1
|
Mitchell TK, Bray L, Blake L, Dickinson A, Carter B. 'I feel like my house was taken away from me': Parents' experiences of having home adaptations for their medically complex, technology-dependent child. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e4639-e4651. [PMID: 35715967 PMCID: PMC10083937 DOI: 10.1111/hsc.13870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 04/28/2022] [Accepted: 05/28/2022] [Indexed: 06/15/2023]
Abstract
Technology-dependent children are a sub-population of seriously ill children with life-limiting conditions who are being cared for at home by their families. Although home-based care has been the model of care for these children since the late 1980s, there is a paucity of literature about parents' experiences of having home adaptations made to enable their home to be a place of care for their child. Using the findings from auto-driven photo-elicitation interviews conducted between August 2017 and June 2018 with 12 parents (10 mothers and 2 fathers) who have a technology-dependent child (aged 5-25 years) living in England, Scotland and Wales and David Seamon's five concepts of at-homeness (appropriation, at-easeness, regeneration, rootedness and warmth) as a conceptual framework, this paper addresses how parents' experienced home adaptations. Thematic analysis generated a meta-theme of 'Home needs to be a home for all family members' and the three key themes: (1) 'You just get told' and 'you're not involved'; (2) It's just the 'cheapest', 'quickest', 'short-term' approach; (3) Having 'control' and 'thinking things through.' The need to involve parents in decision-making about adaptations that are made to their home (family-informed design) is clear, not only from a cost-saving perspective for the state, but for creating an aesthetic and functional home that optimises health, well-being and feelings of at-homeness for the entire family.
Collapse
Affiliation(s)
- Tracy Karen Mitchell
- Faculty of Health, Social Care and MedicineEdge Hill UniversityOrmskirkLancashireUK
- Present address:
Department of Public Health, Policy and Systems, Institute of Population HealthUniversity of LiverpoolLiverpoolUK
| | - Lucy Bray
- Faculty of Health, Social Care and MedicineEdge Hill UniversityOrmskirkLancashireUK
| | - Lucy Blake
- Faculty of Health, Social Care and MedicineEdge Hill UniversityOrmskirkLancashireUK
- Present address:
Department of Health and Social SciencesUniversity of the West of England (UWE)BristolUK
| | | | - Bernie Carter
- Faculty of Health, Social Care and MedicineEdge Hill UniversityOrmskirkLancashireUK
| |
Collapse
|
2
|
Mitchell TK, Bray L, Blake L, Dickinson A, Carter B. 'It doesn't feel like our house anymore': The impact of medical technology upon life at home for families with a medically complex, technology-dependent child. Health Place 2022; 74:102768. [PMID: 35219047 DOI: 10.1016/j.healthplace.2022.102768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 12/18/2021] [Accepted: 02/11/2022] [Indexed: 11/16/2022]
Abstract
The study aimed to identify how medical technology impacts upon the home and life at home. Inductive auto-driven photo-elicitation or semi-structured interviews were conducted with technology-dependent children/young people (n = 2) and their family members (n = 15) from 10 families. Thematic analysis generated three themes: Altered physicality and look of the home; Altered sounds in the home; and 'It's worth it! Technology enables us to stay as a family'. Fundamentally, the detrimental impacts of living with medical technology were perceived as worth it as these enabled their child to be at home. Home was not home, and families were incomplete without their child at home.
Collapse
Affiliation(s)
- Tracy Karen Mitchell
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, UK.
| | - Lucy Bray
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, Lancashire, UK
| | - Lucy Blake
- Department of Health and Social Sciences, University of the West of England (UWE), Bristol, UK
| | | | - Bernie Carter
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, Lancashire, UK
| |
Collapse
|
3
|
Grant M, McNeilly P. Children and young people's experiences of having a sibling with complex health needs: a literature review. Nurs Child Young People 2021; 33:20-26. [PMID: 34121371 DOI: 10.7748/ncyp.2021.e1326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2020] [Indexed: 11/09/2022]
Abstract
Children with complex health needs require significant healthcare input for one or more conditions. Much of the literature on the effects of living with children with complex heath needs focuses on parents, and there is little research into the effects on siblings. This article reports on a literature review that examined the experiences of siblings growing up with a brother or sister with complex health needs and how this affects their lives. Three main themes were identified: emotional experiences; coping strategies and support; and family life. The findings identified in relation to mixed emotions, coping strategies and support systems are similar to those of studies of siblings of autistic children and children with cancer. However, in most countries the provision and availability of support for this group of siblings is inadequate.
