Sarah A Sobotka1, Ayesha Dholakia2, Jay G Berry3, Maria Brenner4, Robert J Graham5, Denise M Goodman6, Rishi K Agrawal7. 1. Section of Developmental and Behavioral Pediatrics, Department of Pediatrics, The University of Chicago, Chicago, Illinois, USA. 2. Department of Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA. 3. Complex Care, Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School. 4. School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, Dublin, Ireland. 5. Division of Critical Care Medicine, Department of Anesthesia, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA. 6. Division of Pediatric Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. 7. Division of Hospital-Based Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Abstract
OBJECTIVES & HYPOTHESIS: Children with home mechanical ventilation (HMV) require skilled care by trained caregivers, and their families feel the impacts of ubiquitous home nursing shortages. It is unknown which factors determine allocation; no standards for private duty nursing intensity exist. We sought to characterize provider experiences with and opinions on home nursing for children with HMV, hypothesizing providers would describe frequent home nursing gaps across clinical scenarios. METHODS: Purposeful and snowball sampling identified key informant clinical providers. Survey topics included hours of home nursing received across clinical and family scenarios. Close-ended responses were analyzed using descriptive statistics and open-ended questions coded with iterative modification for major theme agreement. RESULTS: A total of 59 respondents represented care of patients from 44 states; 49.2% physicians, 37.3% nurses, 10.2% respiratory therapists, and 3.4% case managers. Nearly all (97%) believed that families should receive more hours during initial home transition, yet less than half (47%) do. The majority (80.7%) thought the presence of other children in the home should influence nursing hours, yet only three (5.3%) reported other children have influence. Across hypothetical medical technology scenarios, providers consistently described children receiving fewer nursing hours than the providers' ideal practice. A third (31.7%) described discharging patients without any home nursing arranged. CONCLUSIONS: This HMV provider sample highlights pervasive deficiency in home nursing provision with heterogenous interpretation of what constitutes ideal home care. Family and social contextual factors are infrequently considered in nursing allocations. Provider, community health, and family stakeholders must collaborate to generate national community practice standards for children with HMV.
OBJECTIVES & HYPOTHESIS: Children with home mechanical ventilation (HMV) require skilled care by trained caregivers, and their families feel the impacts of ubiquitous home nursing shortages. It is unknown which factors determine allocation; no standards for private duty nursing intensity exist. We sought to characterize provider experiences with and opinions on home nursing for children with HMV, hypothesizing providers would describe frequent home nursing gaps across clinical scenarios. METHODS: Purposeful and snowball sampling identified key informant clinical providers. Survey topics included hours of home nursing received across clinical and family scenarios. Close-ended responses were analyzed using descriptive statistics and open-ended questions coded with iterative modification for major theme agreement. RESULTS: A total of 59 respondents represented care of patients from 44 states; 49.2% physicians, 37.3% nurses, 10.2% respiratory therapists, and 3.4% case managers. Nearly all (97%) believed that families should receive more hours during initial home transition, yet less than half (47%) do. The majority (80.7%) thought the presence of other children in the home should influence nursing hours, yet only three (5.3%) reported other children have influence. Across hypothetical medical technology scenarios, providers consistently described children receiving fewer nursing hours than the providers' ideal practice. A third (31.7%) described discharging patients without any home nursing arranged. CONCLUSIONS: This HMV provider sample highlights pervasive deficiency in home nursing provision with heterogenous interpretation of what constitutes ideal home care. Family and social contextual factors are infrequently considered in nursing allocations. Provider, community health, and family stakeholders must collaborate to generate national community practice standards for children with HMV.
Authors: David C Van Pelt; Eric B Milbrandt; Li Qin; Lisa A Weissfeld; Armando J Rotondi; Richard Schulz; Lakshmipathi Chelluri; Derek C Angus; Michael R Pinsky Journal: Am J Respir Crit Care Med Date: 2006-10-26 Impact factor: 21.405
Authors: Maria Brenner; Josephine Greene; Carmel Doyle; Berthold Koletzko; Stefano Del Torso; Ivan Bambir; Ann De Guchtenaere; Theofilos Polychronakis; Laura Reali; Adamos A Hadjipanayis Journal: Front Pediatr Date: 2021-12-01 Impact factor: 3.418