Effects of nonlocal geographically separated hospitalizations upon families

Military Medicine, Oct 2003 by Agazio, Janice B, Ephraim, Paula, Flaherty, Norma J, Gurney, Cynthia A

When children are hospitalized at a treatment facility in a different state or country, families must deal with separation from existing support systems and the added burden of travel. The purpose of this study was to identify the stressors, coping mechanisms, and resources used by families hospitalized more than 200 miles away from home. Twenty-eight parents participated in serial interviews throughout their child's hospitalization. Content analysis was used to identify major themes and to describe the experience. From the findings, it was evident that these types of hospitalization and separation have implications for the service member, spouse, hospitalized child, siblings, and the family system. In recognizing the impact of a nonlocal hospitalization, caregivers have an opportunity for early assessment, recognition, and intervention to mediate stress and promote positive outcomes for all parents, children, and families.

Introduction

Over the past several decades, health services have been regionalized as an efficient means to offer specialized medical services and to reduce or contain medical costs.1,2 As a result, centralization of expensive high technology and specialty providers at tertiary care medical centers has resulted in better use of resources and improvement of outcomes.3 Consequently, patients needing specialty services may need to travel to tertiary care centers to access these services.4 For military families, this may mean that the service member/sponsor or other family members may travel out of state, across the country, or from overseas for specialty services. This travel is usually accomplished through the Air Force-managed aeromedical evacuation system or through personally arranged commercial transportation. When the required treatment requires hospitalization, family members may experience separation from the remaining family over an extended period.

Anecdotally, staff nurses at a tertiary care center pediatric unit noted that hospitalization of children from families residing outside the area (defined as more than 200 miles from the medical center) appeared to be more stressful than for families from the local area. Admissions to this particular facility included families from the geographic region that extended from Maine to North Carolina, across the United States, and from overseas locations. Children referred into the facility were often accompanied by one parent, usually the nonmilitary spouse. The remaining spouse would remain at the duty station either due to mission requirements, home responsibilities, or financial concerns. Families with other children at home faced the additional challenge of finding childcare with relatives or friends; the alternative was for the remaining parent to assume all the household and childcare responsibilities in addition to duty requirements. Case conferences often reflected numerous issues resulting from the separation of the family.

A child's hospitalization is a stressful experience for families, even under the best of circumstances.5,6 From observation, hospitalization seemed to pose unique Stressors and resource needs for families admitted from outside the local area that did not appear well documented in the literature. The purposes of this study were to begin to systematically identify the Stressors associated with hospitalization experiences for nonlocal families, identify the coping mechanisms and resources used by these families to mediate their stressors, and determine the effects of the separation on family functioning. This report represents the qualitative component of a larger study comparing the stressors, resources, and coping between families traveling from within and outside the local area.

Background and Significance

To date, no research has been found that examined this particular experience of hospitalization for military families. Related literature, however, supported the possibility that a medical separation necessitates adjustment and precipitates stress and adaptation for families. Support for this study was derived from five main areas of research literature: (1) family stress theory,7 (2) effects of distance on access to services,8-18 (3) effects and needs of family members during hospitalization,19-31 (4) effects of separation on families during wartime or deployment,32-38 and (5) effects of separation during neonatal intensive care hospitalizations for high-risk infants.39-47

Effects of Distance on Access to Services

Most studies considering distance as an issue in medical treatment have focused upon its impact on travel time,16 access,8,10,18 cost of travel,17 and use.11-13 These studies considered primarily the increased travel time and usage patterns after closing local facilities and did not consider travel from distances greater than 70 miles or situations such as overseas travel for extended hospitalizations.

In a related study, Flynn and McCollum9 considered the needs of rural families during hospitalization of infants. This study captured some common concerns of families experiencing hospitalization of family members at some distance from the family's home. Families who lived farther away visited less, spent less time per visit, and reported more financial concerns. These authors implied that families were at risk for additional stress due to restricted access to the child. This body of research suggested that distance could cause hardship for families in seeking medical treatment.