Bakgrund  Sexuellt våld är ett utbrett samhällsproblem med kort- och långsiktiga effekter på både den fysiska och psykiska hälsan. Hälsokonsekvenserna är många men innefattar bland annat depression, trauma, oönskad graviditet och sexuellt överförbara infektioner. Sjukvårdspersonal har en betydande roll, dock är ofta kunskap och erfarenhet för att identifiera och bemöta sexuellt utsatta kvinnor bristfälliga.  Syfte  Syftet var att beskriva hur den sexuellt våldsutsatta kvinnan upplever vårdmötet med vårdpersonal samt vad hon har för vårdbehov efter övergrepp.  Metod  I denna icke-systematiska litteraturöversikt ingår 19 vetenskapliga originalartiklar av både kvantitiv och kvalitativ design. De har hämtats från databaserna PubMed och CINAHL, genom ett flertal sökordskombinationer. Artiklarna har kvalitetsgranskas utifrån Sophiahemmets Högskolas bedömningsunderlag. De har sedan analyserats med stöd av en integrerad analys.  Resultat  Viktiga aspekter i vårdpersonalens bemötande med sexuellt våldsutsatta kvinnor, för att främja läkning, är respekt, integritet, bekräftelse och att värna kvinnans självbestämmande. Sexuellt våldsutsatta kvinnor sårbarhet i vården relaterar till normer och lagar, samt hur hon förhåller sig till förövaren. Det finns behov av specialiserad vård. Resultatet är indelat i tre huvudkategorier, nämligen Upplevelsen av att söka och få vård, Den sexuellt drabbade kvinnans sårbarhet i vården och Behov att bli tagen på allvar.  Slutsats  Resultatet visar att vårdpersonal har en betydande roll för att främja läkning när de möter sexuellt våldsutsatta i vården. Positiva upplevelser kan lägga ett fundament till återhämtning samtidigt som negativa upplevelser istället kan leda till återupplevelse av trauma samt fördröjd eller utebliven vård. Bemötandet i vården kräver närvaro och känslighet för att vården ska upplevas respektfull och medkännande. Resultatet visar också att sexuellt våldsutsatta kvinnor efterfrågar, och har övervägande positiva upplever av, specialiserad vård. / Background  Sexual violence is a common problem in today’s society followed by physical and psychological health effects both short- and long term. The health consequences are many but include depression, trauma, unwanted pregnancy and sexually transmitted infections. Healthcare professionals play a significant role, however, they often lack the knowledge and experience to identify and respond to sexually vulnerable women.  Aim  The purpose of this study was to describe how the sexually abused woman experiences the encounter with health professionals and her care needs following abuse.  Method  This non-systematic literature review includes 19 original scientific articles of both quantitative and qualitative design. These have been retrieved from the databases PubMed and CINAHL, by several keyword combinations. All articles have been quality reviewed on the basis of Sophiahemmet University's assessment data. They have been analyzed with an integrated analysis.  Result  Important aspects of the care staff's interaction with sexually abused women, in order for it to increase healing, are respect, integrity, confirmation and safeguarding the woman's self- determination. Sexually abused women are particularly vulnerable because of aspects regarding norms and lawsystems, as well as how she relates to the perpetrator. There is a need for specialized care. The results are divided into three main categories, namely The experience of seeking and receiving care, The sexually abused woman's vulnerability in health care and The need to be taken seriously.  Conclusion  The results show that healthcare professionals have a significant role in facilitating healing when encountering sexually abused people in healthcare. Positive experiences can lay a foundation for recovery at the same time as negative experiences can lead to revictimization as well as delayed or absent care. The interaction requires presence and sensitivity for the care to be experienced as respectful and compassionate. The results also show that sexually abused women demand, and have positive experiences of, specialized care.

