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Gaskin K, Daniels A. Enhancing discharge preparation for parents after complex cardiac surgery: evaluation of an e-learning resource for nurses. Nurs Child Young People 2024:e1515. [PMID: 38973285 DOI: 10.7748/ncyp.2024.e1515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2024] [Indexed: 07/09/2024]
Abstract
Parents need to be appropriately prepared by knowledgeable healthcare professionals before going home with their infant following cardiac surgery for complex congenital heart disease (CHD). A quality improvement project was undertaken between 2018 and 2021 to equip healthcare professionals including children's cardiac nurses with the knowledge required to use the Congenital Heart Assessment Tool (CHAT) to teach parents how to monitor their infant at home. The project involved developing, implementing and evaluating an e-learning resource that included simulated scenarios captured on video. An online survey showed that users perceived the e-learning resource as having a positive effect on their understanding of complex CHD and their practice of preparing parents for discharge and home monitoring.
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Affiliation(s)
- Kerry Gaskin
- School of Nursing and Midwifery, Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, England
| | - Amanda Daniels
- Three Counties School of Nursing and Midwifery, University of Worcester, Worcester, England
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Wray J, Pagel C, Coats L, Chester AH, Kennedy F, Crowe S. What does good care look like to people living with congenital heart disease in the 21st century? Qualitative online, asynchronous discussion forums. BMJ Open 2024; 14:e079691. [PMID: 38955366 PMCID: PMC11218017 DOI: 10.1136/bmjopen-2023-079691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 05/30/2024] [Indexed: 07/04/2024] Open
Abstract
OBJECTIVES As part of a wider study, our aim was to elicit perspectives of people with congenital heart disease (CHD) and/or their parents/carers about their experiences of healthcare and what is important to them when receiving care. DESIGN AND SETTING A qualitative study involving a series of closed, asynchronous, online discussion forums underpinned by an interpretivist framework and set up and moderated by three patient charities via their Facebook pages. PARTICIPANTS People with CHD and parents/carers of people with CHD from the UK. RESULTS Five forums were run for 12-24 weeks across the three charities, and 343 participants signed up to the forums. Four linked themes related to processes of care were identified following thematic analysis of the transcripts: relationships and communication; access and coordination; experience of discrete episodes of care and psychological support. These impacted how care was experienced and, for some patients, outcomes of CHD and its treatment as well as broader health outcomes. In addition, context relating to stages of the patient journey was described, together with patient-related factors such as patients' knowledge and expertise in their own condition. CONCLUSIONS People with CHD and their parents/carers want individualised, person-centred care delivered within an appropriately resourced, multidisciplinary service. Although examples of excellent care were provided it is evident that, from the perspective of patients and parents/carers, some National Health Service Standards for people with CHD were not being met.
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Affiliation(s)
- Jo Wray
- Heart and Lung Directorate, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Christina Pagel
- Clinical Operational Research Unit, Department of Mathematics, University College London, London, UK
| | - Louise Coats
- Freeman Hospital, Newcastle upon Tyne, UK
- Newcastle University, Newcastle upon Tyne, UK
| | | | | | - Sonya Crowe
- Clinical Operational Research Unit, Department of Mathematics, University College London, London, UK
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Dong WH, Guo JX, Wang L, Zheng SS, Zhu BQ, Shao J. Trend of Mortality Due to Congenital Anomalies in Children Younger Than 5 Years in Eastern China, 2012-2021: Surveillance Data Analysis. JMIR Public Health Surveill 2024; 10:e53860. [PMID: 38829691 PMCID: PMC11184267 DOI: 10.2196/53860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 02/06/2024] [Accepted: 05/08/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND As one of the leading causes of child mortality, deaths due to congenital anomalies (CAs) have been a prominent obstacle to meet Sustainable Development Goal 3.2. OBJECTIVE We conducted this study to understand the death burden and trend of under-5 CA mortality (CAMR) in Zhejiang, one of the provinces with the best medical services and public health foundations in Eastern China. METHODS We used data retrieved from the under-5 mortality surveillance system in Zhejiang from 2012 to 2021. CAMR by sex, residence, and age group for each year was calculated and standardized according to 2020 National Population Census sex- and residence-specific live birth data in China. Poisson regression models were used to estimate the annual average change rate (AACR) of CAMR and to obtain the rate ratio between subgroups after adjusting for sex, residence, and age group when appropriate. RESULTS From 2012 to 2021, a total of 1753 children died from CAs, and the standardized CAMR declined from 121.2 to 62.6 per 100,000 live births with an AACR of -9% (95% CI -10.7% to -7.2%; P<.001). The declining trend was also observed in female and male children, urban and rural children, and neonates and older infants, and the AACRs were -9.7%, -8.5%, -8.5%, -9.2%, -12%, and -6.3%, respectively (all P<.001). However, no significant reduction was observed in children aged 1-4 years (P=.22). Generally, the CAMR rate ratios for male versus female children, rural versus urban children, older infants versus neonates, and older children versus neonates were 1.18 (95% CI 1.08-1.30; P<.001), 1.20 (95% CI 1.08-1.32; P=.001), 0.66 (95% CI 0.59-0.73; P<.001), and 0.20 (95% CI 0.17-0.24; P<.001), respectively. Among all broad CA groups, circulatory system malformations, mainly deaths caused by congenital heart diseases, accounted for 49.4% (866/1753) of deaths and ranked first across all years, although it declined yearly with an AACR of -9.8% (P<.001). Deaths due to chromosomal abnormalities tended to grow in recent years, although the AACR was not significant (P=.90). CONCLUSIONS CAMR reduced annually, with cardiovascular malformations ranking first across all years in Zhejiang, China. Future research and practices should focus more on the prevention, early detection, long-term management of CAs and comprehensive support for families with children with CAs to improve their survival chances.
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Affiliation(s)
- Wen-Hong Dong
- Department of Child Health Care, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
- National Clinical Research Center for Child Health, Hangzhou, China
| | - Jun-Xia Guo
- Department of Child Health Care, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
- National Clinical Research Center for Child Health, Hangzhou, China
| | - Lei Wang
- Department of Child Health Care, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
- National Clinical Research Center for Child Health, Hangzhou, China
| | - Shuang-Shuang Zheng
- Department of Child Health Care, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
- National Clinical Research Center for Child Health, Hangzhou, China
| | - Bing-Quan Zhu
- Department of Child Health Care, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
- National Clinical Research Center for Child Health, Hangzhou, China
| | - Jie Shao
- Department of Child Health Care, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
- National Clinical Research Center for Child Health, Hangzhou, China
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Gramszlo C, Karpyn A, Christofferson J, McWhorter LG, Demianczyk AC, Neely T, Zyblewski S, Shillingford A, Kazak AE, Sood E. Meeting Parents' Needs for Education and Preparation following Congenital Heart Disease Diagnosis: Recommendations from a Crowdsourced Study. Am J Perinatol 2024; 41:e446-e455. [PMID: 35863373 PMCID: PMC10008463 DOI: 10.1055/a-1906-8786] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE This article characterizes the educational needs of parents following fetal or neonatal congenital heart disease (CHD) diagnosis and generates recommendations for meeting these needs. STUDY DESIGN Online crowdsourcing methods were used to collect qualitative data from 95 parents of children with CHD regarding their needs for education and preparation following fetal or neonatal diagnosis. Data were analyzed using qualitative methods and themes were organized around the substructure of met and unmet needs. RESULTS Two themes represented consistently met needs, whereas 10 themes represented needs that were either inconsistently met or consistently unmet. Parents reported needing more information about social, emotional, and financial supports, preparation for long-term care, and guidance toward reputable online resources. Parents also provided recommendations for meeting these needs. CONCLUSION Parents' needs for education and preparation following CHD diagnosis are much broader in scope than what they currently receive. Addressing these may support parental coping and active participation in medical decision-making. KEY POINTS · CHD counseling after diagnosis may provide opportunities to promote parents' mental health.. · Guidelines recommend that this counseling should include emotional and decision-making support, however, it is unclear what parents actually receive.. · This study found that parents' needs for education and preparation following CHD diagnosis are much broader in scope than what they currently receive..
