scholarly journals Establishing action/interaction strategies for care delivery to hospitalized children with chronic conditions

2015 ◽  
Vol 19 (2) ◽  
Author(s):  
Thiago Privado da Silva ◽  
Marcelle Miranda da Silva ◽  
Leila Milman Alcantara ◽  
Ítalo Rodolfo Silva ◽  
Joséte Luzia Leite
Author(s):  
Sharon Ogden Burke ◽  
Mark H. Handley-Derry ◽  
Edith A. Costello ◽  
Elizabeth Kauffmann ◽  
Mary C. Dillon

2016 ◽  
Vol 25 (2) ◽  
Author(s):  
Thiago Privado Silva ◽  
Ítalo Rodolfo Silva ◽  
Joséte Luzia Leite

ABSTRACT The study aimed to understand the intervening conditions in the interactions of nurses in managing the nursing care for hospitalized children with chronic conditions. To do that, it used Complex Thinking and Grounded Theory as theoretical and methodological references, respectively. Eighteen subjects participated in the study, pooled into three sample groups: nurses, nursing technicians, and their families. A semi-structured interview was used for data collection. Data analysis followed three stages of coding: open, axial, and selective. The study considered family members, professional experience, the physical structure of the unit, human and material resources, good mood, job satisfaction, confidence, dialogue, and empathy as conditions that influence nurses' interactions in care management. It found that subjective, cognitive, socio-cultural and institutional conditions influence the interactions of nurses, creating order/disorder in nursing care management.


2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S317-S318
Author(s):  
Jenny Ploeg ◽  
Marie-Lee Yous ◽  
Kimberly Fraser ◽  
Sinéad Dufour ◽  
Sharon Kaasalainen ◽  
...  

Abstract The management of multiple chronic conditions (MCC) in older adults living in the community is complex. Little is known about the experiences of interdisciplinary primary care and home providers who care for this vulnerable group. The aim of this study was to explore the experiences of healthcare providers in managing the care of community-living older adults with MCC and to highlight their recommendations for improving care delivery for this group. A qualitative interpretive description design was used. A total of 42 healthcare providers from two provinces in Canada participated in semi-structured interviews. Participants represented diverse disciplines (e.g., physicians, nurses, social workers, personal support workers) and settings (e.g., primary care and home care). Thematic analysis was used to analyze interview data. The experiences of healthcare providers managing care for older adults with MCC were organized into six major themes: (1) managing complexity associated with MCC, (2) implementing person-centred care, (3), involving and supporting family caregivers, (4) using a team approach for holistic care delivery, (5) encountering rewards and challenges in caring for older adults with MCC, and (6) recommending ways to address the challenges of the healthcare system. Healthcare providers highlighted the need for a more comprehensive integrated system of care to improve care management for older adults with MCC and their family caregivers. Specifically, they suggested increased care coordination, more comprehensive primary care visits with an interprofessional team, and increased home care support.


2021 ◽  
Vol 74 (suppl 4) ◽  
Author(s):  
Tatiana Silva Tavares ◽  
Kênia Lara Silva ◽  
Regina Garcia de Lima ◽  
Elysângela Dittz Duarte

ABSTRACT Objective: To analyze the experiences of families in the exercise of the rights of children with chronic conditions in public health, education and social assistance institutions. Method: ethnographic multiple case study, with qualitative approach, following the theoretical approach of Boaventura Santos. Experiences of the families of these children in a city were studied through interviews with family members, managers and professionals from social institutions (35), participant observations in social spaces (13) and creation of eco-maps (3). Critical Discourse Analysis was performed. Results: the offer of services is lower than the demand, and exclusion processes persist. Given the hegemony of neoliberal and normality ideologies, meetings between family members and professionals revealed obstacles to civil rights; however, when these ideologies were challenged, the realization of their rights was enhanced. Final considerations: the care to promote civil rights requires family members, managers and professionals to develop subjectivities that overcome neoliberal and normality ideologies, recognizing these children as subjects of law.


2020 ◽  
Author(s):  
Kelly Williams ◽  
Sarah Markwardt ◽  
Shannon M Kearney ◽  
Jordan F Karp ◽  
Kevin L Kraemer ◽  
...  

