title: Parents' perspectives of the transition to home when a child has complex technological health care needs.
abstract: BACKGROUND
  There is an increasing number of children with complex care needs, however, there is limited evidence of the experience of families during the process of transitioning to becoming their child's primary care giver. The aim of this study was to explore parents' perspectives of the transition to home of a child with complex respiratory health care needs.
  
  
  METHODS
  Parents of children with a tracheostomy with or without other methods of respiratory assistance, who had transitioned to home from a large children's hospital in the last 5 years, were invited to participate in the interviews. Voice-centred relational method of qualitative analysis was used to analyse parent responses.
  
  
  RESULTS
  Four key themes emerged from the interviews including "stepping stones: negotiating the move to home", "fighting and frustration", "questioning competence" and "coping into the future".
  
  
  CONCLUSIONS
  There is a need for clear and equitable assessments and shared policies and protocols for the discharge of children with complex care needs. Direction and support are required at the level of health service policy and planning to redress these problems. This study provides evidence that the transition of children with complex care needs from hospital to home is a challenging dynamic in need of further improvement and greater negotiation between the parent and health service provider. There are tangible issues that could be addressed including the introduction of a standardised approach to assessment of the needs of the child and family in preparation for discharge and for clear timelines and criteria for reassessment of needs once at home.
authors.affiliation: School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland.
authors.forename: Maria
authors.initials: M
authors.lastname: Brenner
authors.affiliation: Clinical Nursing (Palliative Care), Our Lady's Hospice and Care Services, University College Dublin, Dublin, Ireland.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Larkin
authors.affiliation: Nurse Practice Development Coordinator, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland.
authors.forename: Carol
authors.initials: C
authors.lastname: Hilliard
authors.affiliation: Department of Nursing and Health Science, Athlone Institute of Technology, Athlone, Ireland.
authors.forename: Des
authors.initials: D
authors.lastname: Cawley
authors.affiliation: School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland.
authors.forename: Frances
authors.initials: F
authors.lastname: Howlin
authors.affiliation: School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland.
authors.forename: Michael
authors.initials: M
authors.lastname: Connolly
keywords: children; complex care; homecare; transitional care