The submitted dissertation of the PhD study programme Longevity Studies was prepared and financially supported by the project GAUK - Grant Agency of Charles University No. 760219 entitled "Met and Unmet Needs Of Particularly Vulnerable Older Patients in Home and Inpatient Care", of which I am a co-investigator. The mentioned research project is also in the intentions of the strategic plan and long-term activities of the research team CELLO (Center for the Study of Longevity and Long-Term Care), which is the scientific basis of the PhD study programme Longevity Studies. The main goal of the GAUK project is to provide a comprehensive overview of the needs of vulnerable older patients who are provided health care. The project is focused on three areas, which are: the needs of patients with dementia, the needs of geriatric patients at home and the needs of geriatric patients in hospital care. Partial goals are the exploration of current knowledge of the issue based on a review of Czech and foreign literature. The aim of the survey is to find out attitudes and opinions on satisfying needs from the perspective of patients and healthcare professionals. The practical goal is to create recommendations for good practice for the health care of these patients. The dissertation consists of a total of seven...

<p><strong>Purpose</strong></p> <p>Colorectal cancer (CRC) is the fourth most common cancer and the second leading cause of cancer death among Canadians. Little is known about the types of supportive care needs (SCNs) that patients with colon cancer experience during the diagnostic phase or whether these needs are met. To inform the development of population specific healthcare services, a needs assessment of patients with newly diagnosed advanced colon cancer was conducted to identify the types, prevalence, severity, and importance of unmet SCNs, as well as to identify any gaps between patient priority needs and their use of supportive care services.</p> <p><strong>Patients and Methods </strong></p> <p>A descriptive cross-sectional survey was conducted. Over one year, all newly diagnosed patients with colon cancer at the Juravinski Cancer Centre were screened for eligibility. Sixty-two of 80 eligible patients completed a self-report written questionnaire prior to starting treatment (response rate = 77.5%). The questionnaire included the Supportive Care Needs Survey-Short Form, Functional Assessment of Cancer Therapy-Colorectal and Health Service Utilization Questionnaire.</p> <p><strong>Results</strong></p> <p>‘Fears about the cancer spreading’ was the most prevalent unmet SCN (n = 52/62 or 84%). Unmet SCNs experienced by 65% or more of participants related to lack of control about treatment outcomes, the uncertain future, and concerns about family member well-being. Patients also rated these needs as being most severe.</p> <p>The two most severe CRC-specific concerns were related to ‘body appearance’ (Mean = 1.77, SD = 1.37) and ‘bowel control’ (Mean = 2.28, SD = 1.37). The most important or priority unmet needs were related to uncertainty about the future (43.5%), fatigue (24.2%), and information (22.6%). Less than 12% of participants had used existing supportive care services in the community.</p> <p><strong>Conclusion </strong></p> <p>Prevalent and priority unmet needs were related to psychosocial support and information. Recommendations for designing colon cancer-specific services are provided along with strategies to improve patient use of existing resources.</p> <p><strong> </strong></p> / Master of Science (MSc)

Bakgrund Andelen äldre personer ökar i Sverige och den grupp bland äldre som ökar mest är över 90 år. Antalet äldre som är i behov av vård- och omsorgsinsatser från både socialtjänsten och hälso- och sjukvård förväntas därmed också öka. Ökad efterfrågan på kommunal hjälp i hemmet ställer höga krav på god samverkan och kommunikation mellan de olika instanserna för att minska risken för brister och vårdskador hos den äldre personen med komplexa vårdbehov. Komplexa vårdbehov innebär samtidig närvaro av förändringar som kommer av åldrandet, multisjuklighet, polyfarmaci och skörhet. Syfte Syftet med studien var att undersöka sjuksköterskors erfarenhet av kommunikation kring den äldre patienten med komplexa vårdbehov inom den kommunala hälso- och sjukvården. Metod Studien var en kvalitativ intervjustudie med induktiv ansats. Deltagarna i studien arbetade inom kommunal hälso- och sjukvård i två sydsvenska kommuner. Sex av deltagarna var grundutbildade sjuksköterskor, tre av deltagarna var distriktssjuksköterskor och en var specialistsjuksköterska inom vård av äldre. Datan som samlats in analyserades med hjälp av kvalitativ innehållsanalys. Resultat Resultatet ledde fram till tre huvudkategorier och sju underkategorier. Huvudkategorierna