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Kiljunen O, Savela RM, Välimäki T, Kankkunen P. Managers' perceptions of the factors affecting resident and patient safety work in residential settings and nursing homes: A qualitative systematic review. Res Nurs Health 2024; 47:397-408. [PMID: 38522016 DOI: 10.1002/nur.22382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/23/2024] [Accepted: 03/15/2024] [Indexed: 03/25/2024]
Abstract
Identifying ways to ensure resident safety is increasingly becoming a priority in residential settings and nursing homes. The aim of this qualitative systematic review was to identify, describe, and assess research evidence on managers' perceptions regarding the barriers and facilitators of daily resident and patient safety work in residential settings and nursing homes. A qualitative systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis checklist. Published studies were sought through academic databases: Academic Search Premier, CINAHL, PubMed (MEDLINE), Scopus, SocINDEX, and Web of Science Core Collection in April 2023. Finally, 12 studies were included. The results of the included studies were synthesized using thematic synthesis after data extraction. According to the results, (1) competent staff and material resources; (2) management and culture; (3) communication, networks, optimal use of expertise; and (4) effective use of guidelines, rules, and regulations play a significant role in the success of resident and patient safety work. The findings revealed that promoting resident safety should not be seen solely as the responsibility of individual residential or nursing home personnel, as it requires multiprofessional cooperation and access to wider networks. Staff and managers must be receptive to learning, changing, and improving safety. Moreover, to ensure resident safety, it is essential to ensure that the organizations support safety work in residential and nursing home units.
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Affiliation(s)
- Outi Kiljunen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Roosa-Maria Savela
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Tarja Välimäki
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Päivi Kankkunen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
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Scott J, Sykes K, Waring J, Spencer M, Young-Murphy L, Mason C, Newman C, Brittain K, Dawson P. Systematic review of types of safety incidents and the processes and systems used for safety incident reporting in care homes. J Adv Nurs 2024. [PMID: 38895931 DOI: 10.1111/jan.16264] [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: 02/28/2024] [Revised: 05/15/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024]
Abstract
AIMS To identify the safety incident reporting systems and processes used within care homes to capture staff reports of safety incidents, and the types and characteristics of safety incidents captured by safety incident reporting systems. DESIGN Systematic review following PRISMA reporting guidelines. METHODS Databases were searched January 2023 for studies published after year 2000, written in English, focus on care homes and incident reporting systems. Data were extracted using a bespoke data extraction tool, and quality was assessed. Data were analysed descriptively and using narrative synthesis, with types and characteristics of incidents analysed using the International Classification for Patient Safety. DATA SOURCES Databases were CINAHL, MEDLINE, PsycINFO, EMBASE, HMIC, ASSISA, Nursing and Allied Health Database, MedNar and OpenGrey. RESULTS We identified 8150 papers with 106 studies eligible for inclusion, all conducted in high-income countries. Numerous incident reporting processes and systems were identified. Using modalities, typical incident reporting systems captured all types of incidents via electronic computerized reporting, with reports made by nursing staff and captured information about patient demographics, the incident and post-incident actions, whilst some reporting systems included medication- and falls-specific information. Reports were most often used to summarize data and identify trends. Incidents categories most often were patient behaviour, clinical process/procedure, documentation, medication/intravenous fluids and falls. Various contributing and mitigating factors and actions to reduce risk were identified. The most reported action to reduce risk was to improve safety culture. Individual outcomes were often reported, but social/economic impact of incidents and organizational outcomes were rarely reported. CONCLUSIONS This review has demonstrated a complex picture of incident reporting in care homes with evidence limited to high-income countries, highlighting a significant knowledge gap. The findings emphasize the central role of nursing staff in reporting safety incidents and the lack of standardized reporting systems and processes. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE The findings from this study can inform the development or adaptation of safety incident reporting systems in care home settings, which is of relevance for nurses, care home managers, commissioners and regulators. This can help to improve patient care by identifying common safety issues across various types of care home and inform learning responses, which require further research. IMPACT This study addresses a gap in the literature on the systems and processes used to report safety incidents in care homes across many countries, and provides a comprehensive overview of safety issues identified via incident reporting. REPORTING METHOD PRISMA. PATIENT OR PUBLIC CONTRIBUTION A member of the research team is a patient and public representative, involved from study conception.
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Affiliation(s)
- Jason Scott
- Northumbria University, Newcastle upon Tyne, UK
| | - Kate Sykes
- Northumbria University, Newcastle upon Tyne, UK
| | | | - Michele Spencer
- North Tyneside Community and Health Care Forum, North Shields, UK
| | | | - Celia Mason
- Northumbria University, Newcastle upon Tyne, UK
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de Oliveira LP, da Silva HS. Challenges to the operation of Brazilian LTCIs and changes in oversight. BMC Geriatr 2024; 24:515. [PMID: 38872159 DOI: 10.1186/s12877-024-05129-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 06/06/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Despite 18 years since health surveillance regulations were promulgated in Brazil to govern Long-Term Care Institutions for Older Adults (LTCIs), many institutions fail to comply with the Differentiated Regime for Public Procurement (Resolution No. 502/2021) due to structural and operational conditions. This study aimed to investigate Brazilian LTCI managers' understanding of challenges that significantly impact institutional operation and gather suggestions for enhancing RDC No. 502/21. METHODS A cross-sectional, exploratory, and qualitative study was conducted, involving 90 managers or technical supervisors from Brazilian LTCIs. Data were collected using a self-administered Google Forms instrument and analyzed through Thematic Analysis based on the Organizing for Quality (OQ) framework. RESULTS The most impactful challenges for LTCIs were healthcare, financing, human resources, relationship with oversight bodies, and family members. DISCUSSION Proposed improvements for RDC No. 502/21 included enhanced professional training, infrastructure revision, increased financial support from the state, realistic oversight/regulations, and tailored monitoring approaches. CONCLUSION LTCIs in Brazil face numerous challenges, and the suggested improvements aim to adapt regulations to institutional realities. However, considering the regulations' variability and purposes, further investigation is warranted.