BACKGROUND Digital tools accessed via smartphones can promote chronic condition management, reduce disparities in health care and hospital readmissions, and improve quality of life. However, whether digital care strategies can be implemented successfully on a large scale with traditionally underserved populations remains uncertain. OBJECTIVE As part of a randomized trial comparing care delivery strategies for Medicaid and Medicare-Medicaid beneficiaries with multiple chronic conditions, our stakeholders identified implementation challenges, and we developed stakeholder-driven adaptions to improve a digitally delivered care management strategy (high-tech care). METHODS We used 4 mechanisms (study support log, Patient Partners Work Group log, case interview log, and implementation meeting minutes) to capture stakeholder feedback about technology-related challenges and solutions from 9 patient partners, 129 participants, and 32 care managers and used these data to develop and implement solutions. To assess the impact, we analyzed high-tech care exit surveys and intervention engagement outcomes (video visits and condition-specific text message check-ins sent at varying intervals) before and after each solution was implemented. RESULTS Challenges centered around 2 themes: difficulty using both smartphones and high-tech care components and difficulty using high-tech care components due to connectivity issues. To respond to the first theme’s challenges, we devised 3 solutions: tech visits (eg, in-person technology support visits), tech packet (eg, participant-facing technology user guide), and tailored condition-specific text message check-ins. During the first 20 months of implementation, 73 participants received at least one tech visit. We observed a 15% increase in video call completion for participants with data before and after the tech visit (n=25) and a 7% increase in check-in completion for participants with data before and after the tech visit (n=59). Of the 379 participants given a tech packet, 179 completed care during this timeframe and were eligible for an exit survey. Of the survey respondents, 76% (73/96) found the tech packet helpful and 64% (62/96) actively used it during care. To support condition-specific text message check-in completion, we allowed for adaption of day and/or time of the text message with 31 participants changing the time they received check-ins and change in standard biometric settings with 13 physicians requesting personalized settings for participants. To respond to the second theme’s challenges, tech visits or phone calls were made to demonstrate how to use a smartphone to connect or disconnect from the internet, to schedule video calls, or for condition-specific text message check-ins in a location with broadband/internet. CONCLUSIONS Having structured stakeholder feedback mechanisms is key to identify challenges and solutions to digital care engagement. Creating flexible and scalable solutions to technology-related challenges will increase equity in accessing digital care and support more effective engagement of chronically ill populations in the use of these digital care tools. CLINICALTRIAL ClinicalTrials.gov NCT03451630; https://clinicaltrials.gov/ct2/show/NCT03451630.


2018 ◽  
Vol 12 (5) ◽  
pp. 1397
Author(s):  
Jessica Cardoso Vaz ◽  
Viviane Marten Milbrath ◽  
Ruth Irmgard Bärtschi Gabatz ◽  
Fábio Reis Krug ◽  
Bárbara Hirschmann ◽  
...  

