Characterisation of information Hospitals Provide Parents on Tube Feeding, Including Tube Weaning

"I can't provide what my child needs": Early feeding experiences of caregivers of children with craniofacial microsomia

PURPOSE

Craniofacial microsomia (CFM) is a congenital condition that can be associated with feeding challenges in infants. As part of the larger 'Craniofacial microsomia: Accelerating Research and Education (CARE)' program, this study described caregivers' early feeding experiences.

DESIGN AND MATERIALS

US-based caregivers of 34 children with CFM participated in remote narrative interviews. Two authors completed inductive thematic analysis in an iterative process until consensus was reached.

RESULTS

Caregivers' narratives outlined the inherent challenges of feeding an infant with special healthcare needs. The first theme 'Navigating Challenges and Managing Expectations' describes the distress participants experienced when they were unable to breastfeed and the negative emotional effect of switching to formula. The second theme 'Making Adaptations' outlines the methods participants tried, including breast pumps and feeding tubes. The third theme 'Accessing Support' describes participants' interactions with healthcare providers and challenges accessing feeding support. The final theme 'Growing from Adversity' recounts participants' relief once their child established a feeding pattern and the personal growth gained from their experiences.

CONCLUSIONS

Caregivers reported several feeding related challenges associated with CFM, many of which negatively affected their wellbeing. Negative consequences were particularly pronounced in cases where caregivers' feeding experiences differed from their expectations. Participants identified challenges in accessing reliable feeding information and support. Despite difficult experiences, caregivers cited some positive outcomes, including increased confidence and resilience.

PRACTICE IMPLICATIONS

Holistic feeding information and support for families affected by CFM should be inclusive of several feeding methods to improve care delivery, child health, and the caregiver experience.

Process improvement of a paediatric feeding clinic

Purpose

The purpose of this study is to identify opportunities to improve processes within a paediatric feeding clinic to enhance timely patient access to healthcare through effective and efficient resource use.

Design/methodology/approach

The study involved three interrelated methods. First, de-identified feeding clinic data, collected over seven years, were analysed to understand patient appointments. Second, clinician workshops and the swim lane method were used to map feeding clinic processes. Third, root cause analysis was conducted to identify bottlenecks and identify improvement opportunities.

Findings

The results revealed three, poorly connected sub-processes within the feeding clinic - namely: the patient triaging and appointment scheduling or allocation process; the clinic reporting process; and the cancellation and rescheduling process. These sub-processes were poorly connected because of inadequate resources, few standardised processes, and limited coordination between the different processes. Consequently, patient appointments were typically delayed, and patient reports were not always completed in a timely manner. Processes within the paediatric feeding clinic could therefore be improved by using digital tools, patient portals and telehealth, online interventions, an automated appointment confirmation system, and/or an automated transcription of each appointment.

Originality/value

This is the first published study to apply business process management to a paediatric feeding clinic. By using three methods to clarify opportunities to improve clinic processes, it highlights the potential value of health information technology in this context. This evidence will enable health service managers to ensure that children with feeding difficulties have timely access to appropriate care.

Characteristics and health service utilization of children most at risk for prolonged temporary tube feeding

BACKGROUND

This study aimed to describe children at risk of prolonged temporary tube feeding and evaluate associations between tube feeding duration and child and health service variables.

METHODS

A prospective medical hospital records audit was conducted between November 1, 2018, and November 30, 2019. Children at risk of prolonged temporary tube feeding were identified as having a tube feeding duration of >5 days. Information was collected on patient characteristics (eg, age) and service delivery provision (eg, tube exit plans). Data were collected from the pretube decision-making phase until tube removal (if applicable) or until 4 months after tube insertion.

RESULTS

Descriptively, 211 at-risk children (median, 3.7 years; interquartile range [IQR], 0.4-7.7) differed from 283 not-at-risk children (median age, 0.9 years; IQR, 0.4-1.8) in terms of age, geographical location of residence, and tube exit planning. Medical diagnoses of neoplasms, congenital abnormalities, perinatal problems, and digestive system diseases in the at-risk group were individually associated with longer than average tube feeding duration, as were the primary reasons for tube feeding of nonorganic growth faltering and inadequate oral intake related to neoplasms. Yet, variables independently associated with greater odds of lengthier tube feeding durations were consultations with a dietitian, speech pathologist, or interdisciplinary feeding team.

CONCLUSION

Children at risk of prolonged temporary tube feeding access interdisciplinary management because of their complexity. Identified descriptive differences between at-risk and not-at-risk children may be useful when selecting patients for tube exit planning and developing tube feeding management education programs for health professionals.

How to support parents and healthcare professionals in the decision-making process of tube feeding in children?

BACKGROUND

Tube feeding in children has a severe psychosocial impact on children and their families. Parents also feel that they have limited communication with healthcare professionals (HCPs) about decision-making and the implications of tube feeding.

OBJECTIVE

This study focussed on the parents' experiences and expectations about tube feeding of children and a solution to improve the management and communication of it.

METHODS

We applied a design thinking method in two parts. First, focus groups and individual interviews were conducted with parents of children aged 0-10 years who are or had been tube fed and HCPs. Thereafter, two sounding boards with HCPs and parents were convened to discuss improvements in the management of tube feeding.

RESULTS

In total, 17 parents participated in the study. Two main topics derived from the focus groups and interviews: psychosocial impact and communication with HCPs. The sounding boards (five HCPs and two parents) divided the challenges of tube feeding into three stages: the moment tube feeding is considered, the insertion of the tube in the hospital, and transfer to the domestic environment and follow-up. Interview topics were used to develop a communication sheet to support the decision process of tube feeding.

