Background
Methods
Setting and participants
N | |
---|---|
Types of Technology Used | |
Feeding Tube | 15 |
Mechanical Ventilation | 6 |
Trachea | 3 |
02 Therapy | 6 |
Wheelchair | 15 |
Suctioning | 4 |
Saturation Monitor | 4 |
Lifts | 7 |
Walker/Stroller/Bike/Stander/Cart/Chair | 22 |
Inhaler | 4 |
Catheter | 1 |
Special Bed | 3 |
Braces | 4 |
Speech Device | 4 |
Hearing Device | 4 |
Number of Technologies/Devices Used per child | |
Zero | 6 |
One | 15 |
Two/three | 9 |
Four/five | 6 |
Six/seven | 1 |
Eight/nine | 4 |
Data collection
Data analysis
Results
Intense parenting
Mother: She can’t walk, she can’t talk, she can’t eat, she has no fine motor skills, just sort of flailing around. Because she has CP she can’t articulate, and she is tube fed, in a wheelchair and diapered… Oh yeah. She can say mama… I’ve heard her say it. I know she can say it. She thinks this is very funny. Father: Yeah, ‘N’s’ eleven years old and I’m still waiting for dada or daddy. Mother and Father 9.
No, it didn’t go smoothly because when we first got her out, it was nine months. She was back in the hospital within two days with a serious infection with (inaudible) and 24-hour feed, the equipment never worked, the pumps wouldn’t go. We were always at emergency at midnight. I was off. I never got any sleep. Mother 9.
Yeah, the best way is one of us stays here with ‘K’ and the other one takes ‘L’ out. Like last night I stayed here with ‘K’ and [my husband] took ‘L’ out to his grandmas to pick raspberries, and go to the park, and stuff. And sometimes I’ll just take ‘L’ and, and we’ll just go to the park and I’ll push him on the swing and stuff like that. Mother 18.
The good parent
I would never let him go without. And they do supply a lot of stuff to us and that, but it is just, you know, he has very sensitive skin, so I have to buy all [soap and lotions for sensitive skin]. I can’t just buy cheap stuff for him, it has to be the seven, eight dollars stuff. Um, I can’t just use any kind of soap or he’ll break out, so I can’t just buy cheap soap for him, like, you know…. At the beginning we’ve always had, like when, when he first was sick, I was working and that. And then, that’s when I had to stop because it was stressful for me to be at work when he was in the hospital and that. Mother 11.
She has to be put out, so as parents, you don’t want her to go through that, because she’s gone through enough operations, so we make sure that we brush her teeth, and do a good job, and she’s eighteen years old. Um, you feel pretty good when you go to the dentist and the dentist says, “Yeah, her teeth look pretty good.” So as a parent, that looking after her teeth um, that’s good, but you accept that responsibility of, you know, ‘E’ (mother of child) wants to make sure that ‘K’ (child) looks presentable outside. I mean I think ‘E’ has seen a lot of people with disabilities that look unkempt. Their hair has not been brushed and that, so when we look after ‘K’ we want to make sure that she looks like she’s being looked after. Her hair is brushed. She’s wearing nice clothes um, you know, but that’s just uh the, the role that we’ve taken on. Father 10.
Mother: Well, like nothing’s really visible. It’s not physical…. Father: They just think he’s a misbehaved kid, or they think you’re not very good parents. Mother: Well, I mean, there are a lot of times people look at you and think, “Like, why are you holding that kid’s hands for?” But it’s a comfort level for him. Mother and Father 21.
Father: It is funny in terms of the, whether it is family or I assume, in a sense, whether it’s the system, that ‘N’ is not the only fourteen year old incontinent child. Mother: There’s no place to change her. Father: There’s no places to change her, men’s rooms are pretty awful type things, women’s rooms are better. Mother and Father 9.
More than a nurse
The health care provider
He gets his meds at nine in the morning, nine at night, um and all his appointments we’ve been going to, and there’s the feeding tube…Before I had that electrical pump, we were doing it just through the nose, so then they gave me a stethoscope and all sorts of supplies and stuff and I would check for placement in his stomach. And like even at the hospital, too, I did his vitals and everything, like I did lots for him to help out the nurses, like when I was there. I just kind of watched and I just started doing it because they would say, “Okay I’ll be right back in five minutes.” Well then you’d see the nurse walking by, and you know they were busy. Mother 8.