RESUMOObjetivo: conhecer o que vem sendo produzido sobre o cuidado à família da criança com doença crônica. Método: revisão integrativa que buscou conhecer as publicações dos últimos 10 anos nas bases de dados MEDLINE, LILACS, BDENF, INDEX PSICOL e na biblioteca virtual SciELO. Após a leitura dos artigos selecionados, foram analisados os dados dos estudos referentes à autoria, objetivos, ano de publicação, método e nível de evidência. Resultados: com base nos achados, foram definidas duas categorias temáticas << Enfrentando o diagnóstico da doença crônica, mudança de hábitos e reorganização familiar >> e << Rotinas de cuidado das famílias com crianças com condição crônica >>. Conclusão: as famílias das crianças com doença crônica são afastadas de suas rotinas, muitas vezes, perdendo o controle sobre suas vidas. Acredita-se que se a família for bem informada sobre a patologia e empoderada para os cuidados à criança, esta poderá desenvolver autonomia sobre a organização da sua vida. Descritores: Família; Criança; Doença Crônica; Empatia; Enfermagem Pediátrica; Revisão.ABSTRACT Objective: to know what has been produced about the care provided for families of children with chronic disease. Method: integrative review that sought to survey the publications of the last 10 years in the MEDLINE, LILACS, BDENF, INDEX PSICOL databases and in the virtual library SciELO. After reading the selected articles, we analyzed data of the studies regarding authorship, objectives, year of publication, method and level of evidence. Results: the findings led to two thematic categories << Facing the diagnosis of a chronic disease, change of habits and family reorganization >> and << Care routines of families with children with chronic conditions >>. Conclusion: Families of children with chronic diseases have their routines modified, often losing control over their lives. We believe that if families are well informed about the pathology and if they are empowered to care for the child, they will be able to develop autonomy over the organization of their lives. Descriptors: Family; Child; Chronic disease; Empathy; Pediatric Nursing; Review.RESUMEN Objetivo: conocer lo que viene siendo producido sobre el cuidado a la familia del niño con enfermedad crónica. Método: revisión integradora que buscó conocer las publicaciones de los últimos 10 años en las bases de datos MEDLINE, LILACS, BDENF, INDEX PSICOL y en la biblioteca virtual SciELO. Después de la lectura de los artículos seleccionados, fueron analizados los datos de los estudios referentes a la autoría, objetivos, año de publicación, método y nivel de evidencia. Resultados: con base en los hallados, fueron definidas dos categorías temáticas << Enfrentando el diagnóstico de la enfermedad crónica, cambio de hábitos y reorganización familiar >> y << Rutinas de cuidado de las familias con niños con condición crónica >>. Conclusión: las familias de los niños con enfermedades crónica son alejados de sus rutinas, muchas veces, perdiendo el control sobre sus vidas. Se cree que si la familia fuera bien informada sobre la patología y empoderada para los cuidados al niño, esta podrá desarrollar autonomía sobre la organización de su vida. Descriptores: Familia; Niño; Enfermedad Crónica; Empatía; Enfermería Pediátrica; Revisión.


PEDIATRICS ◽  
1996 ◽  
Vol 98 (5) ◽  
pp. 952-958 ◽  
Author(s):  
Paul W. Newacheck ◽  
Ruth E. K. Stein ◽  
Deborah Klein Walker ◽  
Steven L. Gortmaker ◽  
Karen Kuhlthau ◽  
...  

Objective. Children with chronic illnesses and disabilities are increasingly enrolling in managed care arrangements. Yet, the rapid expansion of managed care has unknown consequences for children with chronic conditions and disabilities. As managed care is likely to become the predominant mode of medical practice for children with chronic health problems, information gained from a thorough assessment of existing managed care models could be helpful in indicating adjustments and modifications that could result in improved outcomes for this population. The purpose of this article is to outline a new strategy for collecting needed information on the effects of managed care on children with chronic health problems. Methods. We reviewed the literature on the effects of managed care on children with chronic conditions and disabilities. We identified key domains relevant to monitoring and evaluating managed care for this population. Results. Two research approaches can provide helpful information for assessing the effects of managed care on children with chronic conditions. First, a monitoring strategy could be pursued in which enrollment trends in managed care, enrollee perceptions of access and satisfaction with care, and other general indicators of outcomes would be tracked over time using inexpensive and rapid turnaround data sources. Second, an evaluative strategy could be pursued using experimental or quasiexperimental designs, in which outcomes across a variety of domains for children with chronic conditions in managed care are compared with: (a) outcomes for the same children before enrollment in managed care; or (b) outcomes for similar children remaining in traditional fee-for-service settings. Evaluation and monitoring strategies should focus on outcomes in a number of domains including: (1) access to care; (2) utilization of services; (3) quality of care; (4) satisfaction with care; (5) expenditures for care; (6) health outcomes; and (7) family impact. Conclusion. Assessing outcomes that result from enrollment in managed care for children with chronic health problems presents a formidable challenge. The research strategy outlined in this article presents one approach to meeting that challenge. The monitoring and evaluation strategies described here would require commitment of additional resources on the part of government, private foundations, and/or health plans. Given the paucity of existing information and the stakes for children with chronic conditions and their families, investment of added resources in a comprehensive monitoring and evaluation strategy is essential.


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