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Bakker L, Jackson B, Miles A. The Impact of Physical and Environment Factors on Parental Presence for Oral Feeding in New Zealand Neonatal Intensive Care Units. HERD 2024; 17:166-182. [PMID: 38083855 DOI: 10.1177/19375867231216517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2024]
Abstract
AIM To identify physical environmental factors influencing family involvement in feeding in New Zealand neonatal units. BACKGROUND Infant oral feeding development is critical for both short-term feeding skills and longer term neurodevelopmental outcomes. The neonatal environment is well-known as challenging for neuroprotection due to negative sensory exposure. The impact of environmental factors on oral feeding in New Zealand (NZ) neonatal units is currently unexplored, and knowledge of this could allow for evidence-based unit design. METHODS Focused ethnography at five neonatal units, a national survey of NZ neonatal professionals (n = 102), and five focus groups were carried out. Current oral feeding practice, and beliefs, experiences, and opinions of unit staff and family about these practices were explored. Data were analyzed using qualitative content analysis. RESULTS Units were providing the best experience to families that they could with the resources they had available. Lack of physical space, lack of privacy, limited on-site accommodation for families, and lack of coordination between maternity and neonatal services were identified as impacting on family's comfort and sense of homeliness on the unit. Unit staff used furniture, screens, and external accommodation providers to support families where they could. CONCLUSIONS The physical design of neonatal units in New Zealand provides barriers to family's spending time privately developing oral feeding. Solutions are proposed to increase the size of bedspaces, provide single-family rooms, create greater on-site family accommodation options, combine maternity and neonatal healthcare, and improve family comfort and therefore connection with their infant.
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Affiliation(s)
- Lise Bakker
- Child Development Service, Palmerston North, New Zealand
- Te Whatu Ora Health New Zealand | Te Pae Hauora O Ruahine O Tararua Midcentral, New Zealand
| | - Bianca Jackson
- School of Psychology, The University of Auckland, New Zealand
| | - Anna Miles
- School of Psychology, The University of Auckland, New Zealand
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2
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Latour JM, Rennick JE, van den Hoogen A. Editorial: Family-centered care in pediatric and neonatal critical care settings. Front Pediatr 2024; 12:1402948. [PMID: 38606367 PMCID: PMC11007701 DOI: 10.3389/fped.2024.1402948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 04/13/2024] Open
Affiliation(s)
- Jos M. Latour
- Faculty of Health, University of Plymouth, Plymouth, United Kingdom
- Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China
- The Curtin School of Nursing, Curtin University, Perth, WA, Australia
| | - Janet E. Rennick
- Department of Nursing, The Montreal Children’s Hospital, McGill University Health Centre, Montreal, QC, Canada
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Department of Pediatrics, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Agnes van den Hoogen
- Department Woman and Baby, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, Utrecht, Netherlands
- Clinical Health Science, Utrecht University, Utrecht, Netherlands
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Tabet M, Kirby RS, Boyd R, Xaverius P. Family-Centered Care and Delayed or Missed Pediatric Preventive Care due to the COVID-19 Pandemic. Acad Pediatr 2024:S1876-2859(24)00067-6. [PMID: 38432513 DOI: 10.1016/j.acap.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/20/2024] [Accepted: 02/25/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE To examine the association between family-centered care and its components with delayed or missed preventive care due to the COVID-9 pandemic among US children. METHODS This is a cross-sectional study using nationally representative data from the 2021 National Survey of Children's Health (NSCH). Children were eligible if they received health care services in the past 12 months (n = 42,649; 79.3%). We excluded children with missing data, for a final sample of 40,511 (93.7% of the eligible sample). Children were deemed to have received family-centered care if caregivers responded "always" or "usually" to all five measures of family-centered care. Poisson regression was used to ascertain weighted prevalence ratios (PRs) and 95% confidence intervals (CIs). Predisposing, enabling, and need factors of health care services use were evaluated as potential confounders. RESULTS Approximately 86.7% of children received family-centered care during the pandemic, with significant racial and ethnic differences, findings consistent with pre-pandemic data. In multivariable analyses adjusted for the child's race and age, family-centered care was associated with a 30% reduced likelihood of delayed or missed preventive care (95% CI: 0.64-0.78). Individual components of family-centered care were associated with a 26%-43% reduced likelihood of delayed or missed preventive care. CONCLUSIONS Family-centered care and its components were associated with a reduced likelihood of delayed or missed pediatric preventive care. Our findings highlight the important role of health care providers in curbing the negative effects of the COVID-19 pandemic on pediatric preventive care utilization and emphasize the need to expand family-centered care among racial and ethnic minority groups.
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Affiliation(s)
- Maya Tabet
- College of Global Population Health (M Tabet and R Boyd), University of Health Sciences and Pharmacy in St. Louis, St. Louis, Mo.
| | - Russell S Kirby
- Chiles Center (RS Kirby), College of Public Health, University of South Florida, Tampa, Fla
| | - Ri'enna Boyd
- College of Global Population Health (M Tabet and R Boyd), University of Health Sciences and Pharmacy in St. Louis, St. Louis, Mo
| | - Pamela Xaverius
- Parkinson's School of Health Sciences and Public Health (P Xaverius), Loyola University Chicago, Maywood, Ill
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Poulos NS, Donovan EE, Mackert M, Mandell DJ. Missed opportunities for prenatal family-centered care during the COVID-19 pandemic: a qualitative study. J Commun Healthc 2024; 17:111-117. [PMID: 38319088 DOI: 10.1080/17538068.2024.2313246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
BACKGROUND The purpose of this study was to describe the impact of COVID-19 on fatherhood experiences during pregnancy. METHODS A semi-structured interview guide was developed to collect qualitative data from fathers about their experiences in pregnancy and prenatal care, how they communicated with providers, strategies for information seeking, and social support they received during the pregnancy. One-time, virtual interviews were conducted via Zoom with fathers that were either expecting a baby or fathers who had a baby after March 2020 and were 18 years or older. Thematic analysis was used to identify themes that highlighted the fatherhood experience. RESULTS In total, 34 interviews with new or expectant fathers were completed. Two central themes that highlight the experiences of fathers: missed opportunities to shift toward family-centered care and inequity in the parent dyad during pregnancy. Additional supporting themes included: limited patient-provider relationship, lack of telemedicine use, inadequate uncertainty management for parents, unidirectional information sharing between parents, and limited opportunities for achieving role attainment during pregnancy. CONCLUSION The COVID-19 pandemic created a decision point for prenatal care. Instead of focusing on family-centered practices, prenatal care exclusively centered on the mother and fetus, resulting in problematic experiences for fathers including limited access to information about the pregnancy and health of the mother and fetus, heightened stress related to COVID-19 safety requirements, and few opportunities to attain their role as a father. Prenatal care should actively seek robust strategies to improve family-centered care practices that will withstand the next public health emergency.
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Affiliation(s)
- Natalie S Poulos
- Department of Nutritional Sciences, The University of Texas at Austin, Austin, TX, USA
- School of Health Professions, The University of Texas at Tyler, Tyler, TX, USA
| | - Erin E Donovan
- Department of Communication Studies, The University of Texas at Austin, Austin, TX, USA
| | - Michael Mackert
- Department of Population Health, Stan Richards School of Advertising & Public Relations, Center for Health Communications, The University of Texas at Austin, Austin, TX, USA
| | - Dorothy J Mandell
- School of Health Professions, The University of Texas at Tyler, Tyler, TX, USA
- School of Public Health, University of Texas Health Science Center Houston, Austin, TX, USA
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5
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Dijkstra BM, Rood PJT, Teerenstra S, Rutten AMF, Leerentveld C, Burgers-Bonthuis DC, Festen-Spanjer B, Klarenbeek T, Van Den Boogaard M, Ewalds E, Schoonhoven L, Van Der Hoeven JG, Vloet LCM. Effect of a Standardized Family Participation Program in the ICU: A Multicenter Stepped-Wedge Cluster Randomized Controlled Trial. Crit Care Med 2024; 52:420-431. [PMID: 37934138 PMCID: PMC10876177 DOI: 10.1097/ccm.0000000000006093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
OBJECTIVES To determine the effect of a standardized program for family participation in essential care activities in the ICU on symptoms of anxiety, depression, posttraumatic stress and satisfaction among relatives, and perceptions and experiences of ICU healthcare providers (HCPs). DESIGN Multicenter stepped-wedge cluster randomized controlled trial. SETTING Seven adult ICUs, one university, and six general teaching hospitals. PARTICIPANTS Three hundred six relatives and 235 ICU HCPs. INTERVENTIONS A standardized program to facilitate family participation inpatient communication, amusement/distraction, comfort, personal care, breathing, mobilization, and nutrition. MEASUREMENTS AND MAIN RESULTS Data were collected through surveys among relatives and ICU HCPs. There were no significant differences in symptoms of anxiety in relatives in the intervention period compared with the control period (median Hospital Anxiety and Depression Scale [HADS] 5 [interquartile range (IQR) 2-10] vs 6 [IQR 3-9]; median ratio [MR] 0.72; 95% CI, 0.46-1.13; p = 0.15), depression (median HADS 4 [IQR 2-6] vs 3 [IQR 1-6]; MR 0.85; 95% CI, 0.55-1.32; p = 0.47) or posttraumatic stress (median Impact of Event Scale-Revised score 0.45 [IQR 0.27-0.82] vs 0.41 [IQR 0.14-1]; MR 0.94; 95% CI, 0.78-1.14; p = 0.54). Reported satisfaction was slightly lower in the intervention period (mean 8.90 [ sd 1.10] vs mean 9.06 [ sd 1.10], difference -0.60; 95% CI, -1.07 to -0.12; p = 0.01). ICU HCPs perceived that more relatives knew how to participate: 47% in the intervention period versus 22% in the control period (odds ratio [OR] 3.15; 95% CI, 1.64-6.05; p < 0.01). They also reported relatives having sufficient knowledge (41% vs 16%; OR 3.56; 95% CI, 1.75-7.25; p < 0.01) and skills (44% vs 25%; OR 2.38; 95% CI, 1.22-4.63; p = 0.01) to apply family participation. CONCLUSIONS Application of a standardized program to facilitate family participation did not change mental health symptoms in relatives of ICU patients 3 months after discharge. ICU HCPs reported increased clarity, knowledge, and skills among relatives and ICU HCPs.
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Affiliation(s)
- Boukje M Dijkstra
- Research Department Emergency and Critical Care, School of Health Studies Nijmegen, HAN University of Applied Sciences, Nijmegen, The Netherlands
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Paul J T Rood
- Research Department Emergency and Critical Care, School of Health Studies Nijmegen, HAN University of Applied Sciences, Nijmegen, The Netherlands
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Steven Teerenstra
- Department for Health Evidence, Section Biostatistics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anne M F Rutten
- Department of Intensive Care Medicine, Elisabeth Tweesteden Hospital, Tilburg, The Netherlands
| | - Crista Leerentveld
- Department of Intensive Care Medicine, ISALA Hospital, Zwolle, The Netherlands
| | | | | | - Toine Klarenbeek
- Department of Intensive Care Medicine, Máxima Medical Center, Veldhoven, The Netherlands
| | - Mark Van Den Boogaard
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Esther Ewalds
- Department of Intensive Care Medicine, Bernhoven, Uden, The Netherlands
| | - Lisette Schoonhoven
- Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
| | | | - Lilian C M Vloet
- Research Department Emergency and Critical Care, School of Health Studies Nijmegen, HAN University of Applied Sciences, Nijmegen, The Netherlands
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Foundation for Family and Patient Centered Intensive Care, Alkmaar, The Netherlands
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Hess SM, Adu-Amankwah D, Elaiho CR, Butler LR, Ranade SC, Shah BJ, Shadman K, Fields R, Lin EP. Qualitative feedback from caregivers in a multidisciplinary pediatric neuromuscular clinic. J Pediatr Rehabil Med 2024:PRM230011. [PMID: 38427510 DOI: 10.3233/prm-230011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2024] Open
Abstract
PURPOSE This study explored family satisfaction and perceived quality of care in a pediatric neuromuscular care clinic to assess the value of the multidisciplinary clinic (MDC) model in delivering coordinated care to children with neuromuscular disorders, such as cerebral palsy. METHODS Caregivers of 22 patients were administered a qualitative survey assessing their perceptions of clinic efficiency, care coordination, and communication. Surveys were audio-recorded and transcribed. Thematic analysis was completed using both deductive and inductive methods. RESULTS All caregivers reported that providers adequately communicated next steps in the patient's care, and most reported high confidence in caring for the patient as a result of the clinic. Four major themes were identified from thematic analysis: Care Delivery, Communication, Care Quality, and Family-Centeredness. Caregivers emphasized that the MDC model promoted access to care, enhanced efficiency, promoted provider teamwork, and encouraged shared care planning. Caregivers also valued a physical environment that was suitable for patients with complex needs. CONCLUSION This study demonstrated that caregivers believed the MDC model was both efficient and convenient for pediatric patients with neuromuscular disorders. This model has the potential to streamline medical care and can be applied more broadly to improve care coordination for children with medical complexity.
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Affiliation(s)
- Skylar M Hess
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dorothy Adu-Amankwah
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Liam R Butler
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sheena C Ranade
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Brijen J Shah
- Department of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kristin Shadman
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Robert Fields
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Elaine P Lin
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Dobrina R, Starec A, Brunelli L, Orzan E, De Vita C, Bicego L, Ronfani L, Castro V, Di Rocco P, Zanchiello S, Dal Cin M, Tagliapietra B, Cinello M, Fontanot D, Stampalija T, Dante A, Petrucci C, Cassone A. Applying the Participatory Slow Design Approach to a mHealth Application for Family Caregivers in Pediatric Ear, Nose, and Throat Surgery. Healthcare (Basel) 2024; 12:442. [PMID: 38391818 PMCID: PMC10888311 DOI: 10.3390/healthcare12040442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/15/2024] [Accepted: 02/04/2024] [Indexed: 02/24/2024] Open
Abstract
Pediatric ear, nose, and throat (ENT) surgery is very common, and its outcomes may improve with family education. In this regard, mobile health (mHealth) applications (apps), which are on the rise due to digital transformation, can be beneficial in healthcare. This study outlines the user-centered design and development of a mHealth app (version 5.15.0) to support family caregivers during the perioperative process of pediatric ENT surgery. Conducted over two years in an Italian maternal and child health hospital (January 2020-May 2022), the study employed a participatory design method based on the Information System Research (ISR) framework and guided by the principles of Slow Medicine. Utilizing the Relevance, Rigor, and Design cycles of the ISR framework, the mHealth app's content, functionalities, and technical features were defined and developed. A committee of fifteen experts guided the process with input from 25 family caregivers and 24 healthcare providers enrolled in the study. The mHealth app content was structured around five crucial educational moments characterizing the ENT perioperative period, providing evidence-based information on surgical procedures, strategies for preparing children for hospitalization and surgery, pain management, and post-discharge care. The mHealth app featured a function that sends customized notifications to guide caregivers at specific perioperative stages. The development of mHealth apps by implementing a rigorous, participatory, and Slow design process can foster accessible and family-centered information and care in the field of maternal and child health and beyond.