Yeah, we’ve been trained on quite a bit of things through, you know, homecare, and through the medical system, and through the specialists that we deal with. So, physio, we’ve been trained in physiotherapy and occupational therapy, we’ve been trained in uh, in catheters and, and any piece of equipment she’s got. We’ve been trained, you know, for oximeters. And so if we go to the hospital we can basically, we bring our own equipment usually and we’re the ones, and we’ll put the mask on for her BiPAP (breathing apparatus), and we will monitor the probe, and then, and all those things. Father 17.
The case manager
Mother: I’m just saying that, that you can’t pre-plan enough here to realize what you’re going to do there, type thing, and it’s not that you can just suddenly, “Well, let’s take a quick tour over there ourselves just to see what it’s like,” and then bring ‘N’ (child). You can’t do that. Father: There are no proper facilities that you need in order to change ‘N’ and care for her Mother and Father 9.
I’m trying to, you know, um get better organized where because ‘M’ (son with complex care needs) is like, I mean he’s, he’s a child, but he’s like running a business in the sense that like there’s so much going on with him continuously. You know, you got surgeries and this and that, like there’s so much always that’s continuous that you need to really run him like a business in a sense. That’s because it’s continual for the rest of his life so. That’s how I look, like I don’t look at him as a business but -- do you know what I mean?… Everything’s scheduled for him, you know, to make sure that um, that he’s getting this and that… You have to go pick up his diapers, and make sure he has his medication, and make sure that he’s getting this many calories, and like it’s just, it’s continually every single day. Mother 31.
The student
He just looked at us one day and said, “I think she’s going to go home with you and you should start making plans.” You start learning. That was the first thing, learning about spina bifida. Father 17.
We have learned so much about ourselves. I would rather not have learned those lessons. I would far rather wish things had been otherwise, but ‘N’ is who he is. He is basically a happy child, we are very thankful for that. He has got his throwing up and everything under control. He does enjoy a lot of his aspects of his life, and it’s been educational to see that a person in his condition does have a life, he does, he really does. It’s not the life we would have wished for him, but it is the life he’s got, and it’s the life we’ve got, and we can live with that. Father14.
The teacher
Especially for rare disorders, the doctors I think need to listen to the parents more,’cause the parents are doing all the research. ‘L’ (wife) went on and did so much research, talked to all the parents who’ve gone through things. At one time she recommended one of the new drugs to the doctors. The doctors never heard of it or had no idea about it, but she knew other parents who had success with [this drug]. She’s informing them. Father 18.
‘D’ (child) is our number one, that, nothing surpasses that. But then… the community is so important. Letting people know, like I’ll have people come up in the grocery store or wherever, and somebody will ask and we always try and answer questions about ‘D’. But the more knowledge people have uh, the better. Mother 17.
The detective
But he suddenly started to play and I just realized, I smiled right at this child and he doesn’t smile back unless I touch him or tickle him. But I can look right in his face and smile and I get no response. And he doesn’t reach out for any of his toys anymore, and uh, and so I, and so I sort of flicked my fingers in his face like this, and I got no response. Mother 18.
When people ask me now about, you know, what about raising children, I go, I don’t know how to raise a traditional child, because all I know is the one we had was very unique. But yeah, so that – it was, it was scary. We were given a lot of tools, but a lot of it we had to figure out ourselves. Father 17.
You know he’s got a stomach ache, but what is it? Is it because he ate something wrong or, or he had the flu, or is it a pain, or is it, you know? And that’s the frustrating part in not being able to get that. Father 24.
The guard
He was good all weekend and then Saturday he just started coughing all night…Yeah, I had to take him the hospital to be, just to be sure that it was nothing serious. They just said it was, you know, a little bug and that it would go away in a couple, a few days. Father 4.
A lot of kids with neurological needs and special needs, you know, once they get really worked up it takes a long time to calm them, and yeah, I was pacing the hall. I could hear him screaming for like just about a half an hour. I could hear him screaming and just screaming…. They were just putting the probes on him and I finally came and banged on the door… and said, “Open it.” And I was just like, “Okay, this is way longer than a little while. He’s never going to calm him down, let me in there with my child.” I’m usually a fairly calm person, but I have to say that riled me up quite a bit, and uh, you know, I came in and then I calmed him Mother 18.
She’s was very timid, and now she’s like a lioness guarding her cub. You don’t want to mess with her. And I guess you find, you find an inner strength that you never knew existed, and cause he’s (referring to their child with complex care needs), this is all we know. Like I, I don’t know how many times we’ve heard, I don’t know how you guys can do that, you know. People really respect us and admire us for what we do, and it is just all we know. Father 7.
