Caring for Children Who Are Technology-Dependent and Their
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Advances in Nursing Science Vol. 42, No. 2, pp. E13–E23 Copyright c 2019 Wolters Kluwer Health, Inc. All rights reserved. Caring for Children Who Are Technology-Dependent and 1.0 Their Families The Application of Watson’s Caring Science to Guide Nursing Practice Sydney Breneol, BScN; Lisa Goldberg, PhD; Jean Watson, PhD Advancements in the medical field have resulted in an increased number of children with complex chronic conditions that may depend on technology to sustain or optimize life. Given that nurses provide substantial physical and emotional care for these children and families during their frequent hospitalizations, the development of an authentic caring relationship is imperative. A critical review of the literature examining the experiences and unmet care needs of this population was carried out and analyzed using Watson’s Caring Science to explore how nurses can create an authentic caring relationship and environment for children who are technology-dependent and their families. Key words: children, critical review, nursing, nursing theory, pediatrics, technology-dependent, Watson’s Caring Science HE aim of this article is to explore how erature examining the experiences of this T nurses can develop a caring relation- vulnerable population was carried out and ship and environment for children who are analyzed through Watson’s Caring Science. technology-dependent and their families. To Watson’s Caring Science provides a theoret- achieve this aim, a critical review of the lit- ical and pragmatic framework that engages the compassion and authentic human caring inherent to nursing practice. Leveraging criti- Author Affiliations: School of Nursing, Dalhousie cal review methodology, this article provides University, Halifax, Nova Scotia, Canada (Ms Breneol and Dr Goldberg); and Watson Caring nurses with an understanding of the unique Science Institute, Boulder, Colorado (Dr Watson). relational and caring needs of children who Authors Contributions: All authors made substantial are technology-dependent and their families. contributions to the conception of the manuscript. S.B. Implications to further develop and enhance and L.G. designed and mapped the aim and methods of this article. S.B. drafted the initial manuscript. L.G. and pediatric practice, education, and research J.W. edited the manuscript and provided substantive are provided. intellectual content. S.B. is supported by funding from the Predoctoral Kil- lam Scholarship, Doctoral Nova Scotia Health Research BACKGROUND Foundation Scotia Scholars Award, Dalhousie Univer- sity School of Nursing PhD Scholarship, Helen Watson Memorial Scholarship, and the BRIC NS Student Re- Advancements in medical technologies and search Award. treatments have resulted in improved survival There are no conflicts of interest to declare. rates and long-term management of children with acute and chronic illnesses. Children Correspondence: Sydney Breneol, BScN, Strengthen- ing Transitions in Care Lab, IWK Health Centre, 8th with special health care needs are a unique Floor Children’s Site, 5980 University Ave, Halifax, NS and resource-intensive population within the B3K 6R8, Canada ([email protected]). pediatric health care system.1 These children DOI: 10.1097/ANS.0000000000000238 and youth are often defined as those “who E13 Copyright © 2019 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. E14 ADVANCES IN NURSING SCIENCE/APRIL–JUNE 2019 is present.2–5 Children who are technology- Statements of Significance dependent have a variety of complex diag- What is known, or assumed to be noses including severe neurological impair- true, about this topic? ments and acquired or congenital multisystem diseases that rely on the use of technologies • Studies emerging from the such as gastrostomies, tracheostomies, oxy- United States and Canada have gen, and/or mechanical ventilation.5,6 shown an increased prevalence The Office of Technology Assessment pro- of children with complex poses that this population may be character- chronic conditions within ized on the basis of the presence of a “medi- pediatric hospitals. caldevicetocompensateforthelossofvital • Nurses provide substantial bodily function and require substantial and physical and emotional care for ongoing nursing care to avert death or further children who are technology- disability.”5(p3) Moreover, it is recognized that dependent and their families this type of nursing care may be provided by during their often frequent a range of individuals, including nursing pro- hospitalizations, thus requiring fessionals and/or trained parents/caretakers.5 special human caring practices Although we present this characteristic, we to attend to these children and recognize the problematic consequences that their families. may further marginalize this vulnerable pop- • Nurses have the unique ulation by imposing a restrictive and nar- opportunity to attend to the row definition. Thus, we remain inclusive and child and family’s relational and broad when describing/identifying this popu- emotional needs within the lation to encompass the wide variety of char- hospitalized setting through the acteristics and conditions present within this development of an authentic population of children. caring relationship. Children who are technology-dependent What this article adds? require substantial health care resources and experience frequent hospitalizations and • Through the application of unplanned readmissions.4,7–9 A cohort study Watson’s Caring Science, this emerging from Ontario, Canada, suggests that article explores how nurses can children with medical complexity represent create a caring relationship and less than 1% of the pediatric population environment for children who while accounting for more than one-third are technology-dependent and of their entire province’s pediatric health their families within the care spending.7 Of this pediatric population, hospitalized setting. approximately 12% required the use of tech- nology to assist or prolong life.7 Furthermore, studies emerging from the United States have shown an increased prevalence of children have or are at increased risk of chronic phys- with complex chronic conditions within ical, developmental, behavioral, or emotional pediatric hospitals.3,10–13 This increasing conditions and require health care and related population of children has been shown to services of a type or amount beyond that re- account for an estimated 75% to 92% of quired by children generally.”1(p138) Within technology assistance–related procedures. this population, an emerging subgroup of chil- This increased use of acute care services, and dren with severe medical fragility and com- the frequent advancements in life-sustaining plex chronic conditions that often depend technologies, highlights the importance on technology to sustain or optimize life for nursing professionals to be prepared to Copyright © 2019 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. Application of Caring Science E15 care for the diverse needs of this vulnerable Dr Jean Watson began the development population. of the Theory of Human Caring to refocus Children with medical fragility require the art and science of care away from the substantial and long-term nursing care both dominant biomedical, technological, and cu- within and outside the hospital setting.14 rative model surrounding nursing practice.22 Nurses must be competent in their psychomo- Watson believes and affirms that human-to- tor skills when caring for these children, human caring should remain foundational to given their risk for adverse health outcomes the nursing discipline.22 Now known as Wat- such as airway obstruction or accidental death son’s Caring Science, this theory has devel- from technology malfunction.9,15 However, oped into a “theoretical, philosophical, and despite reported financial burdens,16,17 dis- ethical framework,”23(p469) placing the art and turbed home life,18 increased stress levels,19 science of care at the core of the nurs- increased rates of depression,17,19 and de- ing discipline.22 Watson’s theory achieves a creased ability to establish trusting provider- greater level of awareness into the various parent relationships,20 there continues to physical and nonphysical dimensions of hu- be a lack of emphasis “on the emotional man care by encouraging nurses to draw and social needs of these children and their upon their artistic, aesthetic, spiritual, empir- families.”14(p38) Given that nurses provide ical, political, and ethical ways of knowing to physical and emotional care for these families achieve a higher level of human connected- during their frequent hospitalizations, the de- ness with their patients.22,24,25 Watson’s Car- velopment of an authentic caring relationship ing Science further explores the connected- is imperative.21 Despite this relationship be- ness between humans and their lives while ing fundamental to providing compassionate placing great emphasis on the relations be- and ethical nursing care, this concept remains tween the nurse and the patient.22 These as- critically understudied in the literature. sumptions allow a deeper understanding into the inner subjective phenomenon of human care experiences of nursing practice, one that Watson’s Caring Science could not be achieved by the prevailing objec- Watson’s Caring Science provides an tive biomedical-technological model.22 insightful framework to explore the act This theory challenges nurses to look be- and process of