Challenges Of Caring For Medically Vulnerable Kids In a PPEC Environment Discussion

Challenges Of Caring For Medically Vulnerable Kids In a PPEC Environment Discussion

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Peer topic:

Should parents with medically fragile children have the option to relinquish their care, even if just for a few hours a day?
I currently work as a rehabilitation nurse at a Prescribed Pediatric Extra Care Center (PPEC) for short. This is a skilled nursing facility for medically fragile children. In South Florida, where I currently live, my PPEC is one of many that exist. In a PPEC setting, a child must go through their insurance, whether it is private or Medicaid, to a physician in order to be accepted and funded to attend a PPEC. Majority of the patients we have in our PPECs are children who have Medicaid. Every PPEC has room for about 20 children. For those 20 children there are only 2 floor nurses and one DON (director of nursing). There are also trained CNAs and various therapists that come through the center such as OT’s, PT’s and SLP’s that provide services to the medically fragile children. We care for these children as if they are our own, since we see them 5-6 days a week for majority of the day. However, when you take a deep dive into PPEC life here in South Florida, some may discover there is more to be done than one could imagine when families are put into situations where medical fragility is involved. Challenges Of Caring For Medically Vulnerable Kids In a PPEC Environment Discussion


The parents or guardians of our center often drop off their children or have them be picked up on a bus from their house in the early hours of the morning. Often, the staff receive children without shoes, underdressed for the weather, with feeding tubes dislodged, and diapers unchanged. I understand, these children are a huge responsibility and require a lot of care and attention, so often we at the PPEC do our best to provide as much care and nurturing as we can. At the center we provide skilled nursing care involving, but not limited to, tube feedings, tracheostomy care, medication administration and much more. We know we are providing these guardians with a break from care for the hours that they are with us, but communication becomes murky when a child’s care cannot be properly completed without the help of the parent or guardian. For example, if a child has formula that they are being tube fed with, and it is running low at the center, we call about a week out requesting the parent or guardian head over to WIC to receive some additional formula. We can not stray from the physician orders, so we rely heavily on the guardians to provide formulas, medications and other prescribed entities. Often these calls and messages go unanswered and management as well as the nurses are scrambling to get a hold of a guardian or someone close to the patient to provide the necessary prescription. This directly leads to my question. Do parents get to completely let go of the reins when a child is at the PPEC facility. Challenges Of Caring For Medically Vulnerable Kids In a PPEC Environment Discussion

If you ask this question to anyone at our staff the swift answer would be no, of course the guardian is responsible for the child. This though, begs the discussion as to whether the parental/ guardian burnout from having a medically fragile child is the barrier to communication between them and the facility. The structure of PPEC is that a physician must create a plan of care for each child going into the PPEC which details why the child requires such care during the day. The facility is then to carry out those orders. On that same plan of care are orders for the guardian as well, such as nightly medications, prescribed formulas and other day to day tasks that need to be performed at home so that the child remains stable. If the guardians are not answering our phone calls or messages for weeks on end, how is the staff at the PPEC to know whether the child is getting proper care at home? My job is to provide the most skilled nursing care to my patients regardless of communication barriers between the center and the guardians that may occur. These children are not only physically vulnerable but mentally as well. Given their circumstance, we may excuse the parents lack of attention to detail about their child’s care, but it does not go unnoticed. Parents should remain in contact with the facility that is providing care to their child as well as the nurse who is directly responsible for their care. I do my part every day to ensure my patients are thriving, I only hope their guardians are doing the same.

Response Post 2 | Accuracy of Facts and Evidence of Critical Thinking (1.5)
3 possible points (20%) Challenges Of Caring For Medically Vulnerable Kids In a PPEC Environment Discussion

Exceeds Expectations
All supportive facts are reported accurately. Response shows knowledge of content and demonstrates significant critical thinking related to the question.

Exceeds Expectations
Multiple (>2) references including professional journals and noncommercial (e.g., .gov, .edu, .org) websites. At least one research article included in references. No errors in APA citations or references.

Response Post 2 | Professional Writing (.5)
1 possible points (6.67%)

Exceeds Expectations
The writer makes no errors in spelling, word usage, sentence structure, grammar, or punctuation.

