How do clinical teams help parents to share care of children ...

How do clinical teams help parents to share care of children ...

How do fathers and mothers share care of their childs long term condition with clinical teams? Research team: Dr Veronica Swallow, Dr Heather Lambert, Professor Sheila Santacroce, Mrs Ann Macfadyen Grateful thanks to : The parents who took part The British Renal Society (Grant 06-017) and The Childrens Kidney Unit Fund, Royal Victoria Infirmary, Newcastle Background Up to 30% of children and young people have a long term condition that needs regular treatments and special care

Children and young people are usually happier at home rather than in hospital The Department of Health (DH) therefore, encourages clinical teams, whenever possible, to help parents give treatments and special care at home But this means parents: may perform the vast majority of care-giving, including tasks that are complex and demanding (DH 2006) Just some of the things parents may need to do for their child at home Previous international research

Fathers opinions about their role in their childs treatments and special care were often not invited Sometimes fathers were invited but chose not to take part in the research However, when fathers who were involved in their childs treatments and special care also took part in research about this, the results suggest there were some benefits for the children Our research at the University of Manchester In our Programme of Research on Family Learning in Long Term Conditions we are trying to find out the best

ways for clinical teams to help parents care for their childs condition This will help parents and professionals to keep children as well and as happy as possible In our earlier research with families, parents said they sometimes find it hard to: give the treatments/special care if it upsets or hurts their child understand: how to give treatments and special care what each parents individual role in this was fit the treatments and special care into busy family life

say if they find any of these things difficult in case the clinical team will think they are not good parents In addition: fathers & mothers views sometimes differed within couples Our earlier research with clinical teams found they sometimes wanted to know more about: The types of teaching that work best for individual parents How much information or support parents want The types of information and support parents would like

To build on previous research and find out more about fathers and mothers individual views The British Renal Society funded our Fathers and Mothers Study We asked 14 couples (parents of 15 children with a long term kidney condition) to take part in tape-recorded research interviews First we talked with each father and mother separately Next we talked with each of the couples jointly Our findings relate to five main areas of parents experiences 1 Developing skills 1.1 Clinical / technical

1.2 Processing information 1.3 Dealing with professionals 1.4 Communicating with others 1.5 Decision making 2 Impact on Life 2.1 Changed opportunities 2.2 Managing medical supplies 2.3 Relationship changes 2.4 View of the future 2.5 Treatment side effect 3 Coping 3.1 Self

3.2 Child 5 Things that help 5.1 Practical support 5.2 Understanding 5.3 Talking 5.4 The child 5.5 Seeing others worse off 4 Mutual support 4.1 Working together 4.2 Active support 4.3 Passive support

4.4 Mutual awareness More on our findings: with the exception of situations where one parent worked away from home, both said they were involved in giving treatments and special care at some time no mothers said that they were left with the bulk of care giving some unexpected findings from our research include: Some (particularly mothers) gave vivid accounts of the

physical and emotional effects on themselves of giving treatments and special care I mean I used to sit there and my heart was going and I was hyperventilating and I was feeling sickit was horrible trying to control that and

learning not to panic - I dont think I ever actually mastered that (Mother) Some fathers commented on the effect that giving treatments and special care had on their relationship with the mother, and the family as a whole,

one said: I think the hardest thing for me was probably trying to come to terms with your reaction and dealing with you (father to mother in joint interview) There were some differences in the ways mothers and fathers processed information

Fathers tended to want the bigger picture, as this quotation from the father of a child who had a kidney transplant shows: That is what I liked about it really, we seemed to know from day one what was going to happen with all the procedures, what would happen if it didnt work

And generally took a long term view: Its [sons condition] a bomb ticking away in the background . . . you wonder what hell be like in 10, 15, 18 years (Father) Mothers wanted to understand what the impact would be on day to day life, the mother of this same child said I still dont think long term . . . he [childs father] wonders more about whats going to happen later;

Im more here and now (Mother) Some fathers said it helped to go quiet, have some space or disengage from caregiving for a short time to think about what was happening. One father, for instance, said new information could be overwhelming: I think the driving back

home sometimes helped, just the drive, because I was on my own and I didnt have information being thrown at me either from what I saw or heard or people speaking to me about stuff, We asked about this in later, joint interviews;

if the father said he found it helped to disengage, the interviewer asked: What is it you are doing when you are quiet? In one joint interview the mother said: Oh I would like to know that! The father explained: I dont know, you just think about what could happen, what is happening, how long is it going to take for the

results to come through?... I think there are a million things going through your head. You think of every possibility This may indicate that mothers and fathers process the same thoughts in different ways. This warrants further investigation We also reviewed results from 29 other research studies that involved fathers and

which took place in other countries Our review tells us more about: 1. the impact of long-term conditions on fathers ability to promote their child's well-being 2. factors influencing fathers involvement in health care 3. personal growth beneficial effects for fathers 4. the impact of fathers involvement on family functioning