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Affiliation(s)
- Letycia Parreira de Oliveira
- Programa de Pós-Graduação Stricto Sensu em Gerontologia. Brasília, Universidade Católica de Brasília, Distrito Federal, Brasil.
| | - Henrique Salmazo da Silva
- Programa de Pós-Graduação Stricto Sensu em Gerontologia. Brasília, Universidade Católica de Brasília, Distrito Federal, Brasil
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Ouyang Q, Zhang G, Xie Y, Yuan H, Cheng F, Huang Q. Effects of a special continuous quality improvement in nursing on the management of adverse care events: a retrospective study. BMC Health Serv Res 2024; 24:692. [PMID: 38822344 PMCID: PMC11143752 DOI: 10.1186/s12913-024-10913-4] [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: 11/17/2023] [Accepted: 03/27/2024] [Indexed: 06/02/2024] Open
Abstract
OBJECTIVE To explore the application effect of the direct reporting system of adverse nursing events and special continuous nursing quality improvement measures in the management of these adverse events. METHODS The implementation time of continuous nursing improvement based on the direct reporting system was the demarcation point. We retrospectively collected and analyzed nursing adverse event reports and hospitalization data from Xiangtan Central Hospital before implementation (2015-2018) and after implementation (2019-2022). The active reporting rate of adverse events, the composition of these events and the processing time were compared between the two groups. RESULTS The rate of active reporting of adverse events before the implementation was lower than that after the implementation (6.7% vs. 8.1%, X2 = 25.561, P < 0.001). After the implementation of the direct reporting system for nursing events and the continuous improvement of nursing quality, the reporting proportion of first-level and second-level events decreased significantly. Moreover, the reporting proportion of third-level events increased significantly. The proportion of falls and medication errors decreased, and the proportion of unplanned extubation, infusion xerostomia and improper operation increased. The processing time of the reported nursing adverse events was significantly reduced (31.87 ± 7.83 vs. 56.87 ± 8.21, t = 18.73, P < 0.001). CONCLUSION The direct reporting system of adverse nursing events and the continuous improvement measures for nursing quality can effectively improve the active reporting rate of adverse events, change their composition and reduce their processing time, as well as help create a safe psychological environment for both patients and nursing staff.
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Affiliation(s)
- Qing Ouyang
- Department of Nursing, The First People's Hospital of Xiangtan City, No. 21 Shuyuan Road, Yuetang District, Xiangtan City, 411101, Hunan, China
| | - Guixiang Zhang
- Department of Nursing, Xiangtan Central Hospital, No.120 Heping Road, Yuhu District, Xiangtan City, 411100, Hunan, China
| | - Ying Xie
- Department of Nursing, Xiangtan Central Hospital, No.120 Heping Road, Yuhu District, Xiangtan City, 411100, Hunan, China
| | - Hongman Yuan
- Department of Nursing, Xiangtan Central Hospital, No.120 Heping Road, Yuhu District, Xiangtan City, 411100, Hunan, China
| | - Fangqun Cheng
- Department of Nursing, Xiangtan Central Hospital, No.120 Heping Road, Yuhu District, Xiangtan City, 411100, Hunan, China
| | - Qiyun Huang
- Department of Nursing, Xiangtan Central Hospital, No.120 Heping Road, Yuhu District, Xiangtan City, 411100, Hunan, China.
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Lyng HB, Ree E, Strømme T, Johannessen T, Aase I, Ullebust B, Thomsen LH, Holen-Rabbersvik E, Schibevaag L, Bates DW, Wiig S. Barriers and enablers for externally and internally driven implementation processes in healthcare: a qualitative cross-case study. BMC Health Serv Res 2024; 24:528. [PMID: 38664668 PMCID: PMC11046894 DOI: 10.1186/s12913-024-10985-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Quality in healthcare is a subject in need of continuous attention. Quality improvement (QI) programmes with the purpose of increasing service quality are therefore of priority for healthcare leaders and governments. This study explores the implementation process of two different QI programmes, one externally driven implementation and one internally driven, in Norwegian nursing homes and home care services. The aim for the study was to identify enablers and barriers for externally and internally driven implementation processes in nursing homes and homecare services, and furthermore to explore if identified enablers and barriers are different or similar across the different implementation processes. METHODS This study is based on an exploratory qualitative methodology. The empirical data was collected through the 'Improving Quality and Safety in Primary Care - Implementing a Leadership Intervention in Nursing Homes and Homecare' (SAFE-LEAD) project. The SAFE-LEAD project is a multiple case study of two different QI programmes in primary care in Norway. A large externally driven implementation process was supplemented with a tracer project involving an internally driven implementation process to identify differences and similarities. The empirical data was inductively analysed in accordance with grounded theory. RESULTS Enablers for both external and internal implementation processes were found to be technology and tools, dedication, and ownership. Other more implementation process specific enablers entailed continuous learning, simulation training, knowledge sharing, perceived relevance, dedication, ownership, technology and tools, a systematic approach and coordination. Only workload was identified as coincident barriers across both externally and internally implementation processes. Implementation process specific barriers included turnover, coping with given responsibilities, staff variety, challenges in coordination, technology and tools, standardizations not aligned with work, extensive documentation, lack of knowledge sharing. CONCLUSION This study provides understanding that some enablers and barriers are present in both externally and internally driven implementation processes, while other are more implementation process specific. Dedication, engagement, technology and tools are coinciding enablers which can be drawn upon in different implementation processes, while workload acted as the main barrier in both externally and internally driven implementation processes. This means that some enablers and barriers can be expected in implementation of QI programmes in nursing homes and home care services, while others require contextual understanding of their setting and work.
