Email updates

Keep up to date with the latest news and content from BMC Health Services Research and BioMed Central.

Open Access Research article

"Fighting the system": Families caring for ventilator-dependent children and adults with complex health care needs at home

Knut Dybwik1*, Terje Tollåli2, Erik W Nielsen134 and Berit S Brinchmann4

Author Affiliations

1 Department of Anaesthesiology, Nordland Hospital, 8092 Bodø, Norway

2 Medical Department, Nordland Hospital, 8092 Bodø, Norway

3 Institute of Clinical Medicine, University of Tromsø, 9037 Tromsø, Norway

4 Faculty of Professional Studies, University of Nordland, 8049 Bodø, Norway

For all author emails, please log on.

BMC Health Services Research 2011, 11:156  doi:10.1186/1472-6963-11-156

Published: 4 July 2011

Abstract

Background

An increasing number of individuals with complex health care needs now receive life-long and life-prolonging ventilatory support at home. Family members often take on the role of primary caregivers. The aim of this study was to explore the experiences of families giving advanced care to family members dependent on home mechanical ventilation.

Methods

Using qualitative research methods, a Grounded Theory influenced approach was used to explore the families' experiences. A total of 15 family members with 11 ventilator-dependent individuals (three children and eight adults) were recruited for 10 in-depth interviews.

Results

The core category, "fighting the system," became the central theme as family members were asked to describe their experiences. In addition, we identified three subcategories, "lack of competence and continuity", "being indispensable" and "worth fighting for". This study revealed no major differences in the families' experiences that were dependent on whether the ventilator-dependent individual was a child or an adult.

Conclusions

These findings show that there is a large gap between family members' expectations and what the community health care services are able to provide, even when almost unlimited resources are available. A number of measures are needed to reduce the burden on these family members and to make hospital care at home possible. In the future, the gap between what the health care can potentially provide and what they can provide in real life will rapidly increase. New proposals to limit the extremely costly provision of home mechanical ventilation in Norway will trigger new ethical dilemmas that should be studied further.