Pediatric considerations in homecare.

"If I had known beforehand how difficult, demanding, time consuming, and exhausting it would be--having my child home on a ventilator--I would never have agreed to bring her home" (personal communication with a parent, 1994). This mother's statement strikes at the heart of pediatric high-tech homecare. Parents assume caregiver roles that professional health providers have taken years to develop. Nurses, as strangers, intrude into intimate family relationships that have cultivated over years. Pioneering agencies attempt to fill a gap in pediatric care using guidelines that have been entrenched in the medical and economic models for years. The multiple dimensions of high-tech pediatric homecare require more than provision of technical nursing services. In homecare, nurses are challenged by cultural differences, language barriers, loss of control, family dynamics, practicing in unfamiliar environments, and new technology. To ensure quality nursing care, all professional dimensions need to be considered to be of equal importance.