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Affiliation(s)
- Colette Gramszlo
- Nemours Cardiac Center, Nemours Children’s Hospital, Delaware, Wilmington, DE
| | - Allison Karpyn
- Center for Research in Education and Social Policy, Department of Human Development and Family Sciences, University of Delaware, Newark, DE
| | | | - Linda G. McWhorter
- Division of Behavioral Health, Nemours Children’s Hospital, Delaware, Wilmington, DE
| | - Abigail C. Demianczyk
- Department of Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Trent Neely
- Brothers by Heart/Sisters by Heart, El Segundo, CA
| | - Sinai Zyblewski
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC
| | - Amanda Shillingford
- Department of Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Anne E. Kazak
- Center for Healthcare Delivery Science, Nemours Children’s Health System, Wilmington, DE
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Erica Sood
- Nemours Cardiac Center, Nemours Children’s Hospital, Delaware, Wilmington, DE
- Center for Healthcare Delivery Science, Nemours Children’s Health System, Wilmington, DE
- Division of Behavioral Health, Nemours Children’s Hospital, Delaware, Wilmington, DE
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
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Driscoll CFB, Christofferson J, McWhorter LG, Demianczyk AC, Brosig CL, Jackson EA, Gramszlo C, Zyblewski SC, Kazak AE, Sood E. A Psychosocial Care Model for Families Affected by Congenital Heart Disease. Pediatr Crit Care Med 2023; 24:901-909. [PMID: 37318266 PMCID: PMC10721719 DOI: 10.1097/pcc.0000000000003293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVES To develop a model of family-based psychosocial care for congenital heart disease (CHD). DESIGN Qualitative study using crowdsourced data collected from parents of young children with CHD who received care across 42 hospitals. SETTING Yammer, a social networking platform used to facilitate online crowdsourcing and qualitative data collection. SUBJECTS Geographically diverse sample of 100 parents (72 mothers and 28 fathers) of young children with CHD. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Parents joined a private group on Yammer and responded to 37 open-ended study questions over a 6-month period. Qualitative data were coded and analyzed using an iterative process. Three broad themes corresponding to pillars of family-based psychosocial care were identified: pillar 1) parent partnership in family-integrated medical care, pillar 2) supportive interactions focused on parent and family wellbeing, and pillar 3) integrated psychosocial care and peer support for parents and families. Each pillar was supported by subthemes corresponding to specific intervention strategies. Most parents described the need for intervention strategies across multiple pillars, with almost half reporting needs across all three pillars of psychosocial care. Parents' preferences for psychosocial support changed over time with changes to their child's medical status and across care settings (e.g., hospital, outpatient clinic). CONCLUSIONS Results support a model of family-based psychosocial care that is multidimensional and flexible to meet the needs of families affected by CHD. All members of the healthcare team play an important role in providing psychosocial support. Future research incorporating components of implementation science is needed to promote uptake of these findings, with the goal of optimizing family-based psychosocial support in the hospital setting and beyond.
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Affiliation(s)
- Colleen F. Bechtel Driscoll
- Division of Behavioral Health, Department of Pediatrics, Nemours Children’s Health, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | - Jennifer Christofferson
- Center for Healthcare Delivery Science, Nemours Children’s Health, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | - Linda G. McWhorter
- Division of Behavioral Health, Department of Pediatrics, Nemours Children’s Health, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | - Abigail C. Demianczyk
- Department of Child and Adolescent Psychiatry and Behavioral Sciences & Cardiac Center, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Cheryl L. Brosig
- Herma Heart Institute, Children’s Wisconsin & Department of Pediatrics, Medical College of Wisconsin, 8915 W Connell Ct, Milwaukee, WI, 53226, USA
| | - Emily A. Jackson
- Department of Patient and Family Services, Nemours Children’s Health, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | - Colette Gramszlo
- Division of Behavioral Health, Department of Pediatrics, Nemours Children’s Health, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | - Sinai C. Zyblewski
- Department of Pediatrics, Medical University of South Carolina, 96 Jonathan Lucas St. Ste. 601, MSC 617, Charleston, SC, USA
| | - Anne E. Kazak
- Center for Healthcare Delivery Science, Nemours Children’s Health, 1600 Rockland Road, Wilmington, DE, 19803, USA
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Erica Sood
- Center for Healthcare Delivery Science, Nemours Children’s Health, 1600 Rockland Road, Wilmington, DE, 19803, USA
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
- Nemours Cardiac Center, Nemours Children’s Health, 1600 Rockland Road, Wilmington, DE, 19803, USA
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Mohiuddin TA, Raol N, Tey CS, Horný M, Zhang C, Sharp WG, Chanani N, Patzer RE. Quantifying the Healthcare Burden of Pediatric Feeding Disorder after Congenital Heart Surgery. J Pediatr 2023; 261:113593. [PMID: 37399917 DOI: 10.1016/j.jpeds.2023.113593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 05/27/2023] [Accepted: 06/26/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVE To determine the healthcare costs and use burden of pediatric feeding disorder after congenital heart surgery. STUDY DESIGN A retrospective, population-based cohort study using claims data (2009-2018) was performed. Participants include patients aged 0-18 years who had undergone congenital heart surgery and were included in the insurance database ≥1 year after surgery. The main exposure variable was the presence of a pediatric feeding disorder, defined as a need for a feeding tube at discharge or diagnosis of dysphagia or feeding-related difficulty within the study timeframe. Main outcomes include overall and feeding-related medical care use, defined as readmissions and outpatient use, and feeding-related cost of care within 1 year of surgery. RESULTS A total of 10 849 pediatric patients were identified, with 3347 (30.9%) presenting with pediatric feeding disorder within 1 year of surgery. Patients with pediatric feeding disorder spent a median of 12 days (IQR, 6-33 days) in the hospital, compared with 5 days (IQR, 3-8 days) in patients without (P < .001). Rate ratios for overall readmissions, feeding-related readmissions, feeding-related outpatient use, and cost of care over the first year after surgery were significantly increased at 2.9 (95% CI, 2.5-3.4), 5.1 (95% CI, 4.6-5.7), 7.7 (95% CI, 6.5-9.1), and 2.2 (95% CI, 2.0-2.3) among patients with pediatric feeding disorder as compared with those without. CONCLUSIONS Pediatric feeding disorder after congenital heart surgery is associated with a significant healthcare burden. Multidisciplinary care for and research on this health condition is needed to identify optimal management strategies to reduce this burden and improve outcomes.
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Affiliation(s)
- Tahmina A Mohiuddin
- Medical Scholars Program, Augusta University/University of Georgia Medical Partnership, Athens, GA
| | - Nikhila Raol
- Department of Otolaryngology, Emory School of Medicine, Atlanta, GA; Department of Pediatrics, Emory School of Medicine, Atlanta, GA; Childrens Healthcare of Atlanta, Atlanta, GA; Division of Pediatric Otolaryngology, Children's Healthcare of Atlanta, Atlanta, GA.
| | - Ching S Tey
- Department of Pediatrics, Emory School of Medicine, Atlanta, GA
| | - Michal Horný
- Department of Radiology and Imaging Sciences, Emory School of Medicine, Atlanta, GA; Department of Epidemiology, Emory Rollins School of Public Health, Atlanta, GA
| | - Chao Zhang
- Department of Pediatrics, Emory School of Medicine, Atlanta, GA
| | - William G Sharp
- Department of Pediatrics, Emory School of Medicine, Atlanta, GA; Childrens Healthcare of Atlanta, Atlanta, GA; Children's Feeding Program, Children's Healthcare of Atlanta, Atlanta, GA
| | - Nikhil Chanani
- Department of Pediatrics, Emory School of Medicine, Atlanta, GA; Childrens Healthcare of Atlanta, Atlanta, GA; Sibley Heart Center, Alpharetta, GA; Division of Pediatric Cardiology, Children's Healthcare of Atlanta, Atlanta, GA
| | - Rachel E Patzer
- Department of Epidemiology, Emory Rollins School of Public Health, Atlanta, GA
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Franklin MK, Karpyn A, Christofferson J, McWhorter LG, Demianczyk AC, Brosig CL, Jackson EA, Lihn S, Zyblewski SC, Kazak AE, Sood E. Barriers and facilitators to discussing parent mental health within child health care: Perspectives of parents raising a child with congenital heart disease. J Child Health Care 2023; 27:360-373. [PMID: 34879743 PMCID: PMC9174345 DOI: 10.1177/13674935211058010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study aimed to identify barriers and facilitators to discussing parent mental health within child health care for parents of children with congenital heart disease (CHD). Seventy-nine parents of young children with CHD who received care across 40 hospitals in the United States responded to questions about barriers and facilitators to discussing their mental health with their child's health care providers. Responses were analyzed using qualitative research methods. Parents described multiple barriers: (1) belief that parent mental health support was outside the care team's scope of practice, (2) perceived expectation to "stay strong," (3) fear of negative judgment or repercussion, (4) individual preferences for communication/support, (5) desire to maintain care resources on their child, (6) perceived need to compartmentalize emotions, and (7) negative reactions to past emotional disclosure. Parents also described several facilitators: (1) confidence in the care team's ability to provide support, (2) intentional efforts by the care team to provide support, (3) naturally extroverted tendencies, and (4) developing personal connections with health care providers. It is important that health care providers normalize the impact of child illness on the family and create an environment in which parents feel comfortable discussing mental health challenges.