Assignment Directions:

Your original response should address the following:

Describe your organization’s structure, culture, and where you fit in.
Discuss any concerns you might have about communication and how the structure is a barrier to or expediter of solutions.
Make suggestions about how it can be reorganized to improve the culture and the delivery of care.
In your follow-up peer responses, you should do the following:

Compare your peers’ organizational structure and culture with your own, noting any similarities and differences.
Comment on any parts of their organization that you would like your organization to adopt.

Peer Response

It is concise from your comprehensive discussion that caring for medically vulnerable kids in a PPEC environment is demanding and challenging. The circumstances you describe concerning guardians and parents of these children open a can of sensitive and composite issues. Further, your description seeks open deliberation on the topic.

In your post, you have a genuine concern about the lack of interest from guardians and parents, which raises critical queries about the degree of responsibility they should possess in the kid’s care, even when the child is at the facility. Parents and guardians may encounter burnout, which is a major issue for families and people looking after vulnerable kids. The frequent needs, limited assistance, and emotional fatigue can overcome guardians, causing communication failure and omissions in care. Thus, tackling communication hurdles is critical. Challenges Of Caring For Medically Vulnerable Kids In a PPEC Environment Discussion

Further, in your post, you have a concern about the communication breakdown between the facility and guardians, and there is a need to tackle it soon to avoid compromising the safety of the children. The facility can seek substitute communication techniques like online platforms and hold frequent family meetings and sessions to enhance communication flow and promote trust. Communication channels must be diverse because using a single channel may not accomplish the needed communication goal.

Moreover, your post also opens up a discussion on the need for guardians to balance responsibility and children’s safety and regardless of their situations or schedules, they must retain the duty for their kid’s welfare. Nonetheless, their capability to achieve this duty may be hindered by burnout, but this should not be a reason to relinquish care solely to the PPEC facility. Notably, this care surrendering is composite and must be approached carefully by considering situations like kids’ safety. Thus, this calls for open, effective communication and partnership between social services, families and PPEC employees (Aasmul et al., 2018). For instance, options like temporary foster care, support schemes, and in-home respite care can be explored.

Furthermore, issues concerning relinquishing or surrendering care, even briefly, must be founded in legal structures and ethical contemplation. This means legal advisors and welfare organizations must be involved to guarantee the kid’s best interest.

Therefore, after scrutinizing all the concerns from your post, it is vital to develop a collaborative and supportive environment. Developing effective communication and trust between PPEC employees and parents can assist in tackling the communication hurdles and guaranteeing excellent care for this population group. When trust and more communication channels are opened, there is a high likelihood of improving care. Further, there is a need to champion intensified support systems, groups and resources for families (Kelly et al., 2022)Challenges Of Caring For Medically Vulnerable Kids In a PPEC Environment Discussion. This may comprise financial help, mental health services, and respite care. Looking for ways to assist guardians while sustaining high care standards for these kids is a critical balance that needs continuous and consistent attention.

There are several similarities between the PPEC facility structure and my outpatient clinic as an FNP. One fundamental similarity is a communication failure and breakdown. In my facility, the failure occurs among departments and colleagues, while in the PPEC facility, it happens between employees and parents of vulnerable children. This breakdown in communication does not matter where it takes place because it affects the delivery of services or care. Notably, it may extend to delayed deliveries, like in the PPEC facility where formula takes weeks to be delivered by parents or indecisive decision-making. Working in an environment with a communication failure means client safety is also compromised and probability of medical errors (Shahid & Thomas, 2018)Challenges Of Caring For Medically Vulnerable Kids In a PPEC Environment Discussion. Thus, mechanisms must be adopted to eliminate these hurdles and improve care quality in all healthcare facilities.



Aasmul, I., Husebo, B. S., Sampson, E. L., & Flo, E. (2018). Advance care planning in nursing homes–improving the communication among patient, family, and staff: results from a cluster randomized controlled trial (COSMOS). Frontiers in Psychology9, 2284.

Kelly, K. J., Doucet, S., Luke, A., Azar, R., & Montelpare, W. (2022). Exploring the use of a Facebook-based support group for caregivers of children and youth with complex care needs a qualitative descriptive study. JMIR Pediatrics and Parenting5(2), e33170.

Shahid, S., & Thomas, S. (2018). Situation, background, assessment, recommendation (SBAR) communication tool for handoff in health care–a narrative review. Safety in Health4(1), 1-9. Challenges Of Caring For Medically Vulnerable Kids In a PPEC Environment Discussion

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