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Affiliation(s)
- Raffaella Dobrina
- Healthcare Professions Directorate, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", 34137 Trieste, Italy
| | | | - Laura Brunelli
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34127 Trieste, Italy
| | - Eva Orzan
- Audiology and Otorhinolaryngology Unit, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", 34137 Trieste, Italy
| | | | - Livia Bicego
- Healthcare Professions Directorate, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", 34137 Trieste, Italy
| | - Luca Ronfani
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", 34137 Trieste, Italy
| | - Veronica Castro
- Audiology and Otorhinolaryngology Unit, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", 34137 Trieste, Italy
| | - Paola Di Rocco
- Surgery Unit, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", 34137 Trieste, Italy
| | | | - Margherita Dal Cin
- Department of Health Prevention, Azienda Sanitaria Universitaria Giuliano Isontina, 34148 Trieste, Italy
| | - Benedetta Tagliapietra
- Surgery Unit, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", 34137 Trieste, Italy
| | | | - Donatella Fontanot
- Public Relations Office, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", 34137 Trieste, Italy
| | - Tamara Stampalija
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34127 Trieste, Italy
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", 34137 Trieste, Italy
| | - Angelo Dante
- Department of Health, Life and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy
| | - Cristina Petrucci
- Department of Health, Life and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy
| | - Andrea Cassone
- Healthcare Professions Directorate, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", 34137 Trieste, Italy
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Ay A, Semerci R, Erkul M. Prediction of family-centered care on the unmet care needs of parents of pediatric oncology patients and their psychosocial problems. Pediatr Blood Cancer 2024; 71:e30795. [PMID: 38038401 DOI: 10.1002/pbc.30795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/14/2023] [Accepted: 11/19/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND/OBJECTIVES It was aimed to determine the predictive power of family-centered care of parents of children with cancer on their unmet care needs and psychosocial problems (anxiety, depression, stress). This study was conducted as a descriptive, correlational, and cross-sectional study. DESIGN/METHODS The study was conducted on 136 parents at a university hospital between January and September 2023, involving parents of children receiving care at the pediatric oncology clinic. Data collection instruments included an Information Form, Family Inventory of Needs Pediatric II (FINPED-II), Family-Centered Care Scale (FCCS), and Depression Anxiety Stress Scale (DASS-21). Data were analyzed using IBM SPSS 28, employing Pearson correlation analysis and linear regression to assess the relationships between variables. RESULTS The study revealed significant positive correlations between Family-Centered Care and Met Needs (r = .676, p < .001) and significant negative correlations between Met Needs and Stress scores (r = -.256, p < .001). Additionally, there were positive correlations between Anxiety and Depression scores (r = .700, p < .001), Anxiety and Stress scores (r = .768, p < .001), and Depression and Stress scores (r = .835, p < .001). Family-centered care significantly predicted Met Needs (p < .001) and accounted for 47% of the variation in Anxiety, Depression, Stress, and Family Inventory of Needs scores. CONCLUSION The findings highlight that family-centered care significantly predicts Met Needs, emphasizing its pivotal role in supporting parents of children with cancer. These findings underscore the importance of family-centered care in pediatric oncology, but also point to the need for further studies to address identified limitations and provide a comprehensive understanding of this complex healthcare dynamic.
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Affiliation(s)
- Ayşe Ay
- Nursing Department, Faculty of Health Sciences, Başkent University, Ankara, Turkey
| | - Remziye Semerci
- Child and Disease Nursing Department, Nursing Faculty, Koç University, İstanbul, Turkey
| | - Münevver Erkul
- Nursing Department, Faculty of Health Sciences, Antalya Science University, Antalya, Turkey
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Bennett T, Drmic I, Gross J, Jambon M, Kimber M, Zaidman-Zait A, Andrews K, Frei J, Duku E, Georgiades S, Gonzalez A, Janus M, Lipman E, Pires P, Prime H, Roncadin C, Salt M, Shine R. The Family-Check-Up® Autism Implementation Research (FAIR) Study: protocol for a study evaluating the effectiveness and implementation of a family-centered intervention within a Canadian autism service setting. Front Public Health 2024; 11:1309154. [PMID: 38292388 PMCID: PMC10826514 DOI: 10.3389/fpubh.2023.1309154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 12/15/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction Prevalence rates of emotional and behavior problems (EBP) in autistic children and youth are high (40-70%), and often cause severe and chronic impairment. Furthermore, autistic children are also more likely to experience family "social-ecological" adversity compared to neurotypically developing peers, including social isolation, child maltreatment, caregiver mental illness, and socioeconomic risk. These family stressors increase the risk of co-occurring EBP among autistic children and can often impede access to evidence-based care, thus amplifying long-term health inequities for autistic children and their caregivers. In the current autism services landscape, there are few scalable, evidence-based programs that adequately address these needs. The Family Check-Up (FCU®) is a brief, strength-based, and tailored family-centered intervention that supports positive parenting and explicitly assesses the social determinants of child and family mental health within an ecological framework. Studies have demonstrated long-term positive child and caregiver outcomes in other populations, but the FCU® has not been evaluated in families of autistic children and youth. Therefore, we aimed to evaluate FCU® implementation within an established, publicly funded Autism Program in Ontario, Canada, with delivery by autism therapists, to demonstrate sustainable effectiveness within real-world settings. Methods In this study, we outline the protocol for a hybrid implementation-effectiveness approach with two key components: (1) A parallel-arm randomized controlled trial of N = 80 autistic children/youth (ages 6-17 years) and high levels of EBP and their caregivers. Primary and secondary outcomes include child EBP, and caregiver well-being and parenting. (2) A mixed methods implementation study, to describe facilitators and barriers to implementation of the FCU® within an autism service setting. Discussion Scalable, ecologically focused family-centered interventions offer promise as key components of a public health framework aimed at reducing mental health inequities among autistic children, youth, and their caregivers. Results of this study will inform further program refinement and scale-up.
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Affiliation(s)
- Teresa Bennett
- Department of Psychiatry and Behavioral Neurosciences, Offord Centre for Child Studies, McMaster University/McMaster Children’s Hospital, Hamilton, ON, Canada
- Ron Joyce Children’s Health Centre Hamilton Health Sciences/McMaster Children’s Hospital, Hamilton, ON, Canada
| | - Irene Drmic
- Ron Joyce Children’s Health Centre Hamilton Health Sciences/McMaster Children’s Hospital, Hamilton, ON, Canada
| | - Julie Gross
- Department of Psychiatry and Behavioral Neurosciences, Offord Centre for Child Studies, McMaster University/McMaster Children’s Hospital, Hamilton, ON, Canada
| | - Marc Jambon
- Department of Psychology, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Melissa Kimber
- Department of Psychiatry and Behavioral Neurosciences, Offord Centre for Child Studies, McMaster University/McMaster Children’s Hospital, Hamilton, ON, Canada
| | | | - K. Andrews
- Department of Psychiatry and Behavioral Neurosciences, Offord Centre for Child Studies, McMaster University/McMaster Children’s Hospital, Hamilton, ON, Canada
| | - Julia Frei
- Ron Joyce Children’s Health Centre Hamilton Health Sciences/McMaster Children’s Hospital, Hamilton, ON, Canada
| | - E. Duku
- Department of Psychiatry and Behavioral Neurosciences, Offord Centre for Child Studies, McMaster University/McMaster Children’s Hospital, Hamilton, ON, Canada
| | - Stelios Georgiades
- Department of Psychiatry and Behavioral Neurosciences, Offord Centre for Child Studies, McMaster University/McMaster Children’s Hospital, Hamilton, ON, Canada
| | - Andrea Gonzalez
- Department of Psychiatry and Behavioral Neurosciences, Offord Centre for Child Studies, McMaster University/McMaster Children’s Hospital, Hamilton, ON, Canada
| | - Magdalena Janus
- Department of Psychiatry and Behavioral Neurosciences, Offord Centre for Child Studies, McMaster University/McMaster Children’s Hospital, Hamilton, ON, Canada
| | - E. Lipman
- Department of Psychiatry and Behavioral Neurosciences, Offord Centre for Child Studies, McMaster University/McMaster Children’s Hospital, Hamilton, ON, Canada
| | - Paulo Pires
- Ron Joyce Children’s Health Centre Hamilton Health Sciences/McMaster Children’s Hospital, Hamilton, ON, Canada
| | - Heather Prime
- Department of Psychology, York University, Toronto, ON, Canada
| | - Caroline Roncadin
- Ron Joyce Children’s Health Centre Hamilton Health Sciences/McMaster Children’s Hospital, Hamilton, ON, Canada
| | - Mackenzie Salt
- Department of Psychiatry and Behavioral Neurosciences, Offord Centre for Child Studies, McMaster University/McMaster Children’s Hospital, Hamilton, ON, Canada
| | - Rebecca Shine
- Ron Joyce Children’s Health Centre Hamilton Health Sciences/McMaster Children’s Hospital, Hamilton, ON, Canada
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Fonseca A, Qian D, Forbes T, Li BSK, Lee C, Burdsall K, Rodriguez S, Jackson C, Wang EY, Caruso TJ. Reducing Preoperative Caregiver Anxiety With Virtual Reality: A Pragmatic, Randomized Controlled Study. J Patient Exp 2024; 11:23743735231220190. [PMID: 38188533 PMCID: PMC10771051 DOI: 10.1177/23743735231220190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024] Open
Abstract
Pediatric patients and their caregivers often experience perioperative anxiety. Interventions reduce caregiver anxiety improve cooperation and contribute to an improved patient experience. This study seeks to evaluate the efficacy of virtual reality (VR)-assisted mindfulness on perioperative caregiver anxiety. Participants were randomized into a standard of care (SOC) group, which included snacks but no technology-based distractions, or a VR group, which included snacks and a VR-guided meditation. Caregiver anxiety was measured before and after the intervention using the Visual Analogue Scale for Anxiety (VAS-A). Secondary aims explored participants' baseline anxiety with the State-Trait Anxiety Inventory (STAI). VR group participants completed a satisfaction survey. Linear regression models of VAS-A and STAI were used to compare group differences. Satisfaction survey results were reported with descriptive statistics. 26 participants were included, with 12 randomized to the SOC group and 14 to the VR group. VAS-A scores in the VR group were lower than those in the SOC group (p = .002). The STAI found no change in participants' state of anxiety in the SOC group (p = .7108), compared to a significant reduction (p = .014) in the VR group when controlling for anxiety traits. 12 of 14 caregivers in the VR group expressed satisfaction or strong satisfaction. This study supports the implementation of VR mindfulness as a method to reduce caregiver anxiety. VR use in the pediatric healthcare setting is safe and inexpensive, and the intervention had a high degree of participant satisfaction.
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Affiliation(s)
- Ahtziri Fonseca
- Chariot Program, Stanford Children's Health, Palo Alto, CA, USA
| | - Daniel Qian
- Division of Pediatric Anesthesia, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford University, Palo Alto, CA, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ty Forbes
- Division of Pediatric Anesthesia, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford University, Palo Alto, CA, USA
- University of Texas McGovern Medical School, Houston, TX, USA
| | - Brian S-K Li
- Division of Pediatric Anesthesia, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford University, Palo Alto, CA, USA
- Department of Comparative Literature, Princeton University, Princeton, NJ, USA
| | - Charles Lee
- Stanford University School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Kylie Burdsall
- Stanford University School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Samuel Rodriguez
- Division of Pediatric Anesthesia, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Christian Jackson
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Ellen Y Wang
- Division of Pediatric Anesthesia, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Thomas J Caruso
- Division of Pediatric Anesthesia, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford University, Palo Alto, CA, USA
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11
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Jimenez-Arberas E, Casais-Suarez Y, Fernandez-Mendez A, Menendez-Espina S, Rodriguez-Menendez S, Llosa JA, Prieto-Saborit JA. Evidence-Based Implementation of the Family-Centered Model and the Use of Tele-Intervention in Early Childhood Services: A Systematic Review. Healthcare (Basel) 2024; 12:112. [PMID: 38201017 PMCID: PMC10779073 DOI: 10.3390/healthcare12010112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/15/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND The purpose of this review is to explore the evidence and efficacy of two trends in early childhood intervention services: the family-centered model and the use of tele-intervention. METHODS A systematic review was carried out following the PRISMA methodology and using three databases: Web of Science, PubMed and Scopus. The studies included were those aimed at children from 0 to 6 years of age, focused on early intervention, and which alluded to the family-centered model and/or tele-intervention. RESULTS a total of 33 studies were included. Five main themes were identified: (1) The participation of children and family is facilitated and improved by the family-centered model of care; (2) the feeling of competence, self-efficacy, satisfaction and empowerment in professionals and families have a positive impact on quality of life; (3) the use of tele-intervention as a tool for prevention and intervention; (4) preparation for telepractice can improve the development of commitment; (5) tele-intervention as a possible solution to contextual barriers. CONCLUSIONS Tele-intervention in pediatrics is presented as a tool inherent to the family-centered model since its implementation involves several common strategies. Future lines of research should explore the use of this tool as a possible solution to contextual barriers.
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Affiliation(s)
| | | | | | | | | | - Jose Antonio Llosa
- University Clinic INYPEMA, Faculty Padre Osso, University of Oviedo, 33008 Oviedo, Spain; (E.J.-A.); (Y.C.-S.); (A.F.-M.); (S.M.-E.); (S.R.-M.); (J.A.P.-S.)