Collapse
Affiliation(s)
- Marie Grant
- School of Nursing and Midwifery, Faculty of Medicine, Health and Life Sciences, Queen's University Belfast, Belfast, Northern Ireland
| | - Patricia McNeilly
- School of Nursing and Midwifery, Faculty of Medicine, Health and Life Sciences, Queen's University Belfast, Belfast, Northern Ireland
| |
Collapse
|
4
|
Knighting K, Pilkington G, Noyes J, Roe B, Maden M, Bray L, Jack B, O’Brien M, Downing J, Mateus C, Spencer S. Respite care and short breaks for young adults aged 18–40 with complex health-care needs: mixed-methods systematic review and conceptual framework development. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
The number of young adults with complex health-care needs due to life-limiting conditions/complex physical disability has risen significantly over the last 15 years, as more children now survive into adulthood. The transition from children to adult services may disrupt provision of essential respite/short break care for this vulnerable population, but the impact on young adults, families and providers is unclear.
Aim
To review the evidence on respite care provision for young adults (aged 18–40 years) with complex health-care needs, provide an evidence gap analysis and develop a conceptual framework for respite care.
Design
A two-stage mixed-methods systematic review, including a knowledge map of respite care and an evidence review of policy, effectiveness, cost-effectiveness and experience.
Data sources
Electronic databases and grey/unpublished literature were searched from 2002 to September 2019. The databases searched included Cumulative Index to Nursing and Allied Health Literature, MEDLINE, EMBASE, PsycINFO, Applied Social Sciences Index and Abstracts, Health Management Information Consortium, PROSPERO, Turning Research into Practice, COnNECT+, British Nursing Index, Web of Science, Social Care Online, the National Institute for Health Research Journals Library, Cochrane Effective Practice and Organisation of Care specialist register, databases on The Cochrane Library and international clinical trials registers. Additional sources were searched using the CLUSTER (Citations, Lead authors, Unpublished materials, Scholar search, Theories, Early examples, Related projects) approach and an international ‘call for evidence’.
Methods and analysis
Multiple independent reviewers used the SPICE (Setting, Perspective, Intervention/phenomenon of interest, Comparison, Evaluation) framework to select and extract evidence for each stage, verified by a third reviewer. Study/source characteristics and outcomes were extracted. Study quality was assessed using relevant tools. Qualitative evidence was synthesised using a framework approach and UK policy was synthesised using documentary content analysis. GRADE-CERQual (Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative Research) was used to assess confidence in the evidence. Logic models developed for each type of respite care constituted the conceptual framework.
Results
We identified 69 sources (78 records) from 126,267 records. The knowledge map comprised the following types of respite care: residential, home based, day care, community, leisure/social provision, funded holidays and emergency. Seven policy intentions included early transition planning and prioritising respite care according to need. No evidence was found on effectiveness and cost-effectiveness. Qualitative evidence focused largely on residential respite care. Facilitators of accessible/acceptable services included trusted and valued relationships, independence and empowerment of young adults, peer social interaction, developmental/age-appropriate services and high standards of care. Barriers included transition to adult services, paperwork, referral/provision delay and travelling distance. Young adults from black, Asian and minority ethnic populations were under-represented. Poor transition, such as loss of or inappropriate services, was contrary to statutory expectations. Potential harms included stress and anxiety related to safe care, frustration and distress arising from unmet needs, parental exhaustion, and a lack of opportunities to socialise and develop independence.
Limitations
No quantitative or mixed-methods evidence was found on effectiveness or cost-effectiveness of respite care. There was limited evidence on planned and emergency respite care except residential.
Conclusions
Policy intentions are more comprehensively met for young people aged < 18 years who are accessing children’s services. Young adults with complex needs often ‘fall off a cliff’ following service withdrawal and this imbalance needs addressing.
Future work
Research to quantify the effectiveness and cost-effectiveness of respite care to support service development and commissioning. Development of a core set of outcomes measures to support future collation of evidence.
