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Tennant R, Allana S, Mercer K, Burns CM. Capturing Home Care Information Management and Communication Processes Among Caregivers of Older Adults: Qualitative Study to Inform Technology Design. JMIR Form Res 2024; 8:e53289. [PMID: 38963695 PMCID: PMC11258521 DOI: 10.2196/53289] [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: 10/02/2023] [Revised: 03/20/2024] [Accepted: 05/14/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND The demand for complex home care is increasing with the growing aging population and the ongoing COVID-19 pandemic. Family and hired caregivers play a critical role in providing care for individuals with complex home care needs. However, there are significant gaps in research informing the design of complex home care technologies that consider the experiences of family and hired caregivers collectively. OBJECTIVE The objective of this study was to explore the health documentation and communication experiences of family and hired caregivers to inform the design and adoption of new technologies for complex home care. METHODS The research involved semistructured interviews with 15 caregivers, including family and hired caregivers, each of whom was caring for an older adult with complex medical needs in their home in Ontario, Canada. Due to COVID-19-related protection measures, the interviews were conducted via Teams (Microsoft Corp). The interview guide was informed by the cognitive work analysis framework, and the interview was conducted using storytelling principles of narrative medicine to enhance knowledge. Inductive thematic analysis was used to code the data and develop themes. RESULTS Three main themes were developed. The first theme described how participants were continually updating the caregiver team, which captured how health information, including their communication motivations and intentions, was shared among family and hired caregiver participants. The subthemes included binder-based health documentation, digital health documentation, and communication practices beyond the binder. The second theme described how participants were learning to improve care and decision-making, which captured how they acted on information from various sources to provide care. The subthemes included developing expertise as a family caregiver and tailoring expertise as a hired caregiver. The third theme described how participants experienced conflicts within caregiver teams, which captured the different struggles arising from, and the causes of, breakdowns in communication and coordination between family and hired caregiver participants. The subthemes included 2-way communication and trusting the caregiver team. CONCLUSIONS This study highlights the health information communication and coordination challenges and experiences that family and hired caregivers face in complex home care settings for older adults. Given the challenges of this work domain, there is an opportunity for appropriate digital technology design to improve complex home care. When designing complex home care technologies, it will be critical to include the overlapping and disparate perspectives of family and hired caregivers collectively providing home care for older adults with complex needs to support all caregivers in their vital roles.
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Affiliation(s)
- Ryan Tennant
- Department of Systems Design Engineering, Faculty of Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Sana Allana
- Department of Systems Design Engineering, Faculty of Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Kate Mercer
- Department of Systems Design Engineering, Faculty of Engineering, University of Waterloo, Waterloo, ON, Canada
- Library, University of Waterloo, Waterloo, ON, Canada
| | - Catherine M Burns
- Department of Systems Design Engineering, Faculty of Engineering, University of Waterloo, Waterloo, ON, Canada
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Aydin M, Bulut TY, Avcİ İA. Adaptation of Caregivers of Individuals on Mechanical Ventilation to Caregiving Role. Indian J Crit Care Med 2024; 28:41-47. [PMID: 38510765 PMCID: PMC10949279 DOI: 10.5005/jp-journals-10071-24596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 11/06/2023] [Indexed: 03/22/2024] Open
Abstract
Aim The aim of this study is to investigate the adaptation of caregivers of individuals on mechanical ventilation (MV) at home to their caregiver role. Study design The phenomenological research method, one of the qualitative research methods, was employed in the study. Materials and methods The sample consisted of 21 individuals who agreed to participate in the research. Necessary legal permissions were obtained to conduct the study. Results The data were analyzed according to the Roy adaptation model (RAM). Accordingly, the domains of the RAM were expressed with the following themes: Physiologic domain: The effects of care on the caregiver (reluctance toward self-care, psychological fatigue, insomnia, and limitation of social life); Self-concept domain: Supportive situations (trust in God and spiritual practices) and non-supportive situations (fear of losing and self-blame); Role-function domain: Adaptation of the caregiver role (thinking no one else can give similar care) and maladaptation of the caregiver role (fear of failing to cope with suddenly emerging situations, failing to fulfill roles and responsibilities, and economic inadequacy); Interdependence domain: Receiving support (support of healthcare professionals and support of family members) and lack of support (inadequacy of health services and loneliness). Conclusion It was concluded that individuals who provided care for patients on MV experienced many difficulties and that these difficulties increased their care burden and made it difficult to adapt to their caregiving roles. How to cite this article Aydin M, Bulut TY, Avcİ İA. Adaptation of Caregivers of Individuals on Mechanical Ventilation to Caregiving Role. Indian J Crit Care Med 2024;28(1):41-47.