5. strategies that increase fathers participation in their child's health care and in research investigating fathers participation Helen and Graeme Walker are one couple who took part in our Fathers and Mothers study In the next 16 slides they explain some of their shared perspective of having a daughter with a long term condition Alex Walker: 4 October 1990 th Alex was a perfectly healthy, normal baby No complications during pregnancy

No problems with her birth Alex through the ages! Alex aged approx 5 months Still no indication of kidney problems She had a talent for projectile vomiting! Doctors told us this was nothing to worry about Toddlerhood All is still well! Infant school years Still apparently OK

Alex aged 7 Starting Junior School Teachers comment that she lacked drive We never suspected anything was wrong as she appeared normal at home With hindsight, she was starting to look pale Alex started to look yellow and became breathless Doctors originally diagnosed asthma, but took blood samples because they also suspected diabetes due to Alexs excessive thirst

February 2000 Rushed to hospital with suspected end stage renal failure Stabilised in Carlisle before being transferred to the RVI in Newcastle Diagnosis confirmed. Hopes that this was a short term problem were dashed. We did not realise the enormity of what was to come Fitted with Tenchkoff catheter and started dialysis Three operations to get the catheter working correctly took an emotional

toll on the whole family. Meanwhile we were taught how to do dialysis at home A six week stay in hospital and we were competent but going home did not equate to going back to normality. Its never normal. Stable on dialysis but cloudy fluid on the first drain after a night off meant many late night trips across to Newcastle Sleepovers with friends had to be

planned well in advance Dietary constraints were always at the front of our minds We tried to make life as normal as possible. Halloween doesnt stop just because of dialysis. Physically, Alexs condition was being managed, but the emotional side was something we werent prepared for Alex would sometimes hide in the bathroom to avoid being connected up for dialysis. Early on, it had caused

extreme pain. As her parents, we found this emotionally draining and each had to find our own way of coping and supporting each other 10 months of dialysis and routine was established Alex did EPO injections herself, despite becoming quite phobic of needles

Calcium carbonate tablets with every meal could be an issue at times She undertook her own catheter care and even put herself on dialysis with dads supervision (mum didnt know!) Transplant 4 January 2001 th Alex had a kidney transplant after 11 months on dialysis The practicalities of life returned to a more normal level BUT There were still drugs

There were still doctors There were still uncertainties about the future Alex and little brother Stephen was 6 when Alex was diagnosed Kidney disease affects the whole family Stephen stayed with grandparents

when Alex was first admitted to hospital When Alex had her transplant he came with us. We couldnt be separated again. Alex grows up! Alex hasnt let any of this hold her back She is proud of her transplant scar and doesnt regret anything that has happened As parents, we have sometimes found it difficult

to let Alex take responsibility for her own health, but that is what you have to do The transition to Adult Services meant that we had to train a new team of health professionals to give us the information we need We still ask her if she has taken her tablets, even though she never misses. Its hard to stop! Alex is now a student Childrens Nurse at Northumbria University and she

works at the hospital where she had her transplant Her kidney might not last forever. She doesnt let it worry her We do! She still celebrates Halloween in style! So what next? We are building on this research with two more studies which both include fathers and mothers: 1. Teaching parents to become home-based care-givers of childrens longterm kidney conditions: a mixed methods survey of Childrens Kidney

Units in England, Scotland and Wales. Funded by Kids Kidney Research UK 2. The OPIS (On-line Parent Information and Support) project: Meeting mothers' and fathers' information and support needs for home-based management of childhood chronic kidney disease. Funded by NIHR Research for Patient Benefit Programme References: DOH. National Service Framework for Renal Services: Working for Children and Young People. London 2006:14 Gavin, L. and T. Wysocki (2006). "Associations of paternal involvement in disease management with

maternal and family outcomes in families of children with chronic illnesses." Journal of Pediatric Psychology 31(5): 481-489. Swallow V, Macfadyen A, Lambert H, Santacroce S. Fathers contributions to management of their childrens long-term medical conditions: a narrative review of the literature. Health Expectations. 2011; Online doi: 10.1111/j.1369-7625.2011.00674.x Swallow V, Lambert H, Santacroce S, Macfadyen A. Fathers and mothers developing skills in managing childrens long-term medical conditions :how do their qualitative accounts compare? Child: Care Health & Development. 2011, 37, 4, 512523 doi:10.1111/j.1365-2214.2011.01219.x Macfadyen A, Swallow V, Santacroce S, Lambert H (2011) Involving fathers in research. Journal for Specialists in Pediatric Nursing doi: 10.1111/j.1744-6155.2011.00287.x Swallow V, Clarke C, Campbell S, Lambert H. Nurses as family learning brokers: shared management

in childhood chronic kidney disease. Journal of Nursing and Healthcare of Chronic Illness. 2009;1:49-59 Swallow V, Lambert H, Clarke C, Campbell S, Jacoby A. Childhood chronic-kidney-disease: A longitudinal-qualitative study of families learning to share management early in the trajectory. Patient Education and Counseling. 2008;73:354-62 Swallow V. An exploration of mothers' and fathers' views of their identities in chronic-kidney-disease management: parents as students? Journal of Clinical Nursing. 2008;17:3177-86

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