Physical and Environmental Barriers to Mobility and Participation in Children With Medical Complexity: A Qualitative Study

Caring for children with medical complexity at home: An integrative review

PROBLEM

Despite reporting significant systemic barriers to providing care, burden among parental caregivers of children with medical complexity (CMC) is often attributed to stressors related to disease management. The relationship between parental caregiver burden and systemic barriers within the healthcare bureaucracy, as defined by Ray's Theory of Bureaucratic Caring (BCT), has not been explored. The purpose of this integrative review was to examine which elements of the bureaucratic healthcare system are contributing to burden among parental caregivers of CMC living at home.

ELIGIBILITY CRITERIA

Refereed research articles related to the experiences of parental caregivers of CMC living in the United States published after 2014.

SAMPLE

1967 articles were obtained on initial literature search. Using the PRISMA algorithm, ten articles published between 2018 and 2022 were ultimately selected for appraisal.

RESULTS

Parental caregiver burden was consistently attributed to barriers and gaps among social-cultural, physical, political, legal, economic, technological, and educational elements of the bureaucratic healthcare system.

CONCLUSIONS

Weaknesses across the bureaucratic elements of the healthcare system prevent CMC from consistently receiving necessary care which in turn, contribute to feelings of burden among their parental caregivers. Efforts to alleviate burden experienced by parental caregivers should focus on addressing gaps within the healthcare bureaucracy.

IMPLICATIONS

Nurses are well-positioned to address these gaps through clinical work, advocacy, and research. Future research should further examine the appropriateness of using BCT to better understand the implications of systems-level weaknesses on parental caregiver burden. Parental caregivers of CMC should be closely involved in this process.

Usability of the dynamic scaffolding system: an adaptive mobility device in children with special needs

PURPOSE

Maintaining vertical position and moving are essential to healthy development. Children with motor difficulties may need assistive devices to stand upright or move. The Dynamic Scaffolding System (DSS) device was developed to support these skills. This study aims to explain the DSS's developmental stages, compare the device's usage times based on diagnoses and motor impairment, and investigate the degree of satisfaction among parents of children using the device.

MATERIALS AND METHODS

The study included children with difficulty standing or stepping and their parents. We compared usage times of DSS depending on diagnosis (cerebral palsy (CP) or other diagnoses) and motor impairment levels. We assessed parental satisfaction by using the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST 2.0) and recorded adverse events.

RESULTS

The ages of the participants (n:100) were between 9 and 108 months (44.94 ± 17.59), and 60% of the children had CP, and 40% had other diagnoses (genetic, metabolic, neuromuscular diseases). The duration of daily use of DSS ranged from 44.17 (±26.16) to 110 (±97.98) minutes, and the duration was similar among children at different levels of motor impairment (p = 0.262). The parents were most satisfied with the size, simplicity of use, and effectiveness, and they were least satisfied with the ease of adjustment, safety, and durability. They did not report any adverse events during the study.

CONCLUSIONS

DSS can be considered a useable assistive device option for children with CP and other diagnoses with difficulty standing or stepping and a satisfactory device for parents of such children.