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Affiliation(s)
- Melanie K. Franklin
- Division of Behavioral Health, Department of Pediatrics, Nemours Children’s Health, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | - Allison Karpyn
- Center for Research in Education and Social Policy, Department of Human Development and Family Sciences, University of Delaware, 111 Alison Hall West, Newark, DE, 19716, USA
| | - Jennifer Christofferson
- Center for Healthcare Delivery Science, Nemours Children’s Health, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | - Linda G. McWhorter
- Division of Behavioral Health, Department of Pediatrics, Nemours Children’s Health, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | - Abigail C. Demianczyk
- Department of Child and Adolescent Psychiatry and Behavioral Sciences & Cardiac Center, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Cheryl L. Brosig
- Herma Heart Institute, Children’s Wisconsin & Department of Pediatrics, Medical College of Wisconsin, 8915 W Connell Ct, Milwaukee, WI, 53226, USA
| | - Emily A. Jackson
- Department of Patient and Family Services, Nemours Children’s Health, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | | | - Sinai C. Zyblewski
- Department of Pediatrics, Medical University of South Carolina, 96 Jonathan Lucas St. Ste. 601, MSC 617, Charleston, SC, USA
| | - Anne E. Kazak
- Center for Healthcare Delivery Science, Nemours Children’s Health, 1600 Rockland Road, Wilmington, DE, 19803, USA
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Erica Sood
- Center for Healthcare Delivery Science, Nemours Children’s Health, 1600 Rockland Road, Wilmington, DE, 19803, USA
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
- Nemours Cardiac Center, Nemours Children’s Health, 1600 Rockland Road, Wilmington, DE, 19803, USA
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Ay A, Koç G. The effect of nursing care and follow-up for mothers of infants undergoing congenital heart surgery: a quasi-experimental study. Cardiol Young 2023; 33:1649-1656. [PMID: 36124651 DOI: 10.1017/s1047951122002979] [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] [Indexed: 11/07/2022]
Abstract
Improvements in congenital heart surgery have resulted in an increasing number of infants surviving, but there remain concerns about home care and difficulties experienced by mothers. This study was designed to evaluate the effect of nursing care and follow-up for the mothers of infants undergoing congenital heart surgery on anxiety, care burden, and self-efficacy. The study was designed as a quasi-experimental study with a pre-test and post-test control group design. The study included 40 mothers whose infants had undergone congenital heart surgery. Nursing care was provided to the mothers of the infants included in the study group through a total of six home follow-ups until the third month after surgery, guided by the North American Nursing Diagnosis Association and Nursing Diagnosis System and Nursing Interventions Classification. Data were collected through Care Needs Identification Form, Spielberger's State-Trait Anxiety Inventory, Zarit Burden Interview, and Parental Self-efficacy Scale. The mean State-Trait Anxiety Inventory and Zarit Burden Interview scores for the mothers in the intervention group decreased, while the mean Parental Self-efficacy Scale scores increased as the follow-up progressed and it was determined that by the third month, the difference between the mothers in the intervention group and those in the control group in terms of post-test State-Trait Anxiety Inventory, Zarit Burden Interview, and Parental Self-efficacy Scale had become statistically significant. Providing appropriate nursing care practices to the mothers of the infants had undergone congenital heart surgery in home setting has the potential to decrease the problems experienced by the mothers.
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Affiliation(s)
- Ayşe Ay
- Nursing Department, Faculty of Health Sciences, Başkent University, Ankara, Turkey
| | - Gülten Koç
- Obstetrics and Gynecologic Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey
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Pridham K, Nemykina Y, Connor A, Melby J, Brown R. Caregiving and Support Issues Identified by Parents of an Infant With Congenital Heart Disease for Interactive Problem-Solving. Res Theory Nurs Pract 2023; 37:RTNP-2022-0062.R1. [PMID: 37130796 PMCID: PMC10620106 DOI: 10.1891/rtnp-2022-0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Background and Purpose: Parents of an infant with complex congenital heart disease report caregiving challenges in the infant's first half year. We studied the issues parent dyads (mothers and fathers) were dealing with and their effect on their coparenting competencies in interactive problem-solving. Methods: The issues 31 parent dyads identified for interactive problem-solving at either or both infants aged 2 and 6 months were typed as caregiving or relational/support. The parent dyad's interactive competencies were assessed from video recording for two types of tasks (i.e., caregiving and the parent dyad's relationship as caregivers). Constructs of Iowa Family Interaction Rating Scales were applied to assess the competencies of mothers, fathers, and the parent dyad for a group that received guided participation (n = 17) and a group that received usual care (n = 8). Results: Pie charts showed feeding, most frequently identified for interactive problem-solving at 2 months, was surpassed at 6 months by growth and development. The time parents spent together was the most mentioned relationship issue at 2 and 6 months. Forest plots showed caregiving issues were associated with at least medium effect sizes for dyadic problem-solving for both parents at 2 and 6 months and for problem-solving for fathers at 2 and 6 months. Relational/support issues were associated with higher hostility and communication hindering than caregiving issues. Implications for Practice: Intervention to aid parents in interactive problem-solving for both caregiving and relationship/support issues merits development and testing.
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Affiliation(s)
- Karen Pridham
- School of Nursing, University of Wisconsin-Madison, Madison WI, USA
| | - Yuliya Nemykina
- School of Nursing, University of Wisconsin-Madison, Madison WI, USA
| | | | - Janet Melby
- Department of Human Development and Family Studies, Iowa State University, Ames IA, USA
| | - Roger Brown
- School of Nursing, University of Wisconsin-Madison, Madison WI, USA
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10
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Puriani D, Allenidekania A, Afiyanti Y. The Experience of Uncertainty in Mothers Caring for Children at Home after Palliative Heart Surgery. Indian J Palliat Care 2023; 29:46-50. [PMID: 36846277 PMCID: PMC9944655 DOI: 10.25259/ijpc_453_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 10/05/2022] [Indexed: 01/22/2023] Open
Abstract
Objectives Palliative heart surgery is a compelling option for some children with congenital heart disease for which corrective heart surgery is not yet possible due to its complexity. As primary caregivers, mothers have the challenge of providing optimal care to their children at home post-surgery. This study aims to explore the experiences of mothers who are caring for children recovering from palliative heart surgery at home. The research applied descriptive, qualitative and phenomenology design. Material and Methods This study was conducted in Jakarta. The participants were 15 mothers of palliative heart surgery patients from seven provinces in Indonesia; Jakarta, Aceh, Bali, North Sumatra, West Java, Central Java and Banten. Data were collected using semi-structured interviews through the WhatsApp video call application and analysed using the Colaizzi method. Results Mothers often felt uncertain about how to provide the best care and felt that their needs for hospital services to assist them went unmet. Conclusions: This study has implications for the development of nursing services related to discharge planning for palliative heart surgery patients.
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Affiliation(s)
- Dewi Puriani
- Department of Paediatric Nursing, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
| | | | - Yati Afiyanti
- Department of Paediatric Nursing, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
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11
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Stewart A, Smith CH, Govender R, Eaton S, De Coppi P, Wray J. Parents' experiences of feeding children born with oesophageal atresia/tracheo-oesophageal fistula. J Pediatr Surg 2022; 57:792-799. [PMID: 36150934 PMCID: PMC9728016 DOI: 10.1016/j.jpedsurg.2022.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/18/2022] [Accepted: 08/14/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Feeding difficulties are widely acknowledged following oesophageal atresia/tracheo-oesophageal fistula repair. However, little is understood about the nature and severity of these difficulties. This study explored feeding in children with oesophageal atresia/tracheo-oesophageal fistula from the parent perspective. METHODS In collaboration with a patient support group, data were collected using a research-specific online discussion forum. Thematic analysis was used to code the data and identify themes. RESULTS One hundred and twenty-seven parents registered for the online forum, of whom 83 (65%) provided demographic data. Seventy-four (89%) of responders were mothers, 75 (90%) were of white ethnicity, 65 (78%) were from the UK. Six key themes were identified: feeding is a traumatic experience, feeding my child is scary, feeding is isolating and filled with uncertainty, feeding outside of the home is difficult, feeding associated emotions, developing coping strategies. Parents described features of medical, nutritional, feeding skill and psychosocial dysfunction across all stages of eating/drinking development. They described how their child's feeding difficulties had an impacted their own well-being. An interactional model of feeding difficulties in OA/TOF is proposed. CONCLUSIONS Exploring parent experiences provides rich data from which to expand understanding of the complex nature of feeding difficulties in OA/TOF. Feeding should be viewed as a dyadic process, occurring within a family system. Intervention for feeding difficulties should be family-centred, addressing parental anxiety, trauma and uncertainty, as well as the child's underlying medical/surgical needs to optimise outcome. Further study of clinical correlates with parental experience is required. LEVEL OF EVIDENCE IV (non-experimental, qualitative).