var Samverkan och dialog, Organisatoriska förutsättningar samt Utbildning, Språk och Kompetens. En nära relationen till omvårdnadspersonalen, rätt kompetens och erfarenhet hos omvårdnadspersonalen samt regelbundna möten och träffar var faktorers som ansågs underlätta kommunikationen. Slutsats  Sjuksköterskorna beskrev att teamsamverkan med planerade teamträffar och fysiska möten med personalen var viktigt för fungerande kommunikation. Att minska distansen mellan personalen och ha fungerande rutiner kring kommunikationen var andra värdefulla aspekter som framkom. Det som ansågs försvåra kommunikationen var stress och tidsbrist samt brister i språket hos omvårdnadspersonalen men även organisatoriska hinder så som dålig täckning på mobiltelefoner, laghinder och bristande kontinuitet hos omvårdnadspersonalen. / Background  The proportion of elderly people is increasing in Sweden, and the group among the elderly that is increasing the most is over 90 years of age. The number of elderly people who need care and care interventions from both social services and health care is therefore also expected to increase. Increased demand for municipal help in the home places high demands on good cooperation and communication between the various agencies to reduce the risk of deficiencies and care injuries in the elderly person with complex care needs. Complex care needs mean the simultaneous presence of changes that come from aging, multimorbidity, polypharmacy and frailty. Purpose The purpose of the study was to investigate nurses' experience of communication regarding the elderly patient with complex care needs within the municipal health care system.  Method The study was a qualitative interview study with an inductive approach. The participants in the study worked in municipal health care in two municipalities in southeast of Sweden. Six of the participants were basic nurses, three of the participants were district nurses and one was a specialist nurse in the care of the elderly. The data collected was analyzed using qualitative content analysis. Results The result led to three main categories and seven subcategories. The main categories were Collaboration and dialogue, Organizational conditions and Education, Language and Competence. A close relationship with the nursing staff, the right skills and experience of the nursing staff and regular meetings were considered to facilitate communication. Conclusion  The nurses described that team cooperation with planned team meetings and physical meetings with the staff was important for effective communication. Reducing the distance between staff and having working routines around communication were other valuable aspects that emerged. What was considered to make communication difficult was stress and lack of time as well as deficiencies in the language of the nursing staff, but also organizational obstacles such as poor mobile phone coverage, legal obstacles and a lack of continuity among the nursing staff.

Bakgrund: Forskning inom omvårdnad har betonat vikten av ett personcentrerat förhållningssätt i vårdmötet, varje patient ska betraktas som en unik individ med olika behov att tillgodose. För patienter med ett akut vårdbehov kan ambulanssjukvården vara det allra första mötet som de gör med hälso- och sjukvården. Tidigare forskning har beskrivit att omhändertagandet i prehospital akutsjukvård fokuserat på det medicinska tillståndet framför de emotionella behoven, vilket har betytt att behov ur ett holistiskt perspektiv inte alltid har tillgodosetts. Forskning från patienters perspektiv är bristfälligt, vilket innebär att patienters upplevelser och känslor inte prioriterats. Syfte: Att beskriva patienters upplevelser av att få sina grundläggande vårdbehov tillgodosedda i prehospital akutsjukvård. Metod:Litteraturöversikt med systematisk sökstrategi. Datainsamling gjordes via två databaser, PubMed och CINAHL. Totalt inkluderades 15 kvalitativa artiklar, publicerade mellan 2011–2023, analyserades med en integrerad analysmetod. Resultat: Beskrev patienternas positiva och negativa upplevelser i ett prehospitalt omhändertagande. Resultatet presenteras i tvåkategorier och fem underkategorier. Kategorierna som arbetades fram beskrev övergripande känslan av att vara patient i prehospital akutsjukvård, vilket belyser känslan av att överlämna sig själv och hur det är att vara patient i en ambulans. Ambulansteamets förhållningssätt belyser viktiga hörnstenar som delaktighet, värdet av dialog, att känna sig bekräftad eller stigmatiserad vid psykisk ohälsa. Resultatet utifrån artiklarna belyser fördelar medpersoncentrerad vård. Slutsats: Patienter som fick sina grundläggande vårdbehov tillgodosedda hade en positiv effekt på dem och även en positiv upplevelse utav ambulanssjukvården oavsett utfall. Genom att