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Challenges of Parents While Providing Complex Medical Care at Home to Children With Cancer: A Cross‐Sectional Convergent Mixed Methods Study

ABSTRACT

Aim

To explore challenges parents of children with cancer encounter while providing complex medical care at home.

Methods

Design: Cross-sectional convergent mixed-methods study. Instruments: Questionnaire and open interviews that mirrored and complemented each other.

Results

Parents (n = 32), with no prior medical training, were expected to remain constantly vigilant as they monitored and managed rapidly changing situations. Regardless of time from diagnosis, they detected a mean of 3.3 ± 1.4 (0–6) symptoms, reported administering up to 22 daily medications, including cytotoxics, narcotics and injections, and dealt with many related challenges. Parents described needing responsive communication channels, especially when dealing with bleeding and infection emergency situations during off-hours.

Conclusions

Findings highlight the constantly shifting demands when managing a child with cancer at home. Educational programmes that address parental needs throughout treatment, tailored to protocol changes and individual circumstances, should be expanded and further developed.

Patient Care Implications

Parents need continual education regarding home management throughout their children's illness and treatment.

Impact

This study addresses challenges parents of children with cancer encounter while providing complex medical care at home. The findings demonstrated that parents, responsible for administering numerous medications via various routes and managing symptoms and side effects, did not feel confident performing these tasks regardless of time from diagnosis. Nurses should adapt ongoing parental education regarding complex medical tasks, symptoms, side effects, emergency detection and management for children with cancer at home. The study adhered to the Mixed Methods Appraisal Tool (MMAT) and STROBE reporting method.

Patient Contribution

Parents of children with cancer participated in the design and questionnaire validation.

Redefining the Journey: A Scoping Systematic Review of PhD and DNP Career Trajectories

ABSTRACT

Background

Globally, doctorally-prepared nurses have pursued career paths centered on research and academic leadership. In the United States, alongside the PhD in nursing, there exists a distinct educational pathway, the Doctor of Nursing Practice (DNP), which emphasizes clinical practice. However, the actual career trajectories of individuals from both groups often diverge from these traditional expectations, prompting questions about how their roles are integrated within academic and clinical environments.

Aims

This systematic review aims to critically examine the career pathways of nurses with doctoral degrees, with a focus on the intersection of research and clinical practice.

Methods

Following the PRISMA guidelines, a systematic search of five databases (PROQUEST Nursing, Scopus, EBSCO, EMBASE, and PubMed) was conducted on October 14, 2024. We identified 6003 references, with 23 studies ultimately meeting inclusion criteria. Thematic analysis was used to synthesize findings.

Results

PhD and DNP nurses in the US exhibit overlapping yet nontraditional career paths, with PhDs taking on clinical leadership and DNPs entering academia. Globally, PhD nurses often hold hybrid roles in research, education, and limited clinical practice. Across contexts, both groups face role misalignment and identity challenges, including marginalization and limited institutional support.

Linking Evidence to Action

The findings highlight the blurring of traditional boundaries between PhD and DNP career paths, underscoring the need for flexible career models that combine academic and clinical practice as a viable option to address these challenges.

Trial Registration

The review was registered in PROSPERO (Registration Number)

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