Resourcefulness Intervention Efficacy for Parent Caregivers of Technology-Dependent Children: A Randomized Trial

Online interventions for the mental health and well-being of parents of children with additional needs: Systematic review and meta-analysis

INTRODUCTION

Parents of children with additional needs experience compromised physical and mental health and higher stress, and their ability to engage in meaningful occupations is impacted by their additional caregiving tasks. Online interventions targeting mental health, stress, and well-being for parents of children with additional needs have potential to increase supports alongside occupational therapy direct services. The aims of this review are to systematically identify and synthesise evidence of effectiveness of online interventions aimed at improving mental health, stress, and well-being of parents of children with additional needs.

METHOD

Eight databases were searched up to July 2024 to identify online interventions for parents of children with additional needs. Studies were appraised for methodological quality. Standardised effect sizes were calculated, and meta-analyses of randomised control trials (RCTs) were conducted on outcomes of mental health, well-being, and stress.

CONSUMER AND COMMUNITY INVOLVEMENT

There was no consumer or community involvement.

RESULTS

Systematic screening identified 30 papers that met inclusion criteria. Most were RCTs or controlled clinical trials (CCTs) with 'moderate' quality ratings: Three were designed by occupational therapists. There was substantial variation in intervention types, methods of delivery, outcomes, and outcome measures used. The pooled standardised effect size estimates (ES) and the lower and upper confidence intervals (CI) of online interventions from RCTs post-interventions were significant for mental health ES = 0.47, 95% CI (0.18, 0.77), p = 0.002; stress ES = 1.27, 95% CI (0.56, 1.98), p = 0.000; and well-being ES = 0.65, 95% CI (1.2, 0.06), p = 0.03, respectively.

CONCLUSION

The online interventions that aimed to improve mental health, stress, and well-being included in this meta-analysis were effective. Occupational therapists supporting families play an important role in guiding parents of children with additional needs to evidence-based interventions to support them with addressing their own mental health and well-being needs.

Telenursing on primary family caregivers and children with disabilities: a scoping review

Introduction

Despite the need for continued support for children with disabilities and their families, COVID-19 has made the support difficult. Telenursing can monitor daily life and support from a remote location, continuously and at a low cost. However, there are few practical reports on its use in children with disabilities.

Objective

This scoping review aims to summarize the published literature on telenursing for children with disabilities in home care settings.

Methods

We included studies involving children (0-18 years of age) with disabilities and their families and specified telecommunication assessment, monitoring, and intervention such as tele-education, teleconsultation and telementoring involving nurses via information communication technologies. We included studies that used any design written in English or Japanese. A comprehensive search was conducted on March 14, 2021 using six databases: MEDLINE via PubMed, Cumulative Index to Nursing & Allied Health Literature, Cochrane Central Register of Controlled Trials, Embase, PsycINFO, and Ichushi Web. Two or more reviewers individually screened eligible studies according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram. Data on the characteristics of the included studies, telecommunications technology interventions, and children with disabilities were mapped in tables.

Results

Eleven studies, published between 2003 and 2020, met the inclusion criteria. Only one study used the term "telenursing," while others used "telehealth" and other terms, which involved multidisciplinary support such as physicians and social workers in addition to nurses. Although there were various types of telecommunications technology interventions, they were categorized as consultation, healthcare provision, monitoring, and education. Most studies have examined telecommunication technology interventions by healthcare professionals, including nurses. Five studies focused on children with medical complexities, and two focused on children with neurodevelopmental disabilities, including developmental delays. There is insufficient information on telecommunications technology interventions, especially assessment tools, trigger points, and the status of the target population.

Conclusion

This scoping review aimed to map the published literature on telenursing for children with disabilities and their families in home care settings. Available evidence indicates a lack of research focusing on the implementation of telecommunications for children with disabilities and their families. Further research is required to assess the effects of telecommunications technology interventions. Additionally, they should provide information for implementing telecommunication technology safety.

Scoping Review Registration

Figshare (https://doi.org/10.6084/m9.figshare.21747047.v1).

Implementing Resourcefulness Training© with Parent Caregivers of Children Dependent on Medical Technology During the COVID-19 Pandemic: Lessons Learned from a Randomized Controlled Trial

