Implementing Nurse-Led Case Management Guideline for Vulnerable Children and Their Families

Abstract

Introduction The challenge of vulnerable children in Thailand is on the rise, affecting both urban and rural communities. Collaborative efforts among multidisciplinary teams and community networks that bridge clinics and local communities are anticipated to bolster the capabilities of healthcare teams in promoting the well-being of vulnerable children and their families. 

Objective To assess the feasibility and effects of implementing nurse-led case management guidelines for vulnerable children and their families 

Design The design of this study was implementation research. 

Methodology This study included a sample of 18 vulnerable children admitted to a secondary-level hospital in a northeastern province, 18 family caregivers and 15 multidisciplinary health professionals, all recruited through purposive sampling. Data collection involved a demographic questionnaire, case management guidelines, satisfaction questionnaires for both vulnerable children and their families, and a satisfaction questionnaire for the multidisciplinary care team. The content validity indices for the case management guideline and satisfaction questionnaires were .81, .80 and .85, respectively. Reliability testing for satisfaction questionnaires resulted in Cronbach’s alpha coefficients of .79 and .76, respectively. Specific guidelines tailored to each type of vulnerability were implemented in all cases, including four post-hospitalization visits. Satisfaction data were collected both before and after the fourth visits. Descriptive statistics and the Wilcoxon Signed Rank test were employed for data analysis. 

Results Most of the vulnerable children were female (72.22%) with an average age of 11.66 years (SD = 3.18). The primary vulnerabilities observed among children in this study included social vulnerability (61.1%), psychological vulnerability (33.33%), and physical vulnerability (5.56%). Family caregivers were predominantly female (77.78%), with an average age of 53 years (SD = 3.64). Most caregivers were grandparents (55.56%) and mothers (38.89%). The multidisciplinary team comprised professional nurses, pediatricians psychologists, pharmacists, and physical therapists. Results revealed that the guidelines were applied at almost every step, with the exception of emergency planning, which was executed only in some cases. Following the nurse-led case management guidelines, satisfaction scores significantly increased for vulnerable children and families (z = -3.626, p<.001) and the multidisciplinary team (z = -3.430, p = .001), respectively. Importantly, there were no records of recurrence admission or complications following the intervention. 

Recommendations The study’s findings highlight the effectiveness of nurse-led case management, revealing positive initial outcomes. Establishing a long-term care management system and strengthening the team’s capacities to address the sophisticated challenges faced by children and their families, along with providing sustained support over time, will empower teams to improve a greater number of children and families from vulnerability.