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Affiliation(s)
- Hilda Bø Lyng
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, N-4036, Norway.
| | - Eline Ree
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, N-4036, Norway
| | - Torunn Strømme
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, N-4036, Norway
| | - Terese Johannessen
- Department of Health and Nursing Sciences, Faculty of Health and Sports Science, University of Agder, Kristiansand, N-4604, Norway
| | - Ingunn Aase
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, N-4036, Norway
| | | | - Line Hurup Thomsen
- Helse Campus Stavanger, University of Stavanger, Stavanger, N-4036, Norway
| | - Elisabeth Holen-Rabbersvik
- Department of Health and Nursing Sciences, Faculty of Health and Sports Science, University of Agder, Kristiansand, N-4604, Norway
- Kristiansand municipality, Kristiansand, N-4604, Norway
| | - Lene Schibevaag
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, N-4036, Norway
| | - David W Bates
- Division of General Internal Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Siri Wiig
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, N-4036, Norway
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Idsøe-Jakobsen I, Dombestein H, Wiig S. Exploring homecare leaders' risk perception and the link to resilience and adaptive capacity: a multiple case study. BMC Health Serv Res 2024; 24:340. [PMID: 38486286 PMCID: PMC10941597 DOI: 10.1186/s12913-024-10808-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 02/29/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Home-based healthcare is considered crucial for the sustainability of healthcare systems worldwide. In the homecare context, however, adverse events may occur due to error-prone medication management processes and prevalent healthcare-associated infections, falls, and pressure ulcers. When dealing with risks in any form, it is fundamental for leaders to build a shared situational awareness of what is going on and what is at stake to achieve a good outcome. The overall aim of this study was to gain empirical knowledge of leaders' risk perception and adaptive capacity in homecare services. METHODS The study applied a multiple case study research design. We investigated risk perception, leadership, sensemaking, and decision-making in the homecare services context in three Norwegian municipalities. Twenty-three leaders were interviewed. The data material was analyzed using thematic analysis and interpreted in a resilience perspective of work-as-imagined versus work-as-done. RESULTS There is an increased demand on homecare services and workers' struggle to meet society's high expectations regarding homecare's responsibilities. The leaders find themselves trying to maneuver in these pressing conditions in alignment with the perceived risks. The themes emerging from analyzed data were: 'Risk and quality are conceptualized as integral to professional work', 'Perceiving and assessing risk imply discussing and consulting each other- no one can do it alone' and 'Leaders keep calm and look beyond the budget and quality measures by maneuvering within and around the system'. Different perspectives on patients' well-being revealed that the leaders have a large responsibility for organizing the healthcare soundly and adequately for each home-dwelling patient. Although the leaders did not use the term risk, discussing concerns and consulting each other was a profound part of the homecare leaders' sense of professionalism. CONCLUSIONS The leaders' construction of a risk picture is based on using multiple signals, such as measurable vital signs and patients' verbal and nonverbal expressions of their experience of health status. The findings imply a need for more research on how national guidelines and quality measures can be implemented better in a resilience perspective, where adaptive capacity to better align work-as-imagined and work-as-done is crucial for high quality homecare service provision.
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Affiliation(s)
- Ingvild Idsøe-Jakobsen
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, N-4036, Stavanger, Norway.
| | - Heidi Dombestein
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, N-4036, Stavanger, Norway
| | - Siri Wiig
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, N-4036, Stavanger, Norway
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Guise V, Chambers M, Lyng HB, Haraldseid-Driftland C, Schibevaag L, Fagerdal B, Dombestein H, Ree E, Wiig S. Identifying, categorising, and mapping actors involved in resilience in healthcare: a qualitative stakeholder analysis. BMC Health Serv Res 2024; 24:230. [PMID: 38388408 PMCID: PMC10882781 DOI: 10.1186/s12913-024-10654-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 01/29/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Resilience in healthcare is the capacity to adapt to challenges and changes to maintain high-quality care across system levels. While healthcare system stakeholders such as patients, informal carers, healthcare professionals and service managers have all come to be acknowledged as important co-creators of resilient healthcare, our knowledge and understanding of who, how, and in which contexts different stakeholders come to facilitate and support resilience is still lacking. This study addresses gaps in the research by conducting a stakeholder analysis to identify and categorise the stakeholders that are key to facilitating and sustaining resilience in healthcare, and to investigate stakeholder relationships relevant for the enactment of resilient healthcare systems. METHODS The stakeholder analysis was conducted using a sample of 19 empirical research projects. A narrative summary was written for 14 of the projects, based on publicly available material. In addition, 16 individual interviews were undertaken with researchers from the same sample of 19 projects. The 16 interview transcripts and 14 narratives made up the data material of the study. Application of stakeholder analysis methods was done in three steps: a) identification of stakeholders; b) differentiation and categorisation of stakeholders using an interest/influence grid; and c) investigation and mapping of stakeholder relationships using an actor-linkage matrix. RESULTS Identified stakeholders were Patients, Family Carers, Healthcare Professionals, Ward/Unit Managers, Service or Case Managers, Regulatory Investigators, Policy Makers, and Other Service Providers. All identified stakeholders were categorised as either 'Subjects', 'Players', or 'Context Setters' according to their level of interest in and influence on resilient healthcare. Stakeholder relationships were mapped according to the degree and type of contact between the various groups of stakeholders involved in facilitating resilient healthcare, ranging from 'Not linked' to 'Fully linked'. CONCLUSION Family carers and healthcare professionals were found to be the most active groups of stakeholders in the enactment of healthcare system resilience. Patients, managers, and policy makers also contribute to resilience to various degrees. Relationships between stakeholder groups are largely characterised by communication and coordination, in addition to formal collaborations where diverse actors work together to achieve common goals.
