American Family Children's Hospital, Madison, Wisconsin, USA.
The University of Wisconsin-Madison School of Nursing, Madison, Wisconsin, USA.
J Spec Pediatr Nurs. 2021 Jan;26(1):e12314. doi: 10.1111/jspn.12314. Epub 2020 Oct 24.
The purpose of this study was to obtain feedback on communication, care coordination, and transitions in care for hospitalized children with medical complexity (CMC).
This descriptive, mixed-methods study used online surveys with forced-choice and open-ended questions to obtain stakeholder feedback. Stakeholders included parents, healthcare providers, and nurses. Participants over 18 years of age were recruited from a Midwest children's hospital inpatient unit dedicated to care of CMC. Quantitative data were analyzed using t-tests and one-way analysis of variance. Qualitative description was used to analyze responses to open-ended questions.
Parents' ratings of communication, care coordination, and transitions in care were generally high. Transitions from other facilities to the emergency department and unit received lower ratings. Providers and nurses gave high ratings to overall care, communication among providers and nurses on the patient unit, and experiences with discharge; however, between unit communication and unit-based coordination received lower ratings. Providers and nurses had higher ratings for discharge preparation than parents (p ≤ .001). Three themes were identified in responses to the open-ended questions: establishing balanced and collaborative relationships between the care team and families, taking a proactive approach to care coordination, and the importance of an inclusive, interdisciplinary, and centralized approach to care coordination and communication.
Collaboration among all stakeholders is needed to achieve coordinated care, inclusive communication, and transitions with positive outcomes during hospitalization. Parents identified a need for consistent communication from care teams, with the primary inpatient team taking a lead role. Including parents in care coordination and transitions in care is key, as they are the experts in their children's health and well-being.
本研究旨在获取有关住院医疗复杂儿童（CMC）的沟通、护理协调和转介的反馈。
本描述性混合方法研究使用带有强制选择和开放式问题的在线调查来获取利益相关者的反馈。利益相关者包括家长、医疗保健提供者和护士。参与者年龄在 18 岁以上，从一家中西部儿童医院的住院病房招募，该病房专门负责 CMC 的护理。使用 t 检验和单因素方差分析对定量数据进行分析。使用定性描述分析对开放式问题的回答进行分析。
家长对沟通、护理协调和转介的评价普遍较高。从其他机构转至急诊部和病房的转介得到的评分较低。提供者和护士对整体护理、病房内提供者和护士之间的沟通以及出院经历给予高度评价；然而，单元间沟通和单元内协调的评价较低。提供者和护士在出院准备方面的评分高于家长（p≤.001）。对开放式问题的回答中确定了三个主题：在护理团队和家庭之间建立平衡和协作关系、采取积极主动的护理协调方法，以及采用包容、跨学科和集中的护理协调和沟通方法的重要性。
需要所有利益相关者之间的协作，以实现协调一致的护理、包容的沟通以及住院期间积极的转介结果。家长表示需要护理团队提供一致的沟通，主要的住院团队应发挥主导作用。让家长参与护理协调和转介非常重要，因为他们是孩子健康和福祉的专家。