Study registration
This study is registered as PROSPERO CRD42018088780.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 6. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Katherine Knighting
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
- Health Research Institute, Edge Hill University, Ormskirk, UK
| | - Gerlinde Pilkington
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
- Health Research Institute, Edge Hill University, Ormskirk, UK
| | - Jane Noyes
- School of Health Sciences, Bangor University, Bangor, UK
| | - Brenda Roe
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
- Health Research Institute, Edge Hill University, Ormskirk, UK
| | - Michelle Maden
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Lucy Bray
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
- Health Research Institute, Edge Hill University, Ormskirk, UK
| | - Barbara Jack
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
- Health Research Institute, Edge Hill University, Ormskirk, UK
| | - Mary O’Brien
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
- Health Research Institute, Edge Hill University, Ormskirk, UK
| | - Julia Downing
- International Children’s Palliative Care Network, Edge Hill University, Ormskirk, UK
| | - Céu Mateus
- Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Sally Spencer
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
- Health Research Institute, Edge Hill University, Ormskirk, UK
| |
Collapse
|
5
|
Beavis J, Davis L, McKenzie S. Clinical Supervision for Support Workers in Paediatric Palliative Care: A Literature Review. Clin Child Psychol Psychiatry 2021; 26:191-206. [PMID: 33050722 DOI: 10.1177/1359104520961431] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Providing home care to children with complex physical health needs is an emotionally challenging role. Extant literature and documents such as the Cavendish Review (2013) have reported that a large proportion of care for this population is carried out by non-registered staff (support workers). Provision of clinical supervision for nurses working in palliative care is increasing, however, supervision needs of support workers are commonly neglected. This paper sought to synthesise what is known about clinical supervision practices for support workers in paediatric palliative care (PPC). A literature review was conducted in accordance with integrative review guidelines. 315 papers were identified initially, 15 studies were included in this review. Four commonalities were identified: importance of team cohesion, varying degrees of formality, self-awareness and practicalities. Support workers received varying forms of supervision and some facilitators faced organisational difficulties involving staff in supervision. Support workers who received staff support generally appreciated it in recognition that their work is complex and emotionally difficult. This paper highlighted that further research should investigate the efficacy of clinical supervision as a method of reducing stress and burnout for support workers. Any implementation of supervision should involve a considered approach to training and supervision to ensure fidelity.
Collapse
Affiliation(s)
- Jonathan Beavis
- The Lifetime Psychology Service, Sirona Care & Health, Bristol, UK
| | - Lucy Davis
- The Lifetime Psychology Service, Sirona Care & Health, Bristol, UK
| | - Sian McKenzie
- The Lifetime Psychology Service, Sirona Care & Health, Bristol, UK
| |
Collapse
|
6
|
Pilkington G, Knighting K, Bray L, Downing J, Jack BA, Maden M, Mateus C, Noyes J, O'Brien MR, Roe B, Tsang A, Spencer S. The specification, acceptability and effectiveness of respite care and short breaks for young adults with complex healthcare needs: protocol for a mixed-methods systematic review. BMJ Open 2019; 9:e030470. [PMID: 31213455 PMCID: PMC6588989 DOI: 10.1136/bmjopen-2019-030470] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION The number of young adults with complex healthcare needs due to life-limiting conditions/complex physical disability has risen significantly as children with complex conditions survive into adulthood. Respite care and short breaks are an essential service, however, needs often go unmet after the transition to adult services, leading to a significant impact on the life expectancy and quality of life for this population. We aim to identify, appraise and synthesise relevant evidence to explore respite care and short breaks provision for this population, and to develop a conceptual framework for understanding service models. METHODS AND ANALYSIS A mixed-methods systematic review conducted in two stages: (1) knowledge map and (2) evidence review. We will comprehensively search multiple electronic databases; use the Citations, Lead authors, Unpublished materials, Google Scholar, Theories, Early examples, and Related projects (CLUSTER) approach, search relevant websites and circulate a 'call for evidence'. Using the setting, perspective, intervention/phenomenon of interest, comparison and evaluation framework, two reviewers will independently select evidence for inclusion into a knowledge map and subsequent evidence review, extract data relating to study and population characteristics, methods and outcomes; and assess the quality of evidence. A third reviewer will arbitrate where necessary.Evidence will be synthesised using the following approaches: quantitative (narratively/conducting meta-analyses where appropriate); qualitative (framework approach); policy and guidelines (documentary analysis informed approach). An overall, integrated synthesis will be created using a modified framework approach. We will use Grading of Recommendations Assessment, Development and Evaluation (GRADE)/GRADE-Confidence in the Evidence from Reviews of Qualitative Research to assess the strength and confidence of the synthesised evidence. Throughout, we will develop a conceptual framework to articulate how service models work in relation to context and setting. ETHICS AND DISSEMINATION Ethical approval is not required as this is a systematic review. We will present our work in academic journals, at appropriate conferences; we will disseminate findings across networks using a range of media. Steering and advisory groups were established to ensure findings are shared widely and in accessible formats. PROSPERO REGISTRATION NUMBER CRD42018088780.