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Affiliation(s)
- Alexandra Stewart
- Department of Language and Cognition, University College London, Chandler house, 2 Wakefield Street, London, WC1N 1PF, UK; Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK.
| | - Christina H. Smith
- Department of Language and Cognition, University College London, Chandler house, 2 Wakefield Street, London, WC1N 1PF, UK
| | - Roganie Govender
- Research Department of Behavioural Science & Health, University College London, Gower Street, London, WC1E 6BT, UK,Head and Neck Academic Centre, University College London Hospital, 250 Euston Road, London, NW1 2PG, UK
| | - Simon Eaton
- Stem Cells and Regenerative Medicine Section, University College London Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Paolo De Coppi
- Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK,Stem Cells and Regenerative Medicine Section, University College London Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Jo Wray
- Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK
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12
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Pridham K, Melby J, Harrison T, Brown R, Mussatto K. Guided Participation Support of Coparenting an Infant With Complex Congenital Heart Disease: A Randomized Pilot Feasibility Study. Res Theory Nurs Pract 2022; 36:361-394. [PMID: 36396460 PMCID: PMC10022131 DOI: 10.1891/rtnp-2021-0096] [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] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Background and Purpose: Parents' competencies in coparenting are critical to adaptive and competent caregiving of an infant with complex congenital heart disease. To date, feasible interventions to support parents in working together-coparenting-for caregiving of these infants have not been developed and systematically examined. The purpose of this feasibility study was to examine the efficacy of the participatory teaching/learning intervention, Guided Participation (GP) on parent dyads' competencies in interactive problem-solving tasks in preparation for a randomized controlled trial. Methods: Nurse guides used GP to support mother and father couples in developing coparenting competencies through the first 6 months after birth. Couples, enrolled from two regional heart centers, were randomly assigned either to the usual care group (n = 10) or the GP group (n = 24). Intervention involved nurse guided GP in hospital and, following the infant's discharge, monthly telephone GP sessions between 2-months and 6-months infant age. In-home data collection visits at 2 and 6 months included video-recorded parent interaction problem-solving tasks with two goals, infant caregiving and the parent couple's relationship. The Iowa Family Interaction Rating Scales were used to score observed interactive competencies. Results: Retention was 82%, and results revealed small to moderate effect sizes for GP on problem-solving constructs for mothers and for the parent couple dyad. Implications for Practice: Our findings support further study in a fully powered randomized trial with a more diverse sample, handbook-enhanced GP, and examination of the effect on a broader spectrum of outcomes, including infant growth and development.
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Affiliation(s)
- Karen Pridham
- University of Wisconsin-Madison School of Nursing, Madison, WI, USA
| | | | - Tondi Harrison
- The Ohio State University College of Nursing, Columbus, OH, USA
| | - Roger Brown
- University of Wisconsin-Madison School of Nursing, Madison, WI, USA
| | - Kathleen Mussatto
- Milwaukee School of Engineering, School of Nursing, Milwaukee, WI, USA
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13
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Imperial-Perez F, Pike NA, Doering LV, Eastwood JA, Heilemann MV. Caregiving for Interstage Infants: A Continuous Process of Compromise During the Pandemic. World J Pediatr Congenit Heart Surg 2022; 13:443-450. [PMID: 35585726 PMCID: PMC9121143 DOI: 10.1177/21501351221099945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Infants born with single ventricle heart disease require
in-home medicalized care during the interstage period (time between the first
and second staged heart surgery). These caregivers rely on extended family,
friends, and hired caretakers to provide respite time. However, the coronavirus
pandemic removed these families’ options due to stay-at-home and social
distancing directives. We explored the caregivers’ experiences during the
interstage period, including impacts on their lifestyle, as they managed their
infants’ critical needs during the coronavirus disease 2019 pandemic.
Method: In-person or telephonic interviews of 14 caregivers
interviewed once or twice were conducted between November 2019 and July 2020.
Constructivist Grounded Theory methodology guided both data collection and
analysis for the inductive and abductive exploration of caregivers’ experiences.
Results: Data analysis led to the development of 2 concepts:
Accepting and adapting to a restrictive home environment
and Reconciling what is and what is yet to come. Refinement of
the relationship between the 2 concepts led to the development of a theory
grounded in the words and experiences of the participants called: A
Continuous Process of Compromise. Conclusions: Our
findings increase understanding of caregivers’ experiences related to
psychosocial and lifestyle impacts and the need for additional support during
the interstage period.
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Affiliation(s)
- Flerida Imperial-Perez
- 5150Children's Hospital Los Angeles, Heart Institute, Section of Cardiothoracic ICU, Los Angeles, CA, USA.,8783University of California Los Angeles School of Nursing, Los Angeles, CA, USA
| | - Nancy A Pike
- 5150Children's Hospital Los Angeles, Heart Institute, Section of Cardiothoracic ICU, Los Angeles, CA, USA.,8783University of California Los Angeles School of Nursing, Los Angeles, CA, USA
| | - Lynn V Doering
- 8783University of California Los Angeles School of Nursing, Los Angeles, CA, USA
| | - Jo-Ann Eastwood
- 8783University of California Los Angeles School of Nursing, Los Angeles, CA, USA
| | - MarySue V Heilemann
- 8783University of California Los Angeles School of Nursing, Los Angeles, CA, USA
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14
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Wilcocks CP, Enlow P, Wasserman R, Wysocki T, Lee J, Aroian K, Pierce JS. Development and Evaluation of the Pediatric Diabetes Routine Questionnaire for Parents of Young Children with Type 1 Diabetes. J Clin Psychol Med Settings 2022; 30:216-226. [PMID: 35716238 DOI: 10.1007/s10880-022-09888-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2022] [Indexed: 11/29/2022]
Abstract
This study describes the development and psychometric evaluation of the Pediatric Diabetes Routines Questionnaire for Parents of Young Children (PDRQ-PYC) with type 1 diabetes, a measure adapted from the school-age and adolescent versions of the PDRQ, to measure diabetes-specific routines in families with children under age 6 years with type 1 diabetes. Participants included 173 parents of young children with type 1 diabetes (YC-T1D) who completed measures of diabetes-specific routines, diabetes adjustment, self-efficacy, benefit finding, depression, child behavior problems, spousal support, and T1D treatment engagement. Exploratory factor analysis supported a one-factor model consisting of a unidimensional PDRQ-PYC total score. The PDRQ-PYC total score demonstrated good internal consistency, convergent validity, and criterion validity. The present study demonstrates that PDRQ-PYC is a valuable and feasible tool for measuring the consistency and regularity with which families of YC-T1D perform T1D management tasks. Along with the school-age and adolescent versions of the PDRQ, the PDRQ-PYC now provides the ability to assess diabetes-specific routines from early childhood through adolescence and findings support the notion that routines are associated with engagement in diabetes tasks.ClinicalTrials.gov Identifier NCT03222180 (first posted July 19, 2017).
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Affiliation(s)
- Chelsea P Wilcocks
- Division of Behavioral Health, Nemours Children's Hospital Delaware, Wilmington, DE, USA
| | - Paul Enlow
- Center for Healthcare Delivery Science, Nemours Children's Health, Wilmington, DE, USA.,Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Rachel Wasserman
- Center for Healthcare Delivery Science, Nemours Children's Health, 6900 Lake Nona Blvd, Orlando, FL, 32827, USA.,University of Central Florida College of Medicine, Orlando, FL, USA
| | - Tim Wysocki
- Center for Healthcare Delivery Science, Nemours Children's Health, Jacksonville, FL, USA
| | - Joyce Lee
- Pediatric Endocrinology, Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Karen Aroian
- University of Central Florida College of Nursing, Orlando, FL, USA
| | - Jessica S Pierce
- Center for Healthcare Delivery Science, Nemours Children's Health, 6900 Lake Nona Blvd, Orlando, FL, 32827, USA. .,University of Central Florida College of Medicine, Orlando, FL, USA.
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15
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Demianczyk AC, Driscoll CFB, Karpyn A, Shillingford A, Kazak AE, Sood E. Coping strategies used by mothers and fathers following diagnosis of congenital heart disease. Child Care Health Dev 2022; 48:129-138. [PMID: 34519072 PMCID: PMC9007227 DOI: 10.1111/cch.12913] [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: 03/15/2021] [Revised: 08/23/2021] [Accepted: 09/05/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Parents of children with congenital heart disease (CHD) exhibit high rates of mental health difficulties, which can influence child developmental and behavioural outcomes. While extensive research has focused on CHD-related stressors that contribute to parental mental health difficulties, few studies have investigated parental coping strategies that may mitigate or heighten risk. This study aimed to identify parental coping strategies following diagnosis of CHD and compare use of coping strategies among different groups (mothers vs. fathers; prenatal vs. postnatal diagnosis). METHODS A diverse sample of 34 parents (20 mothers and 14 fathers) of young children with CHD participated in semistructured interviews focused on their responses to CHD-related stressors. Coping strategies were identified from qualitative data and categorized according to the COPE Inventory, an instrument that assesses common adult responses to stress. Coping strategies deemed as unique to parenting a critically ill child were identified. χ2 and independent sample t tests evaluated group differences. RESULTS Parents described using between 1 and 10 different adaptive and maladaptive strategies measured by the COPE Inventory. Most parents (82.35%) also described coping strategies that may be unique to parenting a critically ill child. Mothers were more likely than fathers to report a focus on and venting of emotions (70% vs. 21.43%) and behavioural disengagement (25% vs. 0%). Compared with parents receiving a postnatal CHD diagnosis, those receiving a prenatal diagnosis described a greater variety of coping strategies (6.23 vs. 4.52) and more often reported positive reinterpretation and growth (69.23% vs. 14.29%), behavioural disengagement (38.46% vs. 0%) and denial (38.46% vs. 0%). CONCLUSIONS Parents of children with CHD utilize a variety of coping strategies, some of which are maladaptive. Interventions tailored to the needs of mothers and fathers of young children with CHD, including those receiving a postnatal diagnosis, are needed to promote adaptive coping and optimize family psychosocial outcomes.