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12
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Wilson JL. An Integrative Review of Grandparents' Experiences in Childhood Cancer. J Pediatr Hematol Oncol Nurs 2024; 41:67-77. [PMID: 37853761 DOI: 10.1177/27527530231194569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
Background: While it is generally accepted that childhood cancer has a profound impact on the family unit, there has been little focus on the experiences of grandparents who are affected by the diagnosis. Grandparents play an integral role throughout the child's illness trajectory as they are called upon to provide support physically, spiritually, emotionally, and at times financially. This integrative review examines the current research specific to grandparents' experiences of childhood cancer. Method: CINAHL, PubMed, and Web of Science were searched using the key terms "grandparent*" AND "experience*" AND "child*" AND "cancer." Inclusion criteria used for this review were as follows: electronic full text, peer-reviewed, and published in English between 2012 and 2022. Results: Grandparents of children with cancer experience an emotional whirlwind, a double-whammy effect, the giving and receiving of support, a balancing act, and attempt to find meaning throughout the diagnosis. They feel unacknowledged and unsupported by the health care team. Discussion: It is difficult to deny the emotional and familial impact the child's cancer diagnosis has not only on the child and immediate family but also on grandparents. While the reports of grandparents are consistent across studies, there have been lackluster attempts to mitigate the suffering experienced by this group. Pediatric oncology nurses, with their family-centered care approach, are in a unique position to uncover and meet the specific needs of grandparents of children diagnosed with cancer.
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13
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Richter M, Angell A, Kellner P, Smith J, Pineda R. Infant and Parent Outcomes Related to NICU-Based Co-occupational Engagement. OTJR (Thorofare N J) 2024; 44:3-12. [PMID: 36945755 DOI: 10.1177/15394492231160690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Neonatal intensive care unit (NICU) co-occupations may impact parent-infant outcomes. The main objective of this study was to explore relationships between parent and infant outcomes based on whether sensory-based interventions (co-occupations) occurred most often between parent-infant dyads or provider/volunteer-infant dyads. Thirty-five families received the Supporting and Enhancing NICU Sensory Experiences (SENSE) program, which includes education defining specific amounts of sensory exposures for infants to receive each day of NICU hospitalization (with a preference for parent delivery). Infant sensory experiences in the NICU were logged, and dyads were grouped based on who conducted most of the sensory interventions with the infant in the NICU into a Parent-Infant Co-occupation group or Other Administered group. The Parent-Infant Co-occupation group had infants with less lethargy on the NICU Network Neurobehavioral Scale (p = .04), and parents with lower scores on the Parental Stress Scale (p = .003) and State-Trait Anxiety Inventory-state (p = .047). Parent-infant engagement in co-occupations was related to parental mental health and infant neurobehavior.
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Affiliation(s)
- M Richter
- University of Southern California, Los Angeles, CA, USA
| | - A Angell
- University of Southern California, Los Angeles, CA, USA
| | - P Kellner
- University of Southern California, Los Angeles, CA, USA
| | - J Smith
- St. Louis Children's Hospital, St. Louis, MO, USA
| | - R Pineda
- University of Southern California, Los Angeles, CA, USA
- Washington University, St. Louis, MO, USA
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14
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Lisanti AJ, Vittner DJ, Peterson J, Van Bergen AH, Miller TA, Gordon EE, Negrin KA, Desai H, Willette S, Jones MB, Caprarola SD, Jones AJ, Helman SM, Smith J, Anton CM, Bear LM, Malik L, Russell SK, Mieczkowski DJ, Hamilton BO, McCoy M, Feldman Y, Steltzer M, Savoca ML, Spatz DL, Butler SC. Developmental care pathway for hospitalised infants with CHD: on behalf of the Cardiac Newborn Neuroprotective Network, a Special Interest Group of the Cardiac Neurodevelopmental Outcome Collaborative. Cardiol Young 2023; 33:2521-2538. [PMID: 36994672 PMCID: PMC10544686 DOI: 10.1017/s1047951123000525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
Infants and children born with CHD are at significant risk for neurodevelopmental delays and abnormalities. Individualised developmental care is widely recognised as best practice to support early neurodevelopment for medically fragile infants born premature or requiring surgical intervention after birth. However, wide variability in clinical practice is consistently demonstrated in units caring for infants with CHD. The Cardiac Newborn Neuroprotective Network, a Special Interest Group of the Cardiac Neurodevelopmental Outcome Collaborative, formed a working group of experts to create an evidence-based developmental care pathway to guide clinical practice in hospital settings caring for infants with CHD. The clinical pathway, "Developmental Care Pathway for Hospitalized Infants with Congenital Heart Disease," includes recommendations for standardised developmental assessment, parent mental health screening, and the implementation of a daily developmental care bundle, which incorporates individualised assessments and interventions tailored to meet the needs of this unique infant population and their families. Hospitals caring for infants with CHD are encouraged to adopt this developmental care pathway and track metrics and outcomes using a quality improvement framework.
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Affiliation(s)
- Amy J. Lisanti
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA, Research Institute, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Dorothy J. Vittner
- Egan School of Nursing and Health Studies, Fairfield University Fairfield, CT, USA, Connecticut Children’s, Hartford, CT, USA
| | | | - Andrew H. Van Bergen
- Advocate Children’s Heart Institute, Advocate Children’s Hospital, Oak Lawn, IL, USA
| | - Thomas A. Miller
- Department of Pediatrics, Maine Medical Center, Portland, ME, USA
| | - Erin E. Gordon
- DO, Inpatient Cardiac Neurodevelopment Program, Division of Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Karli A Negrin
- Department of Therapeutic and Rehabilitative Services, Nemours Children Hospital, Wilmington, Delaware, USA
| | - Hema Desai
- Rehabilitation Services, CHOC Children’s Hospital, Orange, CA, USA
| | - Suzie Willette
- Department of Speech-Language Pathology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Melissa B Jones
- Cardiac Critical Care, Children’s National Hospital, Washington DC USA
| | - Sherrill D. Caprarola
- Heart Institute, Children’s Hospital Colorado, University of Colorado, Aurora, CO, USA
| | - Anna J. Jones
- Office of Advanced Practice Providers, UT Southwestern Medical Center, Dallas, TX, USA, Heart Center, Children’s Health, Dallas, TX, USA
| | - Stephanie M. Helman
- Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Jodi Smith
- Parent Representative, The Mended Hearts, Inc., Program Director, Richmond, VA, USA
| | - Corinne M. Anton
- Department of Psychology and Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA, Department of Cardiology, Children’s Health, Dallas, Texas, USA
| | - Laurel M. Bear
- Department of Pediatrics, Medical College of Wisconsin, Children’s Wisconsin, Milwaukee, WI, USA
| | - Lauren Malik
- Department of Acute Care Therapy Services, Primary Children’s Hospital, Salt Lake City, UT, USA
| | - Sarah K. Russell
- Department of Therapeutic and Rehabilitative Services, Nemours Children Hospital, Wilmington, DE, USA
| | - Dana J. Mieczkowski
- Department of Therapeutic and Rehabilitative Services, Nemours Children Hospital, Wilmington, DE, USA
| | - Bridy O. Hamilton
- Department of Therapeutic and Rehabilitative Services, Nemours Children Hospital, Wilmington, Delaware, USA
| | - Meghan McCoy
- Pediatric and Congenital Heart Center, Duke University Hospital, Durham, NC, USA
| | - Yvette Feldman
- Nursing & Patient Care Center of Excellence, St. Luke’s Health System, Boise, ID, USA
| | - Michelle Steltzer
- Single Ventricle Center of Excellence, Ann & Robert H. Lurie Children’s Hospital, Chicago, IL, USA
| | - Melanie L Savoca
- Department of Clinical Nutrition, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Diane L. Spatz
- Department of Family & Community Health, University of Pennsylvania School of Nursing, The Center for Pediatric Nursing Research and Evidence Based Practice, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Samantha C. Butler
- Department of Psychiatry (Psychology), Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
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15
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Alharbi AA, Albalwi AA. Exploring the Influential Factors Impacting the Provision of Family-Centered Care for Children with Cerebral Palsy in Saudi Arabia. Children (Basel) 2023; 10:1868. [PMID: 38136070 PMCID: PMC10741779 DOI: 10.3390/children10121868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 11/24/2023] [Accepted: 11/27/2023] [Indexed: 12/24/2023]
Abstract
Family-centered care is widely considered as best practice in pediatric rehabilitation. We aimed to investigate parents' perception of the family-centeredness of health care services for their children with cerebral palsy (CP) using the Arabic Measure of Processes of Care-20 (AR-MPOC-20). We also explored factors related to the child (sex, secondary impairments, and gross motor classification system level) and environment (family and residential region) that may influence the family-centeredness of services in Saudi Arabia. This was a cross-sectional study of 223 children with CP (age 6 months-18.2 years, M = 6.2 + 3.7 years) and their parents. Generally, parents perceived services as less family-centered. The lowest average score was for 'Providing General Information' (M = 2.9 ± 1.5), while 'Respectful and Supportive Care' had the highest average (M = 4.6 ± 1.8). Factors influencing the provision of family-centered care included being a female child and a mother's educational level. In addition, all subscales of AR-MPOC-20 differed by region, p < 0.001, except for 'Providing Specific Information' which did not significantly differ by region p = 0.163. Clinicians should consider the families' need for information regarding their children's condition and available services, with special attention to the mothers of female children and mothers with low levels of education.
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Affiliation(s)
- Ahmad Abdullah Alharbi
- Department of Physical Therapy, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk 71491, Saudi Arabia;
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16
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Jacobs L, Gleason D, Gissara D, Congdon N, Smith G, Xu P. Collaboration of health and education sectors drives equity for children with complex disabilities in China. Front Public Health 2023; 11:1292491. [PMID: 38026362 PMCID: PMC10661929 DOI: 10.3389/fpubh.2023.1292491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Medical professionals often find it challenging to assess children having both complex disabilities and visual impairment, which may lead to excluding such children from educational programs and limiting their full participation in family and community activities. Identification and assessment of these children are essential to close this exclusion gap. A five-year project in Shanxi province, China, provided comprehensive training to eye health providers and educators as they learned to assess, identify, refer and serve children with visual impairments, both with and without complex disabilities. A team of teachers, vision and general healthcare providers worked to assess the vision of these children at schools, residential settings, and in homes throughout Shanxi. The project led to deep collaboration between Shanxi's health and education sectors, and established replicable precedents for policy and system changes toward the inclusion of children with complex disabilities and visual impairment.
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Affiliation(s)
- Lisa Jacobs
- Perkins School for the Blind, Watertown, MA, United States
| | | | | | - Nathan Congdon
- Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
- Zhongshan Ophthalmic Center, Guangzhou, China
| | - George Smith
- Orbis International, New York, NY, United States
| | - Peter Xu
- Zhongshan Ophthalmic Center, Guangzhou, China
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17
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Smith BM, Patel PP, Johnson SB, Bethell C. Racial and Ethnic Disparities in the Medical Home for Children Born Premature in the National Survey of Children's Health. Acad Pediatr 2023; 23:1579-1587. [PMID: 37524165 DOI: 10.1016/j.acap.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/21/2023] [Accepted: 07/27/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVE Children born premature are more likely to be from minoritized racial and ethnic groups and face chronic health and developmental problems. The medical home aims to comprehensively address health and social needs of all families. This study evaluates racial and ethnic disparities in the prevalence of a medical home among children born premature compared to children born full-term. METHODS A 2017-18 National Survey of Children's Health data set was used to calculate the medical home performance measure and subcomponents for children aged 0 to 17 born premature (n = 5633) or full-term (n = 45,819). Chi square and logistic regression assessed magnitude and significance of variations by race and ethnicity and prematurity status. RESULTS Prematurity prevalence differed by race and ethnicity (12.0% non-Hispanic Black [NHB], 12.8% Hispanic, 11.1% Multiracial/Other, 11.0% non-Hispanic White [NHW]). Minoritized children born premature had lower adjusted odds of receiving care in a medical home compared to NHW peers (eg, NHB adjusted odds ratio [aOR] 0.54 [95% confidence interval {CI}: 0.38-0.76] and Hispanic aOR 0.56 [95% CI: 0.40-0.79]). Differences were greater in magnitude among children born premature compared to full-term peers (eg, NHB premature aOR 0.54 [95% CI: 0.38-0.76] vs NHB full-term aOR 0.67 [95% CI: 0.58-0.78]), with similar results for "personal doctor/nurse" and "usual sick care." CONCLUSIONS Racial and ethnic disparities exist in the medical home among children born premature, some more pronounced than full-term peers. To deliver equitable care for all children, efforts are needed to expand access to and improve the medical home, including reliable routine and sick care and stronger family-provider relationships.
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Affiliation(s)
- Brandon M Smith
- Department of Pediatrics, Johns Hopkins University School of Medicine (BM Smith), Baltimore, Md.
| | - Palak P Patel
- Johns Hopkins University School of Medicine (PP Patel), Baltimore, Md.
| | - Sara B Johnson
- Department of Pediatrics, Johns Hopkins University School of Medicine; Departments of Population, Family, and Reproductive Health and Mental Health, Johns Hopkins University Bloomberg School of Public Health (SB Johnson), Baltimore, Md.
| | - Christina Bethell
- Department of Pediatrics, Johns Hopkins University School of Medicine; Department of Population, Family, and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health (C Bethell), Baltimore, Md.
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18
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Kieren MQ, Kelly MM, Garcia MA, Chen T, Ngo T, Baird J, Haskell H, Luff D, Mercer A, Quiñones-Pérez B, Williams D, Khan A. Parent Experiences with the Process of Sharing Inpatient Safety Concerns for Children with Medical Complexity: A Qualitative Analysis. Acad Pediatr 2023; 23:1535-1541. [PMID: 37302701 PMCID: PMC11099941 DOI: 10.1016/j.acap.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 05/26/2023] [Accepted: 06/03/2023] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To describe the process of identifying and reporting inpatient safety concerns from the perspective of parents of children with medical complexity (CMC). METHODS We conducted a secondary analysis of qualitative data from semi-structured interviews with 31 English and Spanish-speaking parents of CMC at two tertiary children's hospitals. Interviews lasted 45-60 minutes and were audio-recorded, translated, and transcribed. Three researchers inductively and deductively coded transcripts using an iteratively refined codebook with validation by a fourth researcher. Thematic analysis was used to develop a conceptual model of the process of inpatient parent safety reporting. RESULTS We identified four steps illustrating the process of inpatient parent safety concern reporting 1) parent recognizing concern, 2) parent reporting concern, 3) staff/hospital response continuum, and 4) parent feelings of validation/invalidation. Many parents endorsed that they were the first to catch a safety concern and were identified as unique reporters of safety information. Parents typically described reporting their concerns verbally and in real-time to the person they felt could quickly remedy the situation. There was a spectrum of validation. Some parents reported their concerns were not acknowledged and addressed, which led them to feel overlooked, disregarded, or judged. Others reported their concerns were acknowledged and addressed, resulting in parents feeling heard and seen and often leading to changes in clinical care. CONCLUSIONS Parents described a multi-step process of reporting safety concerns during hospitalization and a spectrum of staff response and validation. These findings can inform family-centered interventions that support safety concern reporting in the inpatient setting.
