invisible". This invisibility leads to poor communication and gaps in understanding between professional health care providers and family caregivers. To address these gaps, health care researchers must work with family caregivers to incorporate their expertise on caregiving and create meaningful and sustainable research partnerships. A growing body of research is attempting to remedy the problem of caregiving invisibility and lay better foundations for successful integration between health care settings, family caregiving, professional caregiving, and community supports for families of CYSHCN. We identify high-priority gaps in CYSHCN caregiving research and propose research questions that are designed to accelerate growth in evidence-based understanding of the work of family caregivers of CYSHCN and how best to support them.
Collapse
Affiliation(s)
| | - Ryan J Coller
- Department of Pediatrics (RJ Coller), School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Win
| | - Amy Houtrow
- Department of Physical Medicine and Rehabilitation (A Houtrow), School of Medicine, University of Pittsburgh, Pittsburgh, Pa
| | - Debbi Harris
- Family Voices of Minnesota (D Harris), Stillwater, Minn
| | - Rishi Agrawal
- Division of Hospital-Based Medicine (R Agrawal), Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Renee Turchi
- Department of Pediatrics (R Turchi), College of Medicine, Drexel University, Philadelphia Pa
| |
Collapse
|
15
|
Leite RC, Ribeiro CA, Cunha MLDR, Maia EBS, Ben LWD, Almeida FDA. Busca de qualidade e segurança no cuidado ao filho: interações familiares com profissionais de Home Care. ESCOLA ANNA NERY 2022. [DOI: 10.1590/2177-9465-ean-2021-0236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo compreender a vivência do cuidador familiar de crianças/adolescentes assistidos pela equipe multiprofissional em Home Care. Método estudo qualitativo, tendo o Interacionismo Simbólico como referencial teórico, realizado com nove famílias de crianças/adolescentes em internação domiciliar, atendidas em uma empresa de Home Care localizada em São Paulo. Os dados foram coletados entre abril e outubro de 2017, por meio de entrevistas semiestruturadas, e submetidos à análise qualitativa de conteúdo convencional. Resultados as subcategorias Vivendo em constante estado de alerta e Dando um passo à frente para garantir um cuidado seguro e qualificado evidenciaram que os familiares ressignificam o cuidado, mostrando-se alertas, no sentido de redirecionar suas ações para prover uma assistência idealizada. Conclusão o Home Care exige dos familiares o enfrentamento de novos desafios e difíceis adaptações, além da preocupação com a segurança e qualidade do atendimento, levando-os a desenvolverem estratégias para lidar com a situação. Implicações para a prática os discursos dos familiares sinalizam a urgência da inserção da temática do cuidado pediátrico em Home Care nas pautas de debates e discussões acadêmicas, e seu desdobramento em investimentos por parte de gestores e serviços de atendimento domiciliar, a fim de garantir uma assistência segura à criança/adolescente e sua família.
Collapse
|