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Affiliation(s)
- Mesiya Aydin
- Department of Public Health Nursing, Division of Nursing, Faculty of Health Science, Ondokuz Mayıs University, Samsun, Turkey
| | - Tuba Yilmaz Bulut
- Department of Public Health Nursing, Faculty of Health Science, Kocaeli University, Kocaeli, Turkey
| | - İlknur Aydin Avcİ
- Department of Public Health Nursing, Division of Nursing, Faculty of Health Science, Ondokuz Mayıs University, Samsun, Turkey
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[Advanced Nursing Practice as a concept of care for people with outpatient ventilation in Germany: Results of a demand- and curriculum analysis]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2023; 177:82-92. [PMID: 36934067 DOI: 10.1016/j.zefq.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 01/20/2023] [Accepted: 01/27/2023] [Indexed: 03/18/2023]
Abstract
INTRODUCTION Outpatient intensive care for people on home mechanical ventilation (HMV) is a complex area of care with high demands on the nurses specialised in this field. Internationally, academic qualification as an Advanced Practice Nurse (APN) has become established in these fields of specialised care. Despite the large number of further training opportunities, there is no university qualification for home mechanical ventilation in Germany. Based on a demand- and curriculum analysis, this study therefore defines the role of an APN for home mechanical ventilation (APN-HMV). METHODS The study structure is based on the PEPPA framework (Participatory, Evidence-based and Patient-focused Process for the Development, Implementation and Evaluation of Advanced Practice Nursing). The need for a new model of care was determined with a qualitative secondary analysis based on interviews with health care professionals (n = 87) and a curriculum analysis (n = 5). Analyses were conducted using the Hamric model with a deductive-inductive approach. Subsequently, the main problems and objectives to improve the model of care were agreed upon in the research group, and the APN-HMV role was defined. RESULTS The qualitative secondary data analysis illustrates the need for APN core competencies, especially in the psychosocial area and in family-centred care. The curriculum analysis resulted in a total of 1,375 coded segments. The focus of the curricula was on the central competency "direct clinical practice" (1,116 coded segments) and thus on ventilatory and critical care measures. Based on the results, the profile of APN-HMV could be defined. CONCLUSIONS The introduction of an APN-HMV can usefully complement the skill and grade mix in outpatient intensive care and counteract care problems in this highly specialised area. The study provides a basis for the development of appropriate academic programmes or advanced training courses at universities.
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Pedersen ML, Handberg C, Dreyer P. Mental health reported in adult invasive home mechanical ventilation through a tracheostomy: A scoping review. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2022; 4:100110. [PMID: 38745622 PMCID: PMC11080294 DOI: 10.1016/j.ijnsa.2022.100110] [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: 03/20/2022] [Revised: 11/15/2022] [Accepted: 11/22/2022] [Indexed: 11/25/2022] Open
Abstract
Background Although people receiving invasive home mechanical ventilation through a tracheostomy are facing both physical and mental health challenges, healthcare services often focus mainly on physical symptoms. To ensure well-functioning treatment and care for people receiving tracheostomy ventilation in a home setting, their mental health needs to be promoted and seen as an integral part of their health in general. Objective This scoping review aimed to provide a summary of the current knowledge on the mental health of people receiving invasive home mechanical ventilation through a tracheostomy. Design A scoping review of published and gray literature based on the framework developed by Arksey and O'Malley and refined by the JBI was performed. The Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews checklist was used for reporting the findings. Methods A literature search was conducted by two researchers independently in the PubMed, CINAHL and PsycINFO databases. Additional searches for gray literature were conducted in Google, Google Scholar, websites of selected organisations, and the reference lists of included studies. The software system Covidence was used in the study selection process. For critical appraisal, the Mixed Methods Appraisal Tool was used. Results Thirteen studies were included in this review, of which six used qualitative, six quantitative, and one mixed methods. The majority of studies were authored in Europe (n = 10), followed by the Americas (n = 2) and the Western Pacific (n = 1). Mental health was investigated both directly and indirectly (61.5% vs. 38.5%). Categorizing the reported mental health outcomes, we found that emotional well-being was reported widely across the studies (n = 13), while psychological well-being (n = 5) and social well-being (n = 4) were less widely reported. Conclusions The mental health of people receiving home tracheostomy ventilation has received some scholarly attention. A heterogeneity of mental health outcomes was reported in the literature with emotional well-being being an important mental health area both in relation to the sub-components positive affect and quality of life appraisal. Mental health outcomes in relation to psychological well-being and social well-being were fragmented and only sparsely investigated.
