Being in control and striving for normalisation: A Norwegian pilot study on parents’ perceptions of hospital‐at‐home

Abstract

In recent decades, there has been a shift from hospitalisation to home care throughout the Western world, even for children. Hospital-at-home for children is in a developmental phase and represents a new service model in Norway. The aim of this pilot study conducted in a Norwegian healthcare setting was to explore how parents with a sick child experienced early hospital discharge and further care at home. The qualitative data are drawn from nine interviews with parents with a child admitted to hospital-at-home. Transcripts of interviews were analysed using a method of qualitative content analysis. In the analysis, Antonovsky's salutogenic perspective on how people cope in demanding life situations was applied. The results show that the parents experienced hospital-at-home as providing a calmer, more predictable family life compared to hospitalisation. They argued that good information and training in medical procedures prior to hospital discharge made hospital-at-home easier to master. The participants pointed out the importance of the professionals' competence and their ability to interact with the child and the parent. The certitude that they could return to the hospital at any time made them feel safe and in control. The parents associated hospital-at-home with a kind of normalisation of their family life. They had a prominent need for normalisation, and this was probably a motivation for agreeing to the hospital-at-home arrangement. The findings indicate that hospital-at-home for children is a good solution if the parents are well prepared and feel in control. In addition, certain structural conditions must be in place before this type of health care is established; there must be a certain volume of patients and the distance to the hospital must be clearly limited. Norwegian policymakers should initiate more pilot testing of hospital-at-home for children. Users and clinicians should be involved in establishing and evaluating these services.

Healthcare costs and productivity losses associated with county‐based home‐care service for sick children in Sweden

“…County‐based home‐care services, provided as a complement to and substitute for hospital care for ill children, does not increase healthcare costs and should, due to positive effects on family everyday life and health 3,9, be a prioritized area when organising future paediatric health care. Productivity losses due to illness are pronounced also when children receive home care, with a trend towards gender‐specific differences.…”

“…Families often prefer care at home to hospital‐based care only 3,8. It can strengthen 7 and normalise everyday family life 9,10 without negative impact on family economy such as the family’s disposable income 11,12,13 or out‐of‐pocket expenses, for example, for travelling 10,14. Systematic reviews indicate that HCS can offer care with medical safety equal to hospital care 2,4.…”

The Childhood Cancer Centre Is Coming Home: Experiences of Hospital-Based Home Care

“…The children stressed that the healthcare professionals had to be skilled, and the parents had to be convinced that the care had been fulfilled satisfactorily. The need for trust has also been highlighted in previous research, where the parents felt it was important to trust and have confidence in the healthcare professionals’ care [ 4 ]. Trust in healthcare professionals is not self-evident and needs to be built up over time [ 30 ].…”

“…However, hospital-based home care can be offered as a viable alternative to hospital care. In previous research, parents experienced this as a calmer and more predictable solution, and more compatible with family life, than being forced to stay in hospital [ 4 ]. In addition, parents can often be financially affected by hospital stays [ 5 , 6 ] and home care can strengthen family life without negatively impacting on the family’s finances due to, for example, travel costs [ 5 ].…”

The work of nurses to provide good and safe services to children receiving hospital‐at‐home: A qualitative interview study from the perspectives of hospital nurses and physicians

“…In other countries, such as the United States and Australia, hospital-based outreach services tend to dominate. In the literature, these services are referred to as 'hospital-based home care' services (Hansson et al, 2012), 'home care services' (Castor et al, 2017), 'paediatric home care service' (Parker et al, 2002), 'early discharge hospital-at-home programmes' (Gonçalves-Bradley et al, 2017) or 'HAH' (Aasen et al, 2018;Parab et al, 2013). In this study, we apply the concept of 'HAH', referring to treatment for children and adolescents with acute or chronic diseases.…”