Care Needs Assessment for Pediatric Home Care

Pediatric home care services currently use various tools for care assessment. This project adapts the interRAI PEDS-HC and interRAI Early Years instruments to establish a standardized and transparent foundation for care provision.

Factsheet

Schools involved School of Health Professions
Institute(s) Nursing
Research unit(s) Innovation in the Field of Digital Health
Funding organisation Others
Duration 01.10.2024 - 31.03.2025
Head of project Pascale Denise Zürcher
Project staff Prof. Dr. Friederike J.S. Thilo
Sabrina Gröble
Esther Bättig
Pascale Denise Zürcher

Situation

The assessment of care needs in pediatric home care (Kinderspitex) is currently carried out using various, partly unstructured instruments. Therefore, Spitex Switzerland aims to introduce a standardized and structured needs assessment tool for all age groups in order to systematically and transparently capture the situation of children and their families. The interRAI Pediatric Home Care (PEDS-HC) for children and adolescents aged 4–18 years, as well as the interRAI Early Years (EY) for children aged 0–3 years, are part of the interRAI family of instruments, which is already established in adult home care (Spitex) in Switzerland. However, these instruments have not yet been used in pediatric home care. Since they were originally only available in English, they were translated into German by Spitex Switzerland. A pilot project conducted by the Bern University of Applied Sciences in 2023 showed that the PEDS-HC is generally suitable for pediatric home care, but requires adaptations to meet the cultural context of Switzerland and age-specific needs. The EY was used for the first time in the follow-up project described here.

Course of action

This follow-up project prepared the two needs assessment instruments, PEDS-HC and EY, for use in Swiss pediatric home care organizations. Both instruments were professionally refined in collaboration with nursing experts, and success factors for effective application and implementation were identified.

Result

Four nursing experts from Swiss pediatric home care organizations contributed their practical experience to the revision of the PEDS-HC and EY instruments. It became clear that both instruments are fundamentally suitable for systematically assessing care needs, provided they are appropriately revised. There was particular potential for improvement regarding the clarity of individual items, the completeness of content, and practical applicability. The PEDS-HC, which had already been tested in the pilot project, underwent a renewed systematic review and adaptation across its 20 thematic sections. Two sections were adopted without changes, three were adjusted linguistically and culturally, five were moderately expanded, and ten were extensively revised—among other things, through the inclusion of practice-relevant topics such as respiration and heart failure. These enhancements were strongly guided by practical applicability and the day-to-day needs of nurses. The EY was evaluated for the first time in terms of its suitability for needs assessments in Swiss pediatric home care. The experts deemed it insufficiently suitable, as key somatic topics were not adequately addressed. The strong emphasis on psychological aspects was also critically questioned. From the experts’ perspective, this age group requires a tailored instrument that better captures their assessments and observations. Spitex Switzerland therefore plans to further develop the EY as part of a follow-up project.

Looking ahead

To ensure successful implementation in practice, the experts defined clear requirements: the digital versions of the instruments should be user-friendly, incorporating features such as drop-down menus, automatic calculations, and integrated scales (e.g., the PaPaS Scale). Additionally, the ability to reuse existing data during repeated assessments, standardized free-text fields, and direct access to manuals were identified as important improvements. The experts also called for stronger integration with existing systems—such as an interface with the disability insurance (IV) questionnaire—to avoid duplicate data entry. A notable criticism was the lack of support for nursing diagnostics. Currently, the instruments do not include Clinical Assessment Protocols (CAPs), which are used in other interRAI tools to support interpretation and guide care planning. The participants recommended further testing and training to support effective integration into existing workflows. The announcement of a new international version of the PEDS-HC with CAPs shortly before the project's conclusion was seen as a valuable opportunity to enhance the clinical depth and practical usefulness of the instrument in everyday care. Overall, the project demonstrates that with targeted adjustments, practical extensions, and user-friendly digitalization, the interRAI instruments can significantly improve the quality and transparency of needs assessment in pediatric home care.