The advocate
‘C’ (child) has apraxia (short pause). This is ‘C’s’ road to walk and I can guide her along as best I can, but I can’t take it away. I have to make sure that she is everything that she can possibly be, but I have to protect her, and I have to advocate for her, and teach people how to treat her Mother 29.
You have to pull your boot straps up, and you’ve got to go online, and you’ve got to go to the library. You’ve got to do all this and then I had to learn to stand up for myself, which is huge. Not just myself, I had to learn to stand up for my kids. You have to become, um, what – their advocate. You have to learn, you know, that there’s nice ways to get things and to get what you want and then there’s a time when you have to stand up to a nurse and say, “Look, you have no right to treat me this way.” Mother 25.
And then we got into it with the hospital because we said, “Until you can tell me my kid’s safe, you’re not getting the machine (portable suctioning machine) back.” And they said, “Well there are other kids that need it.” I said, “Yeah, you tell me my kid’s safe, then you can have the machine back, but I’m not compromising my child.” Mother 19.
You know, like if you don’t try to go through the right channels or speak to the right people and, or the right resources, then, you know, then you can’t sit and complain or, you know, be frustrated… I’ve had to develop it (the role of the advocate) with ‘N’ (child with complex care needs). Um, like I have social anxiety, but with ‘N’ I try to push through and speak up. Mother 7.
Then we have the other things that exist in our society such as politics, and I think both of us have become more interested. We’ve actually even met with political figures and we’ve sent advocacy letters on things that relate to ‘D’ (child with complex care needs), but also I’ve become much more aware of the need to, to do these things. So, I’ve been sending letters to federal politicians about work-related things and other stuff. Father 14.
There’s just not enough
Well, the support system just isn’t there for us, for one family to cope with a special needs kid by themselves, just a mom and a dad. And even if you’ve got other kids that aren’t special needs it’s, you know… They’re just, there’s just not enough. They’re like, you know, fine, come in and put a ramp system. That doesn’t help you at all when you, when you need to get out of the house for a couple hours or you’re going to burn it down, and believe me, there are days like that. Father 6.
Services/Supports | Quotes |
---|---|
Financial Supports | I know families they can’t make a financial go of it. We have most of our drugs covered and, and, you know the medical appointments are covered, but overall our expenses are so high and there’s no way of supplementing our income…. So they need to start looking at help for us. Mother 5 |
° Examples: disability tax credit; tax free savings account for parents of children with complex care needs; drug benefit programs; funds for supplies (e.g., diapers, formula) | |
Efficient Respite Services | Evening, evening respite shifts. You know, even if it’s like once every two weeks just so that we have that night to, to go out and go catch a movie. Mother 7 |
° Including: more respite hours; more flexibility with respite hours; access to respite when needed with no waiting period; qualified and consistent respite workers | |
Mother: Respite. Of whatever community respite you can access. Father: You need to recharge your batteries and you’ll be better for yourself and for your child. Mother and Father 34 | |
Qualified Professionals and Support Workers who are: knowledgeable, caring, empathetic, respectful of parents’ knowledge, accessible, trustworthy, understanding of the child’s needs, good listeners | What I would say is try to remember that you have no idea what someone else is going through, you have no idea, and you need to listen to parents. What I would say makes a difference between a great doctor and an okay doctor or nurse is just that ability to empathize professionally… Mother 18 |
Family and Community Supports | Before you might have to be the one who calls up and says, “Come over, I need you (friend) to come over. I want to talk to you. I need you”…. People might not, they might not be there for you unless you really just call them up and say, “I need to talk to you.” Mother 18 |
° Examples: help from extended family and/or community members or organizations; understanding of the child and what it is like to be a parent of a child with complex care needs | |
To find a good support system that you can fall back on and find out exactly what can help you out there.’Cause my wife has found so many different programs and organizations and stuff that can help out, and I think that’s the biggest thing. Father 7 | |
Integrated Knowledge Translation | I would find someone who can give you all the information as to what’s available out there for your child but I, I still after five years have not found that person…. There’s no one, whether social work, or government level, or whatever, and it should be [someone] who can say to you “Okay, your child has lots of needs, let’s go through everything from physiotherapy to occupational therapy to whatever. Let’s look at all the resources that at some point you might like for your child, let’s say in the first five years, you know, music programs, swimming lessons, whatever.” Mother and Father 3 |