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Affiliation(s)
- Martin Locht Pedersen
- Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark
- Forensic Mental Health Research Unit Middelfart (RFM), Department of Regional Health Research, Faculty of Health Science, University of Southern Denmark, Østre Hougvej 70, 5500 Middelfart, Denmark
- Psychiatric Department Middelfart, Mental Health Services in the Region of Southern Denmark, Østre Hougvej 70, 5500 Middelfart, Denmark
| | - Charlotte Handberg
- Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark
- National Rehabilitation Centre for Neuromuscular Diseases, Kongsvang Allé 23, 8000 Aarhus C, Denmark
| | - Pia Dreyer
- Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- Department of Global Public Health and Primary Care, University of Bergen, Årstadveien 17, 5020 Bergen, Norway
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Alrø AB, Klitnaes C, Dreyer P. Personal care assistants' lived experience of working in the home setting with children and adults on mechanical ventilation. Scand J Caring Sci 2021; 36:536-544. [PMID: 34908178 DOI: 10.1111/scs.13056] [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: 04/24/2021] [Revised: 11/09/2021] [Accepted: 12/05/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Working as a personal care assistant (PCA) with children and adults on mechanical ventilation in a home setting may be complex and challenging due to the physical and mental working conditions. AIM To explore the lived experience of working as a (PCA) with patients, children and adults on mechanical ventilation in the home setting. DESIGN AND METHODS A qualitative study using a phenomenological-hermeneutic approach. Data collection involved semi-structured individual interviews with 20 PCAs (n = 15 women and n = 5 men) in Denmark in 2020. Their work experience with patients on home mechanical ventilation ranged from 8 months to 25 years (median 8 years). The Consolidated Criteria for Reporting Qualitative Research checklist was used as a guideline. FINDINGS Four main themes emerged from the structural analysis: Being a fly on the wall or part of the family, Always being in a state of readiness is exhausting, Being a team player and Mutual respect is key in the work relationship. CONCLUSION PCAs had to balance on a knife's edge when working with children and adults on mechanical ventilation in the home setting and try to strike a happy medium. Enduring the job required a proper physical and mental work environment, and thorough preparation, achieved not only through technical training, but also through learning how to be part of a professional relationship characterised by mutual respect and matched expectations. RELEVANCE TO CLINICAL PRACTICE The findings provide clinical practice with important insights into how to inform, prepare and educate PCAs working with patients on mechanical ventilation in the home setting. Further research into home care education and training programmes with a patient- and family-centred care approach is needed.