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Affiliation(s)
- Veslemøy Guise
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, N-4036, Stavanger, Norway.
| | - Mary Chambers
- Kingston University & St. George's University of London, London, UK
| | - Hilda Bø Lyng
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, N-4036, Stavanger, Norway
| | - Cecilie Haraldseid-Driftland
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, N-4036, Stavanger, Norway
| | - Lene Schibevaag
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, N-4036, Stavanger, Norway
| | - Birte Fagerdal
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, N-4036, Stavanger, Norway
| | - Heidi Dombestein
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, N-4036, Stavanger, Norway
| | - Eline Ree
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, N-4036, Stavanger, Norway
| | - Siri Wiig
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, N-4036, Stavanger, Norway
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Ding Z, Qu X, Li C. Digital economy and high-quality development of the healthcare industry. Front Public Health 2024; 12:1331565. [PMID: 38282760 PMCID: PMC10820708 DOI: 10.3389/fpubh.2024.1331565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/02/2024] [Indexed: 01/30/2024] Open
Abstract
The high-quality development of the healthcare industry is of great significance for improving people's health and promoting the construction of a harmonious society. This paper focuses on the relationship between the development of China's digital economy and the high-quality development of the healthcare industry. Based on the panel data of 30 provinces in China from 2011 to 2020, this paper empirically studies whether the development of the digital economy promotes the high-quality development of the healthcare industry. This study finds that the development of digital economy has significantly promoted the high-quality development of the medical and health industry. The results of this study are still valid after a series of robustness tests including variable substitution, sample adjustment, and endogenous problem mitigation. Heterogeneity analysis shows that the effect of this policy is more significant in the eastern region and southern areas. The results of spatial econometric analysis show that the development of digital economy has obvious spatial spillover effect. The research in this paper can provide reference for developing countries to enhance the development level of digital health industry and improve people's lives.
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Affiliation(s)
- Zijing Ding
- School of Economic and Management, Wuhan University, Wuhan, China
| | - Xinyue Qu
- School of Economic and Management, Wuhan University, Wuhan, China
| | - Chen Li
- School of Management, Shanghai University of Engineering Science, Shanghai, China
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Stokke R, Wibe T, Sogstad M. Forming Nursing Home Practices That Support Quality of Care for Residents. A Qualitative Observational Study. J Multidiscip Healthc 2023; 16:2667-2680. [PMID: 37720269 PMCID: PMC10503513 DOI: 10.2147/jmdh.s426913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/21/2023] [Indexed: 09/19/2023] Open
Abstract
Background Residents of nursing homes are increasingly frail and dependent. At the same time, there are increased demands for quality of care and social life for individual residents. In this article, we explore how care workers contribute to quality of care and social life in shared living rooms in nursing homes. Methods An ethnographically inspired design was applied, and a purposive sample of six units for long-term care in three nursing homes in Norway was included in the study. Data were collected by participant observation, including informal conversations with the staff and residents, and the data were analyzed using thematic analysis. Results The analysis identified three main themes: working within the given context, creating care practices and organizing activities. The empirical findings demonstrate that care work focuses on meeting both the residents' physical and social needs and aiming for high-quality care and social life for the residents in nursing homes. Conclusion The results of this study illustrate that nursing home practices are focused on residents as a group. However, care workers take advantage of personal skills and resources to work towards person-centred care within the given context. The quality of care is recognized in terms of how care workers meet individual residents' needs. The quality of care seems highly related to the capability and skills of individual care workers.
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Affiliation(s)
- Randi Stokke
- Faculty of Medicine and Health Sciences, Centre for Care Research, Norwegian University of Science and Technology NTNU, Gjøvik, Norway
| | - Torunn Wibe
- Centre for Development of Institutional and Home Care Services in Oslo, Oslo, Norway
| | - Maren Sogstad
- Faculty of Medicine and Health Sciences, Centre for Care Research, Norwegian University of Science and Technology NTNU, Gjøvik, Norway
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Yu J, Huang J, Yang Q. Long-Term Adoption or Abandonment of Smart Technology in the Chinese Elderly Home Care Environment: A Qualitative Research Study. Healthcare (Basel) 2023; 11:2440. [PMID: 37685474 PMCID: PMC10486740 DOI: 10.3390/healthcare11172440] [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: 08/03/2023] [Revised: 08/20/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
China's rapidly aging population and shortage of care resources have made it difficult for its traditional model to meet the home care needs of the elderly. On this premise, China is implementing home digital health interventions based on smart technology. During implementation, instead of the expected explosion in long-term adoption, there has been a large amount of abandonment. But so far, the relationship between service experience and these behaviors has been ignored. This study aims to explore the reasons for the long-term adoption or abandonment behaviors of technology by elders in the home care environment. A qualitative study was conducted based on Golant's framework of smart technology adoption behaviors among elders. Semi-structured interviews were conducted with 26 elders who are long-term or former users of smart technology in a home care environment, and data from the interviews were analyzed using directed content analysis. This study identified three themes that influence elders' adoption behaviors of smart technology in the home care environment, including immediate effectiveness, long-term usability, and possible collateral damage. The findings indicated that the experience of the elders is the key point that affects long-term adoption behavior. For more elders to use smart technology in the home care environment, it is necessary for the government, technology developers, and nursing institutions to further reform the existing system.