° Examples: two-way information exchange between parents and those involved in the child’s care; keeping parents informed in a timely and ongoing manner; more information regarding navigating multiple systems | |
Um, you know, it’s helpful to know what resources are available and I didn’t find that I had that information. I felt lost and like we were floundering for years. I just didn’t feel like we had those resources, didn’t know where to turn, you know. Mother 27 | |
Access to services/supports (including technology and/or equipment) | Um, and Homecare made sure that we had all our equipment, Manitoba Home Nutrition made sure that we knew, you know, how to make formula and how to mix, you know, mix it properly, because we were making a big batch of it’cause that’s all he had. Um, I guess it was pretty smooth in that the services were trying to make sure we could take him home. Mother 7 |
Improved Transportation | …We had purchased a van and, but they’re not able to put in a lift and . . . to the van. What we have is just a portable, a portable ramp. Yeah, it’s very expensive to modify the van plus it’s the, the portable ramp, we were able to get a lighter one, but it’s not really very light, you know, so it’s, it’s for me, it’s harder . . . to be on my own to, it’s really hard to do it. And uh, a lift would have been much easier, you know, to take him. Mother 16 |
° Examples: access to appropriate and affordable transportation; access to adequate parking spaces and loading zones | |
They pay to have a wheelchair cab come and pick us up to take us to and from doctors’ appointments, which is really great, especially in the winter. Uh, especially when you’re dealing around the hospital’cause there’s never any parking, so it’s nice not to have to do the driving. Mother 5 | |
Accessible Spaces | [Looking at a picture they’ve taken] This whole space is just barely enough to get her chair through. I have to come through here to get into the teen room, the teenage room. Parents put their bags; put their wheelchairs, everything blocking that. Mother 5 |
° Examples: space that afford parents the ability to carry out their multiple parenting roles | |
Promoting Self-Care in Parents | Yeah. I’m going to be fifty. I don’t want to be dead at sixty or before sixty’cause stress kills, so I have to reduce that stress in my life. And so right now I’m dealing with people that are trying to help me recognize where the stresses are in my life and how are we going to reduce those, and I’m trying to get my wife on board, because um, I’m sure that she’s under the same kind of stresses. And so we have to decide whether we’re going to be on the same path or we’re going to have to decide to take separate paths,’cause I can’t, I can’t continue to do what I’m doing. That’s, that’s an obvious, so uh, we’re dealing with that at this time right now, between each other and so. Father 10 |
° Examples: ensuring there is the time and opportunity for parents to take care of themselves (e.g., rest/relax, ‘me time,’ taking part in leisure activities, going for counselling, and so on). |
There is duplication between that agency and the school division. So there’s a social worker at the school and a social worker at that agency. There’s an occupational therapist at the school, an occupational therapist at the agency. And I’m like “Well, why does there have to be a duplication?” The problem is that there’s lots of room for conflicts to arise because of the fact that you have dual roles occurring. Father 20.
It takes a toll on the health of parents
Well, it’s just he needs suction and then, you know, he wakes up and, or his diaper change…when you have a special needs son like that you can’t, you can’t really sleep, you know, unless there’s somebody there looking after him right. Because you don’t want to just sleep and then something might happen to him, you know. Mother 16.
I have arthritis symptoms sometimes. I can’t open a jar from lifting her. And you put your back out and you’ve had your arms, you get physio and everything else, you get physical ailments. Like literally, I’m wearing out my joints. Mother 9.
Well it’s changed drastically. Um, uh you’re never prepared for that…. Um, it creates unbelievable amounts of stress, unbelievable amounts of anxiety. As a family it took a long time to get past that, “Hmm, am I going to wake up in the morning and she’s not going to be breathing anymore?” Mother 3.
I think over the years it’s, it’s basically dragged me down where I, I’ve definitely dealt with physical problems… Just prior to [the holidays] I started to feel not well and then … I collapsed in the house, rushed, rushed me to the hospital. I went through the whole gamut of tests and that, go through my own doctor testing and everything, and physically everything’s okay. So, then you have to deal with the other aspect of it, the mental aspect of it… I have been diagnosed with anxiety, depression… You’re dealing with that and it’s not like just, it all of a sudden appeared, it’s just been gradually a progression where your body’s basically said, “Okay, we’ve had enough,” and it shuts down. Father 10.