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Affiliation(s)
- Madeline Q Kieren
- University of Wisconsin-Madison School of Medicine and Public Health, Department of Pediatrics (MQ Kieren, MM Kelly, MA Garcia, and T Chen)
| | - Michelle M Kelly
- University of Wisconsin-Madison School of Medicine and Public Health, Department of Pediatrics (MQ Kieren, MM Kelly, MA Garcia, and T Chen).
| | - Miguel A Garcia
- University of Wisconsin-Madison School of Medicine and Public Health, Department of Pediatrics (MQ Kieren, MM Kelly, MA Garcia, and T Chen)
| | - Tessa Chen
- University of Wisconsin-Madison School of Medicine and Public Health, Department of Pediatrics (MQ Kieren, MM Kelly, MA Garcia, and T Chen)
| | - Tiffany Ngo
- Division of General Pediatrics, Department of Medicine (A Mercer, B Quiñones-Pérez, and A Khan), Boston Children's Hospital
| | - Jennifer Baird
- Institute for Nursing and Interprofessional Research (J Baird), Children's Hospital Los Angeles
| | - Helen Haskell
- Mothers Against Medical Error (H Haskell) South Carolina Columbia
| | - Donna Luff
- Department of Anesthesiology (D Luff), Critical Care, and Pain Medicine, Boston Children's Hospital
| | - Alexandra Mercer
- Division of General Pediatrics, Department of Medicine (A Mercer, B Quiñones-Pérez, and A Khan), Boston Children's Hospital
| | - Bianca Quiñones-Pérez
- Division of General Pediatrics, Department of Medicine (A Mercer, B Quiñones-Pérez, and A Khan), Boston Children's Hospital
| | - David Williams
- Institutional Centers for Clinical and Translational Research (D Williams), Boston Children's Hospital
| | - Alisa Khan
- Division of General Pediatrics, Department of Medicine (A Mercer, B Quiñones-Pérez, and A Khan), Boston Children's Hospital; Department of Pediatrics (A Khan), Harvard Medical School
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19
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Alsadaan N, Ramadan OME, Alqahtani M, Shaban M, Elsharkawy NB, Abdelaziz EM, Ali SI. Impacts of Integrating Family-Centered Care and Developmental Care Principles on Neonatal Neurodevelopmental Outcomes among High-Risk Neonates. Children (Basel) 2023; 10:1751. [PMID: 38002842 PMCID: PMC10670637 DOI: 10.3390/children10111751] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Integrating family-centered care (FCC) and developmental care (DC) principles in neonatal care settings may improve neurodevelopmental outcomes for high-risk neonates. However, the combined impact of FCC and DC has been underexplored. This study aimed to investigate the effects of integrated FCC and DC on neurodevelopment and length of hospital stay in high-risk neonates. METHODS A quasi-experimental pre-post study was conducted among 200 high-risk neonates (<32 weeks gestation or <1500 g) admitted to neonatal intensive care units (NICU) in Saudi Arabia. The intervention group (n = 100) received integrated FCC and DC for 6 months. The control group (n = 100) received standard care. Neurodevelopment was assessed using the Bayley Scales of Infant Development-III. Length of stay and readmissions were extracted from medical records. RESULTS The intervention group showed significant improvements in cognitive, motor, and language scores compared to controls (p < 0.05). The intervention group had a 4.3-day reduction in the mean length of stay versus a 1.4-day reduction in controls (p = 0.02). Integrated care independently predicted higher cognitive scores (p = 0.001) and shorter stays (p = 0.006) in regression models. CONCLUSION Integrating FCC and DC in neonatal care enhances neurodevelopmental outcomes and reduces hospitalization for high-risk neonates compared to standard care. Implementing relationship-based, developmentally supportive models is critical for optimizing outcomes in this vulnerable population.
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Affiliation(s)
- Nourah Alsadaan
- College of Nursing, Jouf University, Sakaka 72388, Al Jawf, Saudi Arabia; (O.M.E.R.); (M.S.); (N.B.E.); (E.M.A.)
| | | | - Mohammed Alqahtani
- College of Applied Medical Sciences, Department of Nursing, King Faisal University, Al Hofuf 31982, Al-Ahsa, Saudi Arabia;
| | - Mostafa Shaban
- College of Nursing, Jouf University, Sakaka 72388, Al Jawf, Saudi Arabia; (O.M.E.R.); (M.S.); (N.B.E.); (E.M.A.)
| | - Nadia Bassuoni Elsharkawy
- College of Nursing, Jouf University, Sakaka 72388, Al Jawf, Saudi Arabia; (O.M.E.R.); (M.S.); (N.B.E.); (E.M.A.)
| | - Enas Mahrous Abdelaziz
- College of Nursing, Jouf University, Sakaka 72388, Al Jawf, Saudi Arabia; (O.M.E.R.); (M.S.); (N.B.E.); (E.M.A.)
| | - Sayed Ibrahim Ali
- Department of Family and Community Medicine, College of Medicine, King Faisal University, Al Hofuf 31982, Al-Ahsa, Saudi Arabia
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20
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Klimesch A, Martinez-Pereira A, Topf C, Härter M, Scholl I, Bravo P. Conceptualization of patient-centered care in Latin America: A scoping review. Health Expect 2023; 26:1820-1831. [PMID: 37491799 PMCID: PMC10485332 DOI: 10.1111/hex.13797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 05/18/2023] [Accepted: 06/04/2023] [Indexed: 07/27/2023] Open
Abstract
INTRODUCTION Patient-centered care (PCC) has been declared as a desirable goal for health care in Latin American countries, but a coherent definition of what exactly PCC entails for clinical practice is missing. This article's aim was to identify how PCC is conceptualized in Latin American countries. METHODS Scientific databases (MEDLINE, EMBASE, PsycINFO, CINAHL, Scielo, Scopus, Web of Science) and webpages of the ministries of health were searched, and experts were contacted for suggestions of literature. References were included if they contained one of a range of a priori defined keywords related to PCC in the title, were published between 2006 and 2021, and were carried out in or concerned Latin America. Definitions of PCC were extracted from the included articles and analyzed using deductive and inductive coding. Deductive coding was based on the integrative model of patient-centeredness, which unites the definitions of PCC in the international literature (mainly North America and Europe) and proposes 16 dimensions describing PCC. RESULTS Thirty-two articles were included in the analysis and about half of them were from Brazil. Numerous similarities were found between the integrative model of patient-centeredness and the definitions of PCC given in the selected literature. The dimensions of the integrative model of patient-centeredness that were least and most prominent in the literature were physical support and patient information, respectively. A differentiation between PCC and family-centered care (FCC) was observed. Definitions of PCC and FCC as well as their cited references were diverse. CONCLUSION A considerable overlap between the conceptualization of PCC in Latin America and the integrative model of patient-centeredness has been identified. However, there are substantial differences between countries in Latin America regarding the emphasis of research on PCC versus FCC and diverse conceptualizations of PCC and FCC exist. PATIENT CONTRIBUTION This scoping review takes the patient's perspective based on the integrative model of patient-centeredness. Due to the study being a review, no patients, neither caregivers, nor members of the public, were involved.
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Affiliation(s)
- Anne Klimesch
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Cheyenne Topf
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Isabelle Scholl
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Paulina Bravo
- School of Nursing, Pontificia Universidad Católica de Chile, Santiago, Chile
- Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
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Johannsen LM, Frerichs W, Philipp R, Inhestern L, Bergelt C. Effectiveness of a training program for healthcare professionals on parental cancer: Results of a randomized controlled pilot-study. Psychooncology 2023; 32:1567-1577. [PMID: 37649177 DOI: 10.1002/pon.6207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 08/08/2023] [Accepted: 08/08/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVE Cancer patients parenting minor children face specific burden and supportive needs, which are often not adequately addressed by their healthcare professionals (HCPs), due to a lack of knowledge, self-efficacy and competencies. Therefore, we developed a 3-h intervention enhancing HCPs' competencies in caring for these patients. We pilot-evaluated the intervention's feasibility and efficacy, assuming intervention group participants reveal higher improvements over time compared to non-trained participants. METHODS We conducted a 3-armed randomized controlled pilot-trial (RCT), comparing face-to-face training (F2F), e-Learning (EL), waitlist-control group with three measurements (baseline, post-training, 3-month follow-up). Primary outcome was the competency to approach child- and family-related themes; secondary outcomes were knowledge, self-efficacy in (specific) communication skills. Intervention effects were analyzed using linear mixed models. RESULTS Participants (n = 152) were mostly female (89%) and psychologists (38%; physicians 26%; nurses 18%). F2F and EL participants reported high training satisfaction. Analyses did not reveal any significant differences on the primary outcome between groups, but indicate positive intervention effects over time regarding secondary outcomes including knowledge and self-efficacy in communication skills. CONCLUSIONS This is the first pilot-study evaluating a training for HCPs in oncology on parental cancer using a 3-armed RCT. The 3-h training program is a feasible approach and findings indicate to increase HCPs' knowledge and self-efficacy in caring for cancer patients with minor children. Further research is needed to verify preliminary findings of this pilot study. The study was pre-registered within the German Clinical Trial Register (DRKS-00015794).
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Affiliation(s)
- Lene Marie Johannsen
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Wiebke Frerichs
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rebecca Philipp
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Laura Inhestern
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Corinna Bergelt
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Medical Psychology, University Medicine Greifswald, Greifswald, Germany
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Brito S, Williams A, Fox J, Mohammed T, Chahin N, McCarthy K, Nubayaat L, Nunlist S, Brannon M, Xu J, Hendricks-Muñoz KD. Lactation Support as a Proxy Measure of Family-Centered Care Quality in Neonates with Life-Limiting Conditions-A Comparative Study. Children (Basel) 2023; 10:1635. [PMID: 37892298 PMCID: PMC10605637 DOI: 10.3390/children10101635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/17/2023] [Accepted: 09/27/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Lactation support is an important measure of Family-Centered Care (FCC) in the Neonatal Intensive Care Unit (NICU). Life-limiting conditions (LLCs) raise complex ethical care issues for providers and parents in the NICU and represent a key and often overlooked population for whom FCC is particularly important. We investigated healthcare disparities in FCC lactation support quality in infants with LLCs. METHODS A retrospective cohort of inborn infants with or without LLCs admitted to the NICU between 2015-2023 included 395 infants with 219 LLC infants and 176 matched non-LLC infants and were compared on LLC supports. RESULTS The LLC cohort experienced greater skin-to-skin support, but less lactation specialist visits, breast pumps provided, and human milk oral care use. LLC infants also experienced less maternal visitation, use of donor milk (LLC: 15.5%, non-LLC: 33.5%), and breastfeeds (LLC: 24.2%, non-LLC: 43.2%), with lower mean human milk provision (LLC: 36.6%, non-LLC: 67.1%). LLC infants who survived to discharge had similar human milk use as non-LLC infants (LLC: 49.8%, non-LLC: 50.6%). CONCLUSION Lactation support was significantly absent for families and infants who presented with LLCs in the NICU, suggesting that policies can be altered to increase lactation support FCC quality for this population.
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Affiliation(s)
- Suneeta Brito
- Division of Neonatal Medicine, Department of Pediatrics, Children's Hospital of Richmond at VCU, Virginia Commonwealth University School of Medicine, P.O. Box 980646, Richmond, VA 23298-0646, USA
| | - Allison Williams
- Department of Psychology, Virginia Commonwealth University School of Medicine, P.O. Box 980646, Richmond, VA 23298-0646, USA
| | - Jenny Fox
- Division of Neonatal Medicine, Department of Pediatrics, Children's Hospital of Richmond at VCU, Virginia Commonwealth University School of Medicine, P.O. Box 980646, Richmond, VA 23298-0646, USA
| | - Tazuddin Mohammed
- Division of Neonatal Medicine, Department of Pediatrics, Children's Hospital of Richmond at VCU, Virginia Commonwealth University School of Medicine, P.O. Box 980646, Richmond, VA 23298-0646, USA
| | - Nayef Chahin
- Division of Neonatal Medicine, Department of Pediatrics, Children's Hospital of Richmond at VCU, Virginia Commonwealth University School of Medicine, P.O. Box 980646, Richmond, VA 23298-0646, USA
| | - Kaitlin McCarthy
- Eastern Virginia School of Medicine, P.O. Box 1980, Norfolk, VA 23501-1980, USA
| | | | - Shirley Nunlist
- Virginia Commonwealth University School of Medicine, P.O. Box 980646, Richmond, VA 23298-0646, USA
| | - Mason Brannon
- Virginia Commonwealth University School of Medicine, P.O. Box 980646, Richmond, VA 23298-0646, USA
| | - Jie Xu
- Division of Neonatal Medicine, Department of Pediatrics, Children's Hospital of Richmond at VCU, Virginia Commonwealth University School of Medicine, P.O. Box 980646, Richmond, VA 23298-0646, USA
| | - Karen D Hendricks-Muñoz
- Division of Neonatal Medicine, Department of Pediatrics, Children's Hospital of Richmond at VCU, Virginia Commonwealth University School of Medicine, P.O. Box 980646, Richmond, VA 23298-0646, USA
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Boutillier B, Ethier G, Boucoiran I, Reichherzer M, Luu TM, Morin L, Pearce R, Janvier A. Prenatal Workshops and Support Groups for Prospective Parents Whose Children Will Need Neonatal Care at Birth: A Feasibility and Pilot Study. Children (Basel) 2023; 10:1570. [PMID: 37761531 PMCID: PMC10529479 DOI: 10.3390/children10091570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/25/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023]
Abstract
Introduction: Support groups in neonatal intensive care units (NICUs) are beneficial to parents. The usefulness of prenatal support groups for prospective parents who will have a newborn requiring admission to the NICU has never been investigated. Methods: We assessed the needs of NICU parents regarding topics they would have wished to discuss prenatally and developed the content of a prenatal support workshop. A standardized survey prospectively evaluated the perspectives of pregnant women admitted to a high-risk pregnancy unit who participated in the resulting workshops. Results: During needs assessment, 295 parents invoked themes they would have wished to discuss antenatally: parental guilt, future parental role, normalizing their experience/emotions, coping with many losses, adapting to their new reality, control and trust, information about the NICU, technology around the baby, common neonatal interventions, the NICU clinical team, and the role of parents in the team. These findings were used to develop the workshop, including a moderator checklist and a visual presentation. Practical aspects of the meetings were tested/finalized during a pre-pilot phase. Among 21 pregnant women who answered the survey (average gestational age 29.3 weeks), all agreed that the workshop was useful, that it made them feel less lonely (95%), that exchanges with other women were beneficial (95%) and gave them a certain amount of control over their situation (89%). All answers to open-ended questions were positive. Conclusion: Prenatal educational/support workshops provide a unique and useful means to support future NICU parents. Future investigations will explore whether these prenatal interventions improve clinical outcomes.