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Affiliation(s)
| | - Charlotte Klitnaes
- Department of Intensive Care, Aarhus University Hospital, Aarhus N, Denmark
| | - Pia Dreyer
- Department of Intensive Care, Aarhus University Hospital, Aarhus N, Denmark.,Section of Nursing, Institute of Public Health, Aarhus University, Aarhus C, Denmark.,Bergen University, Bergen, Norway
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Klingshirn H, Gerken L, Hofmann K, Heuschmann PU, Haas K, Schutzmeier M, Brandstetter L, Ahnert J, Wurmb T, Kippnich M, Reuschenbach B. How to improve the quality of care for people on home mechanical ventilation from the perspective of healthcare professionals: a qualitative study. BMC Health Serv Res 2021; 21:774. [PMID: 34353315 PMCID: PMC8341833 DOI: 10.1186/s12913-021-06743-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/06/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The rapid increase in the use of home mechanical ventilation (HMV) for people with chronic respiratory failure poses extreme challenges for the healthcare system. People on HMV have complex care needs and require support from an interprofessional team. In Germany, HMV is criticised for inadequate quality standards, particularly in outpatient intensive care practice. The objective of this study was to describe the quality of care for people on outpatient HMV in Germany, Bavaria and provide recommendations for improvement from the perspective of healthcare professionals (HCPs). METHODS Semi-structured qualitative telephone interviews with HCPs (i.e., nurses, equipment providers, therapists, and physicians) were analysed using the framework method. The quality framework of Health Improvement Scotland (HIS), which aims to improve the quality of person-centred care, was used to build a deductive analysis matrix. The framework includes the three key areas: (1) Outcomes and impact, (2) Service delivery, and (3) Vision and leadership. The domains (meta-codes) and quality indicators (sub-codes) of the quality framework were used for deductive coding. RESULTS Overall, 87 HCPs (51 female, mean age of 44.3 years, mean professional experience in HMV of 9.4 years) were interviewed (mean duration of 31 min). There was a complex interaction between the existing health care system (Outcomes and impact, 955 meaning units), the delivery of outpatient intensive care (Service delivery, 939 meaning units), and improvement-focused leadership (Vision and leadership, 70 meaning units) that influenced the quality of care for people on HMV. The main barriers were an acceleration in transition management, a neglect of weaning potential, a shortage of qualified professionals and missing quality criteria. The central recommendations for promoting person-centred care were training and supervision of staff and an inspiring leadership. An integrated care structure supporting medical home visits and outpatient rehabilitation should be developed. CONCLUSION This study describes a heterogeneous and partly deficient care situation for people on HMV, but demonstrates that high quality care is possible if person-centred care is successfully implemented in all areas of service provision. The recommendations of this study could inform the development of a person-centred integrated care structure for people on HMV.
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Affiliation(s)
- Hanna Klingshirn
- Catholic University of Applied Sciences Munich, Preysingstraße 95, 81667 Munich, Germany
| | - Laura Gerken
- Catholic University of Applied Sciences Munich, Preysingstraße 95, 81667 Munich, Germany
| | - Katharina Hofmann
- Catholic University of Applied Sciences Munich, Preysingstraße 95, 81667 Munich, Germany
| | - Peter Ulrich Heuschmann
- Institute for Clinical Epidemiology and Biometry, Julius-Maximilian University Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany
- Clinical Trial Center Würzburg, University Hospital Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany
- Comprehensive Heart Failure Center Würzburg, University and University Hospital Würzburg, Am Schwarzenberg 15, 97078 Würzburg, Germany
| | - Kirsten Haas
- Institute for Clinical Epidemiology and Biometry, Julius-Maximilian University Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany
| | - Martha Schutzmeier
- Institute for Clinical Epidemiology and Biometry, Julius-Maximilian University Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany
| | - Lilly Brandstetter
- Institute for Clinical Epidemiology and Biometry, Julius-Maximilian University Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany
| | - Jutta Ahnert
- Institute for Clinical Epidemiology and Biometry, Julius-Maximilian University Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany
| | - Thomas Wurmb
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - Maximilian Kippnich
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - Bernd Reuschenbach
- Catholic University of Applied Sciences Munich, Preysingstraße 95, 81667 Munich, Germany
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MacLaren J, Smith P, Rodgers S, Bateman AP, Ramsay P. A qualitative study of experiences of health and social care in home mechanical ventilation. Nurs Open 2019; 6:283-292. [PMID: 30918680 PMCID: PMC6419121 DOI: 10.1002/nop2.213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 07/09/2018] [Accepted: 09/03/2018] [Indexed: 11/25/2022] Open
Abstract
AIM To contribute insight into health and social care integration through an exploration of the care experiences of adults with degenerative neuromuscular conditions who use a mechanical ventilator at home. DESIGN Descriptive qualitative research. METHODS Seventeen semi-structured interviews were conducted with patients and family carers living in Scotland during 2015-2016 and thematically analysed. RESULTS To achieve a satisfying life, home ventilated participants required help from a variety of health and social care services, as well as care from family. Examples of successful care were identified, but there were also serious failures and conflict with services. Identifying how care fails or succeeds for this patient population and their families requires an understanding of the interdependency of health and social care. This was achieved by examining health and social care provision from the experiential perspective of care-users to provide insights into how disconnected provision has an impact on users' lives in numerous, idiosyncratic ways.
