Who benefits when parents administer intravenous antibiotics, at home, to children with cystic fibrosis? A critical review.
[Dissertation (University of Nottingham only)]
Introduction: Cystic fibrosis (C.F.) is the most prevalent hereditary life-limiting disorder in the United Kingdom (Cystic Fibrosis Trust, 2008). Contemporary social policy states that, whenever possible, young people are best cared for at home(Department of Health, 2003; Department of Health, 2004c). Parents are being taught to perform many complex tasks that would only have been undertaken by healthcare professionals, in the hospital setting, in the past. Since the introduction of home intravenous antibiotic therapy, by parents (H.I.V.A.T.) the prevalence of parents administering it has greatly increased.
Aims: To undertake a critical review into the administration of H.I.V.A.T. for children who have C.F. All stakeholders will also be identified. The advantages and disadvantages will be explored to investigate who benefits.
Methodology: A critical review was undertaken using the ‘Stages of the reviewing process’ framework (Hek et. al., 2000; Figure 1) and a search strategy containing the keywords ‘home’ ‘intravenous’ and ‘cystic fibrosis’. Literature was evaluated using critical appraisal frameworks (Public Health Resource Unit, 2008a; Langton, 1999).
Results: Of 109 articles found, 90 potentially relevant studies were accessible. Of these 90, 23 remained once the inclusion/exclusion criteria was applied. These articles were then supplemented with exploration of social policy and relevant grey literature. Thematic analysis highlighted the risks and benefits of H.I.V.A.T. from the perspectives of numerous stakeholder groups.
Conclusion: It was discovered that in the short-term, H.I.V.A.T. can be beneficial to all stakeholders if implemented effectively, although hospitalisation remains favourable for some service users. ‘The conical model’ was constructed depicting the stakeholders and considerations which must be made before responsibility for administering H.I.V.A.T. is given to parents.
Recommendations: The conical model should be implemented by healthcare professionals, when a family is considering H.I.V.A.T. as an aid-memoir to take into account individual family circumstances, prior to commencing each course of therapy. It is also vital that rigorous, long-term and multi-centred research is undertaken including exploration of the effect it has on all stakeholders.
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