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Gershater MA, Brenner J, Nordberg M, Hommel A. Nurse assistants' perception of caring for older persons who are dying in their own home : An interview study. BMC Palliat Care 2024; 23:70. [PMID: 38468298 DOI: 10.1186/s12904-024-01399-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 02/27/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND As the proportion of older persons in society increases, there is a growing trend towards providing end-of-life care in their homes. Palliative care is a complex and knowledge-demanding form of care, and nurse assistants are those who work closest to the older person at the end-of-life in their own homes. However, nurse assistants sometimes have low educational and insufficient levels of knowledge in palliative care, which can affect the quality of care they provide. Moreover, nurse assistants' experiences are relatively unexplored in this context. The purpose of the study was to illuminate nurse assistants' experiences in caring for dying older persons at home. METHOD An empirical, qualitative interview study was conducted with 14 nurse assistants with experience of palliative care in homecare. The material was analyzed using thematic content analysis. RESULTS From the nurse assistant's experiences, one main theme emerged: doing everything possible for the dying older person despite challenges. Moreover, three sub-themes emerged: making a difference at a crucial time, death awakens emotions, and balancing personal and professional relationships. The nurse assistants' saw their role primarily as relieving symptoms but also focusing on next of kin. The following are described as essential parts of their role: carrying out practical nursing tasks, focusing on the physical environment, working alone and seeking help from colleagues due to a physical distance to the other members of the multidisciplinary team. The nurse assistants experienced a lack of support as there was no structured guidance or debriefing available in difficult emotional situations. Furthermore, they disclosed that they were left alone to deal with their feelings. CONCLUSION This study demonstrates that nurse assistants strive to provide comprehensive care for dying older persons despite facing obstacles from their working conditions and work organization. They lack supervision and education in palliative care, but they rely on their experience-based knowledge to a large extent and provide care according to the four cornerstones of palliative care.
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Affiliation(s)
- Magdalena Annersten Gershater
- Department of Care Science, Faculty of Health and Society, Malmö University, Jan Waldenströms gata 25, Malmö, 206 05, Sweden.
| | - Josefin Brenner
- Department of Health and Social Care, Home Care Kungsparken, Malmö Municipality, Västra Kanalgatan 4, Malmö, 211 41, Sweden
| | - Malin Nordberg
- Department of Health and Social Care, Malmö Municipality, Villa Vikhem, Vikhems bygata 100, Staffanstorp, 245 46, Sweden
| | - Ami Hommel
- Department of Care Science, Faculty of Health and Society, Malmö University, Jan Waldenströms gata 25, Malmö, 206 05, Sweden
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Silverglow A, Wijk H, Lidén E, Johansson L. Patient safety culture in home care settings in Sweden: a cross-sectional survey among home care professionals. BMC Health Serv Res 2023; 23:998. [PMID: 37716938 PMCID: PMC10505324 DOI: 10.1186/s12913-023-10010-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 09/07/2023] [Indexed: 09/18/2023] Open
Abstract
BACKGROUND The connection between a weak patient safety culture and adverse patient events is well known, but although most long-term care is provided outside of hospitals, the focus of patient safety culture is most commonly on inpatient care. In Sweden, more than a third of people who receive care at home have been affected by adverse events, with the majority judged to be preventable. The aim of this study was to investigate the patient safety culture among care professionals working in care at home with older people. METHODS This cross-sectional study used a purposive sample of 66 municipal care workers, health care professionals, and rehabilitation staff from five municipal care units in two districts in western Sweden who provided care at home for older people and had been employed for at least six months. The participants completed the Hospital Survey on Patient Safety Culture (HSOPSC) self-report questionnaire, which assessed aspects of patient safety culture-norms, beliefs, and attitudes. Logistic regression analysis was used to test how the global ratings of Patient safety grade in the care units and Reporting of patient safety events were related to the dimensions of safety culture according to the staff's professions and years of work experience. RESULTS The most positively rated safety culture dimension was Teamwork within care units (82%), which indicates good cooperation with the closest co-workers. The least positively rated dimensions were Handoffs and transitions among care units (37%) and Management support (37%), which indicate weaknesses in the exchange of patient information across care units and limited support from top-level managers. The global rating of Patient safety grade was associated with Communication openness and Management support (p < 0.01 and p = 0.03, respectively). Staff with less work experience evaluated the Patient safety grade higher than those with more work experience. CONCLUSIONS This study suggests that improvements are needed in care transitions and in support from top-level managers and that awareness of patient safety should be improved in staff with less work experience. The results also highlight that an open communication climate within the care unit is important for patient safety.