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Affiliation(s)
- Béatrice Boutillier
- CHU Sainte-Justine Research Center, Montréal, QC H3T 1C5, Canada; (B.B.); (I.B.); (T.M.L.); (L.M.)
- Division of Neonatology, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada; (G.E.); (M.R.)
- Unité D’éthique Clinique, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada
| | - Guillaume Ethier
- Division of Neonatology, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada; (G.E.); (M.R.)
| | - Isabelle Boucoiran
- CHU Sainte-Justine Research Center, Montréal, QC H3T 1C5, Canada; (B.B.); (I.B.); (T.M.L.); (L.M.)
- Division of Maternal-Fetal Medicine, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada
- Department of Obstetrics and Gynecology, Université de Montréal, Montréal, QC H3T 1J4, Canada
| | - Martin Reichherzer
- Division of Neonatology, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada; (G.E.); (M.R.)
| | - Thuy Mai Luu
- CHU Sainte-Justine Research Center, Montréal, QC H3T 1C5, Canada; (B.B.); (I.B.); (T.M.L.); (L.M.)
- Department of Pediatrics, Université de Montréal, Montréal, QC H3T 1C5, Canada
| | - Lucie Morin
- CHU Sainte-Justine Research Center, Montréal, QC H3T 1C5, Canada; (B.B.); (I.B.); (T.M.L.); (L.M.)
- Division of Maternal-Fetal Medicine, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada
- Department of Obstetrics and Gynecology, Université de Montréal, Montréal, QC H3T 1J4, Canada
| | - Rebecca Pearce
- Parent Representative, Collaborates with Canadian Premature Babies Foundation, Etobicoke, ON M8X 1Y3, Canada;
| | - Annie Janvier
- CHU Sainte-Justine Research Center, Montréal, QC H3T 1C5, Canada; (B.B.); (I.B.); (T.M.L.); (L.M.)
- Division of Neonatology, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada; (G.E.); (M.R.)
- Unité D’éthique Clinique, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada
- Department of Pediatrics, Université de Montréal, Montréal, QC H3T 1C5, Canada
- Bureau de L’éthique Clinique (BEC), Université de Montréal, Montréal, QC H3C 3J7, Canada
- Unité de Soins Palliatifs, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada
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Ahlqvist-Björkroth S, Thernström Blomqvist Y, Nyberg J, Normann E, Axelin A. Improving NICU staff decision-making with parents in medical rounds: a pilot study of reflective group dialogue intervention. Front Pediatr 2023; 11:1249345. [PMID: 37772036 PMCID: PMC10523391 DOI: 10.3389/fped.2023.1249345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/28/2023] [Indexed: 09/30/2023] Open
Abstract
Introduction The communication skills of healthcare professionals play a crucial role in successful shared decision-making with parents in neonatal intensive care. Improving communication skills can be achieved through practice and reflection on personal experiences after authentic interaction events with parents. The process of reflection typically involves three phases: description, reflection, and critical reflection. In this study, our aim was to explore the acceptability of the Reflective Group Dialogue intervention and its effectiveness in supporting the reflective process. Methods This qualitative pilot study was conducted in the neonatal intensive care unit at Uppsala University Children's Hospital, Sweden. The sample consisted of nine medical rounds with seven families, five neonatologists, seven registered nurses, and five assistant nurses. Purposive sampling was used to collect the data. The intervention comprised four elements: (1) before the intervention, a recorded presentation on shared decision-making was given to the entire unit staff, (2) an observation of a normal medical round discussion with parents, (3) an interview with parents about their experience after the same round, and (4) a reflective discussion with the participating health care professionals after the round. The parent interviews and reflective discussions were audio-recorded and transcribed verbatim. They were analyzed using thematic analysis as a theoretical strategy. Results Both parents and staff widely accepted the intervention and found it beneficial. We identified four discussions that remained in the descriptive phase of the reflection process, four that reached the reflective phase, and one that reached the critical reflection phase. The descriptive discussions were characterized by using a single perspective to reflect, often based on personal opinions. The reflective discussions included analyzing interaction sequences from both staff and parent perspectives and were primarily based on actual observations of communication during medical rounds. The critical discussion led to a new awareness of current practices concerning parental involvement in decision-making. These discussions also utilized "what-if" thinking to evaluate potential new practices and their pros and cons. Conclusions The intervention seems promising as it was perceived as beneficial by the recipients and facilitated reflection in most cases. However, to enhance the feasibility of the intervention, some improvements are discussed.
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Affiliation(s)
- Sari Ahlqvist-Björkroth
- Department of Psychology and Speech-Language Pathology, University of Turku, Turku, Finland
- Department of Clinical Medicine, University of Turku, Turku, Finland
| | | | - Jenni Nyberg
- Department of Psychology and Speech-Language Pathology, University of Turku, Turku, Finland
| | - Erik Normann
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Anna Axelin
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- Departmentof Nursing Science, University of Turku, Turku, Finland
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Han J, Oh WO, Heo Y, Kim S. Psychometric Validation of the Korean Version of the Family-Centered Care Questionnaire-Revised. J Nurs Meas 2023; 31:347-359. [PMID: 37558256 DOI: 10.1891/jnm-2021-0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
Background and Purpose: Family-centered care (FCC) is a philosophy of care that applies to all areas of pediatric nursing and is a key component of the care model for patient safety and management activities in the medical environment of hospitalized children. The aim of this study was to translate and evaluate the psychometric properties of the Korean version of the Family-Centered Care Questionnaire-Revised (FCCQ-R). Methods: A total of 239 questionnaires were completed by pediatric nurses at four consenting general hospitals. Results: Fourteen items were removed from the original questionnaire through exploratory factor analysis and nine subscales were reduced to five. The factor loadings of the 30 items on the five subscales ranged from 0.50-0.80. The model of the Korean version of the questionnaire was validated by an exploratory and confirmatory factor analysis. Reliability analysis for internal consistency showed an acceptable to high Cronbach's α of 0.96 in total and the subscales ranged from 0.59-0.92. Conclusions: This study verified the validity and reliability of the tool to measure the perception of FCC. Future research will need to correlate FCC with more relevant measures, such as the nurse-parent partnership measure tool, to confirm predictive and concurrent validity. The Korean version of the FCCQ-R of 30 questions on five subscales is a valid and reliable measurement of Korean nurses' perceptions of FCC.
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Affiliation(s)
- Jihee Han
- College of Nursing, Korea University, Seongbuk-gu, Seoul, South Korea
| | - Won-Oak Oh
- College of Nursing, Korea University, Seongbuk-gu, Seoul, South Korea
| | - YooJin Heo
- College of Nursing, Korea University, Seongbuk-gu, Seoul, South Korea
| | - Sunho Kim
- Department of Nursing, U1 University, Yeongdong-gun, Chugbuk, South Korea
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Sun WJ, Peng YJ, Liang Y. Barriers and facilitators for healthcare providers to implement family-centered care in Parkinson's disease: a scoping review. Front Neurol 2023; 14:1231654. [PMID: 37693752 PMCID: PMC10486989 DOI: 10.3389/fneur.2023.1231654] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/25/2023] [Indexed: 09/12/2023] Open
Abstract
Aims This study aimed to identify and synthesize the barriers and facilitators to the implementation of family-centered care in Parkinson's disease (PD) and to provide a reference for evidence-based Parkinson's disease nursing practice. Methods This scoping review follows the methodology framework proposed by Arksey and O'Malley. Four databases including PubMed, Web of Science, Embase, and Cochrane Library were searched. Barriers and facilitators were summarized based on the ecological family-centered model. Results Through a comprehensive literature search, 35 studies were found for this scoping review. Barriers and facilitators to implementing family-centered care in PD included physiological factors, environmental factors, culturally based conflicts, living arrangements, education or skills training, group experiences, and individual and family consultations. Conclusion Implementing family-centered care in Parkinson's disease is essential to providing comprehensive care that improves outcomes for both PD patients and their family members.
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Affiliation(s)
- Wen-Jing Sun
- Department of Neurosurgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Ye-Jie Peng
- West China School of Nursing, Sichuan University/Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yan Liang
- West China School of Nursing, Sichuan University/Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
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Aduful AK, Boamah-Mensah F, Nyarko MY, Neizer ML, Brew YN, Williams LA, Calys-Tagoe BNL, Ackun HKM, Tette EMA. Family Needs Assessment of Patients with Cerebral Palsy Attending Two Hospitals in Accra, Ghana. Children (Basel) 2023; 10:1313. [PMID: 37628312 PMCID: PMC10453618 DOI: 10.3390/children10081313] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/19/2023] [Accepted: 07/24/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND The family represents the most essential and supportive environment for children with cerebral palsy (CP). To improve children's outcomes, it is crucial to consider the needs of families in order to offer family-centered care, which tailors services to these needs. OBJECTIVE We conducted a needs assessment to identify the family needs of patients with CP attending two hospitals in Accra. METHODS The study was a cross-sectional study involving primary caregivers of children with CP attending neurodevelopmental clinics. Structured questionnaires were used to collect data spanning an 8-month period. The data were summarized, and statistical inference was made. RESULTS Service needs identified were childcare, counseling, support groups, financial assistance, and recreational facilities. Information needs included adult education, job training/employment opportunities, education, health and social programs, knowledge about child development, and management of behavioral and feeding/nutrition problems. Reducing extensive travel time was desirable to improve access to healthcare. With the increasing severity of symptoms came the need for improved accessibility in the home to reduce the child's hardship, as well as assistive devices, recreational facilities, and respite for the caregiver(s). CONCLUSION Families of children with CP have information, service, and access needs related to their disease severity and family context.
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Affiliation(s)
- Abena K. Aduful
- Department of Family Medicine, Korle-Bu Teaching Hospital, Accra P.O. Box GP 4236, Ghana
| | - Faye Boamah-Mensah
- Princess Marie Louise Children’s Hospital, Accra P.O. Box GP 122, Ghana (M.L.N.)
| | - Mame Yaa Nyarko
- Princess Marie Louise Children’s Hospital, Accra P.O. Box GP 122, Ghana (M.L.N.)
| | - Margaret L. Neizer
- Princess Marie Louise Children’s Hospital, Accra P.O. Box GP 122, Ghana (M.L.N.)
| | - Yvonne N. Brew
- Department of Child Health, Greater Accra Regional Hospital (GARH), Accra P.O. Box GP 473, Ghana
| | - Lovia A. Williams
- Department of Child Health, Korle-Bu Teaching Hospital, Accra P.O. Box GP 4236, Ghana
| | | | - Henry K. M. Ackun
- Department of Family Medicine, Duffus Health Center, Halifax, NS B3M 3Y7, Canada
| | - Edem M. A. Tette
- Princess Marie Louise Children’s Hospital, Accra P.O. Box GP 122, Ghana (M.L.N.)
- Department of Community Health, University of Ghana Medical School, Accra P.O. Box GP 4236, Ghana
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Overmann KM, Porter SC, Zhang Y, Britto MT. Caregiver Quality of Life During Pediatric Influenza-Like Illness: A Cross-Sectional Study During the COVID-19 Pandemic. J Patient Exp 2023; 10:23743735231188840. [PMID: 37528955 PMCID: PMC10388629 DOI: 10.1177/23743735231188840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Abstract
The objective of this study was to quantify the quality of life (QoL) of caregivers with children with influenza-like illnesses (ILI) and to identify factors associated with worse QoL. This was a cross-sectional cohort study of caregivers in a pediatric emergency department with previously healthy young children with ILI. The primary outcome was caregiver QoL. Additional measures included health literacy, social support, and caregiver health status. Two hundred and eighty-one caregivers completed the study. And 41% reported overall QoL was worse during their child's illness. The median QoL score was 3.8 [3.1, 4.6] in a 7-point scale. Illness duration was associated with worse overall QoL score (0.128 worse for each additional day of illness). The median emotions domain score was 2.5 [1.5, 4.0], the worst of any domain. Caregivers who perceived worse illness severity had lower emotions domain scores (2.61 vs 6.00, P = .0269). Caregivers with adequate literacy had lower mean QoL scores (3.08 vs 4.44, P < .0001). Childhood illnesses worsen caregiver QoL. Factors associated with worse QoL were perception of illness severity and duration. Addressing caregiver QoL could mitigate the impact of childhood acute illnesses on caregiver wellbeing.
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Affiliation(s)
- Kevin M Overmann
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Stephen C Porter
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Yin Zhang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Maria T Britto
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
- Division of Adolescent Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Vismara LA, Nyugen L, McCormick CEB. Abbreviating the Early Start Denver Model for community-based family-centered care. Front Psychol 2023; 14:1167885. [PMID: 37546470 PMCID: PMC10399628 DOI: 10.3389/fpsyg.2023.1167885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/22/2023] [Indexed: 08/08/2023] Open
Abstract
Introduction Parent-mediated approaches for young children with or with a higher likelihood of autism have gained traction, with mounting evidence of efficacy, but a research-to-gap practice exists, and community effectiveness remains to be firmly established. Methods Using a community-participatory framework, a total of 10 parent-child dyads received a five-day workshop and six follow-up sessions of ESDM parent coaching. Intervention was implemented across two phases with in-person and telehealth delivery. Results From pre to post intervention across both phases, parents improved in their fidelity of intervention implementation and children maid gains on proximal measures of social communication. Discussion Community delivery of an evidence-based parent-mediated interventions for toddlers on the autism spectrum is feasible and promising. Giving resource efficiencies associated with parent-mediated approaches, particularly when delivered through government-funded programs, findings bolster current efforts to promote earlier and more widespread community access to necessary interventions. Facilitators and barriers to supporting parent learning and behavior change via interactive strategies are discussed.