fokusera på patientperspektivet är det möjligt för framtida hälso- och sjukvårdspersonal att öka förståelsen och därmed förbättra kvalitén på vården, med betoning på personcentrerad vård. Det är viktigt att varje individ får vård och omsorg utifrån ett helhetsperspektiv där både de fysiska och emotionella behoven tillgodoses, oavsett om det gäller medicinsk vård eller omvårdnad. / Background: Research in nursing has emphasized the importance of a person-centered approach in the care encounter, where each patient should be seen as a unique individual with different needs to be met. For patients with an acute care need, ambulance care may be their very first encounter with health care. Previous research has described that care in prehospital emergency medicine has focused on the medical condition rather than the emotional needs, meaning that holistic needs have not always been met. Research from the perspective of patients is lacking, hindering a comprehensive description of their experiences and emotions. Aim: describe patients' experiences of having their basic care needs met in prehospital emergency care. Method: A literature review with a systematic search strategy. Data was collected from two databases, PubMed and CINAHL. A total of 15 qualitative articles published between 2011–2023 were included and analyzed using an integrated analysis method. Results: Described patients' positive and negative experiences in prehospital care. The results were presented in two main categories and five subcategories. The categories described the overall feeling of being a patient in prehospital emergency care, highlighting the feeling of surrendering oneself and what it is like to be a patient in an ambulance. The approach of ambulance staff highlighted important aspects such as participation, the value of dialogue, feeling validated or stigmatized in cases of mental illness. The results from the articles emphasized the benefits of person-centered care. Conclusion: Patients whose basic care needs were met had a positive impact on them and a positive experience with ambulance care regardless of the outcome. By focusing on the patient perspective, future healthcare professionals can increase understanding and improve the quality of care, with an emphasis on person-centered care. It is important that each individual receives care and support from a holistic perspective where both physical and emotional needs are met, whether it is medical care or nursing care.

Background: Every year in the United States approximately half a million youth with special health care needs (SHCN) turn 18. Little is known about how this population fares during the transition to adulthood. Purpose: To examine transitions to adulthood for young adults with SHCN. Methods: Using data from two national longitudinal surveys: the Panel Study of Income Dynamics and the Survey of Adult Transitions and Health, I built linear and logistic regression models to evaluate the relationship between having a history of SHCN during childhood and key transitional outcomes during young adulthood (e.g., mental health status, educational attainment, employment, financial independence and subjective indicators of adulthood). A second set of logistic models examined associations between hypothesized risk and protective factors during childhood (e.g. family financial burden, care in a medical home and access to adequate insurance) and physical health outcomes during young adulthood for youth with SHCN. Multivariate models were adjusted for key confounders. Results: The majority of youth with a history of SHCN were doing well during the transition to adulthood. That said, compared to young adults without a history of SHCN, young adults with a history of SHCN were in significantly worse mental health (adjusted OR of experiencing a non-specific psychological disorder 3.90, 95% CI 1.78-8.53) and had significantly lower odds of graduating from high school (adjusted OR 0.55, 95% CI 0.32-0.96), attending college (adjusted OR 0.61, 95% CI 0.38-0.96), and receiving financial assistance from their families (adjusted OR 0.56, 95% CI 0.38-0.83). Amongst young adults with a history of SHCN, family financial burden during childhood significantly decreased the odds of being in good physical health during the transition to adulthood. There was limited evidence that receipt of care in a medical home or access to adequate insurance during childhood increased the odds of being in good physical health for young adults with a history of SHCN. Conclusions: These findings have important policy implications for programs serving youth with SHCN. Specifically, mental health and educational services may need to be expanded and more emphasis placed on addressing the non-medical determinants of health, like family financial burden.