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Affiliation(s)
- Jessica MacLaren
- University of EdinburghOld Medical SchoolTeviot PlaceEdinburghUK
- Present address:
School of Health and Social CareEdinburgh Napier UniversityEdinburghUK
| | - Pam Smith
- University of EdinburghOld Medical SchoolTeviot PlaceEdinburghUK
| | - Sheila Rodgers
- University of EdinburghOld Medical SchoolTeviot PlaceEdinburghUK
| | | | - Pam Ramsay
- University of EdinburghOld Medical SchoolTeviot PlaceEdinburghUK
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Lindahl B, Kirk S. When technology enters the home – a systematic and integrative review examining the influence of technology on the meaning of home. Scand J Caring Sci 2018; 33:43-56. [DOI: 10.1111/scs.12615] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 07/29/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Berit Lindahl
- Faculty of Caring Sciences Work Life & Social Welfare University of Borås Borås Sweden
| | - Sue Kirk
- Division of Nursing Midwifery & Social Work University of Manchester Manchester UK
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Ethical challenges in tracheostomy-assisted ventilation in amyotrophic lateral sclerosis. J Neurol 2018; 265:2730-2736. [DOI: 10.1007/s00415-018-9054-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 09/07/2018] [Accepted: 09/07/2018] [Indexed: 12/11/2022]
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Schaepe C, Ewers M. "I see myself as part of the team" - family caregivers' contribution to safety in advanced home care. BMC Nurs 2018; 17:40. [PMID: 30220881 PMCID: PMC6137892 DOI: 10.1186/s12912-018-0308-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 08/23/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The use of medical technology and the various contributing and interdepending human factors in home care have implications for patient safety. Although family caregivers are often involved in the provision of advanced home care, there is little research on their contribution to safety. The study aims to explore family caregivers in Home Mechanical Ventilation (HMV) safety experiences and how safety is perceived by them in this context. Furthermore, it seeks to understand how family caregivers contribute to the patients' and their own safety in HMV and what kind of support they expect from their health care team. METHODS An explorative, qualitative study was applied using elements from grounded theory methodology. Data were collected through individual interviews with 15 family caregivers to patients receiving HMV in two regions in Germany. The audiotaped interviews were then subject to thematic analysis. RESULTS The findings shows that family caregivers contribute to safety in HMV by trying to foster mutual information sharing about the patient and his/her situation, coordinating informally health care services and undertaking compensation of shortcomings in HMV. CONCLUSION Consequently, family caregivers take on considerable responsibility for patient safety in advanced home care by being actively and constantly committed to safety work.Nurses working in this setting should be clinically and technically skilled and focus on building partnership relations with family caregivers. This especially encompasses negotiation about their role in care and patient safety. Support and education should be offered if needed. Only skilled nurses, who can provide safe care and who can handle critical situations should be appointed to HMV. They should also serve as professional care coordinators and provide educational interventions to strengthen family caregivers' competence.
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Affiliation(s)
- Christiane Schaepe
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Health and Nursing Science, Berlin, Germany
| | - Michael Ewers
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Health and Nursing Science, Berlin, Germany
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Dickson A, Karatzias T, Gullone A, Grandison G, Allan D, Park J, Flowers P. Negotiating boundaries of care: an interpretative phenomenological analysis of the relational conflicts surrounding home mechanical ventilation following traumatic spinal cord injury. Health Psychol Behav Med 2018; 6:120-135. [PMID: 34040825 PMCID: PMC8114355 DOI: 10.1080/21642850.2018.1462708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objectives: The aim of this study is to explore the phenomena of mechanical ventilation following traumatic spinal cord injury from three simultaneous perspectives; patients who require full-time mechanical ventilation (n = 8), their informal family carers (n = 8) and their formal carers (n = 11). We focus upon the intra and inter- personal challenges of establishing boundaries within the triad. Design: Qualitative study. Methods: Semi-structured interviews were transcribed verbatim and analysed using interpretative phenomenological analysis (IPA). In order to encapsulate the inter-subjective, multi-dimensional and relational aspects of the experience, we focussed on recurrent themes which were independently reported across all three participant groups. Results: One major inter-connected recurrent theme was identified: 1) 'Negotiating boundaries of care and finding a "fit"'. It centres around establishing a 'line', or a boundary, which was imperative for retaining a sense of independence (for patients), a sense of home and privacy (for informal carers) and difficulties balancing complex care provision with the needs of family members so as not to cross that 'line' (for formal carers). Conclusions: The findings highlight the need for focussing on a 'fit' within the triad, balancing boundaries of care in order to establish a productive, satisfactory psycho-social environment for all three participant groups to live and/or work within. Recommendations for both future care provision and future research are suggested.