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Affiliation(s)
- Anastasia Silverglow
- Institute of Health and Care Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Helle Wijk
- Institute of Health and Care Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska University Hospital, Gothenburg, Sweden
- The Centre for Healthcare Architecture (CVA), Chalmers University of Technology, Gothenburg, Sweden
| | - Eva Lidén
- Institute of Health and Care Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lena Johansson
- Institute of Health and Care Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, Centre for Ageing and Health (AgeCap) at the University of Gothenburg, Gothenburg, Sweden
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Ekstedt M, Nordheim ES, Hellström A, Strandberg S, Hagerman H. Patient safety and sense of security when telemonitoring chronic conditions at home: the views of patients and healthcare professionals - a qualitative study. BMC Health Serv Res 2023; 23:581. [PMID: 37340472 DOI: 10.1186/s12913-023-09428-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 04/20/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Chronic diseases are increasing worldwide, and the complexity of disease management is putting new demands on safe healthcare. Telemonitoring technology has the potential to improve self-care management with the support of healthcare professionals for people with chronic diseases living at home. Patient safety threats related to telemonitoring and how they may affect patients' and healthcare professionals' sense of security need attention. This study aimed to explore patients' and healthcare professionals' experiences of safety and sense of security when using telemonitoring of chronic conditions at home. METHODS Semi-structured interviews were conducted with twenty patients and nine healthcare professionals (nurses and physicians), recruited from four primary healthcare centers and one medical department in a region in southern Sweden using telemonitoring service for chronic conditions in home healthcare. RESULTS The main theme was that experiences of safety and a sense of security were intertwined and relied on patients´ and healthcare professionals´ mutual engagement in telemonitoring and managing symptoms together. Telemonitoring was perceived to increase symptom awareness and promote early detection of deterioration promoting patient safety. A sense of security emerged through having someone keeping track of symptoms and comprised aspects of availability, shared responsibility, technical confidence, and empowering patients in self-management. The meeting with technology changed healthcare professionals' work processes, and patients' daily routines, creating patient safety risks if combined with low health- and digital literacy and a naïve reliance on technology. Empowering patients' self-management ability and improving shared understanding of the patient's health status and symptom management were prerequisites for safe care and the patient´s sense of security. CONCLUSIONS Telemonitoring chronic conditions in the homecare context can promote a sense of security when care is co-created in a mutual understanding and responsibility. Attentiveness to the patient's health literacy, symptom management, and health-related safety behavior when using eHealth technology may enlighten and mitigate latent patient safety risks. A systems approach indicates that patient safety risks related to telemonitoring are not only associated with the patient's and healthcare professionals functioning and behavior or the human-technology interaction. Mitigating patient safety risks are likely also dependent on the complex management of home health and social care service.
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Affiliation(s)
- Mirjam Ekstedt
- Faculty of Health and Life Sciences, Department of Health and Caring Sciences, Linnaeus University, Universitetsplatsen 1, Kalmar/Växjö, 392 31, Sweden.