Parent caregivers of children requiring life-saving medical technology (e.g., mechanical ventilation) report higher levels of stress and poorer health than other caregivers, often neglecting health-promoting behaviors for themselves. This article describes an iterative implementation science strategy used to improve intervention delivery for a randomized controlled trial testing a telehealth, cognitive-behavioral resourcefulness intervention with this population during the COVID-19 pandemic. This process consisted of reflective team meetings and content analysis. Initial adjustments were made after content analysis of pilot study materials before intervention delivery including an intervention script, checklist, online daily log, Health Insurance Portability and Accountability Act (HIPAA)-compliant texting option, training material access, and fidelity checks. In vivo adjustments were implemented in four areas: recruitment/engagement, participation and use of resources, in-person delivery, and virtual delivery. Our efforts to streamline intervention delivery were enhanced by incorporating an iterative implementation science strategy including analysis and adjustment of intervention delivery procedures to decrease participant burden and promote intervention adherence. Reflective team meetings and a collaborative, problem-solving approach to resolve the various barriers and challenges with the randomized controlled trial were integral components of intervention delivery. This study informs future intervention research by providing details of barriers faced, pragmatic adjustments made to intervention implementation, and lessons learned (NCT0410524; www.clinicaltrials.gov).

Global trends in technology-dependent children, home care, and parental discharge education: A bibliometric analysis using Biblioshiny

BACKGROUND

Parents of technology-dependent children constitute a different population in society and face diverse problems during caregiving.

METHODS

This study aimed to identify and visualize studies conducted from 1990 to 2024 on technology-dependent children, home care, and parental discharge education and determine global trends. A descriptive and bibliometric study design was employed. Data were obtained from the Web of Science Core Collection database, and bibliometric analyses were performed with performance analysis, visualization, and mapping using the Biblioshiny interface in the R software. Screening yielded a total of 157 publications. A total of 138 publications were included.

FINDINGS

The keywords frequently used by the authors included "home care," "technology-dependent children," "palliative care," "home mechanical ventilation," "child," "family," and "pediatric." Co-author keywords with moderate centrality and density are "home mechanical ventilation" (Betw = 106.47), "technology-dependent" (Betw = 106.47), "home mechanical ventilation" (Betw = 106.47). Each article had 4.41 co-authorships, with an international co-authorship rate of 6.52 %.

CONCLUSIONS

This study provided important data on studies focusing on technology-dependent children, home care, and parental discharge education.

APPLICATION TO PRACTICE

Since the number of studies in the field is small, the findings of this study are essential in guiding researchers about gaps in the literature.

Efficacy of a Resourcefulness Intervention to Enhance the Physical and Mental Health of Parents Caring for Technology-dependent Children at Home: A Randomized Controlled Trial

INTRODUCTION

Parent caregivers of children who require lifesaving medical technology (e.g., mechanical ventilation, feeding tubes) must constantly maintain vigilance. Poor physical and psychological health can negatively impact their ability to do so.

METHOD

A two-arm randomized controlled trial was conducted with 197 parent caregivers of technology-dependent children (aged < 18 years) to test the efficacy of Resourcefulness Training1, a cognitive-behavioral intervention that teaches social (help-seeking) and personal (self-help) resourcefulness skills, in improving key outcomes including mental health-related quality of life (HRQOL), depressive cognitions and symptoms, perceived and physiological chronic stress, burden, and physical HRQOL at five-time points.

RESULTS

Mixed-effects models using the intent-to-treat principle indicated statistically significant improvement with intervention participants at six and/or nine months postintervention for depressive cognitions, perceived stress, and physical HRQOL, controlling for covariates.

DISCUSSION

Study findings support the efficacy of Resourcefulness Training to significantly decrease perceived stress and improve psychological/physical outcomes with these vulnerable caregivers.

Symptom and Technology Management Intervention Usefulness for Caregivers of Children With Tracheostomies and Feeding Tubes

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.

Resourcefulness Among Initial Ischemic Stroke Patients: A Longitudinal Study of 12 Months

Objective

To explore distinct longitudinal trajectories of resourcefulness among initial ischemic stroke patients from diagnosis to 12 months, and to identify whether sociodemographic factors, disease-related factors, self-efficacy, family function, and social support can predict patterns in the trajectories of resourcefulness.

Methods

A prospective longitudinal study was conducted. Initial ischemic stroke patients who met inclusion and exclusion criteria were followed up when still in hospital (Preparing for discharge, Baseline, T1), at 1 month (T2), at 3 months (T3), at 6 months (T4), at 9 months (T5) and 12 months (T6) (±1 week) after discharge. General information, National Institute of Health Stroke Scale (NIHSS), Modified Rankin Scale (mRS), General Self-Efficacy Scale (GSES), General Family Functioning Subscale (FAD-GF), and Social Support Rate Scale (SSRS) were used in T1. The Resourcefulness Scale© was evaluated at 6 time points. Growth mixture modeling was used to identify trajectory patterns of resourcefulness. Logistic regression was used to identify predictors of resourcefulness trajectories.