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Affiliation(s)
- Abigail C Demianczyk
- Department of Child and Adolescent Psychiatry and Behavioral Sciences and Cardiac Center, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Colleen F Bechtel Driscoll
- Division of Behavioral Health, Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA
| | - Allison Karpyn
- Center for Research in Education and Social Policy, Department of Human Development and Family Sciences, University of Delaware, Newark, Delaware, USA
| | - Amanda Shillingford
- Cardiac Center, Children’s Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Anne E Kazak
- Center for Healthcare Delivery Science, Nemours Children’s Health System, Wilmington, Delaware, USA., Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Erica Sood
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA., Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA
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16
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Wray J, Pagel C, Chester AH, Kennedy F, Crowe S. What was the impact of the first wave of COVID-19 on the delivery of care to children and adults with congenital heart disease? A qualitative study using online forums. BMJ Open 2021; 11:e049006. [PMID: 34593493 PMCID: PMC8487016 DOI: 10.1136/bmjopen-2021-049006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Globally, healthcare systems have been stretched to the limit by the COVID-19 pandemic. Significant changes have had to be made to the way in which non-COVID-19-related care has been delivered. Our objective was to understand, from the perspective of patients with a chronic, life-long condition (congenital heart disease, CHD) and their parents/carers, the impact of COVID-19 on the delivery of care, how changes were communicated and whether healthcare providers should do anything differently in a subsequent wave of COVID-19 infections. DESIGN AND SETTING Qualitative study involving a series of asynchronous discussion forums set up and moderated by three patient charities via their Facebook pages. PARTICIPANTS Patients with CHD and parents/carers of patients with CHD. MAIN OUTCOME MEASURES Qualitative responses to questions posted on the discussion forums. RESULTS The forums ran over a 6-week period and involved 109 participants. Following thematic analysis, we identified three themes and 10 subthemes related to individual condition-related factors, patient-related factors and health professional/centre factors that may have influenced how patients and parents/carers experienced changes to service delivery as a result of COVID-19. Specifically, respondents reported high levels of disruption to the delivery of care, inconsistent advice and messaging and variable communication from health professionals, with examples of both excellent and very poor experiences of care reported. Uncertainty about follow-up and factors related to the complexity and stability of their condition contributed to anxiety and stress. CONCLUSIONS The importance of clear, consistent communication cannot be over-estimated. Our findings, while collected in relation to patients with CHD, are not necessarily specific to this population and we believe that they reflect the experiences of many thousands of people with life-long conditions in the UK. Recommendations related to communication, service delivery and support during the pandemic may improve patients' experience of care and, potentially, their outcomes.
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Affiliation(s)
- Jo Wray
- Heart and Lung Directorate, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Research Department of Children's Cardiovascular Diseases, Institute of Cardiovascular Science, University College London, London, UK
| | - Christina Pagel
- Clinical Operational Research Unit, Department of Mathematics, University College London, London, UK
| | - Adrian H Chester
- Heart Valve Research Group, The Magdi Yacoub Institute, Heart Science Centre, Harefield, UK
- Myocardial Function, National Heart and Lung Institute, Imperial College London, London, UK
| | - Fiona Kennedy
- Adult Congenital Heart Disease Department, Barts Health NHS Trust, London, UK
| | - Sonya Crowe
- Clinical Operational Research Unit, Department of Mathematics, University College London, London, UK
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17
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Moore EF, Gephart SM. State of the science of care coordination, rurality, and well-being for infants with single ventricle heart disease in the Interstage period, an integrative review. Heart Lung 2021; 50:720-729. [PMID: 34107397 DOI: 10.1016/j.hrtlng.2021.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 04/23/2021] [Accepted: 04/28/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Ensuring the quality of interstage management of infants with single ventricle heart disease (SVHD) residing in rural communities is difficult. Tailored care coordination through parental discharge education, formal and informal care team and family communication, adequate access to healthcare, and informed provider handoffs are crucial to the infant's well-being and survival. OBJECTIVE To discuss the state of the science related to care coordination factors and infant wellbeing during the interstage period. METHODS An integrative review approach to synthesize findings across studies was used. Through constant comparative analysis, all articles were read and coded, broken down into "data bits" or key phrases. RESULTS Four major themes were inductively derived: 1) education and confidence-building, 2) communication for building relationships, 3) social work and related mental health support, and 4) availability of resources. CONCLUSIONS Despite advances in cardiac surgery and related interventions, a clear gap exists regarding care coordination factors and infant well-being, especially in rural communities.
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Affiliation(s)
- Emily F Moore
- Seattle Children's Hospital 4800 Sand point Way NE, Seattle WA 98105 MS FA.2.114; The University of Arizona College of Nursing PO Box 210203 Tucson, AZ 85721.
| | - Sheila M Gephart
- The University of Arizona College of Nursing PO Box 210203 Tucson, AZ 85721
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18
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Sood E, Lisanti AJ, Woolf-King SE, Wray J, Kasparian N, Jackson E, Gregory MR, Lopez KN, Marino BS, Neely T, Randall A, Zyblewski SC, Brosig CL. Parent mental health and family functioning following diagnosis of CHD: a research agenda and recommendations from the Cardiac Neurodevelopmental Outcome Collaborative. Cardiol Young 2021; 31:900-914. [PMID: 34082841 PMCID: PMC8759239 DOI: 10.1017/s1047951121002134] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Diagnosis of CHD substantially affects parent mental health and family functioning, thereby influencing child neurodevelopmental and psychosocial outcomes. Recognition of the need to proactively support parent mental health and family functioning following cardiac diagnosis to promote psychosocial adaptation has increased substantially over recent years. However, significant gaps in knowledge remain and families continue to report critical unmet psychosocial needs. The Parent Mental Health and Family Functioning Working Group of the Cardiac Neurodevelopmental Outcome Collaborative was formed in 2018 through support from an R13 grant from the National Heart, Lung, and Blood Institute to identify significant knowledge gaps related to parent mental health and family functioning, as well as critical questions that must be answered to further knowledge, policy, care, and outcomes. Conceptually driven investigations are needed to identify parent mental health and family functioning factors with the strongest influence on child outcomes, to obtain a deeper understanding of the biomarkers associated with these factors, and to better understand how parent mental health and family functioning influence child outcomes over time. Investigations are also needed to develop, test, and implement sustainable models of mental health screening and assessment, as well as effective interventions to optimise parent mental health and family functioning to promote psychosocial adaptation. The critical questions and investigations outlined in this paper provide a roadmap for future research to close gaps in knowledge, improve care, and promote positive outcomes for families of children with CHD.
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Affiliation(s)
- Erica Sood
- Nemours Cardiac Center & Nemours Center for Healthcare Delivery Science, Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA; Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Amy Jo Lisanti
- Department of Nursing and Clinical Care Services, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | | | - Jo Wray
- Centre for Outcomes and Experience Research in Children’s Health, Illness and Disability and NIHR GOSH Biomedical Research Centre, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Nadine Kasparian
- Cincinnati Children’s Center for Heart Disease and Mental Health, Heart Institute and the Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children’s Hospital; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Heart Centre for Children, The Sydney Children’s Hospitals Network, Sydney, Australia
| | - Emily Jackson
- Department of Patient and Family Services, Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA
| | - Mary R. Gregory
- Department of Nursing, School of Nursing and Health Professions, Missouri Western State University, Saint Joseph, Missouri, USA
- Department of Developmental Medicine/Behavior Sciences, Children’s Mercy Hospital, Kansas City, Missouri, USA
| | - Keila N. Lopez
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Bradley S. Marino
- Department of Pediatric Cardiology, Cleveland Clinic Children’s Hospital, Cleveland, Ohio, USA
| | - Trent Neely
- Sisters by Heart/Brothers by Heart, El Segundo, California, USA
| | - Amy Randall
- Mended Little Hearts of Wisconsin, Mended Hearts/Mended Little Hearts, Albany, Georgia, USA
| | - Sinai C. Zyblewski
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Cheryl L. Brosig
- Herma Heart Institute, Children’s Wisconsin, Milwaukee, Wisconsin, USA; Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Oulton K, Gibson F, Williams A, Geoghegan S, Aldiss S, Wray J. Supporting families of children with an undiagnosed genetic condition: Using co-design to ensure the right person is in the right post doing the right job. Child Care Health Dev 2021; 47:300-310. [PMID: 33305423 DOI: 10.1111/cch.12838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/21/2020] [Accepted: 11/29/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Families and professionals caring for a child without a definitive diagnosis face unique challenges, particularly in relation to managing uncertainty; access to healthcare; obtaining relevant information and support; and trying to navigate a healthcare system that is often fragmented. We used co-design to inform the establishment of the first UK specialist nursing post dedicated to working with children with undiagnosed genetic conditions and their families. OBJECTIVES (1) To understand what families and hospital staff want from the service; (2) To understand how the post should be operationalized in practice; (3) To develop the job description and person specification for the postholder. METHODS A range of approaches were used to collect data: interviews (nine parents and 10 hospital staff); a focus group (three parents); a creative workshop (six patients and siblings); and an online forum (81 parents). Data were analyzed using framework and thematic analysis. The strands of data were brought together and reviewed as a whole to formulate the postholder's job description and person specification. RESULTS Stakeholders identified nine key elements to the role which were incorporated into the job description: practical support; point of contact; community liaison; signposting to other services; care coordination; supporting families; advocacy; raising awareness; and emotional support. CONCLUSIONS Highlighted in this paper are the practical aspects of engaging and involving all relevant stakeholders in the process of co-designing a new post and subsequent staff recruitment. The flexibility employed in the setting and methods of data collection were instrumental in ensuring that the views of a diverse range of participants were ascertained. A major consideration is the resources required to undertake co-design, in terms of time and finances. We believe that the resources required for the co-design are offset by the advantages of having the right person in the right post, doing the right job.