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Affiliation(s)
- Jiahao Yu
- Population Research Institute, Hohai University, Nanjing 211100, China;
| | - Jianyuan Huang
- Population Research Institute, Hohai University, Nanjing 211100, China;
| | - Qi Yang
- Population Research Institute, Nanjing University of Posts and Telecommunications, Nanjing 210042, China;
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Amer B, Ayed A, Malak M, Bashtawy M. Nursing Informatics Competency and Self-Efficacy in Clinical Practice among Nurses in Palestinian Hospitals. Hosp Top 2023:1-8. [PMID: 37643293 DOI: 10.1080/00185868.2023.2252974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
This study purposed to determine the levels of nursing informatics competency and self-efficacy in clinical practice and influencing factors on self-efficacy among Palestinian nurses in hospitals. A descriptive-correlational design was adopted. The nurses who worked in the North West Bank of Palestine (N = 331) were recruited. The data were collected using the Self-Assessment of Nursing Informatics Competencies Scale (SANICS) which consists of 30 items rated on a 5-point Likert scale, ranging from 1(not competent) to 5 (expert), and scored by calculating the mean as follows: novice/low (1.00-2.59), beginner/moderate (2.60-3.39), and competent/high (3.40-5.00); and the New General Self-Efficacy Scale (NGSE) that consists of eight items rated on a 5-point Likert scale, ranging from 1(strongly disagree) to 5(strongly agree) and scored according to the average of the scale, whereas the average of > 3 indicated high self-efficacy, and ≤ 3 reflected low self-efficacy. The data were collected during the period from September to November 2020. Findings showed that the total mean score for the nursing informatics competency scale was 2.9 (SD = 0.7), which indicated that the nurses had a moderate level of nursing informatics competency. The average score for the self-efficacy scale was 3.5 (SD = 0.8), which reflected that nurses had high self-efficacy. Self-efficacy in clinical practice increased with age and with nursing informatics competency. Thus, it is necessary to enhance nurses' informatics competency by developing continuous educational programs about this technology for nurses and engaging nurses in such programs to enhance their competencies in this system.
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Affiliation(s)
- Burhan Amer
- Health informatics, Ministry of Health, Jenin, Palestine
| | - Ahmad Ayed
- Pediatric Health Nursing, Faculty of Nursing, Arab American University, Jenin, Palestine
| | - Malakeh Malak
- Community Health Nursing, Faculty of Nursing, Al- Zaytoonah University of Jordan, Amman, Jordan
| | - Mohammad Bashtawy
- Community Health Nursing, Princess Salma Faculty of Nursing, Al al-Bayt University, Mafraq, Jordan
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Seljemo C, Wiig S, Røise O, Ree E. The role of local context for managers' strategies when adapting to the COVID-19 pandemic in Norwegian homecare services: a multiple case study. BMC Health Serv Res 2023; 23:492. [PMID: 37194101 DOI: 10.1186/s12913-023-09444-1] [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: 11/25/2022] [Accepted: 04/25/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic had a major impact on healthcare systems around the world, and lack of resources, lack of adequate preparedness and infection control equipment have been highlighted as common challenges. Healthcare managers' capacity to adapt to the challenges brought by the COVID-19 pandemic is crucial to ensure safe and high-quality care during a crisis. There is a lack of research on how these adaptations are made at different levels of the homecare services system and how the local context influences the managerial strategies applied in response to a healthcare crisis. This study explores the role of local context for managers' experiences and strategies in homecare services during the COVID-19 pandemic. METHODS A qualitative multiple case study in four municipalities with different geographic locations (centralized and decentralized) across Norway. A review of contingency plans was performed, and 21 managers were interviewed individually during the period March to September 2021. All interviews were conducted digitally using a semi-structured interview guide, and data was subjected to inductive thematic analysis. RESULTS The analysis revealed variations in managers' strategies related to the size and geographical location of the homecare services. The opportunities to apply different strategies varied among the municipalities. To ensure adequate staffing, managers collaborated, reorganized, and reallocated resources within their local health system. New guidelines, routines and infection control measures were developed and implemented in the absence of adequate preparedness plans and modified according to the local context. Supportive and present leadership in addition to collaboration and coordination across national, regional, and local levels were highlighted as key factors in all municipalities. CONCLUSION Managers who designed new and adaptive strategies to respond to the COVID-19 pandemic were central in ensuring high-quality Norwegian homecare services. To ensure transferability, national guidelines and measures must be context-dependent or -sensitive and must accommodate flexibility at all levels in a local healthcare service system.
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Affiliation(s)
- Camilla Seljemo
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.
| | - Siri Wiig
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Olav Røise
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Eline Ree
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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13
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Lund SB, Skolbekken JA, Mosqueda L, Malmedal W. Making Neglect Invisible: A Qualitative Study among Nursing Home Staff in Norway. Healthcare (Basel) 2023; 11:healthcare11101415. [PMID: 37239698 DOI: 10.3390/healthcare11101415] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/05/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Research shows that nursing home residents' basic care needs are often neglected, potentially resulting in incidents that threaten patients' safety and quality of care. Nursing staff are at the frontline for identifying such care practices but may also be at the root of the problem. The aim of this study was to generate new knowledge on reporting instances of neglect in nursing homes based on the research question "How is neglect reported and communicated by nursing home staff?" METHODS A qualitative design guided by the principles of constructivist grounded theory was used. The study was based on five focus-group discussions (20 participants) and 10 individual interviews with nursing staff from 17 nursing homes in Norway. RESULTS Neglect in nursing homes is sometimes invisible due to a combination of personal and organizational factors. Staff may minimize "missed care" and not consider it neglect, so it is not reported. In addition, they may be reluctant to acknowledge or reveal their own or colleagues' neglectful practices. CONCLUSION Neglect of residents in nursing homes may continue to occur if nursing staff's reporting practices are making neglect invisible, thus proceeding to compromise a resident's safety and quality of care for the foreseeable future.