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Affiliation(s)
- A Dickson
- School of Health & Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - T Karatzias
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - A Gullone
- School of Health and Social Sciences, University of Edinburgh, Edinburgh, UK
| | - G Grandison
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - D Allan
- Queen Elizabeth National Spinal Injuries for Scotland, Southern General Hospital, Glasgow, UK
| | - J Park
- School of Health & Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - P Flowers
- School of Health & Life Sciences, Glasgow Caledonian University, Glasgow, UK
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Transitions to Home Mechanical Ventilation: The Experiences of Canadian Ventilator-Assisted Adults and Their Family Caregivers. Ann Am Thorac Soc 2017; 15:357-364. [PMID: 29283698 DOI: 10.1513/annalsats.201708-663oc] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Lerum SV, Solbraekke KN, Frich JC. Healthcare professionals' accounts of challenges in managing motor neurone disease in primary healthcare: a qualitative study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2017; 25:1355-1363. [PMID: 28226395 DOI: 10.1111/hsc.12432] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/09/2017] [Indexed: 06/06/2023]
Abstract
Motor neurone disease (MND) is a progressive neurological disease causing muscle wasting, gradual paralysis and respiratory failure, with a life expectancy of 2-4 years. In order to better understand how MND is managed in the community, we conducted a qualitative study to explore the challenges healthcare professionals encounter when managing MND in primary healthcare. Based on data from 15 semi-structured interviews with primary healthcare professionals in Norway, we found that MND is viewed as a condition that requires exceptional effort and detailed planning. Healthcare professionals reported five main challenges in managing MND in primary healthcare: (i) building relationships with those giving and receiving care in the home; (ii) preventing caregiver burnout and breakdown; (iii) providing tailored care; (iv) ensuring good working conditions in patients' homes; and (v) recruiting and retaining qualified nursing assistants. Healthcare professionals reported needing working conditions that allow them to tailor their approach to the personal, emotional and existential nature of care preferences of those living with MND. However, people with MND and their families were sometimes perceived by healthcare professionals to prefer a strictly task-focused relationship with care providers. Such relationships limited the healthcare professionals' control over the MND trajectory and their capacity to prevent family caregiver burnout and breakdown. Adequate resources, along with training and support of nursing assistants, may increase the continuity of nursing assistants. Responsiveness to patient and family needs may enhance collaboration and promote tailored primary care and support for patients with MND and their families.
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Affiliation(s)
| | | | - Jan C Frich
- Institute of Health and Society, University of Oslo, Oslo, Norway
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Abstract
Although precise numbers are difficult to obtain, the population of patients receiving long-term ventilation has increased over the last 20 years, and includes patients with chronic lung diseases, neuromuscular diseases, spinal cord injury, and children with complex disorders. This article reviews the equipment and logistics involved with ventilation outside of the hospital. Discussed are common locations for long-term ventilation, airway and secretion management, and many of the potential challenges faced by individuals on long-term ventilation.