CONCLUSIONS

The empowerment of parents in the process of tube feeding is important. More attention should be paid to alternatives, consequences, and planning for the long term. The developed communication sheet offers suggestions for issues to discuss and could support communication between parents and HCPs about tube feeding.

Education Following Pediatric Gastrostomy Tube Placement: An Integrative Review

BACKGROUND

There is a gap in knowledge regarding the necessary components for pediatric gastrostomy tube education. This integrative review addresses the question "What are the educational components following pediatric gastrostomy placement?"

METHODS

A literature search was conducted using PubMed, CINAHL, and Cochrane Library electronic databases, along with a hand search. Articles for review included those in the pediatric population, English language, and publication dates between 2010 and 2020.

RESULTS

Ultimately, 7 articles met the inclusion criteria for review. Articles were all pediatric focused (0-18 years), and were a mix of quantitative and qualitative designs, along with one non-research paper. Three major themes were identified from the literature including that gastrostomy tube education should be a multidisciplinary effort, that education should take a standardized approach, and that it should include psychosocial elements that enhance caregiver knowledge and empowerment.

DISCUSSION

This review demonstrates that while there is no consensus on a superior mode or means of education, pediatric gastrostomy discharge education must be standardized and high quality to promote the best patient and caregiver outcomes. Further research should aim to address which forms of education, if any, lead to the best outcomes, and how education can best be delivered to promote caregiver knowledge and ease.

A Decision Aid for Nutrition Support is Acceptable in the Pediatric Hospital Setting

PURPOSE

Incorporating a Decision Aid (DA) about nutrition support into the general pediatric healthcare setting may improve parent and patient understanding about the risks and benefits of nutrition support options. We aimed to evaluate the acceptability and usability of our newly developed DA for parents of children in the general pediatric healthcare setting who require nutrition support.

DESIGN AND METHODS

Participants were 18 parents with a child who had received nutrition support; and 12 Healthcare Professionals (HCPs) involved in pediatric nutrition support discussions. Parents' and HCPs' ratings of acceptability and feasibility of the booklet, and parents' perceived knowledge acquisition after reading the booklet were assessed.

RESULTS

Parents were satisfied with the DA, reporting that it was an appropriate length and unbiased. Most parents felt the DA was relevant to their decision-making, improved understanding, and would recommend it to other parents. HCPs felt that the booklet clearly described the essential information for nutrition support options, but less certain of the booklets' impact on parent decision-making. Regardless, most HCPs would recommend the booklet to other clinicians.

CONCLUSION

Our decision aid appears to be acceptable and useful for parents deciding on nutrition support for their child in the general pediatric hospital setting.

PRACTICE IMPLICATIONS

A DA may facilitate shared decision-making through improved understanding of the risks and benefits of different nutrition support options in the pediatric setting. Further evaluation is required with specific pediatric conditions, to determine the effectiveness for parents actively deciding on their child's nutrition support.

Parenting children who are enterally fed: How families go from surviving to thriving

BACKGROUND

Complex feeding difficulties requiring enteral (tube) feeding affect everyone around the child. Parents experience additional stress and are at risk of social isolation. This study investigated the strategies families develop and use to adjust and adapt to enteral feeding so they were not just surviving but thriving as a family.

METHODS

Twenty parents whose children had been or continued to be enterally fed were interviewed, four of them twice as their experience of enteral feeding progressed. Learning theory was used to conceptualize findings in terms of changing use of tools that mediated parents' response to feeding-related challenges.

RESULTS

Parents encountered dilemmas relating to enteral feeding: maintaining participation in everyday activities, managing responses to the use of tubes for feeding, and doing what feels right for their child. They used four kinds of mediating tools to overcome these: memory aids and readiness tools, metaphors and narratives, repurposed everyday objects and personalized routines and materialities.

CONCLUSIONS

This novel account of tool used to resolve dilemmas provides an empirically and theoretically grounded basis for supporting parents to thrive despite the challenges of enteral feeding. Specifically, it can guide information given to help parents anticipate and cope with dilemmas arising from enteral feeding.

Weaning children from temporary tube feeding: Staff survey of knowledge and practices

AIM

To explore the understanding of and practices of health-care workers in weaning children from feeding tubes.

METHODS

An electronic survey of doctors, nurses, and allied health professionals at Children's Health Queensland obtained demographic information and awareness of various areas of tube feeding management particularly tube weaning.

RESULTS

The 155 health-care providers formed three well-matched groups in terms of number and years of experience. Only 18 had formal training in tube weaning. Participants had high levels of knowledge regarding reasons for commencing and possible complications associated with tube feeding. However, health-care providers generally were found to have limited to no knowledge of tube weaning practices. Nearly half of participants (46%) did not know the best time to plan for a tube wean and only 16 indicated that they or their work units documented tube exit plans, regardless of type of feeding tube, in children's medical charts. Time frames were rarely included as part of tube exit plans. Participants ranked medical stability and presence of a safe swallow most highly as important indicators for successful tube weaning. Multidisciplinary management was also identified as valuable. Tube weaning was predominately managed by children's primary health unit/service and largely involved a medical officer and dietician.

CONCLUSIONS

Poor awareness of tube weaning practices such as tube exit strategies may be impacting on the quality of care received by children who are tube fed. Future research should be directed towards developing and evaluating guidelines accompanied by educational resources to further advance tube weaning practices.