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Affiliation(s)
- Stine Borgen Lund
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway
| | - John-Arne Skolbekken
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway
| | - Laura Mosqueda
- Keck School of Medicine, University of Southern California, Los Angeles, CA 91803, USA
| | - Wenche Malmedal
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway
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14
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Shahrestanaki SK, Rafii F, Najafi Ghezeljeh T, Farahani MA, Majdabadi Kohne ZA. Patient safety in home health care: a grounded theory study. BMC Health Serv Res 2023; 23:467. [PMID: 37165357 PMCID: PMC10171141 DOI: 10.1186/s12913-023-09458-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 04/27/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND The home environment is designed for living, not for professional care. For this reason, safe patient care is one of the most important challenges of home health care. Despite abundant research on safe care, there is still little understanding of safety issues in home care. DESIGN The aim of the present study was to explain the process of safe patient care in home health care. A qualitative, grounded theory study was conducted based on the approach proposed by Corbin & Strauss in 2015. METHOD In total, 22 interviews were conducted with 16 participants including 9 home care nurses, 2 home care nursing assistants, 1 home care inspector, 1 home care physician and 3 family caregivers in Tehran, Iran. Four observation sessions were conducted in different homes. Purposeful sampling was used followed by theoretical sampling from August 2020-July 2022. Data analysis was carried out based on the approach proposed by Corbin & Strauss in 2015. RESULTS The results showed that the healthcare members (nurses, family caregivers, patients and home care centers) used the model of safe patient care in home health care based on four assessment methods, i.e. prevention, foresight, establishment of safety and verification. The core variable in this process is foresight-based care. CONCLUSION The results of this study showed that the key to safe patient care in home health care, which helps to maintain patient safety and prevent threats to safe care, is the foresight of healthcare members, which is essential for identifying threats to safe care considering the many risks of home health care.
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Affiliation(s)
| | - Forough Rafii
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Tahereh Najafi Ghezeljeh
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
- Cardiovascular Nursing Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mansoureh Ashghali Farahani
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
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15
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van de Bovenkamp H, van Pijkeren N, Ree E, Aase I, Johannessen T, Vollaard H, Wallenburg I, Bal R, Wiig S. Creativity at the margins: A cross-country case study on how Dutch and Norwegian peripheries address challenges to quality work in care for older persons. Health Policy 2023; 127:66-73. [PMID: 36543693 DOI: 10.1016/j.healthpol.2022.12.008] [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: 03/10/2021] [Revised: 11/15/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Peripheral areas are often overlooked in health-care research but they in fact deserve specific attention. Such areas struggle to maintain access to good quality health-care services due to their geographical context. At the same time, new interventions or promising innovations often emerge in places where creativity is urgently needed. In this paper, we explore this creativity at the margins in older persons care organizations in peripheral areas, which other healthcare providers and policymakers can learn from. METHODS This exploratory study is based on two large research projects on the quality of care for older persons in Norway and the Netherlands. We performed secondary analysis of interviews with quality managers and other quality workers and used additional document analysis and expert interviews to deepen our analysis. RESULTS The results show that older persons care organizations working in peripheral areas must deal with a number of challenges caused by their geographical context, e.g. geographical distances (between services and to the geographical center), workforce shortages, and landscape characteristics. We found that organizations use different strategies to tackle these challenges, such as scaling up, brightening up and opening up. These strategies, conceptualized as creativity at the margins, impact quality work in different ways, for example by enabling more person-centered care. CONCLUSION We conclude that both policymakers and research should overcome their peripheral blindness by learning from and supporting creativity at the margins in future policies and research.
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Affiliation(s)
- Hester van de Bovenkamp
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Postbus 1738, 3000 DR Rotterdam, The Netherlands.
| | - Nienke van Pijkeren
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Postbus 1738, 3000 DR Rotterdam, The Netherlands
| | - Eline Ree
- Faculty of Health Sciences, University of Stavanger, Norway
| | - Ingunn Aase
- Faculty of Health Sciences, University of Stavanger, Norway
| | | | - Hans Vollaard
- Utrecht School of Governance, Utrecht University, The Netherlands
| | - Iris Wallenburg
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Postbus 1738, 3000 DR Rotterdam, The Netherlands
| | - Roland Bal
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Postbus 1738, 3000 DR Rotterdam, The Netherlands
| | - Siri Wiig
- Faculty of Health Sciences, University of Stavanger, Norway
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16
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Indarwati R, Efendi F, Fauziningtyas R, Fauziah A, Sudarsiwi NP. Efforts to Improve the Safety Culture of the Elderly in Nursing Homes: A Qualitative Study. Risk Manag Healthc Policy 2023; 16:393-400. [PMID: 36936883 PMCID: PMC10015942 DOI: 10.2147/rmhp.s399826] [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: 12/13/2022] [Accepted: 02/23/2023] [Indexed: 03/16/2023] Open
Abstract
Introduction The attention to building a safety culture in nursing homes is relatively less when compared to hospitals. Good patient safety will improve the quality of health services and minimize incidents related to patient safety. This study aims to look at efforts that can be made to improve safety culture in nursing homes. Materials and Methods The research design uses phenomenological qualitative with in-depth interviews. Purposive sampling was used with interpretive phenomenological analysis. Participants were 29 staff from four government and private institutions in East Java, Indonesia. Results The sub-themes resulting from the research efforts to improve the safety culture of the elderly in nursing homes are the provision of new staff orientation, training, improvement of infrastructure, and procurement of security staff. Conclusion The analysis shows that efforts to improve safety culture can be carried out with various strategies by paying attention to risk assessment steps, patient risk identification, and management, incident reporting, and analysis, the ability to learn from incidents and their follow-up, as well as implementing solutions to minimize risks and prevent them from occurring injury. Safety culture plays an essential role in improving the quality of care.