- Department of Learning Informatics Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
| | - Espen S Nordheim
- Faculty of Health and Life Sciences, Department of Health and Caring Sciences, Linnaeus University, Universitetsplatsen 1, Kalmar/Växjö, 392 31, Sweden
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
| | - Amanda Hellström
- Faculty of Health and Life Sciences, Department of Health and Caring Sciences, Linnaeus University, Universitetsplatsen 1, Kalmar/Växjö, 392 31, Sweden
| | - Susanna Strandberg
- Faculty of Health and Life Sciences, Department of Health and Caring Sciences, Linnaeus University, Universitetsplatsen 1, Kalmar/Växjö, 392 31, Sweden
| | - Heidi Hagerman
- Faculty of Health and Life Sciences, Department of Health and Caring Sciences, Linnaeus University, Universitetsplatsen 1, Kalmar/Växjö, 392 31, Sweden
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Nilsson L, Lindblad M, Johansson N, Säfström L, Schildmeijer K, Ekstedt M, Unbeck M. Exploring nursing-sensitive events in home healthcare: A national multicenter cohort study using a trigger tool. Int J Nurs Stud 2023; 138:104434. [PMID: 36630873 DOI: 10.1016/j.ijnurstu.2022.104434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/10/2022] [Accepted: 12/19/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND The provision of home healthcare is increasing in response to the growing aging population with the need for chronic disease management in their homes. Safety work differs from hospital care. The incidence of adverse events in home healthcare is sparsely studied but is estimated to occur in-one third of patients, and most are deemed preventable. Although nursing care is crucial for risk assessment and preventive work in the home environment, the role of registered nurses in the prevention of no-harm incidents and adverse events has not received sufficient scientific attention. OBJECTIVES To explore nursing-sensitive events in patients receiving home healthcare. DESIGN, SETTING AND PARTICIPANTS A Swedish national multicenter study based on a structured record review of 600 randomly chosen healthcare records from 10 organizations in different regions of the country. METHODS Ten trained teams, each including physician(s) and registered nurses, undertook a review based on the Global Trigger Tool method. The review covered a maximum of 90 days from admission to home healthcare. First, each record was screened for the presence of 38 predefined triggers. In the second step, every potential event was assessed according to preventability, types of events, severity, time of occurrence, consequences of the event, and potential contributing causes. RESULTS In total, 699 events were identified in the study. Of these, 495 (74.0%) were classified as nursing-sensitive (227 no-harm incidents and 268 adverse events) and affected 267 (44.5%) patients, with a mean of 1.9 events per patient. The majority (n = 367, 73.1%) were considered preventable. The most prominent types of nursing-sensitive event were falls (n = 138, 27.9%), pressure ulcers (n = 62, 12.5%), healthcare-associated infections (n = 58, 11.7%) and medication management (n = 50, 10.1%). Concerning severity, 45.9% were classified as no-harm incidents and another 36.6% resulted in temporary harm that required extra healthcare resources: 226 hospital days, 66 physician visits in outpatient care, and 99 in home healthcare. All severity types occurred from day 1, except death, which included only one patient. The most frequent contributing factors were deficiencies in nursing care, treatment & diagnosis, with the subgroups nursing care, observation, treatment & follow-up, followed by deficiencies in the organization. CONCLUSIONS Nursing-sensitive events in home healthcare are common, often preventable, and occur from the start of the care period. This study contributes to increased knowledge of patient safety shortcomings and points to the important role that registered nurses play in patient safety work.
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Affiliation(s)
- Lena Nilsson
- Department of Anaesthesiology and Intensive Care, Department of Medical and Health Sciences, Faculty of Medicine and Health Science, Linköping University, Linköping, Sweden.
| | - Marléne Lindblad
- Department of Health Sciences, Swedish Red Cross University, Stockholm, Sweden
| | - Nathalie Johansson
- School of Health and Welfare, Dalarna University, Falun, Sweden; Örsundsbro Health Center, Region Uppsala, Sweden
| | - Lisa Säfström
- School of Health and Welfare, Dalarna University, Falun, Sweden; Heby Home Health Care, Heby, Sweden
| | | | - Mirjam Ekstedt
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden; Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Maria Unbeck
- School of Health and Welfare, Dalarna University, Falun, Sweden; Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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Lindberg C, Fock J, Nilsen P, Schildmeijer K. Registered nurses' efforts to ensure safety for home-dwelling older patients. Scand J Caring Sci 2022; 37:571-581. [PMID: 36582025 DOI: 10.1111/scs.13142] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 10/23/2022] [Accepted: 12/11/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND The international development of health care, an ageing population and rapid technical development mean that more care is being performed in patient homes. This care environment is often unpredictable and involves both formal and informal caregivers, making it potentially unsafe. There is sparse knowledge about how patient safety is protected in home health care in Sweden and how registered nurses work to prevent risks and promote safe care. AIM The aim of the study was to explore registered nurses' efforts to reduce perceived risks for home-dwelling older patients and ensure safe home health care. METHOD We used a qualitative design with individual interviews with 13 registered nurses working in municipalities in southeast Sweden. The narratives were analysed with inductive content analysis. FINDINGS The findings showed that the registered nurses tried to secure a safe care environment and took an active role in care, striving to stay one step ahead of the patient. These three types of efforts are likely interdependent, suggesting they are all needed to reduce perceived risks for home-dwelling older patients and ensure patient safety in home health care. CONCLUSIONS It is a challenge for registered nurses to maintain patient safety when performing care in patient homes. Continuity of care is required and must be based not only on self-reliance among registered nurses but also on trusting relationships with patients, next of kin, colleagues and other personnel, as well as on the development of organisational conditions adapted to patient needs.