Collapse
Affiliation(s)
- Gerlinde Pilkington
- Postgraduate Medical Institute (PGMI), Faculty of Health & Social Care, Edge Hill University, Ormskirk, UK
| | - Katherine Knighting
- Research and Innovation Team, Faculty of Health & Social Care, Edge Hill University, Ormskirk, UK
| | - Lucy Bray
- Research and Innovation Team, Faculty of Health & Social Care, Edge Hill University, Ormskirk, UK
| | - Julia Downing
- International Children's Palliative Care Network, Assagay, South Africa
- Edge Hill University, Ormskirk, UK
| | - Barbara A Jack
- Research and Innovation Team, Faculty of Health & Social Care, Edge Hill University, Ormskirk, UK
| | - Michelle Maden
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Ceu Mateus
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Jane Noyes
- School of Health Sciences, Bangor University, Bangor, UK
| | - Mary R O'Brien
- Research and Innovation Team, Faculty of Health & Social Care, Edge Hill University, Ormskirk, UK
| | - Brenda Roe
- Research and Innovation Team, Faculty of Health & Social Care, Edge Hill University, Ormskirk, UK
| | - Anthony Tsang
- Research and Innovation Team, Faculty of Health & Social Care, Edge Hill University, Ormskirk, UK
| | - Sally Spencer
- Postgraduate Medical Institute (PGMI), Faculty of Health & Social Care, Edge Hill University, Ormskirk, UK
| |
Collapse
|
7
|
Researching children's perspectives in pediatric palliative care: A systematic review and meta-summary of qualitative research. Palliat Support Care 2018; 17:107-118. [DOI: 10.1017/s1478951518000172] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveQualitative research is pivotal in gaining understanding of individuals’ experiences in pediatric palliative care. In the past few decades, the number of qualitative studies on pediatric palliative care has increased slightly, as has interest in qualitative research in this area. Nonetheless, a limited number of such studies have included the first-person perspective of children. The aim of this article is to understand the contribution of previous qualitative research on pediatric palliative care that included the voices of children.MethodA systematic review of qualitative studies and a meta-summary were conducted. MEDLINE, CINAHL, PsycINFO, PsycARTICLES, and ERIC were searched without limitations on publication date or language. Eligible articles were qualitative research articles in which the participants were children ranging in age from 3 to 18 years.ResultWe retrieved 16 qualitative research articles reporting on 12 unique studies, and we selected two mixed-method articles. The meta-summary shows eight themes: the relationship with professional caregivers, pain and its management, “living beyond pain,” the relationship between pediatric patients and their families, children's view on their treatment and service provision, meanings children give to their end-of-life situation, consequences of clinical decisions, and the relationships among children in pediatric palliative care and their peers.Significance of resultsThis meta-summary presents the “state of the art” of pediatric palliative care qualitative research on children and highlights additional research areas that warrant qualitative study.