Made available in DSpace on 2016-01-26T12:51:44Z (GMT). No. of bitstreams: 1 josivazdelimapaschoal_dissert.pdf: 1330092 bytes, checksum: d120bcabf80ff477cd1a550207e2b2b9 (MD5) Previous issue date: 2012-04-09 / Introduction: The increasing complexity of nursing work demands fast and accurate decision-making skills about patients care needs. Assessment is one of the tools professional use to identify these needs and guides care actions. Aims: This descriptive and exploratory study aimed to: 1. analyze agreement and disagreement between assessments made through clinical reasoning and application of a patient classification instrument and, 2. investigate the association between the agreement and the professionals personal (age) and professional characteristics (function, professional experience and time on the job, professional and academic qualification, working at an Intensive Care Unit or another hospitalization unit). Method: 105 adult patients were investigated, hospitalized at a teaching hospital in the interior of São Paulo State between May and January 2011). Each patient was assessed by three nurses active at six hospitalization units or not and using a classification instrument or not. To verify the inter-rater agreement level, weighted kappa statistics were used 95% CI and, to investigate the association between agreement and personal characteristics, the Bootstrap method. Results: Inter-rater agreement indicated: kw 0.87 very good level (instrument x internal evaluator), Kw 0.78 (instrument x external evaluator) and Kw 0.76 (among evaluators), considered a good level. The main care areas the nurses identified were Research and Monitoring, Locomotion and Activity and Bodily Care and Eliminations. The mean number of care areas identified in the assessments by the internal evaluator was 2.8 (1.8), against 3.5 (1.6) by the external evaluator. The personal and professional characteristics that influenced inter-rater agreement were: age &#8805; 30 years 0.73(0.08), professional experience &#8805; 5 years 0.73 (0.08), professional qualification 0.83 (0.08) and working at an Intensive Care Unit 0.80 (0.11) for the internal evaluator. As for the external evaluator, the following results were observed: academic qualification 0.19 (0.26) and time on the job &#8805; 2 years 0.14 (0.13). Conclusion: The assessments based on clinical reasoning and the classification instrument similarly identified patients nurse care demand and care categories (care profile), although many areas were not addressed in the nurses clinical assessment. / Introdução: A crescente complexidade do trabalho do enfermeiro demanda habilidade de tomada de decisões rápidas e acuradas sobre as necessidades cuidativas dos pacientes. A avaliação é uma das ferramentas utilizadas pelos profissionais para a identificação dessas necessidades e norteia as ações assistenciais. Objetivos: Este estudo descritivo exploratório teve por objetivos: 1. analisar a concordância e discordância entre as avaliações realizadas por raciocínio clínico e aplicação de instrumento de classificação de pacientes e, 2. investigar a associação entre a concordância e características pessoais (idade) e profissionais dos avaliadores (função, tempo de atuação profissional e na unidade, qualificação profissional e acadêmica, ser profissional atuante em Unidade de Terapia Intensiva ou em outra unidade de internação). Casuística e Método: Foram investigados 105 pacientes adultos internados em um hospital de ensino do interior do Estado de São Paulo no período de maio a janeiro de 2011. Cada paciente foi avaliado por três enfermeiros alocados dentro e fora de seis unidades de internação com e sem instrumento