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Affiliation(s)
- Kate Oulton
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Faith Gibson
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,School of Health Sciences, University of Surrey, Guildford, UK
| | - Anna Williams
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Sophie Geoghegan
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Susie Aldiss
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Jo Wray
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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20
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Sood E, Wysocki T, Alderfer MA, Aroian K, Christofferson J, Karpyn A, Kazak AE, Pierce J. Topical Review: Crowdsourcing as a Novel Approach to Qualitative Research. J Pediatr Psychol 2021; 46:189-196. [PMID: 33236059 DOI: 10.1093/jpepsy/jsaa096] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/18/2020] [Accepted: 09/15/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To describe a novel, five-phase approach to collecting qualitative data from hard-to-reach populations using crowdsourcing methods. METHODS Drawing from experiences across recent studies with type 1 diabetes and congenital heart disease stakeholders, we describe five phases of crowdsourcing methodology, an innovative approach to conducting qualitative research within an online environment, and discuss relevant practical and ethical issues. RESULTS Phases of crowdsourcing methodology are: (I) Preparing; (II) Forming Crowds; (III) Collecting Crowdsourced Data; (IV) Coding and Analyzing Crowdsourced Data; and (V) Generating and Disseminating Findings. Iterative feedback from stakeholders is obtained in all five phases. Practical and ethical issues include accessing diverse stakeholders, emotional engagement of crowd participants, responsiveness and transparency of crowdsourcing methodology, and limited personal contact with crowd participants. CONCLUSIONS Crowdsourcing is an innovative, efficient, feasible, and timely approach to engaging hard-to-reach populations in qualitative research.
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Affiliation(s)
- Erica Sood
- Center for Healthcare Delivery Science, Nemours Children's Health System.,Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children.,Division of Behavioral Health, Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children.,Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University
| | - Tim Wysocki
- Center for Healthcare Delivery Science, Nemours Children's Health System
| | - Melissa A Alderfer
- Center for Healthcare Delivery Science, Nemours Children's Health System.,Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University
| | - Karen Aroian
- University of Central Florida, College of Nursing
| | | | - Allison Karpyn
- Center for Research in Education and Social Policy, Department of Human Development and Family Sciences, University of Delaware
| | - Anne E Kazak
- Center for Healthcare Delivery Science, Nemours Children's Health System.,Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University
| | - Jessica Pierce
- Center for Healthcare Delivery Science, Nemours Children's Health System.,Division of Behavioral Health, Department of Pediatrics, Nemours Children's Hospital.,Department of Pediatrics, College of Medicine, University of Central Florida
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21
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Roberts SD, Kazazian V, Ford MK, Marini D, Miller SP, Chau V, Seed M, Ly LG, Williams TS, Sananes R. The association between parent stress, coping and mental health, and neurodevelopmental outcomes of infants with congenital heart disease. Clin Neuropsychol 2021; 35:948-972. [PMID: 33706666 DOI: 10.1080/13854046.2021.1896037] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Caring for the complex needs of a child with congenital heart disease (CHD) can place significant burden on the family. Parent mental health and coping have important influences on resilience and neurodevelopmental outcomes in children with CHD. Objectives: To describe the uptake of a cardiac neurodevelopmental program (CNP), examine parent mental health and coping specific to parenting a child with CHD, and explore the relationship between parent mental health and child neurodevelopmental outcomes. Method: Implementation and uptake of the CNP was examined, and forty-four parents of children with CHD completed the DASS and RSQ-CHD. Results: The CNP showed significant uptake in follow-up and interventions offered including 100% completed brain MRIs of eligible patients, 35% increase in neonatal neurology consults, and 100% of families counselled on neurodevelopmental outcomes. A significant proportion of parents endorsed moderate/severe levels of anxiety (25%), depression (20%), and CHD-specific stress. Parents predominantly engaged in secondary control engagement coping (F(2,64)=75.04, p<.001, ηp2=.70). Secondary control engagement coping was associated with lower parent total stress (r=-.48, p=.006) and anxiety (r=-.47, p=.009). Higher parent stress was associated with higher anxiety (r=.45, p=.016), depression (r=.37, p=.05), more severe types of CHD (r=.35, p=.048), older child age (t(30)= -2.33, p=.03), and lower child cognitive scores (r=-.37, p=.045). More severe types of CHD were associated with lower language scores (F(3,35)=3.50, p=.03). Conclusions: This study highlights the relationship between parent mental health and early child cognitive outcomes in CHD and helps inform models of psychological care to reduce family burden and improve child outcomes.
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Affiliation(s)
- Samantha D Roberts
- Division of Neurology, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada.,York University, Toronto, Ontario, Canada
| | - Vanna Kazazian
- Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Meghan K Ford
- Division of Neurology, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Davide Marini
- Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Steven P Miller
- Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada
| | - Vann Chau
- Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michael Seed
- Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada
| | - Linh G Ly
- Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tricia S Williams
- Division of Neurology, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada
| | - Renee Sananes
- Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada.,Division of Cardiology, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
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22
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Stewart A, Smith CH, Eaton S, De Coppi P, Wray J. COVID-19 pandemic experiences of parents caring for children with oesophageal atresia/tracheo-oesophageal fistula. BMJ Paediatr Open 2021; 5:e001077. [PMID: 34192203 PMCID: PMC8136802 DOI: 10.1136/bmjpo-2021-001077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/27/2021] [Accepted: 05/05/2021] [Indexed: 12/16/2022] Open
Abstract
PURPOSE The COVID-19 pandemic has resulted in a global health crisis of unparalleled magnitude. The direct risk to the health of children is low. However, disease-containment measures have society-wide impacts. This study explored the pandemic experiences of parents of children with oesophageal atresia/tracheo-oesophageal fistula (OA/TOF) in the UK. DESIGN A phenomenological approach underpinned use of an asynchronous online forum method, in collaboration with a patient support group. Data were evaluated using thematic analysis. RESULTS The online forum ran between 7 November and 18 December 2020 with 109 participants.Pandemic experiences were divided into themes relating to healthcare and disease containment. Participants described positive experiences with remote healthcare but identified limitations. Delays and cancellations led to escalation of care to an emergency level, slower developmental progress and feelings of being abandoned by services. Inpatient care was perceived as safe but caring alone was emotionally and practically challenging. Disease containment themes revealed anxiety regarding health risks, 'collateral' damage to well-being because of isolation, and an impact on finances and employment. Parents described a transition from worry about direct health risks to concern about the impact of isolation on socialisation and development. A process of risk-benefit analysis led some to transition to a more 'normal life', while others continued to isolate. Benefits to their child's health from isolation were reported. CONCLUSIONS Parents' experiences of caring for a child with OA/TOF during the pandemic were varied. Rapid adoption of telehealth has demonstrated the enormous potential of remote healthcare delivery but requires refinement to meet the needs of the individual. Future pandemic planning should aim to retain community healthcare services to avoid escalation of care to an emergency, manage chronic and developmental concerns, and support parental well-being. Accurate and consistent disease-specific information is highly valued by parents. Third sector organisations are ideally positioned to support this.
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Affiliation(s)
- Alexandra Stewart
- Department of Speech and Language Therapy, Great Ormond Street Hospital For Children NHS Trust, London, UK.,Department of Language and Cognition, University College London, London, UK
| | - Christina H Smith
- Department of Language and Cognition, University College London, London, UK
| | - Simon Eaton
- Stem Cells and Regenerative Medicine Section, University College London Institute of Child Health, London, UK
| | - Paolo De Coppi
- Stem Cells and Regenerative Medicine Section, University College London Institute of Child Health, London, UK.,Specialist Paediatric and Neonatal Surgery, Great Ormond Street Hospital For Children NHS Trust, London, UK
| | - Jo Wray
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital For Children NHS Trust, London, UK
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23
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Fathers of Children With Congenital Heart Disease: Sources of Stress and Opportunities for Intervention. Pediatr Crit Care Med 2020; 21:e1002-e1009. [PMID: 32639475 PMCID: PMC7609567 DOI: 10.1097/pcc.0000000000002388] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To examine sources of stress for fathers of children with congenital heart disease and opportunities for intervention to prevent or reduce paternal mental health problems. DESIGN Qualitative study using online crowdsourcing, an innovative research methodology to create an online community to serve as a research sample. SETTING Yammer, an online social networking site. SUBJECTS Geographically diverse sample of 70 parents (25 fathers and 45 mothers) of young children with congenital heart disease. INTERVENTIONS Participants joined a private group on Yammer and responded to 37 open-ended study questions over a 6-month period. Qualitative data were coded and analyzed using an iterative process, and themes regarding sources of stress for fathers of children with congenital heart disease and opportunities for intervention were identified. MEASUREMENTS AND MAIN RESULTS Four broad themes regarding sources of stress for fathers of children with congenital heart disease emerged from the qualitative data from both mothers and fathers: societal expectations for fatherhood and standards of masculinity, balancing work and family responsibilities, feeling overlooked as a partner in care, and lack of father supports. To begin to address these sources of stress, participants recommended that care teams acknowledge and normalize the impact of congenital heart disease on fathers, provide support for balancing work and family responsibilities, recognize and promote father knowledge and engagement, and provide formal and informal supports for fathers of children with congential heart disease. CONCLUSIONS Fathers of children with congenital heart disease experience unique sources of stress in the absence of targeted interventions to meet their needs. Care teams play an important role in acknowledging the experiences of fathers and including and engaging fathers in care.