Collapse
|
8
|
Knighting K, Bray L, Downing J, Kirkcaldy AJ, Mitchell TK, O'Brien MR, Pilkington M, Jack BA. Meeting the needs of young adults with life-limiting conditions: A UK survey of current provision and future challenges for hospices. J Adv Nurs 2018; 74:1888-1898. [PMID: 29732597 DOI: 10.1111/jan.13702] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 02/23/2018] [Accepted: 03/09/2018] [Indexed: 11/26/2022]
Abstract
AIM The aim of this study was to seek views of UK children's and adult hospices on the availability and challenges of providing services for young adults with life-limiting conditions. BACKGROUND Internationally, there are a growing number of young adults with life-limiting conditions and/or complex needs which are degenerative, progressive and diverse and involve complex life-long symptom, medication management as well as palliative care. There are 55,721 young adults, aged 18-40 in England, which continues to increase. The hospice sector is experiencing demands to extend services for this population despite concerns about the appropriateness of adult hospices and their nursing staff to provide care for the complex and unfamiliar conditions of this patient group. Evidence is needed of hospices' views and the main challenges faced providing services for young adults. DESIGN Descriptive cross-sectional survey. METHODS xChildren and adult hospices completed an online survey exploring service provision and their views of respite care for young adults with life-limiting conditions from 18 years old and onward. Data were collected between October 2015 - February 2016. FINDINGS Respondents (N = 76 hospices) reported that children's hospices predominantly provided short breaks and end-of-life care; adult hospices provided mainly symptom management, end-of-life care and day services. Main challenges were lack of existing adult respite services; lack of funding and capacity; lack of a skilled workforce in adult hospices; and the need for better integrated service provision. CONCLUSION Examples of good collaborative working were reported. With an increasing population of young adults and pressure on families, it is vital that services work together to find sustainable solutions to the challenges.
Collapse
Affiliation(s)
- Katherine Knighting
- Evidence-Based Practice Research Centre, Faculty of Health & Social Care, Edge Hill University, Ormskirk, Lancashire, UK
| | - Lucy Bray
- Evidence-Based Practice Research Centre, Faculty of Health & Social Care, Edge Hill University, Ormskirk, Lancashire, UK
| | - Julia Downing
- Evidence-Based Practice Research Centre, Faculty of Health & Social Care, Edge Hill University, Ormskirk, Lancashire, UK
- International Children's Palliative Care Network (ICPCN), UK/Uganda
| | - Andrew J Kirkcaldy
- Evidence-Based Practice Research Centre, Faculty of Health & Social Care, Edge Hill University, Ormskirk, Lancashire, UK
| | - Tracy K Mitchell
- Evidence-Based Practice Research Centre, Faculty of Health & Social Care, Edge Hill University, Ormskirk, Lancashire, UK
| | - Mary R O'Brien
- Evidence-Based Practice Research Centre, Faculty of Health & Social Care, Edge Hill University, Ormskirk, Lancashire, UK
| | - Melissa Pilkington
- Evidence-Based Practice Research Centre, Faculty of Health & Social Care, Edge Hill University, Ormskirk, Lancashire, UK
| | - Barbara A Jack
- Evidence-Based Practice Research Centre, Faculty of Health & Social Care, Edge Hill University, Ormskirk, Lancashire, UK
| |
Collapse
|
9
|
Affiliation(s)
- Bernie Carter
- Journal of Child Health Care; Edge Hill University, UK; University of Tasmania, Australia
| |
Collapse
|
10
|
Mitchell TK, Knighting K, O'Brien MR, Jack BA. Short break and emergency respite care: what options for young people with life-limiting conditions? Int J Palliat Nurs 2016; 22:57-65. [DOI: 10.12968/ijpn.2016.22.2.57] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Tracy K Mitchell
- Research Assistant, at the Evidence-Based Practice Research Centre, Edge Hill University, Faculty of Health and Social Care, Ormskirk, Lancashire, UK
| | - Katherine Knighting
- Senior Research Fellow, at the Evidence-Based Practice Research Centre, Edge Hill University, Faculty of Health and Social Care, Ormskirk, Lancashire, UK
| | - Mary R O'Brien
- Professor of Palliative and Supportive Care, at the Evidence-Based Practice Research Centre, Edge Hill University, Faculty of Health and Social Care, Ormskirk, Lancashire, UK
| | - Barbara A Jack
- Director and Head of Research and Scholarship, at the Evidence-Based Practice Research Centre, Edge Hill University, Faculty of Health and Social Care, Ormskirk, Lancashire, UK
| |
Collapse
|