presented by Deborah Boroughs
This course gives students an overview of the high-stake, high-risk nature of nursing care in the home of medically-complex, fragile children. Common diagnostic categories of children with complex health care needs who receive in-home nursing care are identified. Primary preventable causes of death in pediatric home care are listed. Nurse competence to care for the fragile child and family at home is defined. Essential training components for the home care nurse are listed.
Deborah Boroughs, RN, MSN, has extensive professional and personal experience in the management of medically complex children. As an advanced practice nurse, she led a professional team of nurses and social workers as the director of the Pennsylvania Ventilator Assisted Children’s Home Program (VACHP), a Pennsylvania Department of Health program with offices at Children’s Hospital of Philadelphia and Pittsburgh Children’s Hospital. She is a much-published author of professional journal articles and textbook chapters, and a lecturer about care of the complex pediatric patient. She has taught pediatric and community health nursing at two universities. She currently serves as a consultant to home care agencies, an expert witness for legal cases, and a nurse educator of home care nurses. Personally, she is the mother of eight children, six of whom are adopted and have complex health care needs, including two ventilator-dependent children.
The pediatric intensive care unit has moved to a home setting. This chapter will explain the high-risk nature of caring for a medically-fragile child at home. The common diagnostic categories of medically-fragile children in pediatric home care are listed. Preventable accidental death causes and statistics in pediatric home care are presented. The process for decreasing accidental mortality of fragile children in home care is outlined.
The specific training and assessment skills required for home care nurses of medically-fragile children is described. Autonomous home care of a fragile child requires a different focus than hospital nursing care; thus, training methodology and a training agenda for nursing care of the fragile child at home is suggested.
Evidence-based practice differentiates clinical opinion and scientific evidence in pediatric home care nursing. What defines competence of the nurse who cares for a fragile child at home? This chapter describes the elements and assessment of competence for pediatric home care nurses before they assume autonomous care of a fragile child.