de classificação. Para aferição do grau de concordância entre as avaliações foi utilizada a estatística Kappa ponderado IC 95% e, para investigar a associação entre a concordância e as características pessoais, o método Bootstrap. Resultados: A concordância entre as avaliações apontou: kw 0,87- nível muito bom (instrumento x avaliador interno), Kw 0,78 (instrumento x avaliador externo) e Kw 0,76 (entre os avaliadores), consideradas nível bom. As principais áreas de cuidados identificadas pelos enfermeiros foram Investigação e Monitoramento, Locomoção e Atividade e Cuidado Corporal e Eliminações. A média de áreas de cuidados identificadas nas avaliações realizadas pelo avaliador interno foi de 2,8 (1,8) e do externo de 3,5 (1,6). As características pessoais e profissionais que apresentaram influência na concordância entre as avaliações foram: idade &#8805; 30 anos - 0,73(0,08), tempo de atuação profissional &#8805; 5 anos - 0,73 (0,08), ter qualificação profissional - 0,83 (0,08) e estar lotado em Unidade de Terapia Intensiva 0,80 (0,11) para o avaliador interno. Em relação ao avaliador externo observaram-se os seguintes resultados: ter qualificação acadêmica - 0,19 (0,26) e tempo de atuação na unidade &#8805; 2 anos - 0,14 (0,13). Conclusão: As avaliações conduzidas através de raciocínio clínico e mediante instrumento de classificação identificaram de forma similar a demanda de atenção dos pacientes em relação à enfermagem e categorias de cuidados (perfil assistencial) embora muitas áreas não tenham sido contempladas na avaliação clínica dos enfermeiros.

Older adults have an increased risk for illness and disease, factors that can lead to functional impairment and intensify the need for reliance on supportive services. Planning for long-term care needs is a vital component of healthy aging and continued autonomy. Yet, many older adults fail to make plans in advance, perhaps due to differences in personal characteristics. The moderating effects of trait hope on the relationship between health-related quality of life (HRQoL) and preparation for future care needs (PFCN) was studied in a sample of 65 older adult primary care patients (<65 years) in western New York. Participants completed a questionnaire on 5 dimensions of PFCN (awareness of risk, information gathering, decisions about care preferences, concrete planning, and active avoidance). In addition, data were collected on five HRQoL domains (physical function, physical role function, emotional role function, social function, and bodily pain) and trait hope. Moderated multiple regression was used to test the moderator hypothesis controlling for personal characteristics. Post-hoc probing was used to further examine significant interactions. At the bivariate level, social functioning, physical functioning, and emotion-based role were inversely related to PFCN and positively related to hope. Multivariate moderation models covarying age, sex, race, education, illness burden, and functional impairment indicated that hopefulness, particularly agentic thinking or goal identification, moderated the relationship between those three HRQoL dimensions and PFCN behaviors. Among those with greater role limitations, lower hope was associated with more awareness of risk and information gathering and less concrete decision making, whereas among individuals with fewer role limitations and better social and physical functioning, higher levels of hopefulness were associated with increased decision making. These results highlight the need for health professionals to gain a better understanding of their patients'intrapersonal characteristics when discussing issues related to future care planning.