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Affiliation(s)
- Retno Indarwati
- Faculty of Nursing, Universitas Airlangga, Campus C Mulyorejo, Surabaya, East Java, 60115, Indonesia
- Correspondence: Retno Indarwati, Email
| | - Ferry Efendi
- Faculty of Nursing, Universitas Airlangga, Campus C Mulyorejo, Surabaya, East Java, 60115, Indonesia
| | - Rista Fauziningtyas
- Faculty of Nursing, Universitas Airlangga, Campus C Mulyorejo, Surabaya, East Java, 60115, Indonesia
| | - Anis Fauziah
- Faculty of Nursing, Universitas Airlangga, Campus C Mulyorejo, Surabaya, East Java, 60115, Indonesia
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17
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Keyvanloo Shahrestanaki S, Rafii F, Najafi Ghezeljeh* T, Ashghali Farahani M, Amrollah Majdabadi Kohne Z. Concept analysis of patient safety in home care: a hybrid model. BMJ Open Qual 2022; 11:bmjoq-2022-002077. [PMID: 36521926 PMCID: PMC9756164 DOI: 10.1136/bmjoq-2022-002077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/16/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Patient safety in home care is a fundamental and complex concept in nursing. This concept includes a number of challenges in patient care. Studies have shown that there is no clear and uniform definition for this concept. OBJECTIVE The objective of the present study was to analyse patient safety in home care in Iran. METHODS The study was done using a hybrid model at three phases, including theoretical, field work and the final analysis. We searched valid databases including MEDLIN and CINHAL; electronic references including Web of Science, Scopus, Ovid, ProQuest, PubMed and Persian databases including Magiran, IranDoc and SID during 2008-2022, using these Persian and English keywords: Patient Safety, Safety, Home Care Service, Domiciliary Care, Home Care and Home Health Care. A total of 16 articles were searched in the theoretical phase and then analysed by content analysis. In field work phase, nine participants were interviewed (nurse, family and patient) and then the interviews were analysed by the content analysis method. In the final analysis phase, a general analysis of the previous two phases was performed and after determining the attributes, antecedents and consequences, a final definition of patient safety in home care in Iran was presented. FINDINGS Based on different studies, patient safety in home care is a multifaceted concept, which encompasses physical, mental, social and practical dimensions. Evaluation, prevention, participation and commitment to the safety culture are the core features of this concept. The patient care concept depends on the commitment of the involved participants, adequate resources, environmental conditions, support of the involved centres (home care agency, hospital and the insurance), self-efficacy and the ability of the caregivers (nurses). CONCLUSION Defining the concept of patient safety in home care provides a basis for the development of a safe patient care system at home. This concept analysis for patient safety in home care could be a guide for future studies.
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Affiliation(s)
| | - Forough Rafii
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Tahereh Najafi Ghezeljeh*
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Mansoureh Ashghali Farahani
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
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18
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Lee S, Lee JY, Kim H, Lee K, Lee T. Advanced Practice Nurses' Experiences on Patient Safety Culture in Hospital-Based Home Healthcare: A Qualitative Descriptive Study. Healthc Policy 2022; 15:2297-2309. [PMID: 36504488 PMCID: PMC9733626 DOI: 10.2147/rmhp.s388902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 11/26/2022] [Indexed: 12/12/2022] Open
Abstract
Purpose Despite the increasing interest in patient safety, most research have been conducted in hospital settings, thereby demonstrating an overall lack of research regarding patient safety culture in home healthcare. South Korea has three types of home healthcare services based on hospitals, public health centers, and long-term care insurance. Home healthcare nurses in hospitals require a master's degree and advanced nursing skills. They play important roles in ensuring patients' safe transition into home health care. This study aimed to explore the experience of patient safety culture among South Korean advanced practice nurses in hospital-based home healthcare. Methods This qualitative descriptive study was conducted through purposive sampling, whereby twenty advanced practice nurses involved in home healthcare were recruited from twelve hospitals located in three different cities throughout South Korea. Face-to-face semi-structured interviews were conducted, and the collected data were analyzed through inductive and deductive content analyses. Results Three main categories were finally confirmed: (a) teamwork climate, (b) safety climate, and (c) working condition. The sub-categories of the teamwork climate included the collaboration between patients, caregivers, and nurses, collaboration within medical institutions, and collaboration among the individuals involved in community partnerships. The sub-categories of the safety climate included nurses' commitment to patient safety, the associated institutions' commitment to patient safety, and the government's commitment to patient safety. The sub-categories of the working condition included the frontline working environments and the associated institutions' support aimed at ensuring effective working environments. Conclusion Cultivating patient safety culture is crucial for ensuring the safe transition of patients from acute care hospitals to home healthcare. This study revealed significant aspects of patient safety culture in hospital-based home healthcare, allowing for the continuum of care among the associated patients. Such aspects include communicating with caregivers, building community partnerships, understanding unexpected home environments, and enhancing the safety of nurses.
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Affiliation(s)
- Soohee Lee
- College of Nursing, Gachon University, Incheon, South Korea
| | - Ji Yeon Lee
- College of Nursing, Yonsei University, Seoul, South Korea
| | - Hyejin Kim
- Red Cross College of Nursing, Chung-Ang University, Seoul, South Korea
| | - Kayoung Lee
- College of Nursing, Gachon University, Incheon, South Korea,Correspondence: Kayoung Lee, Gachon University College of Nursing, 191 Hambakmoero, Yeonsu-Gu, Incheon, 21936, South Korea, Tel +82-32-820-4227, Email
| | - Taewha Lee
- Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, South Korea,Taewha Lee, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea, Tel +82-2-2227-8303, Email
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19
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Ree E, Wiig S, Seljemo C, Wibe T, Lyng HB. Managers' strategies in handling the COVID-19 pandemic in Norwegian nursing homes and homecare services. Leadersh Health Serv (Bradf Engl) 2022; ahead-of-print:200-218. [PMID: 36448830 PMCID: PMC10433966 DOI: 10.1108/lhs-05-2022-0052] [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: 05/13/2022] [Revised: 08/19/2022] [Accepted: 09/09/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE This study aims to explore nursing home and home care managers' strategies in handling the COVID-19 pandemic. DESIGN/METHODOLOGY/APPROACH This study has a qualitative design with semistructured individual interviews conducted digitally by videophone (Zoom). Eight managers from nursing homes and five managers from home care services located in a large urban municipality in eastern Norway participated. Systematic text condensation methodology was used for the analysis. FINDINGS The managers used several strategies to handle challenges related to the COVID-19 pandemic, including being proactive and thinking ahead in terms of possible scenarios that might occur, continuously training of staff in new procedures and routines and systematic information sharing at all levels, as well as providing different ways of disseminating information for staff, service users and next-of-kins. To handle staffing challenges, managers used strategies such as hiring short-term staff that were temporary laid off from other industries and bringing in students. ORIGINALITY/VALUE The COVID-19 pandemic heavily affected health-care systems worldwide, which has led to many health-care studies. The situation in nursing homes and home care services, which were strongly impacted by the pandemic and in charge of a vulnerable group of people, has not yet received enough attention in research. This study, therefore, seeks to contribute to this research gap by investigating how managers in nursing homes and home care services used different strategies to handle the COVID-19 pandemic.