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Affiliation(s)
- Sarina Sahetya
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sarah Allgood
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Peter C Gay
- Pulmonary and Critical Care, The Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
| | - Noah Lechtzin
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Smith BK, Renno MS, Martin AD, Corti M, Byrne BJ. Reply: Respiratory motor function in centronuclear myopathy. Muscle Nerve 2015; 53:660-1. [DOI: 10.1002/mus.24961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 11/06/2015] [Indexed: 11/12/2022]
Affiliation(s)
- Barbara K. Smith
- Department of Physical Therapy; University of Florida; Gainesville Florida USA
- Department of Pediatrics; University of Florida; Gainesville Florida USA
| | - Markus S. Renno
- Department of Pediatrics; Vanderbilt University; Nashville Tennessee USA
| | - Anatole D. Martin
- Department of Physical Therapy; University of Florida; Gainesville Florida USA
| | - Manuela Corti
- Department of Pediatrics; University of Florida; Gainesville Florida USA
| | - Barry J. Byrne
- Department of Pediatrics; University of Florida; Gainesville Florida USA
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Rul B, Quijano-Roy S, Golse A, Beynier D, Estournet B, Desguerre I, Barnerias C, Hervé C. Les principaux changements apportés par la trachéotomie chez des enfants atteints de maladies neuromusculaires. Rech Soins Infirm 2013. [DOI: 10.3917/rsi.114.0046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Johannessen B. Nurses experience of aromatherapy use with dementia patients experiencing disturbed sleep patterns. An action research project. Complement Ther Clin Pract 2013; 19:209-13. [PMID: 24199975 DOI: 10.1016/j.ctcp.2013.01.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 01/24/2013] [Accepted: 01/24/2013] [Indexed: 10/26/2022]
Abstract
The purpose of this study was to gain an insight into nurses' experiences of incorporating aromatherapy into the care of residents suffering from dementia, anxiety and disturbed sleep patterns. Twenty-four residents and twelve nurses from four nursing homes participated in an action research study. The use of lavender augustofolia essential oil diffused nightly was perceived as an effective care modality reducing insomnia and anxiety in this patient cohort. Nurses experienced some negative attitudes among colleagues because they considered aromatherapy as not evidence based. Nurses require greater access to evidence based use of Aromatherapy. Further research is needed to study how smell can enhance dementia care.
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Affiliation(s)
- Berit Johannessen
- Institute of Health and Nursing Science, Faculty of Health and Sports, University of Agder, Norway.
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Family members' caregiving situations in palliative home care when sitting service is received: The understanding of multiple realities. Palliat Support Care 2013; 12:425-37. [PMID: 23782917 DOI: 10.1017/s1478951513000333] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To deepen the understanding of the variation of complexity in family members' caregiving situations, when the private home is the place for care, dying, and sitting service. METHODS Seven relatives to a deceased family member from four different families were interviewed twice. Data were analyzed by direct interpretation and categorical aggregation. RESULTS Various patterns of becoming a caregiver were showed, but family members' willingness to become family caregivers was strongly related to fulfilling the dying persons' wishes to be cared for in their own homes. Important factors for coping with the caregiving situation were their needs of support, the possibility to prepare for death related to a need of communication and planning, the length and predictability of the illness trajectory, and experiences of losses and grief. Sitting service was experienced as supportive for family caregivers when they had possibility to hand over care responsibilities, but as non-supportive when expected help not was received. SIGNIFICANCE OF THE RESEARCH Family members' experiences of caregiving and their degree of vulnerability must be different, depending on whether it is a self-selected position or an imposed task. In general, family members in this study were willing to participate in caregiving for end-of life care, but subject to their own conditions. One way to decrease vulnerability is to assess the resources and competence in relation to the responsibility the person is expected to assume. The support and other efforts to help family caregivers must be related to their specific needs and reality, not only to what the care organization can offer as a standard solution.
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Dyrstad DN, Hansen BS, Gundersen EM. Factors that influence user satisfaction: tracheotomised home mechanical ventilation users’ experiences. J Clin Nurs 2012; 22:331-8. [DOI: 10.1111/j.1365-2702.2012.04304.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2012] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Evy M Gundersen
- Department of Health Studies; Faculty of Social Sciences; University of Stavanger; Stavanger; Norway
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Egerod I, Overgaard D. Taking a back seat: support and self-preservation in close relatives of patients with left ventricular assist device. Eur J Cardiovasc Nurs 2012; 11:380-7. [DOI: 10.1177/1474515111435609] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Ingrid Egerod
- University of Copenhagen, Copenhagen, Denmark
- Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Dorthe Overgaard
- Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Rul B, Carnevale F, Estournet B, Rudler M, Hervé C. Tracheotomy and children with spinal muscular atrophy type 1: ethical considerations in the French context. Nurs Ethics 2012; 19:408-18. [PMID: 22323397 DOI: 10.1177/0969733011429014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Spinal muscular atrophy (SMA) type 1 is a genetic neuromuscular disease in children that leads to degeneration of spinal cord motor neurons. This sometimes results in severe muscular paralysis requiring mechanical ventilation to sustain the child's life. The onset of SMA type 1, the most severe form of the disease, is during the first year of life. These children become severely paralysed, but retain their intellectual capacity. Ethical concerns arise when mechanical ventilation becomes necessary for survival. When professionals assess the resulting life for the child and family, they sometimes fear it will result in unreasonably excessive care. The aim of this article is to present an analysis of ethical arguments that could support or oppose the provision of invasive ventilation in this population. This examination is particularly relevant as France is one of the few countries performing tracheotomies and mechanical ventilation for this condition.