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24
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Alphonso N, Angelini A, Barron DJ, Bellsham-Revell H, Blom NA, Brown K, Davis D, Duncan D, Fedrigo M, Galletti L, Hehir D, Herberg U, Jacobs JP, Januszewska K, Karl TR, Malec E, Maruszewski B, Montgomerie J, Pizzaro C, Schranz D, Shillingford AJ, Simpson JM. Guidelines for the management of neonates and infants with hypoplastic left heart syndrome: The European Association for Cardio-Thoracic Surgery (EACTS) and the Association for European Paediatric and Congenital Cardiology (AEPC) Hypoplastic Left Heart Syndrome Guidelines Task Force. Eur J Cardiothorac Surg 2020; 58:416-499. [DOI: 10.1093/ejcts/ezaa188] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Nelson Alphonso
- Queensland Pediatric Cardiac Service, Queensland Children’s Hospital, University of Queensland, Brisbane, QLD, Australia
| | - Annalisa Angelini
- Department of Cardiac, Thoracic Vascular Sciences and Public health, University of Padua Medical School, Padua, Italy
| | - David J Barron
- Department of Cardiovascular Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | | | - Nico A Blom
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Katherine Brown
- Paediatric Intensive Care, Heart and Lung Division, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Deborah Davis
- Department of Anesthesiology, Thomas Jefferson University, Philadelphia, PA, USA
- Nemours Cardiac Center, A.I. Du Pont Hospital for Children, Wilmington, DE, USA
| | - Daniel Duncan
- Nemours Cardiac Center, A.I. Du Pont Hospital for Children, Wilmington, DE, USA
| | - Marny Fedrigo
- Department of Cardiac, Thoracic Vascular Sciences and Public Health, University of Padua Medical School, Padua, Italy
| | - Lorenzo Galletti
- Unit of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - David Hehir
- Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ulrike Herberg
- Department of Pediatric Cardiology, University Hospital Bonn, Bonn, Germany
| | | | - Katarzyna Januszewska
- Division of Pediatric Cardiac Surgery, University Hospital Muenster, Westphalian-Wilhelm’s-University, Muenster, Germany
| | | | - Edward Malec
- Division of Pediatric Cardiac Surgery, University Hospital Muenster, Westphalian-Wilhelm’s-University, Muenster, Germany
| | - Bohdan Maruszewski
- Department for Pediatric Cardiothoracic Surgery, Children's Memorial Health Institute, Warsaw, Poland
| | - James Montgomerie
- Department of Anesthesia, Birmingham Children’s Hospital, Birmingham, UK
| | - Christian Pizzaro
- Nemours Cardiac Center, A.I. Du Pont Hospital for Children, Wilmington, DE, USA
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Dietmar Schranz
- Pediatric Heart Center, Justus-Liebig University, Giessen, Germany
| | - Amanda J Shillingford
- Division of Cardiology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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25
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Brown KL, Pagel C, Ridout D, Wray J, Tsang VT, Anderson D, Banks V, Barron DJ, Cassidy J, Chigaru L, Davis P, Franklin R, Grieco L, Hoskote A, Hudson E, Jones A, Kakat S, Lakhani R, Lakhanpaul M, McLean A, Morris S, Rajagopal V, Rodrigues W, Sheehan K, Stoica S, Tibby S, Utley M, Witter T. Early morbidities following paediatric cardiac surgery: a mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background
Over 5000 paediatric cardiac surgeries are performed in the UK each year and early survival has improved to > 98%.
Objectives
We aimed to identify the surgical morbidities that present the greatest burden for patients and health services and to develop and pilot routine monitoring and feedback.
Design and setting
Our multidisciplinary mixed-methods study took place over 52 months across five UK paediatric cardiac surgery centres.
Participants
The participants were children aged < 17 years.
Methods
We reviewed existing literature, ran three focus groups and undertook a family online discussion forum moderated by the Children’s Heart Federation. A multidisciplinary group, with patient and carer involvement, then ranked and selected nine key morbidities informed by clinical views on definitions and feasibility of routine monitoring. We validated a new, nurse-administered early warning tool for assessing preoperative and postoperative child development, called the brief developmental assessment, by testing this among 1200 children. We measured morbidity incidence in 3090 consecutive surgical admissions over 21 months and explored risk factors for morbidity. We measured the impact of morbidities on quality of life, clinical burden and costs to the NHS and families over 6 months in 666 children, 340 (51%) of whom had at least one morbidity. We developed and piloted methods suitable for routine monitoring of morbidity by centres and co-developed new patient information about morbidities with parents and user groups.
Results
Families and clinicians prioritised overlapping but also different morbidities, leading to a final list of acute neurological event, unplanned reoperation, feeding problems, renal replacement therapy, major adverse events, extracorporeal life support, necrotising enterocolitis, surgical infection and prolonged pleural effusion. The brief developmental assessment was valid in children aged between 4 months and 5 years, but not in the youngest babies or 5- to 17-year-olds. A total of 2415 (78.2%) procedures had no measured morbidity. There was a higher risk of morbidity in neonates, complex congenital heart disease, increased preoperative severity of illness and with prolonged bypass. Patients with any morbidity had a 6-month survival of 81.5% compared with 99.1% with no morbidity. Patients with any morbidity scored 5.2 points lower on their total quality of life score at 6 weeks, but this difference had narrowed by 6 months. Morbidity led to fewer days at home by 6 months and higher costs. Extracorporeal life support patients had the lowest days at home (median: 43 days out of 183 days) and highest costs (£71,051 higher than no morbidity).
Limitations
Monitoring of morbidity is more complex than mortality, and hence this requires resources and clinician buy-in.
Conclusions
Evaluation of postoperative morbidity provides important information over and above 30-day survival and should become the focus of audit and quality improvement.
Future work
National audit of morbidities has been initiated. Further research is needed to understand the implications of feeding problems and renal failure and to evaluate the brief developmental assessment.
Funding
This project was funded by the NIHR Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 30. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Katherine L Brown
- Heart and Lung Division, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Christina Pagel
- Clinical Operational Research Unit, University College London, London, UK
| | - Deborah Ridout
- Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Jo Wray
- Heart and Lung Division, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Victor T Tsang
- Heart and Lung Division, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - David Anderson
- Departments of Paediatric Intensive Care, Cardiology and Cardiac Surgery, Evelina London Children’s Hospital, London, UK
| | - Victoria Banks
- Heart and Lung Division, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - David J Barron
- Departments of Intensive Care and Paediatric Cardiac Surgery, Birmingham Children’s Hospital, Birmingham, UK
| | - Jane Cassidy
- Departments of Intensive Care and Paediatric Cardiac Surgery, Birmingham Children’s Hospital, Birmingham, UK
| | - Linda Chigaru
- Heart and Lung Division, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Peter Davis
- Departments of Intensive Care and Paediatric Cardiac Surgery, Bristol Royal Hospital for Children, Bristol, UK
| | - Rodney Franklin
- Paediatric Cardiology Department, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Luca Grieco
- Clinical Operational Research Unit, University College London, London, UK
| | - Aparna Hoskote
- Heart and Lung Division, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Emma Hudson
- Department of Applied Health Research, University College London, London, UK
| | - Alison Jones
- Departments of Intensive Care and Paediatric Cardiac Surgery, Birmingham Children’s Hospital, Birmingham, UK
| | - Suzan Kakat
- Heart and Lung Division, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Rhian Lakhani
- Departments of Paediatric Intensive Care, Cardiology and Cardiac Surgery, Evelina London Children’s Hospital, London, UK
| | - Monica Lakhanpaul
- Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, London, UK
- Community Child Health, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Andrew McLean
- Department of Intensive care, Royal Hospital for Children, Glasgow, UK
| | - Steve Morris
- Department of Applied Health Research, University College London, London, UK
| | - Veena Rajagopal
- Heart and Lung Division, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Warren Rodrigues
- Department of Intensive care, Royal Hospital for Children, Glasgow, UK
| | - Karen Sheehan
- Departments of Intensive Care and Paediatric Cardiac Surgery, Bristol Royal Hospital for Children, Bristol, UK
| | - Serban Stoica
- Departments of Intensive Care and Paediatric Cardiac Surgery, Bristol Royal Hospital for Children, Bristol, UK
| | - Shane Tibby
- Departments of Paediatric Intensive Care, Cardiology and Cardiac Surgery, Evelina London Children’s Hospital, London, UK
| | - Martin Utley
- Clinical Operational Research Unit, University College London, London, UK
| | - Thomas Witter
- Departments of Paediatric Intensive Care, Cardiology and Cardiac Surgery, Evelina London Children’s Hospital, London, UK
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26
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Patterns of Growth and Nutrition From Birth to 6 Months in Infants With Complex Congenital Cardiac Defects. Nurs Res 2020; 69:S57-S65. [PMID: 32569101 DOI: 10.1097/nnr.0000000000000460] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Infants with complex congenital heart defects (CCHDs) experience alterations in growth that develop following surgical intervention and persist throughout early infancy, but the roles of nutritional intake and method of feeding require further exploration as their roles are not fully explained. OBJECTIVES The purpose of this study was to characterize trends in growth and nutritional intake during the first 6 months of life in infants with CCHD. METHODS We conducted a secondary analysis of growth and nutritional data from a pilot study designed to test the feasibility of nurse-guided participatory intervention with parents of infants with CCHD. Measures included demographic data, anthropometric data at birth, hospital discharge, and 6 months of age, nutritional intake at 2 and 6 months of age from parent-completed 24-hour nutrition diaries, and assessment of oral-motor skills between 1 and 2 months of age. Descriptive statistics and correlation and group differences were examined. RESULTS Data for 28 infants were analyzed. Infants demonstrated a decrease in weight-for-age z score (WAZ) and length-for-age z score (LAZ) from birth to hospital discharge and an increase in WAZ and LAZ by 6 months of age. Many of the infants developed failure to thrive. Across the study period, one third of the infants were receiving enteral nutrition. Infants who were orally fed had better growth WAZ and LAZ at 6 months of age when compared to infants who were enterally fed. DISCUSSION Infants with CCHD exhibit growth faltering throughout early infancy. Reliance on enteral nutrition did not improve growth outcomes in these infants. Findings suggest nutritional intake may not be enough to meet the nutrient requirements to stimulate catch-up growth.