Results

Three longitudinal trajectories of resourcefulness were identified and named as the high-stable class (38.9%, n=71), fluctuation class (41.2%, n=75), and low-stable class (19.9%, n=36), respectively. Dwelling areas (x2=6.805, P=0.009), education (x2=44.865, P=0.000), monthly income (x2=13.063, P=0.001), NIHSS scores (x2=44.730, P=0.000), mRS scores (x2=51.788, P=0.000), Hcy (x2=9.345, P=0.002), GSES (x2=56.933, P=0.000), FAD-GF (x2=41.305, P=0.000) and SSRS (x2=52.373, P=0.000) were found to be statistically significant for distinguishing between different resourcefulness trajectory patterns. Lower education (OR=0.404), higher NIHSS(OR=6.672) scores, and higher mRS(OR=21.418) scores were found to be risk factors for lower resourcefulness, whereas higher education(OR=0.404), GSES(OR=0.276), FAD-GF(OR=0.344), and SSRS(OR=0.358) scores were identified as protective factors enhancing resourcefulness.

Conclusion

This study obtained three patterns of trajectories and identified their predictive factors in initial ischemic stroke. The findings will assist health care professionals in identifying subgroups of patients and when they may be at risk of low resourcefulness and provide timely targeted intervention to promote resourcefulness.

Lived Experience of Parents with Technology-Dependent Children: A Phenomenological Study

Caring for technology-dependent children significantly impacts the family unit, a topic that has not been researched in Portugal. Understanding this impact can help nurses to improve their interventions. This study aimed to describe the lived experiences of parents with technology-dependent children using a qualitative descriptive design. We applied Giorgi's approach to analyze 10 individual semi-structured interviews with parents recruited through a children's hospital in Portugal. Our analysis identified two major themes: (1) Discovering a new parenthood: parent and caregiver, comprising two subthemes: Family reorganization and Learning to use a medical device; (2) Reconciling daily life with the needs of the technology-dependent children, comprising two subthemes: Importance of support systems and Experiencing difficulties. These results indicate that parents experience a wide range of concerns and challenges in managing medical devices, starting from the moment the need for a device is communicated and continuing through the process of learning and providing care. This journey involves significant changes in family dynamics and is marked by sacrifice and adaptation, supported by family, formal support systems, and healthcare professionals. Our findings provide valuable insights into the vulnerabilities faced by these parents and highlight how nursing care can enhance the quality of care for these families.

Experiences of Parents of Children With Medical Complexity in the Pediatric Intensive Care Unit: A Scoping Review

BACKGROUND

Medical advances and decreased mortality rates in the pediatric intensive care unit have increased the number of children surviving illnesses they may not have survived previously. The term child with medical complexity is poorly defined.

OBJECTIVES

The purposes of this scoping review were to examine the experiences of parents of children with medical complexity in the pediatric intensive care unit and describe strategies to help support these parents.

RESULTS

Eight studies were eligible for inclusion. All were published from 2009 through 2021. One study was a quantitative observational study, 2 were mixed-methods studies, and 5 had a qualitative design. Parents experienced significant stress and depression. Sources of stress were parenting a child with complex chronic illness in the pediatric intensive care unit, uncertainty, communication between family members and clinicians, and lack of subspecialty communication. Strategies to assist parents included respecting parents' expertise and providing consistent and clear communication with family members and among subspecialty clinicians.

CONCLUSION

This review is the first to examine the experiences of parents of children with medical complexity in the pediatric intensive care unit. The study was limited by lack of available research and lack of consensus for the definition of child with medical complexity. However, this review describes strategies that nurses may find useful when caring for parents of children with medical complexity.

Postal Delivery of Sleep Monitoring Devices: Research Implications

The purpose of this article is to describe the protocol development, feasibility, and lessons learned in the postal mail delivery of sleep monitoring devices to study participants. The original study protocol included four in-person visits with distribution of a sleep monitoring device (Actiwatch) and return of the Actiwatch via the postal service in a self-addressed, stamped envelope. The COVID-19 pandemic limited in-person research contact thus requiring a remote study protocol for application and return of the Actiwatches using postal delivery. While there were postal delivery and return challenges, the overall return rate of 94.4% confirmed remote protocol feasibility. Key lessons learned were: consistent and frequent communication via telephone calls and/or text; confirming required postage; and use of package tracking labels. All these strategies contributed to successful postal delivery/return and concomitantly decreased the potential loss of data and valuable research equipment.

Examining Children With Complex Care and Technology Needs in the Context of Social Determinants of Health

Children with complex care and technology needs require daily, intensive care from family caregivers. These children are understudied, particularly in relation to the social determinants of health (SDOH) that affect their health, well-being, and quality of life. This paper examines the salient research on SDOH among this population, focusing on the Healthy People 2030 domains. Gaps in the research are identified and recommendations for future research, practice, policy, and education are presented. Pediatric nurses, advanced practice nurses, and other health care provider teams that care for these children and families can improve their health by examining and addressing SDOH.