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Affiliation(s)
| | - Lucy Nyugen
- Thrive Autism Collaborative, Denver, CO, United States
| | - Carolyn E. B. McCormick
- Department of Human Development and Family Science, Purdue University, West Lafayette, IN, United States
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Litwin S, Clarke L, Copeland J, Tyrrell J, Tait C, Mohabir V, Campbell F. Designing a Child-, Family-, and Healthcare Provider-Centered Procedure Room in a Tertiary Care Children's Hospital. HERD 2023; 16:195-209. [PMID: 37021379 PMCID: PMC10328143 DOI: 10.1177/19375867231161097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
AIM The study aim was to co-design new pediatric procedure room prototypes with children, caregivers, and healthcare providers (HCPs). BACKGROUND Medical procedures can cause pain and anxiety for children and their families. If spaces are not designed for patients' needs, procedures may take longer, require sedation, and result in an inferior care experience. Involving HCPs in co-designing optimal spaces can result in more efficient and safer environments. co-designing spaces with patients and their families can inform psychologically safer and less traumatic environments. METHODS We followed human-centered design methodology. Data were collected via semi-structured interviews, field observations, and two multidisciplinary design workshops with patients, caregivers, and HCPs. Themes from the data were extracted using a content analysis and used to make evidence-informed recommendations for design features. RESULTS The study took place from October 2021 to February 2022. Patients, families, and HCPs reported similar needs: (1) control over the environment, including the ability to adjust lighting, temperature, and sound; (2) space that supports patient privacy; (3) the use of evidence-based pain reduction and distraction methods; (4) attention to the sensory environment, including visual (light, color), tactile (textures of furniture and equipment), auditory, and olfactory stimuli; (5) human factors organization of the space and equipment; (6) accessible and equitable spatial design; and (7) the significance of the journey leading up to and after the procedure. CONCLUSIONS It is feasible to co-design procedure rooms that support evidence-based psychological, physical, and pharmacological interventions that are known to minimize pain for children.
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Affiliation(s)
- Sasha Litwin
- Division of Emergency Medicine, Department of Pediatrics, Hospital for Sick Children, Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Lindsay Clarke
- Design and Improvement, Process Improvement and Innovation Team, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jocelyne Copeland
- Facilities Planning and Redevelopment Project Horizon, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jennifer Tyrrell
- Transitional Pain Clinic, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Caleb Tait
- Department of Child Life, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Vina Mohabir
- Child Health Evaluative Sciences, SickKids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Fiona Campbell
- Department of Anesthesiology and Pain Medicine, Hospital for Sick Children, Faculty of Medicine, University of Toronto, Ontario, Canada
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Fan SJS, Chen SP. Does culture play a role? A pilot study on Western services for a Chinese-Canadian family with children with Autism spectrum disorder. Disabil Rehabil 2023:1-9. [PMID: 37382677 DOI: 10.1080/09638288.2023.2227566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
Purpose: Autism spectrum disorder (ASD) affects one in 66 children in Canada, and its symptoms may be particularly challenging for parents from a Chinese background. Further, when working with Chinese families, Western-educated service providers may experience difficulty in applying culturally relevant and family-centered care. This study examined the experiences of one Chinese-Canadian family as they receive intervention services for their two children with ASD.Materials and methods: This pilot, single-case design, qualitative case study included semi-structured interviews with the parents, grandparents, as well as three service providers' views.Results: Three major themes emerged from the data in the form of tensions: (1) within the family members; (2) within the therapeutic relationships, and (3) in addressing culture in therapy.Conclusions: Results suggested that although the family identified key cultural differences, service providers did not sufficiently address these within the therapeutic relationship, and the need for culturally-relevant and family-centered care was not fulfilled.
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Affiliation(s)
- Shu Jun Selina Fan
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Shu-Ping Chen
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
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Jawed A, Mowry M. Strengthening Equitable Access to Care and Support for Children with Cerebral Palsy and Their Caregivers. Children (Basel) 2023; 10:994. [PMID: 37371227 DOI: 10.3390/children10060994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 05/27/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023]
Abstract
Cerebral palsy is one of the most prevalent groups of motor disorders affecting children and adults across the world. As increasingly more children with cerebral palsy are living longer into adulthood, it is ever more crucial to ensure access to timely and needed early intervention from the onset of diagnosis, on a continuum, to optimize medical, developmental, socio-emotional, and academic outcomes for these children over time. The American Academy of Pediatrics (AAP), in collaboration with the American Academy of Cerebral Palsy and Developmental Medicine (AACPDM), substantially revised the clinical practice guidelines for cerebral palsy in 2022, after their prior publication of the guidelines in 2006. The revised guidelines account for a range of considerations that are in line with the biopsychosocial, risk and resilience, and family-centered care models as well as promote a more strengths-based approach to care. Furthermore, there is increased emphasis in the guidelines on promoting equitable access to care as part of contributing towards health equity for all children with cerebral palsy. In addition, the 2022 guidelines clearly present recommendations for earlier diagnosis of cerebral palsy, potentially as early as infancy, as the basis for activating access to early intervention services for children that can bolster their neuroplasticity and global development from an earlier age onward. We consolidate the existing literature on caregiver perceptions, beliefs and concerns surrounding earlier diagnosis of cerebral palsy and connect them to the recommendations in the revised guidelines. We also delineate several considerations surrounding education for healthcare providers and caregivers of children in navigating the chronicity of cerebral palsy in both community and healthcare contexts. There is a scant amount of literature on cerebral palsy across traditional and nontraditional sources of media in published studies, which we also review. Lastly, we present a wealth of recommendations for further research and practice that account for the revised 2022 guidelines, caregiver preferences and acceptability of care, and health equity as the bases for strengthening equitable access to care for children with cerebral palsy on a continuum as they transition into adulthood.
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Affiliation(s)
- Aysha Jawed
- Johns Hopkins Children's Center, Baltimore, MD 21287, USA
- Department of Pediatric Social Work, Johns Hopkins Children's Center, Baltimore, MD 21287, USA
| | - Michelle Mowry
- Johns Hopkins Children's Center, Baltimore, MD 21287, USA
- Department of Pediatric Nursing, Johns Hopkins Children's Center, Baltimore, MD 21287, USA
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Wang G, Antel R, Goldfarb M. The Impact of Randomized Family-Centered Interventions on Family-Centered Outcomes in the Adult Intensive Care Unit: A Systematic Review. J Intensive Care Med 2023:8850666231173868. [PMID: 37161268 DOI: 10.1177/08850666231173868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Objective: To review the literature for randomized family-centered interventions with family-centered outcomes in the adult intensive care unit (ICU). Data Sources: We searched MEDLINE, EMBASE, PsycINFO, CINAHL, and the Cochrane Library database from inception until February 2023. Study Selection: We included articles involving randomized controlled trials (RCTs) in the adult critical care setting evaluating family-centered interventions and reporting family-centered outcomes. Data Extraction: We extracted data on author, year of publication, setting, number of participants, intervention category, intervention, and family-centered outcomes. Data Synthesis: There were 52 RCTs included in the analysis, mostly involving communication and receiving information (38%) and receiving care and meeting family member needs (38%). Nearly two-thirds of studies (N = 35; 67.3%) found improvements in at least 1 family-centered outcome. Most studies (N = 24/40; 60%) exploring the impact of family-centered interventions on mental health outcomes showed improvement. Improvements in patient-centered outcomes (N = 7/17; 41%) and healthcare worker outcomes (N = 1/5; 20%) were less commonly found. Conclusions: Family-centered interventions improve family-centered outcomes in the adult ICU and may be beneficial to patients and healthcare workers.
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Affiliation(s)
- Gary Wang
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Ryan Antel
- McGill Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Michael Goldfarb
- Division of Cardiology, Jewish General Hospital, McGill University, Montreal, QC, Canada
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Watland S, Solberg Nes L, Hanson E, Ekstedt M, Stenberg U, Børøsund E. The Caregiver Pathway, a Model for the Systematic and Individualized Follow-up of Family Caregivers at Intensive Care Units: Development Study. JMIR Form Res 2023; 7:e46299. [PMID: 37097744 PMCID: PMC10170368 DOI: 10.2196/46299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/30/2023] [Accepted: 03/30/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Family caregivers of patients who are critically ill have a high prevalence of short- and long-term symptoms, such as fatigue, anxiety, depression, symptoms of posttraumatic stress, and complicated grief. These adverse consequences following a loved one's admission to an intensive care unit (ICU) are also known as post-intensive care syndrome-family. Approaches such as family-centered care provide recommendations for improving the care of patients and families, but models for family caregiver follow-up are often lacking. OBJECTIVE This study aims to develop a model for structuring and individualizing the follow-up of family caregivers of patients who are critically ill, starting from the patients' ICU admission to after their discharge or death. METHODS The model was developed through a participatory co-design approach using a 2-phased iterative process. First, the preparation phase included a meeting with stakeholders (n=4) for organizational anchoring and planning, a literature search, and interviews with former family caregivers (n=8). In the subsequent development phase, the model was iteratively created through workshops with stakeholders (n=10) and user testing with former family caregivers (n=4) and experienced ICU nurses (n=11). RESULTS The interviews revealed how being present with the patient and receiving adequate information and emotional care were highly important for family caregivers at an ICU. The literature search underlined the overwhelming and uncertain situation for the family caregivers and identified recommendations for follow-up. On the basis of these recommendations and findings from the interviews, workshops, and user testing, The Caregiver Pathway model was developed, encompassing 4 steps: within the first few days of the patient's ICU stay, the family caregivers will be offered to complete a digital assessment tool mapping their needs and challenges, followed by a conversation with an ICU nurse; when the patient leaves the ICU, a card containing information and support will be handed out to the family caregivers; shortly after the ICU stay, family caregivers will be offered a discharge conversation by phone, focusing on how they are doing and whether they have any questions or concerns; and within 3 months after the ICU stay, an individual follow-up conversation will be offered. Family caregivers will be invited to talk about memories from the ICU and reflect upon the ICU stay, and they will also be able to talk about their current situation and receive information about relevant support. CONCLUSIONS This study illustrates how existing evidence and stakeholder input can be combined to create a model for family caregiver follow-up at an ICU. The Caregiver Pathway can help ICU nurses improve family caregiver follow-up and aid in promoting family-centered care, potentially also being transferrable to other types of family caregiver follow-up.
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Affiliation(s)
- Solbjørg Watland
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Medicine Intensive Care Unit, Department of Acute Medicine, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lise Solberg Nes
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatry and Psychology, College of Medicine and Science, Mayo Clinic, Rochester, MN, United States
| | - Elizabeth Hanson
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
- Swedish Family Care Competence Centre, Kalmar, Sweden
| | - Mirjam Ekstedt
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
- Department of Learning Informatics Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Una Stenberg
- Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Oslo, Norway
- Frambu Resource Center for Rare Disorders, Ski, Norway
| | - Elin Børøsund
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
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Correia T, Martins MM, Barroso F, Pinho L, Longo J, Valentim O. The Family's Contribution to Patient Safety. Nurs Rep 2023; 13:634-643. [PMID: 37092484 PMCID: PMC10123717 DOI: 10.3390/nursrep13020056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/24/2023] [Accepted: 03/26/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Person- and family-centered care is one of the recommendations to achieve quality of care and patient safety. However, many health professionals associate the family with insecurity in care. OBJECTIVE To analyze, based on nurses' statements, the advantages and disadvantages of the family's presence in hospitals for the safety of hospitalized patients. METHODS This was a qualitative interpretative study based on James Reason's risk model, conducted through semi-structured interviews with 10 nurses selected by convenience. A content analysis was performed using Bardin's methodology and MAXQDA Plus 2022 software. RESULTS We identified 17 categories grouped according to the representation of the family in patient safety: The family as a Potentiator of Security Failures (7) and Family as a Safety Barrier (10). CONCLUSIONS The higher number of categories identified under Family as a Safety Barrier shows that nurses see strong potential in the family's involvement in patient safety. By identifying the need to intervene with and for families so that their involvement is safe, we observed an increase in the complexity of nursing care, which suggests the need to improve nursing ratios, according to the participants.
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Affiliation(s)
- Tânia Correia
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto (UP), 4050-313 Porto, Portugal
- CINTESIS@RISE, Nursing School of Porto (ESEP), 4200-450 Porto, Portugal
- Escola Superior de Saúde de Viseu (ESSV), Instituto Politécnico de Viseu (IPV), 3500-843 Viseu, Portugal
| | - Maria Manuela Martins
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto (UP), 4050-313 Porto, Portugal
- CINTESIS@RISE, Nursing School of Porto (ESEP), 4200-450 Porto, Portugal
- Escola Superior de Enfermagem do Porto (ESEP), 4050-313 Porto, Portugal
| | | | - Lara Pinho
- Nursing Department, Universidade de Évora, 7000-811 Évora, Portugal
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, 7000-811 Évora, Portugal
| | - João Longo
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), 1990-096 Lisboa, Portugal
- Escola Superior de Saúde Ribeiro Sanches (ERISA)-IPLUSO, 1950-396 Lisboa, Portugal
| | - Olga Valentim
- CINTESIS@RISE, Nursing School of Porto (ESEP), 4200-450 Porto, Portugal
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), 1990-096 Lisboa, Portugal
- Escola Superior de Enfermagem de Lisboa (ESEL), 1600-096 Lisboa, Portugal
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Pickard K, Wainer A, Broder-Fingert S, Sheldrick RC, Stahmer AC. Overcoming tensions between family-centered care and fidelity within Early Intervention implementation research. Autism 2023; 27:858-863. [PMID: 36317362 DOI: 10.1177/13623613221133641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
LAY ABSTRACT Early Intervention systems provide therapeutic services to families of young children birth to 3 years with developmental delays and are considered a natural access point to services for young children and their families. Research studies in the autism field have been interested in training providers to deliver evidence-based practices in Early Intervention systems to increase access to services for young children with an increased likelihood of being autistic. However, research has often overlooked that Early Intervention systems prioritize family-centered care, an approach to working with families that honors and respects their values and choices and that provides supports to strengthen family functioning. This commentary points out that family-centered care deserves greater attention in research being done in Early Intervention systems. We describe how family-centered care may shape how interventions are delivered, and discuss directions for future research to evaluate the impact of family-centered care alongside intervention delivery.
