Evaluation of home health service care children with tracheotomy and mechanical ventilator

Abstract

Objective: The aim of this study was to evaluate the clinical characteristics of children with tracheotomy, dependent to mechanical ventilator, taking home care service, their families’ socioeconomic status and attitudes about disease process in Samsun.

Methods: A total of 32 pediatric patients with tracheotomy dependent to mechanical ventilation who were enrolled in the Home Health Services Unit of Samsun Training and Research Hospital between June 2015 and June 2019 were included in the study. After the families of the pediatric patients were informed, verbal and written consent was obtained. The questionnaire consisting of 19 questions was filled by asking the parents during the home visit by the researcher. Demographic and medical data of children, socio-demographic and economic characteristics of the families, their education about the disease process and their psychological status were evaluated by the questionnaire. Statistical evaluation was made by giving percentage rates.

Results: In our study group, there were 19 male and 13 female patients aged between 1 and 16 years. While 28 of the pediatric patients were followed up due to mechanical ventilation, 4 pediatric patients were followed up only by tracheotomy. During the 48-month followup period, 5 ventilator-dependent pediatric patients died and the tracheotomy of 2 pediatric patients was closed. When the primary diseases of our pediatric patients were grouped, 16 (50%) were neurological, 6 (18.7%) were respiratory diseases, 5 (15.6%) were muscle diseases and 5 (15.6%) were metabolic diseases. Thirty-one (96.8%) families with tracheotomy and/or ventilator-dependent pediatric patients who continued their care at home reported that their work and social lives were affected; while one family reported as not affected. It was found that the mothers took care of all the patients and 31 (96.8%) of the mothers stated that their education related to the disease process and the maintenance and use of medical devices were sufficient. The fathers stated that they could not go to work and even they were at work they had to come home in unexpected situations of children. Mothers, on the other hand, stated that they could not leave their child alone in any way, because they could not get out of the house, their neighbors did shopping for them. The results showed that all of the pediatric patients were cared by mothers and 31 of the mothers (96.8%) did not consider themselves sufficient, despite being educated on the disease process, the care and use of medical devices, before their discharge.

Conclusion: We consider that there is a need for comprehensive studies to reduce the repeated hospitalization of children with tracheotomy and mechanical ventilators, to provide in-service training to the relevant healthcare workers within the home healthcare services; and to provide economic, social and psychological support to the families providing care.