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27
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Pridham KF, Harrison TM, Brown R, Mussatto K. Collaborative caregiving of parents who have an infant with congenital heart disease. J SPEC PEDIATR NURS 2020; 25:e12283. [PMID: 31793183 DOI: 10.1111/jspn.12283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/05/2019] [Accepted: 11/06/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Describe collaborative caregiving of the parents of an infant with congenital heart disease (CHD) with partner, health-care clinicians, and substitute caregivers (SC). DESIGN AND METHODS In a national online survey, 53 mothers and 12 fathers described collaborative caregiving for infants after CHD intervention with respect to facets of Bowlby's concept of the internal working model of caregiving. Parents identified concern for 24 everyday common problems or goals (i.e., issues; 10 for partner, 9 for clinician, 5 for SC), rated issue importance and difficulty, indicated an intention for seeking and using help (help use), and identified help source. RESULTS All survey items were a concern to at least 11 parents. Most prominently, all five of the SC items were identified by at least 44% of the parents as a concern. Everyday, common problems and goals were generally reported to be more important than difficult. Two items identified as partner issues, "Talking about life change" and "Handling stress," were a concern for about 50% of parents and identified by at least 74% as very important and 72% as moderately to greatly difficult. Help use was highest for SC items followed by items related to the partner. The partner was most frequently identified as a help source. PRACTICE IMPLICATIONS Nurses are in a position to assess and support parent collaboration within partner, clinician, and SC relationships for everyday problems and goals. The survey questions, with further development and testing, could be used for clinician assessment and tailoring of intervention to support parents' collaborative caregiving for infants with CHD.
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Affiliation(s)
- Karen F Pridham
- School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - Roger Brown
- School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin
| | - Kathleen Mussatto
- Herma Heart Institute, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
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28
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Kamiński M, Borger M, Prymas P, Muth A, Stachowski A, Łoniewski I, Marlicz W. Analysis of Answers to Queries among Anonymous Users with Gastroenterological Problems on an Internet Forum. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17031042. [PMID: 32041356 PMCID: PMC7037061 DOI: 10.3390/ijerph17031042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/05/2020] [Accepted: 02/05/2020] [Indexed: 12/24/2022]
Abstract
Internet forums are an attractive source of health-related information. We aimed to investigate threads in the gastroenterological section of a popular Polish medical forum for anonymous users. We characterised the following aspects in threads: the main problem of the original poster, declared ailments and rationale of the responses (rational, neutral, harmful or not related to the problem of the original poster). We analysed over 2717 forum threads initiated in the years 2010–2018. Users mostly asked for diagnosis of the problem [1814 (66.8%)], treatment [1056 (38.9%)] and diagnostic interpretation [308 (11.3%)]. The most commonly declared symptoms were abdominal pain [1046 (38.5%)], diarrhea [454 (16.7%)] and bloating [354 (13.0%)]. Alarm symptoms were mentioned in 309 (11.4%) threads. From the total 3550 responses, 1257 (35.4%) were assessed as rational, 693 (19.5%) as neutral, 157 (4.4%) as harmful and 1440 (40.6%) as not related to the user’s problem. The original poster’s declaration of blood in stool, dyspepsia, pain in the abdominal right lower quadrant, weight loss or inflammatory bowel disease was positively related to obtaining at least one potentially harmful response. Advice from anonymous users on Internet forums may be irrational and disregards alarm symptoms, which can delay the diagnosis of life-threatening diseases.
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Affiliation(s)
- Mikołaj Kamiński
- Sanprobi Sp.z o.o. Sp. k., 70-535 Szczecin, Poland
- Correspondence: ; Tel.: +48-516268563
| | - Michał Borger
- Faculty of Medicine I, Poznan University of Medical Sciences, 60-780 Poznań, Poland; (M.B.); (P.P.); (A.M.); (A.S.)
| | - Piotr Prymas
- Faculty of Medicine I, Poznan University of Medical Sciences, 60-780 Poznań, Poland; (M.B.); (P.P.); (A.M.); (A.S.)
| | - Agnieszka Muth
- Faculty of Medicine I, Poznan University of Medical Sciences, 60-780 Poznań, Poland; (M.B.); (P.P.); (A.M.); (A.S.)
| | - Adam Stachowski
- Faculty of Medicine I, Poznan University of Medical Sciences, 60-780 Poznań, Poland; (M.B.); (P.P.); (A.M.); (A.S.)
| | - Igor Łoniewski
- Department of Biochemistry and Human Nutrition, Pomeranian Medical University, 70-204 Szczecin, Poland;
| | - Wojciech Marlicz
- Department of Gastroenterology, Pomeranian Medical University, 70-204 Szczecin, Poland;
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29
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Salvador PTCDO, Alves KYA, Rodrigues CCFM, Oliveira LVE. Online data collection strategies used in qualitative research of the health field: a scoping review. Rev Gaucha Enferm 2020; 41:e20190297. [DOI: 10.1590/1983-1447.2020.20190297] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 01/21/2020] [Indexed: 01/21/2023] Open
Abstract
ABSTRACT Objective: To identify and map the online data collection strategies used in qualitative researches in the health field. Methods: This is a scoping review guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) from the Joanna Briggs Institute. We analyzed scientific articles, theses and dissertations from 12 databases. The analysis was made by descriptive statistics. Results: The final sample consisted of 121 researches. It was found that the number of publications increased sharply in the last five years, with predominance of studies from the United Kingdom. The highlight fields were psychology (28.1%), medicine (25.6%) and nursing (12.4%). The publications used 10 online data collection strategies: Online questionnaires, online forums, Facebook, websites, blogs, e-mail, online focus group, Twitter, chats, and YouTube. Conclusions: Online data collection strategies are constantly expanding and increasingly used in the health area.
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30
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Rajagopal V, Brown K, Pagel C, Wray J. Parental understanding of our communication of morbidity associated with paediatric cardiac surgery: a qualitative study. BMJ Paediatr Open 2020; 4:e000578. [PMID: 32154385 PMCID: PMC7047488 DOI: 10.1136/bmjpo-2019-000578] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 01/11/2020] [Accepted: 01/22/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Following paediatric cardiac surgery, quality of life may be significantly impacted by morbidities associated with cardiac surgery. Parental understanding of the potential for postoperative morbidity is important for informed decision making. As part of a broader research study, we aimed to elicit parental understanding and experience of the communication of morbidities following their child's cardiac surgery, using traditional focus groups together with an online forum. METHODS The Children's Heart Federation set up and moderated a closed, anonymous online discussion group via their Facebook page, focusing on complications, information needs and methods of providing families with information. Additionally, we ran three focus groups with parents/carers, moderated by an experienced independent professional. Focus groups were recorded and transcribed and a single transcript was generated from the online forum. All transcripts were thematically analysed. RESULTS All data were collected in 2014. The forum ran over 3 months in 2014 and involved 72 participants. Focus groups involved 13 participants. Three broad themes were identified: (1) clinicians' use of language, (2) feeling unprepared for complications and (3) information needs of families. CONCLUSIONS Clinicians' language is often misunderstood, with wide variability in the way morbidities are described, and between differing teams looking after the same child. Information may not be easily absorbed or retained by families, who often felt unprepared for morbidities that arose after their child's heart surgery. Here, we propose key principles of good communication tailored to the individual receiving it.
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Affiliation(s)
- Veena Rajagopal
- Heart and Lung, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Katherine Brown
- Heart and Lung, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Christina Pagel
- Heart and Lung, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK.,Clinical Operational Research Unit, University College London, London, UK
| | - Jo Wray
- Heart and Lung, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
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