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Raj M, Stephenson AL, DePuccio MJ, Sullivan EE, Tarver W, Fleuren B, Thomas SC, Scheck McAlearney A. Conceptual Framework for Integrating Family Caregivers Into the Health Care Team: A Scoping Review. Med Care Res Rev 2023; 80:131-144. [PMID: 36000495 DOI: 10.1177/10775587221118435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
More than 80% of family care partners of older adults are responsible for coordinating care between and among providers; yet, their inclusion in the health care delivery process lacks recognition, coordination, and standardization. Despite efforts to include care partners (e.g., through informal or formal proxy access to their care recipient's patient portal), policies and procedures around care partner inclusion are complex and inconsistently implemented. We conducted a scoping review of peer-reviewed articles published from 2015 to 2021 and reviewed a final sample of 45 U.S.-based studies. Few articles specifically examine the inclusion of care partners in health care teams; those that do, do not define or measure care partner inclusion in a standardized way. Efforts to consider care partners as "partners" rather than "visitors" require further consideration of how to build health care teams inclusive of care partners. Incentives for health care organizations and providers to practice inclusive team-building may be required.
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Affiliation(s)
| | | | | | | | | | | | - Samuel C Thomas
- Stanford School of Medicine and Intermountain Healthcare, USA
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Bruce CR, Kamencik-Wright A, Zuniga-Georgy N, Vinh TM, Shah H, Shallcross J, Giammattei C, O’Rourke C, Smith M, Bruchhaus L, Bowens Y, Goode K, Arabie LA, Sauceda K, Pacha M, Martinez S, Chisum J, Saldaña DO RB, Desai SN, Awar M, R. Vernon T. Design and Integration of a Texting Tool to Keep Patients’ Family
Members Updated During Hospitalization: Family Members’
Perspectives. J Patient Exp 2023; 10:23743735231154963. [PMID: 36968006 PMCID: PMC10037736 DOI: 10.1177/23743735231154963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023] Open
Abstract
While there is an evolving literature on the benefits of texting and
patient-centered technologies, texting initiatives have not focused on family
members. We sought to identify patients’ family members’ perspectives on
facilitators and barriers to using 1 digital texting innovation to promote
family-centered care during patients’ hospitalizations. This qualitative study
was conducted at a tertiary care center in Houston, consisting of 7 hospitals (1
academic hospital and 6 community hospitals), involving analyzation of 3137
comments from family members who used the digital texting technology. Thematic
analysis methods were used. The data analysis for loved ones’ feedback resulted
in 4 themes as facilitators: (1) inpatient text messaging keeps loved ones
updated and connected (n = 611); (2) inpatient text messaging allows for
stronger continuity of communication (n = 69); (3) messaging promotes a sense of
staff compassion and service (n = 245); and (4) messaging reduces phone calls
(n = 65). The data analysis resulted in 4 themes as barriers to text messaging
helpfulness: (1) messages could feel generic (n = 31); (2) inpatient texting was
not needed if all loved ones were regularly at bedside (n = 6); (3) messages
could have a perceived delay (n = 37); and (4) security features could impact
convenience (n = 29). Our findings indicate that family members and loved ones
value inpatient text messages, not only for the information the messages
provide, but also because the act of writing text messages and preparing loved
ones shows inclusiveness, compassion, and family-centered care.
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Affiliation(s)
- Courtenay R. Bruce
- System Patient Experience, Houston Methodist Hospital
System, Houston, TX, USA
- Courtenay R. Bruce, System Patient
Experience, Houston Methodist System, 6565 Fannin Street, Mail Code B164 A/B,
Houston, TX 77030, USA.
| | | | | | - Thomas M. Vinh
- Information Technology Division, Houston Methodist Hospital
System, Houston, TX, USA
| | - Hema Shah
- Information Technology Division, Houston Methodist Hospital
System, Houston, TX, USA
| | - Jamie Shallcross
- Department
name is CareSense, MedTrak, Inc.,
Conshohocken, PA, USA
| | | | - Colleen O’Rourke
- Department
name is CareSense, MedTrak, Inc.,
Conshohocken, PA, USA
| | - Mariana Smith
- Service Quality and Guest Relations,
Houston
Methodist Sugar Land Hospital, Sugar Land,
TX, USA
| | - Lindsey Bruchhaus
- Service Quality and Guest Relations,
Houston
Methodist Sugar Land Hospital, Sugar Land,
TX, USA
| | - Yashica Bowens
- Service Quality and Guest Relations,
Houston
Methodist Hospital, Houston, TX, USA
| | - Kimberly Goode
- Service Quality and Guest Relations,
Houston
Methodist Hospital, Houston, TX, USA
| | - Lee Ann Arabie
- Service Quality and Guest Relations,
Houston
Methodist Clear Lake Hospital, Nassau Bay,
TX, USA
| | - Katherine Sauceda
- Service Quality and Guest Relations,
Houston
Methodist Sugar Land Hospital, Sugar Land,
TX, USA
| | - Majeedah Pacha
- Service Quality and Guest Relations,
Houston
Methodist Sugar Land Hospital, Sugar Land,
TX, USA
| | - Sandra Martinez
- Service Quality and Guest Relations,
Houston
Methodist Willowbrook Hospital, Houston,
TX, USA
| | - James Chisum
- Service Quality and Guest Relations,
Houston
Methodist Baytown Hospital, Baytown, TX,
USA
| | | | - S. Nicholas Desai
- Department of Surgery, Houston Methodist Sugar Land
Hospital, Sugar Land, TX, USA
| | - Melina Awar
- Department of Medicine, Houston Methodist
Hospital, Houston, TX, USA
| | - Thomas R. Vernon
- System Patient Experience, Houston Methodist Hospital
System, Houston, TX, USA
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Kovaleva MA, Jones AC, Kimpel CC, Lauderdale J, Sevin CM, Stollings JL, Jackson JC, Boehm LM. Patient and caregiver experiences with a telemedicine intensive care unit recovery clinic. Heart Lung 2023; 58:47-53. [PMID: 36399862 PMCID: PMC9992018 DOI: 10.1016/j.hrtlng.2022.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 10/20/2022] [Accepted: 11/06/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Intensive Care Unit Recovery Clinics (ICU-RCs) were founded to address post-intensive care syndrome among ICU survivors. Telemedicine ICU-RCs may facilitate access for more ICU survivors, however, patient and caregiver experiences with telemedicine ICU-RCs have not been explored qualitatively. OBJECTIVE To explore patient and informal caregiver experiences with a telemedicine ICU-RC. METHODS Our qualitative exploratory cross-sectional study was guided by qualitative description methodology. Telemedicine ICU-RC visits were conducted at 3- and 12-weeks post-discharge following critical illness. Patients, and caregivers when available, met with an ICU pharmacist, ICU physician, and a neuropsychologist via Zoom. Thereafter, we conducted qualitative (1:1) telephone interviews with 14 patients and 12 caregivers recruited purposefully. Data were analyzed using conventional content analysis. RESULTS Five themes were identified: (1) general impressions of the intervention; (2) intervention organization and delivery; (3) intervention substance; (4) caregiver participation; and (5) ways to improve the intervention. Participants found the telemedicine delivery acceptable, convenient, time-saving, and conducive to thorough discussions. Participants appreciated the information, reassurance, and validation. Attention to mental health during the visits was strongly endorsed. Caregiver involvement depended on patient self-management and technical ability. Suggestions included scheduling a 1-week post-discharge visit, more follow-up visits, and individualizing content for in-depth discussions, including mental health evaluation. CONCLUSIONS The study results enhance the understanding of patient and caregiver experiences with a telemedicine ICU-RC. Participants' narratives helped to formulate recommendations to improve telemedicine ICU-RC delivery and content. Acceptability of this intervention indicates the potential for wider implementation of telemedicine ICU-RCs to reach more ICU survivors.
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Affiliation(s)
- Mariya A Kovaleva
- University of Nebraska Medical Center College of Nursing, Omaha, NE.
| | - Abigail C Jones
- Yale University School of Nursing, Orange, CT; Vanderbilt University School of Nursing, Nashville, TN
| | - Christine Cleary Kimpel
- Vanderbilt University School of Nursing, Nashville, TN; Tennessee Valley Health Care System, Nashville, TN, USA
| | | | | | - Joanna L Stollings
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN, USA; Critical Illness, Brain dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN
| | - James C Jackson
- Vanderbilt University Medical Center, Nashville, TN; Critical Illness, Brain dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN; Department of Medicine, Division of Pulmonary and Critical Care, Vanderbilt University Medical Center, Nashville, TN; Geriatrics Research, Education, and Clinical Center, Tennessee Valley Veterans Affairs Healthcare System, Nashville, TN
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Lee MH, Jones CW, White P, Johnson D, Kim-Godwin YS. Preparing health professional students for interprofessional practice related to neurodevelopmental disabilities: a pilot program. J Interprof Care 2023; 37:333-337. [PMID: 35403552 DOI: 10.1080/13561820.2022.2047906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Many health professional students have insufficient general knowledge about individuals with neurodevelopmental disabilities. Students lack the expertise required to work with this population and their families. Interprofessional practice education (IPE) programs, designed for working with individuals with specialized needs and their families, are needed to improve overall care provided. An IPE program related to neurodevelopmental disabilities for health professional students was implemented focusing on applied learning and community engagement to develop competencies for students related to neurodevelopmental disabilities at a state university in the U.S. The purpose of this research was to describe the development and implementation of an IPE program and to examine the effectiveness of the IPE program aimed at developing identified competencies and increase awareness related to care of individuals with ND for health professional students. The findings suggest the IPE program enhanced health professional students' perceived competencies to identify and provide culturally sensitive and family-centered care for individuals with neurodevelopmental disabilities and their families. This experience also provided an opportunity for personal/professional growth and increased awareness of the unique needs of these individuals with neurodevelopmental disabilities and their families.
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Affiliation(s)
- Meen Hye Lee
- Department of Nursing, Gangneung-Wonju National University, Gangwon-do, South Korea
| | - Carolyn W Jones
- School of Nursing, University of North Carolina Wilmington, Wilmington, NC, USA
| | - Patricia White
- School of Nursing, University of North Carolina Wilmington, Wilmington, NC, USA
| | - Dan Johnson
- Recreation Therapy, University of North Carolina Wilmington, Wilmington, NC, USA
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Corcoran J, Marley Campbell C, Ladores S. Transitioning to telehealth during the coronavirus disease 2019 pandemic: Perspectives from partners of women with cystic fibrosis and healthcare providers. Chronic Illn 2023; 19:95-101. [PMID: 34812062 PMCID: PMC9219411 DOI: 10.1177/17423953211060257] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Cystic fibrosis is a chronic, genetic disease that primarily affects the respiratory system. The coronavirus disease 2019 pandemic has altered how people with cystic fibrosis receive healthcare. This paper explores the perceptions of cystic fibrosis healthcare providers and partners of women with cystic fibrosis regarding the use of telehealth in routine cystic fibrosis healthcare in the US. METHODS As part of a larger study examining fertility counseling for women with cystic fibrosis, we conducted qualitative, semi-structured interviews. Participants included partners of women with cystic fibrosis (n = 20) and cystic fibrosis healthcare providers (n = 20). We completed the interviews before and during the global coronavirus disease 2019 pandemic. We analyzed the data using thematic analysis. RESULTS When in-person healthcare could not be achieved safely, partners and healthcare providers found new value in telehealth. Three themes emerged: (1) increased connection between healthcare team and family, (2) increased efficiency of healthcare appointments, and (3) improved interdisciplinary collaboration. Partners found that telehealth allowed for more engagement in their significant others' healthcare. Providers reported enhanced efficiency and opportunities for collaboration across specialties that improved healthcare delivery and care coordination. DISCUSSION Results from this study highlighted the positive value of telehealth. Telehealth presents as a potential alternative to delivering outpatient care for people with chronic illnesses beyond the pandemic.
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Affiliation(s)
- Jessica Corcoran
- School of Nursing, 16077The University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Sigrid Ladores
- School of Nursing, 16077The University of Alabama at Birmingham, Birmingham, AL, USA
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Lim SA, Khorrami A, Wassersug RJ, Agapoff JA. Gender Differences among Healthcare Providers in the Promotion of Patient-, Person- and Family-Centered Care-And Its Implications for Providing Quality Healthcare. Healthcare (Basel) 2023; 11. [PMID: 36833099 DOI: 10.3390/healthcare11040565] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/08/2023] [Accepted: 02/11/2023] [Indexed: 02/17/2023] Open
Abstract
The concept of "patient-centered care" (PCC) emphasizes patients' autonomy and is commonly promoted as a good healthcare practice that all of medicine should strive for. Here, we assessed how six medical specialties-pediatrics, OBGYN, orthopedics, radiology, dermatology, and neurosurgery-have engaged with PCC and its derivative concepts of "person-centered care" (PeCC) and "family-centered care" (FCC) as a function of the number of female physicians in each field. To achieve this, we conducted a scoping review of three databases-PubMed, CINAHL, and PsycInfo-to assess the extent that PCC, PeCC, FCC, and RCC were referenced by different specialties in the medical literature. Reference to PCC and PeCC in the literature correlates significantly with the number of female physicians in each field (all p < 0.00001) except for neurosurgery (p > 0.5). Pediatrics shows the most extensive reference to PCC, followed by OBGYN, with a significant difference between all disciplines (p < 0.001). FCC remains exclusively embraced by pediatrics. Our results align with documented cognitive differences between men and women that recognize gender differences in empathizing (E) versus systemizing (S) with females demonstrating E > S, which supports PCC/PeCC/FCC approaches to healthcare.
