Nurse parental support using a proactive mobile app to enhance parental self-efficacy in symptom management for the children requiring mechanical ventilation

Background: Children with medical complexity (CMC) who require mechanical ventilation often experience multiple physical and psychological symptoms that significantly impact their quality of life (QoL). The literature suggests that enhancing parental self-efficacy in managing these symptoms can improve child health outcomes. In Hong Kong, home-based nursing services are available for CMC and their families, but these services face challenges due to a significant shortage in the nursing workforce. Nurse parental support using a mobile App in symptom management is another method considered more accessible and nurse-parent interactivity to continue home-based support. The aims of this study were to examine the effectiveness of a 3-month nurse parental support using a proactive mobile App in symptom management for their CMC living at home, and explore Reach, Adoption, Implementation, Maintenance of the implementation process of this intervention in real life setting.

Methods: Implementation science approach adopted a single group pre-post quasi-experimental design was conducted to evaluate the effects of a nurse support using a proactive mobile app to enhance parental self-efficacy in symptom management for their child requiring mechanical ventilation, and alongside identify factors facilitating or deterring the program implementation. Data collection is ongoing, with parents recruited from a non-governmental organization. The estimated sample size is 52.  Data are collected via self-administered questionnaires and semi-structured interviews. Outcomes include caregiving self-efficacy, modified memorial symptom assessment scale, and child health service utilization. Assessments are conducted at four time points: 1^st month (T1), and 3^th month (T2) as self-controlled for comparing any differences with another two identical assessments in 6^th month (T3 pre-intervention), and in 9^th month (T4 post-intervention). Implementation facilitators and barriers are analysed using the RE-AIM framework. Data will be analysed using the intention-to-treat principle and generalized estimating equations.

Results: To date, 43 parents have been recruited, and all have completed data collection at T1 and T2.

Conclusion: The study is progressing as planned, with smooth recruitment and data collection. It is anticipated that the intervention will enhance parental self-efficacy, reduce symptom burden in CMC, and decrease health service utilization.

Professor Winsome LAM is a community nurse who gets experiences in taking care of paediatric patients with complex medical conditions i.e., children with cancer or life-limiting disease at home or in the community. She is the subject lead for the Community Health Nursing courses offered in both undergraduate and postgraduate programmes. Her current research studies focus on paediatric palliative service, parental support in symptom management for children with medical complexity, and health technology application. Winsome has been a PhD supervisor since 2020 and has secured several external competitive grants.