Investigating the Connections Between Delivery of Care, Reablement, Workload, and Organizational Factors in Home Care Services: Mixed Methods Study

BACKGROUND

Home care is facing increasing demand due to an aging population. Several challenges have been identified in the provision of home care, such as the need for support and tailoring support to individual needs. Goal-oriented interventions, such as reablement, may provide a solution to some of these challenges. The reablement approach targets adaptation to disease and relearning of everyday life skills and has been found to improve health-related quality of life while reducing service use.

OBJECTIVE

The objective of this study is to characterize home care system variables (elements) and their relationships (connections) relevant to home care staff workload, home care user needs and satisfaction, and the reablement approach. This is to examine the effects of improvement and interventions, such as the person-centered reablement approach, on the delivery of home care services, workload, work-related stress, home care user experience, and other organizational factors. The main focus was on Swedish home care and tax-funded universal welfare systems.

METHODS

The study used a mixed methods approach where a causal loop diagram was developed grounded in participatory methods with academic health care science research experts in nursing, occupational therapy, aging, and the reablement approach. The approach was supplemented with theoretical models and the scientific literature. The developed model was verified by the same group of experts and empirical evidence. Finally, the model was analyzed qualitatively and through simulation methods.

RESULTS

The final causal loop diagram included elements and connections across the categories: stress, home care staff, home care user, organization, social support network of the home care user, and societal level. The model was able to qualitatively describe observed intervention outcomes from the literature. The analysis suggested elements to target for improvement and the potential impact of relevant studied interventions. For example, the elements "workload" and "distress" were important determinants of home care staff health, provision, and quality of care.

CONCLUSIONS

The developed model may be of value for informing hypothesis formulation, study design, and discourse within the context of improvement in home care. Further work will include a broader group of stakeholders to reduce the risk of bias. Translation into a quantitative model will be explored.

Teamwork in home care nursing: A scoping literature review

Due to an increased number of complex multi- and long-term ill patients, healthcare and nursing provided in patients' homes are expected to grow. Teamwork is important in order to provide effective and safe care. As care becomes more complex, the need for teamwork in home care nursing increases. However, the literature on teamwork in the patients' home environment is limited. The aim of this study is to describe the scope of the current literature on teamwork in home care nursing and outline needs for future research. Seven electronic databases were systematically searched and 798 articles were identified and screened. Seventy articles remained and were assessed for eligibility by two of the authors. Eight themes were identified among the 32 articles that met the inclusion criteria. Studies concerned with teamwork regarding isolated tasks/problems and specific teamwork characteristics were most common. Methods were predominantly qualitative. Multiple method approaches and ethnographic field studies were rare. Descriptions of the context were often lacking. The terms 'team' and 'teamwork' were inconsistently used and not always defined. However, it is apparent that teamwork is important and home care nurses play a crucial role in the team, acting as the link between professionals, the patient and their families. Future studies need to pay more attention to the context and be more explicit about how the terms team and teamwork are defined and used. More research is also needed regarding necessary team skills, effects of teamwork on the work environment and technology-mediated teamwork.

A framework for participatory work environment interventions in home care - success factors and some challenges

Background

Home care is beset with work environment issues and high staff turnover, while research concerned with interventions to improve the work environment is sparse. Few of the existing interventions apply a participative approach, despite this being associated with more positive outcomes and sustainable change. This paper presents a framework, rooted in action research and action learning, for participatory work environment interventions in home care, and demonstrates how this framework has been implemented in four Swedish home care organizations.

Methods

The framework has three phases (pre-intervention, intervention planning and intervention implementation) and consists of cycles of action and reflection in three constellations: a group of researchers, a reference group with labour market organization representatives and home care managers, and intervention work groups in the home care organizations. The work was documented and analysed with focus on the realization of the framework and challenges that were met on the way. The interventions were evaluated using a pre-/post-test questionnaire design.

Results

Parts of the framework were successfully implemented. The pre-intervention phase and the intervention planning phase, with intervention work groups, worked well. All four groups identified one intervention relevant to their own context. However, only two of the proposed interventions were fully implemented and evaluated. The high staff and management turnover, and the high rate of organizational changes made it impossible to evaluate the interventions statistically. Yet, data from open-ended questions in the post questionnaire showed that the two implemented interventions were perceived as successful.

Conclusions

The participatory framework, presented in this paper, seems promising for work environment interventions in home care. The framework was designed to reduce the risk of known disturbances affecting the process in unstable organizations. Despite this, it proved challenging to execute the framework, and especially the interventions, due to changes happening at high speed. In the two cases where organizational changes were not dominating, the interventions were implemented successfully. While the prerequisites for participation and successful implementation could be improved somewhat, the main issue, the instability of the organizational context, is hard for researchers or the individual home care units to tackle alone.

Bounded Solidarity as an Asset for Public Health Care Intervention

The relationship between social capital and public health has been extensively analyzed. However, not much has been written about the formation of social capital among citizens and public health workers in times of a pandemic. Our aim is to analyze social capital development through the prism of bounded solidarity and seek its manifestations toward public health workers. A qualitative self-administered survey was used to analyze what actions, practices, attitudes, and reasons inspired citizens to behave as they did with respect to public health workers during the first weeks of lockdown under the COVID-19 pandemic. Respondents, mostly from European countries, reveal that citizens aimed to prevent the collapse of the public health system through reinforcing trust toward institutions, legitimizing health care personnel expertise, practicing reciprocity and altruism, giving recognition to public health workers, and providing them with means. Finally, recommendations for public health communication on risks and crises are discussed.

Managing Multiple Medications and Their Packaging for Older People in Home Care Nursing: An Interview Study

Home care nurses assist older people in their daily living and well-being, including medication management. Medication management can be challenging for older people with functional constraints and several chronic conditions. This paper presents how home care nurses manage medications and their packaging for older people at their homes. This study followed an explorative qualitative research design, in which semi-structured interviews were conducted with home care nurses in Sweden (n = 14). The study revealed that home care nurses need to coordinate a multitude of interrelated tasks, with documentation being paramount. Regarding medication management, automated systems were preferred, as they reduce medication errors and facilitate dispensing of medications for each patient when compared with analogue systems still in use (i.e., dosing boxes), commonly used by older people. Importantly, the lack of a common journal system for updates on prescribed medication among health care providers and analogue communication still in place creates space for outdated prescription of medications for patients. There are opportunities for further investigation on how technology can help home care nurses in coordinating medication management tasks with other health care providers, and on receiving updates about medication intake by older patients when the nurse is not at their homes.