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Affiliation(s)
- Catharina Lindberg
- Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Jenni Fock
- Centre for Healthcare Development, University Hospital Linköping, Linköping, Sweden
| | - Per Nilsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Silverglow A, Johansson L, Lidén E, Wijk H. Perceptions of providing safe care for frail older people at home: A qualitative study based on focus group interviews with home care staff. Scand J Caring Sci 2021; 36:852-862. [PMID: 34423863 DOI: 10.1111/scs.13027] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 08/08/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Providing safe care is a core competence in healthcare. The concept usually refers to hospitals but, consistent with the increasing importance of integrated care, the provision of safe care needs to be extended to the context of home care, and more research is needed concerning home healthcare providers' perspectives in this context. AIM The aim of this study was to describe care providers' perceptions of providing safe care for frail older persons living at home. METHOD A qualitative methodology was chosen. In total, 30 care providers agreed to participate. Data were collected through five focus group interviews and analysed using a phenomenographic approach. RESULTS Three themes regarding care providers' perceptions of providing safe care emerged from the data: 'safe care is created in the encounter and interaction with the older person', 'safe care requires responsibility from the caregiver' and 'safe care is threatened by insufficient organisational resources'. The findings show that providing safe care is an endeavour that requires a holistic view among the care providers as well as effective collaboration within the team, but insufficient competence or a lack of time can make it difficult to safeguard the psychological and existential needs of older persons. CONCLUSION Providing safe care in home environments encompasses more than just risk reduction. The findings highlight the importance of establishing and integrating team-based and person-centred care into home care settings. Traditional communication structures for inpatient care also need to be adapted to the cross-disciplinary work in municipalities. Care providers should be given the opportunity to develop and maintain their competences and to prioritise relationship-oriented care.
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Affiliation(s)
- Anastasia Silverglow
- Institute of Health and Care Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lena Johansson
- Institute of Health and Care Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, Centre for Ageing and Health (AgeCap) at the University of Gothenburg, Gothenburg, Sweden
| | - Eva Lidén
- Institute of Health and Care Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Helle Wijk
- Institute of Health and Care Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Sahlgrenska University Hospital, Gothenburg, Sweden.,The Centre for Healthcare Architecture (CVA), Chalmers University of Technology, Gothenburg, Sweden
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Lindblad M, Unbeck M, Nilsson L, Schildmeijer K, Ekstedt M. Identifying no-harm incidents in home healthcare: a cohort study using trigger tool methodology. BMC Health Serv Res 2020; 20:289. [PMID: 32252755 PMCID: PMC7137226 DOI: 10.1186/s12913-020-05139-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 03/23/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Patient safety in home healthcare is largely unexplored. No-harm incidents may give valuable information about risk areas and system failures as a source for proactive patient safety work. We hypothesized that it would be feasible to retrospectively identify no-harm incidents and thus aimed to explore the cumulative incidence, preventability, types, and potential contributing causes of no-harm incidents that affected adult patients admitted to home healthcare. METHODS A structured retrospective record review using a trigger tool designed for home healthcare. A random sample of 600 home healthcare records from ten different organizations across Sweden was reviewed. RESULTS In the study, 40,735 days were reviewed. In all, 313 no-harm incidents affected 177 (29.5%) patients; of these, 198 (63.2%) no-harm incidents, in 127 (21.2%) patients, were considered preventable. The most common no-harm incident types were "fall without harm," "deficiencies in medication management," and "moderate pain." The type "deficiencies in medication management" was deemed to have a preventability rate twice as high as those of "fall without harm" and "moderate pain." The most common potential contributing cause was "deficiencies in nursing care and treatment, i.e., delayed, erroneous, omitted or incomplete treatment or care." CONCLUSION This study suggests that it is feasible to identify no-harm incidents and potential contributing causes such as omission of care using record review with a trigger tool adapted to the context. No-harm incidents and potential contributing causes are valuable sources of knowledge for improving patient safety, as they highlight system failures and indicate risks before an adverse event reach the patient.
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Affiliation(s)
- Marléne Lindblad
- School of Engineering Sciences in Chemistry, Biotechnology and Health, Royal Institute of Technology, Stockholm, Sweden
- Department of Healthcare Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Maria Unbeck
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Acute and Reparative Medicine Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Lena Nilsson
- Department of Anesthesiology and Intensive Care, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Kristina Schildmeijer
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
| | - Mirjam Ekstedt
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
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