Developing a nursing dependency scoring tool for children's palliative care: the impact on hospice care

BACKGROUND

Occupancy is commonly used to measure bed management in hospices. However, the increasing complexity of children and young people and growing dependence on technology mean that this is no longer effective.

AIM

To develop a dependency tool that enables the hospice to safely and effectively manage the use of beds for planned short breaks (respite care), preserving capacity for children requiring symptom management and end-of-life care.

METHODS

A comprehensive literature review and existing tools were used to inform the development of the Martin House Dependency Tool Framework. Training was provided to staff and the tool was piloted before applying it across the hospice caseload.

FINDINGS

The tool has been used on 431 children (93.1% of caseload). The tool enabled consistency of assessment and more effective management of resources, due to a contemporaneous understanding of the clinical needs of those on the caseload.

CONCLUSION

The tool has enabled consistent and transparent assessment of children, improving safety, effectiveness and responsiveness, and the management of the workforce and resources.

What it means to be the parent of a child with a disability or complex health need

AIM

To explore how parents of children with disabilities and complex health needs make sense of the circumstances in which they find themselves.

METHOD

A series of in-depth semi-structured interviews were undertaken with the parents of 34 children (from 33 families) with a disability or a complex health need. The families were nominated by health professionals to one of three study subgroups: children with a disability, children with a life-limiting or life-threatening illness, or children with technology dependence. Interviews were recorded and transcribed.

FINDINGS

Analysis of parents' responses related to sense-making revealed two main categories: 'diagnosis' and 'personal, cultural and personality factors'. These two categories alongside the two other main study themes, 'impact' and 'need for help and support' reported in the previous two articles in this series - linked into a final study theme: 'battleground'.

CONCLUSION

For the parents of children with complex health needs and disabilities, the sense that they make of their situation plays a pivotal role in determining how parents experience the impact of disability and the need for help and support.