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Hogden A, Greenfield D, Nugus P, Kiernan MC. Engaging in patient decision-making in multidisciplinary care for amyotrophic lateral sclerosis: the views of health professionals. Patient Prefer Adherence 2012; 6:691-701. [PMID: 23055703 PMCID: PMC3468167 DOI: 10.2147/ppa.s36759] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The aim of this study was to explore clinician perspectives on patient decision-making in multidisciplinary care for amyotrophic lateral sclerosis (ALS), in an attempt to identify factors influencing decision-making. METHODS Thirty-two health professionals from two specialized multidisciplinary ALS clinics participated in individual and group interviews. Participants came from allied health, medical, and nursing backgrounds. Interviews were audio recorded, and the transcripts were analyzed thematically. RESULTS Respondents identified barriers and facilitators to optimal timing and quality of decision-making. Barriers related to the patient and the health system. Patient barriers included difficulties accepting the diagnosis, information sources, and the patient-carer relationship. System barriers were timing of diagnosis and symptom management services, access to ALS-specific resources, and interprofessional communication. Facilitators were teamwork approaches, supported by effective communication and evidence-based information. CONCLUSION Patient-centered and collaborative decision-making is influenced by a range of factors that inhibit the delivery of optimal care. Decision-making relies on a fine balance between timing of information and service provision, and the readiness of patients to receive them. Health system restrictions impacted on optimal timing, and patients coming to terms with their condition. Clinicians valued proactive decision-making to prepare patients and families for inevitable change. The findings indicate disparity between patient choices and clinician perceptions of evidence, knowledge, and experience. To improve multidisciplinary ALS practice, and ultimately patient care, further work is required to bridge this gap in perspectives.
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Affiliation(s)
- Anne Hogden
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, University of New South Wales, New South Wales, Australia
- Correspondence: Anne Vaughan Hogden, Centre for Clinical Governance Research, Australian Institute of Health Innovation, Faculty of Medicine, Level 1, AGSM, Building, University of New South Wales, Sydney, NSW 2052, Australia, Tel +612 9385 3071, Fax +612 9663 4926, Email
| | - David Greenfield
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, University of New South Wales, New South Wales, Australia
| | - Peter Nugus
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, University of New South Wales, New South Wales, Australia
| | - Matthew C Kiernan
- Prince of Wales Clinical School, University of New South Wales, and Neuroscience Research Australia, Sydney, New South Wales, Australia
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Dybwik K, Tollåli T, Nielsen EW, Brinchmann BS. "Fighting the system": families caring for ventilator-dependent children and adults with complex health care needs at home. BMC Health Serv Res 2011; 11:156. [PMID: 21726441 PMCID: PMC3146406 DOI: 10.1186/1472-6963-11-156] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Accepted: 07/04/2011] [Indexed: 11/29/2022] Open
Abstract
Background An increasing number of individuals with complex health care needs now receive life-long and life-prolonging ventilatory support at home. Family members often take on the role of primary caregivers. The aim of this study was to explore the experiences of families giving advanced care to family members dependent on home mechanical ventilation. Methods Using qualitative research methods, a Grounded Theory influenced approach was used to explore the families' experiences. A total of 15 family members with 11 ventilator-dependent individuals (three children and eight adults) were recruited for 10 in-depth interviews. Results The core category, "fighting the system," became the central theme as family members were asked to describe their experiences. In addition, we identified three subcategories, "lack of competence and continuity", "being indispensable" and "worth fighting for". This study revealed no major differences in the families' experiences that were dependent on whether the ventilator-dependent individual was a child or an adult. Conclusions These findings show that there is a large gap between family members' expectations and what the community health care services are able to provide, even when almost unlimited resources are available. A number of measures are needed to reduce the burden on these family members and to make hospital care at home possible. In the future, the gap between what the health care can potentially provide and what they can provide in real life will rapidly increase. New proposals to limit the extremely costly provision of home mechanical ventilation in Norway will trigger new ethical dilemmas that should be studied further.
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Affiliation(s)
- Knut Dybwik
- Department of Anaesthesiology, Nordland Hospital, 8092 Bodø, Norway.
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