Background: There is considerable evidence that physicians lack sufficient training in facilitating transition from pediatric to adult care systems for adolescents and young adults (A/YA). While several primary care residency programs have introduced health care transition (HCT) curricula in recent years, there are few studies that assess the effectiveness of HCT teaching models. Purpose: To assess the impact of a residency education program that uses electronic health records (EHR) and other methods to teach residents how to prepare A/YA for transition to adult care. Methods: In a mixed methods, quasi-experimental research design, quantitative methods were used to measure change in knowledge, confidence and experience among 67 Pediatrics and Med-Peds residents who participated in the program. All residents and a comparison group were invited to complete a 35-item pre/post-survey; a retrospective chart review provided documentation of age-specific HCT preparation tasks completed by residents during well visits for A/YA aged 12-21. Descriptive and correlational analyses were conducted to compare differences between resident and control test scores for 5 outcome variables, and to measure resident utilization of the HCT tool in the EHR. Using the Reach Effectiveness-Adoption Implementation Maintenance (RE-AIM) evaluation model as a guide, semi-structured interviews were conducted concurrently with residents and faculty to assess program acceptability, feasibility, and other important attributes. Interviews were transcribed and analyzed using a constant comparative, iterative process. Results: Survey results showed residents (11 matched pairs) scored significantly higher than controls (13 matched pairs) in 2 of 5 outcomes: exposure to HCT learning activities (p=.0005) and confidence in providing primary care for YSHCN (p=.0377). Overall utilization of the EHR tool among 51 residents was 52.8% (57 of 108 patient visits). In interviews conducted with 16 residents and 6 faculty, both groups said that HCT training is a highly relevant need. Residents said they had little knowledge or experience in HCT prior to the intervention but felt more confident in their abilities afterwards. The HCT tool in the EHR was the only intervention element among multiple modalities that reached all study participants, with more than 80% of residents interviewed reporting they used the HCT tool "usually" or "always." Factors that influenced program adoption included accessibility of educational materials, ease of use, time constraints, patient age and health condition, and attending physicians' enforcement of the protocol. Conclusion: This study contributes to the body of knowledge concerning HCT by increasing our understanding of ways to effectively educate residents about transition preparation. Results show a positive intervention effect on selected dimensions of resident knowledge, confidence, and practice in HCT, highlighting program strengths and weaknesses. The program is distinctive in educating residents to prepare all A/YA for HCT, as recommended by major medical associations for pediatric and adult care physicians, and in its use of the EHR as a primary teaching tool, a consideration for reducing time-intensive didactic instruction. It provides a model that can be adapted by other residency and provider training programs, and suggests a need to integrate acquisition of health care self-management skills more broadly in child and adolescent health preventive care tools and policies.

It is estimated that one out of every five household with children in the United States includes a Child with Special Health Care Needs (CSHCN). Families of CSHCN face many challenges including financial burdens beyond that of other families and difficulty accessing much needed pediatric specialty care. Telemedicine provides a potential solution or, at the least, an alternative to the traditional system of care, for health care providers and communities to address access and financial concerns of families of CSHCN. A quasi-experimental research design was used in this study to examine the differences in cost, caring, and family-centered care in relation to pediatric specialty services utilizing telemedicine technology compared to traditional face-to-face care. The study sample included a convenience sample of 222 parents/ guardians of CSHCN residing in rural, remote and medically underserved areas of Southeast Florida enrolled in the Children's Medical Services (CMS) program. The sample was comprised of two study groups: traditional (n = 110) which included families receiving traditional face-to-face pediatric specialty care; and the telemedicine group (n = 112) which included families who have received telemedicine visits along with traditional face-to-face pediatric specialty care. Measures of cost, caring, and family-centered care were obtained using three instruments including a Family Cost Survey, Caring Professional Scale (CPS), and Measure of Processes of Care- 20 Item Scale (MPOC-20). Results indicated that there were no significant differences in family costs when telemedicine was available locally compared to traditional face-to-face care in the local community. Family costs were anticipated to be significantly higher if telemedicine was not available in their communities. There were no differences in the families' perceptions of care as caring for the telemedicine and traditional groups. Results indicated significant differences between the groups in regards to family-centered care, with telemedicine group parents/ guardians reporting more positive perceptions of the system of care as family-centered compared to families receiving traditional face-to-face pediatric specialty care. These results together underscore the importance of assuring and facilitating access to pediatric specialty care for CSHCN and their families by further reducing their burdens and costs. The use of innovative systems of care such as telemedicine has promise to promote caring, family-centered systems of care in their home communities. Future research is recommended to further examine nursing roles and interventions in telemedicine programs, measurement tools, and family perceptions of systems of care across different populations.