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Seniwati T, Rustina Y, Nurhaeni N, Wanda D. Patient and family-centered care for children: A concept analysis. Belitung Nurs J 2023; 9:17-24. [PMID: 37469640 PMCID: PMC10353635 DOI: 10.33546/bnj.2350] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/02/2022] [Accepted: 01/08/2023] [Indexed: 07/21/2023] Open
Abstract
Background Family-centered care has evolved into patient and family-centered care. Although this is not a new concept; however, its application to nursing practice is very challenging among nurses due to its ambiguity. Objective This study aimed to clarify the concept of patient and family-centered care for children. Methods Walker and Avant's concept analysis method was used. A literature search was also done using the following databases: Google Scholar, ProQuest, ScienceDirect, and Scopus, for articles published from 2011 to 2021. Results The defining attributes of patient and family-centered care are partnership, communication, respect, and compassion. Antecedents include patient and family involvement, readiness to collaborate and participate, competency and desire of the care professional team, supportive environment, and policies. Consequences of the patient and family-centered care include improved child outcomes and quality of life, promotion of patient safety, increased patient and family satisfaction, enhancement of humanistic values, reduction of hospitalization cost and length of stay, and decreased stress, anxiety, and depression in family members. Conclusion Four attributes of patient and family-centered care, its antecedents, and consequences may aid researchers in better understanding the concept and its application in nursing practice. This concept can also be used to establish quality care delivery strategies and promote professional relationships between nurses, patients, and families in clinical settings.
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Affiliation(s)
- Tuti Seniwati
- Postgraduate Program, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
- Pediatric Nursing Department, Faculty of Nursing, Universitas Hasanuddin, Makassar, Indonesia
| | - Yeni Rustina
- Pediatric Nursing Department, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
| | - Nani Nurhaeni
- Pediatric Nursing Department, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
| | - Dessie Wanda
- Pediatric Nursing Department, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
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Parlier-Ahmad AB, Eglovitch M, Martin S, Svikis DS, Martin CE. Project BETTER: A Family-Centered, Technology-Delivered Intervention for Pregnant People with Opioid Use Disorder. Children (Basel) 2023; 10:children10020359. [PMID: 36832488 PMCID: PMC9955349 DOI: 10.3390/children10020359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 02/17/2023]
Abstract
Birthing people with opioid use disorder (OUD) face unique stressors during the transition from pregnancy to postpartum that can negatively impact the maternal-infant dyad. This study aimed to describe the development of a family-centered, technology-delivered intervention tailored to help pregnant people receiving medication for OUD (MOUD) prepare for this transition. Formative data from patients and providers identified intervention content: (1) recovery-oriented strategies for the pregnancy-to-postpartum transition; (2) guidance around caring for an infant with opioid withdrawal symptoms; and (3) preparation for child welfare interactions. The content was reviewed in successive rounds by an expert panel and modified. Pregnant and postpartum people receiving MOUD pre-tested the intervention modules and provided feedback in semi-structured interviews. The multidisciplinary expert panel members (n = 15) identified strengths and areas for improvement. Primary areas for improvement included adding content, providing more structure to help participants navigate the intervention more easily, and revising language. Pre-testing participants (n = 9) highlighted four themes: reactions to intervention content, navigability of the intervention, feasibility of the intervention, and recommendation of the intervention. All iterative feedback was incorporated into the final intervention modules for the prospective randomized clinical trial. Family-centered interventions tailored for pregnant people receiving MOUD should be informed by patient-reported needs and multidisciplinary perspectives.
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Affiliation(s)
- Anna Beth Parlier-Ahmad
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA
- Correspondence: ; Tel.: +804-828-8069
| | - Michelle Eglovitch
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Sarah Martin
- School of Medicine, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Dace S. Svikis
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Caitlin E. Martin
- Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA 23298, USA
- Department of Obstetrics and Gynecology, School of Medicine, Virginia Commonwealth University, Richmond, VA 23298, USA
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Musselman E, Shea K, Johnson L. Developmentally Appropriate Care of Pediatric Patients in the Perioperative Setting. AORN J 2023; 117:98-108. [PMID: 36705448 DOI: 10.1002/aorn.13863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 06/06/2022] [Accepted: 06/06/2022] [Indexed: 01/28/2023]
Abstract
Pediatric patients do not undergo procedures exclusively at pediatric specialty facilities. Many perioperative nurses will care for a pediatric patient at some point in their career. Children and their caregivers often experience elevated levels of anxiety during the perioperative experience. Possessing knowledge of the child's age and developmental stage and using effective communication techniques can decrease this anxiety. This article presents insights into the stages of pediatric cognitive and psychosocial development and special pediatric health care considerations. Approaching and interacting with a child in a manner appropriate for their age and developmental stage can foster a more trusting nurse-child-caregiver relationship and reassure the caregiver that the perioperative team is providing their child with safe, high-quality care. Also included are five hypothetical case studies that illustrate effective communication styles and developmentally appropriate techniques that personnel can apply during the pediatric patient's perioperative experience.
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Keim-Malpass J, Constantoulakis L, Shaw EK, Letzkus LC. Lagging coverage for mental health services among children and adolescents through home and community-based Medicaid waivers. J Child Adolesc Psychiatr Nurs 2023; 36:21-27. [PMID: 36075862 PMCID: PMC10087945 DOI: 10.1111/jcap.12392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 07/20/2022] [Accepted: 08/24/2022] [Indexed: 02/04/2023]
Abstract
PROBLEM Many states cover mental health home and community-based services (HCBS) for youth through 1915(c) Medicaid HCBS waivers that allow states to waive certain Medicaid eligibility criteria and define high-risk populations based on age, medical condition(s), and disability status. We sought to evaluate how States are covering children and adolescents with mental health needs through 1915(c) waivers compared to other youth waiver populations. METHODS Data elements were extracted from Medicaid 1915(c) approved waivers applications for all included waivers targeting any pediatric age range through October 31, 2018. Normalization criteria were developed and an aggregate overall coverage score and level of funding per person per waiver were calculated for each waiver. FINDINGS One hundred and forty-two waivers across 45 states were included in this analysis. Even though there was uniformity in the Medicaid applications, there was great heterogeneity in how waiver eligibility, transition plans, services covered, and wait lists were defined across group classifications. Those with mental health needs (termed serious emotional disturbance) represented 5% of waivers with the least annual funding per person per waiver. CONCLUSIONS We recommend greater links between public policy, infrastructure, health care providers, and a family-centered approach to extend coverage and scope of services for children and adolescents with mental health needs.
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Affiliation(s)
- Jessica Keim-Malpass
- Department of Acute and Specialty Care, School of Nursing, University of Virginia, Charlottesville, Virginia, USA.,Department of Pediatrics, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Leeza Constantoulakis
- Department of Acute and Specialty Care, School of Nursing, University of Virginia, Charlottesville, Virginia, USA
| | - Emily K Shaw
- Atlantic Medical Group Child Development Center, Morristown, New Jersey, USA
| | - Lisa C Letzkus
- Department of Acute and Specialty Care, School of Nursing, University of Virginia, Charlottesville, Virginia, USA.,Department of Pediatrics, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
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Campbell-Yeo M, Dol J, McCulloch H, Hughes B, Hundert A, Bacchini F, Whitehead L, Afifi J, Alcock L, Bishop T, Dorling J, Earle R, Elliott Rose A, Inglis D, Leighton C, MacRae G, Melanson A, Simpson CD, Smit M. The Impact of Parental Presence Restrictions on Canadian Parents in the NICU During COVID-19: A National Survey. J Fam Nurs 2023; 29:18-27. [PMID: 35915967 PMCID: PMC9850074 DOI: 10.1177/10748407221114326] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The purpose of this research was to explore parental perspectives on the impact of parent restrictions imposed in response to the COVID-19 pandemic across Canadian Neonatal Intensive Care Units (NICUs). A co-designed online survey was conducted targeting parents (n = 235) of infants admitted to a Canadian NICU from March 1, 2020, until March 5, 2021. Parents completed the survey from 38 Canadian NICUs. Large variation in the severity of policies regarding parental presence was reported. Most respondents (68.9%) were classified as experiencing high restrictions, with one or no support people allowed in the NICU, and felt that policies were less easy to understand, felt less valued and respected, and found it more challenging to access medicine or health care. Parents reported gaps in care related to self-care, accessibility, and mental health outcomes. There is significant variation in parental restrictions implemented across Canadian NICUs. National guidelines are needed to support consistent and equitable care practices.
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Affiliation(s)
| | | | | | | | | | | | | | - Jehier Afifi
- Dalhousie University, Halifax, NS,
Canada
- IWK Health, Halifax, NS, Canada
| | | | | | - Jon Dorling
- University Hospital Southampton NHS
Foundation Trust, Southampton, UK
| | | | | | | | | | | | | | - C. David Simpson
- Dalhousie University, Halifax, NS,
Canada
- IWK Health, Halifax, NS, Canada
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48
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Desai P, Kazmi SH, Schneider S, Angert R. Virtual Care Across the Neonatal Intensive Care Continuum. Cureus 2023; 15:e35183. [PMID: 36960267 PMCID: PMC10029832 DOI: 10.7759/cureus.35183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2023] [Indexed: 02/21/2023] Open
Abstract
The ongoing coronavirus disease 2019 (COVID-19) pandemic has highlighted the need for establishing effective parent and family engagement throughout all aspects of medicine. Though there has been some discussion in the literature regarding the transition from typical outpatient visits to telehealth visits, there has been less written about the inpatient approach to family inclusion. Here, we seek to describe our institution's experience with implementing virtual medicine across the full continuum of the neonatal intensive care unit (NICU) experience, including inpatient rounding, child life family visits, and outpatient high-risk developmental follow-up after discharge.
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Affiliation(s)
- Purnahamsi Desai
- Pediatrics, New York University (NYU) Grossman School of Medicine, New York, USA
| | - Sadaf H Kazmi
- Pediatrics, New York University (NYU) Grossman School of Medicine, New York, USA
| | - Stacey Schneider
- Child Life, New York University (NYU) Langone Health, New York, USA
| | - Robert Angert
- Pediatrics, New York University (NYU) Grossman School of Medicine, New York, USA
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Hriberšek M, Eibensteiner F, Kapral L, Teufel A, Nawaz FA, Cenanovic M, Sai CS, Devkota HP, De R, Singla RK, Parvanov ED, Tsagkaris C, Atanasov AG, Schaden E. "Loved ones are not 'visitors' in a patient's life"-The importance of including loved ones in the patient's hospital stay: An international Twitter study of #HospitalsTalkToLovedOnes in times of COVID-19. Front Public Health 2023; 11:1100280. [PMID: 36778575 PMCID: PMC9909431 DOI: 10.3389/fpubh.2023.1100280] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/06/2023] [Indexed: 01/27/2023] Open
Abstract
Background Hospitals are institutions whose primary task is to treat patients. Family-centered care, which considers loved ones as equal partners in patient care, has been gaining recognition in the adult care setting. Our aim was to record experiences of and opinions on communication between hospital-based healthcare providers and patients' loved ones, related but not limited to the rigorous mitigation measures implemented during the COVID-19 pandemic. Methods The Twitter profile @HospitalsTalkTo and hashtag #HospitalsTalkToLovedOnes were created to interact with the Twitter public between 7 June 2021 and 7 February 2022. Conversations surrounding #HospitalsTalkToLovedOnes were extracted and subjected to natural language processing analysis using term frequency and Markov chain analysis. Qualitative thematic analysis was performed on the 10% most interacted tweets and of tweets mentioning "COVID" from a personal experience-based subset. Results We collected 4412 unique tweets made or interacted by 7040 Twitter users from 142 different countries. The most frequent words were patient, hospital, care, family, loved and communication. Thematic analysis revealed the importance of communication between patients, patients' loved ones and hospitals; showed that patients and their loved ones need support during a patient's hospital journey; and that pediatric care should be the gold standard for adult care. Visitation restrictions due to COVID-19 are just one barrier to communication, others are a lack of phone signal, no space or time for asking questions, and a complex medical system. We formulate 3 recommendations to improve the inclusion of loved ones into the patient's hospital stay. Conclusions "Loved ones are not 'visitors' in a patient's life". Irrespective of COVID-19, patient's loved ones need to be included during the patient's hospital journey. Transparent communication and patient empowerment increase patient safety and improve the hospital experience for both the patients and their loved ones. Our findings underline the need for the concept of family-centered care to finally be implemented in adult nursing clinical practice.
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Affiliation(s)
- Mojca Hriberšek
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
| | - Fabian Eibensteiner
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria,Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Lorenz Kapral
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
| | - Anna Teufel
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
| | - Faisal A. Nawaz
- Department of Psychiatry, Al Amal Psychiatric Hospital, Dubai, United Arab Emirates
| | | | | | - Hari Prasad Devkota
- Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan,Pharmacy Program, Gandaki University, Pokhara, Nepal
| | - Ronita De
- Department of ICMR-NICED Virus Lab, Indian Council of Medical Research-National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India
| | - Rajeev K. Singla
- Institutes for Systems Genetics, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China,School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab, India
| | - Emil D. Parvanov
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria,Department of Translational Stem Cell Biology, Research Institute of the Medical University of Varna, Varna, Bulgaria
| | | | - Atanas G. Atanasov
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria,Department of Biotechnology and Nutrigenomics, Institute of Genetics and Animal Biotechnology of the Polish Academy of Sciences, Magdalenka, Poland
| | - Eva Schaden
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria,Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria,*Correspondence: Eva Schaden ✉
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50
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Wilson JL. Concept Analysis of Family-Centered Care in Childhood Cancer: An Evolutionary Approach. J Pediatr Hematol Oncol Nurs 2023; 40:111-118. [PMID: 36694935 DOI: 10.1177/27527530221140060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The purpose of this article is to further develop the concept of family-centered care (FCC) in childhood cancer using Rodgers' evolutionary method of concept analysis. A search of the existing literature related to the overarching concept of FCC revealed several concept analyses specific to hospitalized children and children with chronic illness; however, none of these were specific to children with cancer. Five defining attributes of FCC in childhood cancer were identified through this concept analysis: ripple effect, customized care, family functioning, collaboration, and communication. A definition of FCC in childhood cancer is offered based on identified characteristics of the concept. Findings of this concept analysis provide a starting point for on-going development of the concept of FCC in childhood cancer and may facilitate more rigorous nursing studies involving FCC in childhood cancer.
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Affiliation(s)
- Jennifer L Wilson
- College of Nursing, 4292The University of Tennessee Knoxville, Knoxville, TN, USA.,School of Nursing, University of North Carolina Greensboro, Greensboro, NC, USA
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