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Maintaining family life balance while facing a child's imminent death-A mixed methods study


Eskola, Katri; Bergstraesser, Eva; Zimmermann, Karin; Cignacco, Eva (2017). Maintaining family life balance while facing a child's imminent death-A mixed methods study. Journal of Advanced Nursing, 73(10):2462-2472.

Abstract

AIM: To understand parents' experiences and needs during a child's end-of-life care at home and to identify systemic factors that influence its provision.
BACKGROUND: A child's end-of-life phase is an extremely difficult time for the whole family. Parents have specific needs, especially when they care for a dying child at home.
DESIGN: Concurrent embedded mixed methods design.
METHODS: This sub-study of the nationwide survey, 'Paediatric End-of-Life Care Needs in Switzerland' (2012-2015) included 47 children who received EOL care at home from 2011-2012. We extracted quantitative data from patients' medical charts and obtained information via parental questionnaire and then compared parents whose child died at home or in hospital by computing generalized estimation equations. We thematically analysed interviews with parents who provided EOL care at home.
RESULTS: Parents created an intimate lifeworld and a sense of normality for the child at home. They constantly balanced the family's lifeworld with the requirements and challenges posed by the outside world. This work exhausted parents. Parental 'readiness' and social support drove EOL care for children at home. Parents needed practical help with housekeeping and had negative experiences when dealing with insurance. In only 34.8% of cases was a child's EOL home care supported by paediatric palliative care team.
CONCLUSION: Paediatric end-of-life care at home is only feasible if parents make extraordinary efforts. If family-centred end-of-life home care is provided by a hospital-based paediatric palliative home care team, which includes paid housekeeping help and psychological support, parents' needs could be better met.

Abstract

AIM: To understand parents' experiences and needs during a child's end-of-life care at home and to identify systemic factors that influence its provision.
BACKGROUND: A child's end-of-life phase is an extremely difficult time for the whole family. Parents have specific needs, especially when they care for a dying child at home.
DESIGN: Concurrent embedded mixed methods design.
METHODS: This sub-study of the nationwide survey, 'Paediatric End-of-Life Care Needs in Switzerland' (2012-2015) included 47 children who received EOL care at home from 2011-2012. We extracted quantitative data from patients' medical charts and obtained information via parental questionnaire and then compared parents whose child died at home or in hospital by computing generalized estimation equations. We thematically analysed interviews with parents who provided EOL care at home.
RESULTS: Parents created an intimate lifeworld and a sense of normality for the child at home. They constantly balanced the family's lifeworld with the requirements and challenges posed by the outside world. This work exhausted parents. Parental 'readiness' and social support drove EOL care for children at home. Parents needed practical help with housekeeping and had negative experiences when dealing with insurance. In only 34.8% of cases was a child's EOL home care supported by paediatric palliative care team.
CONCLUSION: Paediatric end-of-life care at home is only feasible if parents make extraordinary efforts. If family-centred end-of-life home care is provided by a hospital-based paediatric palliative home care team, which includes paid housekeeping help and psychological support, parents' needs could be better met.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Children's Hospital Zurich > Medical Clinic
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:October 2017
Deposited On:08 Feb 2018 11:46
Last Modified:19 Feb 2018 10:58
Publisher:Wiley-Blackwell Publishing, Inc.
ISSN:0309-2402
Additional Information:This is the peer reviewed version of the following article: Volume 73, Issue 10 October 2017, Pages 2462–2472, which has been published in final form at http://onlinelibrary.wiley.com/doi/10.1111/jan.13304/abstract. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.
OA Status:Hybrid
Publisher DOI:https://doi.org/10.1111/jan.13304
PubMed ID:28329430

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