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Affiliation(s)
- Eline Ree
- SHARE Centre for Resilience in Healthcare, Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Siri Wiig
- SHARE Centre for Resilience in Healthcare, Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Camilla Seljemo
- SHARE Centre for Resilience in Healthcare, Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Torunn Wibe
- Centre for Development of Institutional and Home Care Services, Oslo, Norway
| | - Hilda Bø Lyng
- SHARE Centre for Resilience in Healthcare, Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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20
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Kiljunen O, Kankkunen P, Välimäki T. Identification of Contributing Factors of Falls and Non-Fall Accidents Among Home Care Clients: A Retrospective Study Using Incident Reports. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2022. [DOI: 10.1177/10848223221134095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
To prevent falls and other accidents among home care clients, it is essential to gather high-quality information on the factors contributing to the accidents. Incident reporting systems are used in home care units to generate information for risk management. This study aimed to explore the contributing factors of falls and non-fall accidents among home care clients and to evaluate the accuracy of the information on contributing factors gained from the incident reporting system. An existing dataset was used—safety incident reports concerning accidents involving home care clients. The incident reports (n = 323) were stored in the social- and health care organization’s incident reporting database from 2018 to 2020. The free-text narratives describing factors contributing to the event’s occurrence were analyzed using inductive content analysis, and the frequencies of the main category codes were recorded. The results were then compared with the frontline managers’ analyses of the narratives, where the managers used the classification of contributing factors provided by the system. According to incident reports, intrinsic (person-specific), behavior-related and extrinsic (environment-related) factors contributed to accidents among home care clients. Intrinsic and behavior-related factors were reported more often than extrinsic factors. The classified information on contributing factors did not correspond in all respects to the descriptions in the incident reports. To ensure high-quality information for safety management, incident reporting tools must be appropriate for use in the home care context. Both the reporter of an adverse event and the individual responsible for analyzing the report play essential roles in identifying contributing factors of accidents.
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Affiliation(s)
- Outi Kiljunen
- University of Eastern Finland, Department of Nursing Science, Kuopio, Finland
| | - Päivi Kankkunen
- University of Eastern Finland, Department of Nursing Science, Kuopio, Finland
| | - Tarja Välimäki
- University of Eastern Finland, Department of Nursing Science, Kuopio, Finland
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21
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Ma G, Hou J, Peng S, Luo L, Xu R, Liu Y, Fan Y, Shi Z, Zhang C, Zhang J. Nurses' Willingness and Demand for Internet +home Care Services and Its Influencing Factors in Different Levels of Hospitals in China - A Nationwide Survey. Risk Manag Healthc Policy 2022; 15:1395-1405. [PMID: 35911086 PMCID: PMC9326896 DOI: 10.2147/rmhp.s367412] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 07/08/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose The present study aimed to investigate nurses’ willingness and demand for Internet +home care services in different levels of hospitals in China and analyze the influencing factors. Participants and Methods From October 1 to December 31, 2021, 5714 nurses from 15 hospitals in five regions of China were recruited in this cross-sectional study using a two-stage random sampling method. A self-designed questionnaire with good reliability and validity was used to measure nurses’ willingness and demand for Internet +home care services. χ2 test, Welch t-test, and multiple linear regression analyses were used to analyze the data. Results Nurses were highly willing to provide Internet +home care services. Statistical differences were found in the willingness to provide Internet +home care services and the preference for service distance, service platform, and single service fee between nurses in different levels of hospitals (both P<0.05). The willingness to provide “catheter maintenance service” and “rehabilitation nursing service” of nurses in different levels of hospitals were statistically significant (both P<0.05). Nurses’ demand for Internet +home care services increased with the level of their hospital. Multiple linear regression showed that professional title, educational level, monthly family income, and mortgage or car loan influence nurses’ demand for Internet +home care services. Conclusion Nurses’ willingness and demand for Internet +home care services vary with the level of their hospitals. It is recommended that government and hospitals regulate the service items, the service distance, single service fee, and other contents according to nurses’ willingness and demand and establish relevant laws and regulations to ensure the steady and orderly development of the Internet +home care services.
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Affiliation(s)
- Guiyuan Ma
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, People's Republic of China.,Xiangya School of Nursing, Central South University, Changsha, People's Republic of China
| | - Jianmei Hou
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, People's Republic of China
| | - Sha Peng
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, People's Republic of China.,Xiangya School of Nursing, Central South University, Changsha, People's Republic of China
| | - Lingxia Luo
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, People's Republic of China
| | - Ran Xu
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, People's Republic of China.,Xiangya School of Nursing, Central South University, Changsha, People's Republic of China
| | - Yanhui Liu
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, People's Republic of China
| | - Yuhua Fan
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, People's Republic of China
| | - Zhengkun Shi
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, People's Republic of China
| | - Cailan Zhang
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, People's Republic of China
| | - Jinghui Zhang
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, People's Republic of China.,Xiangya School of Nursing, Central South University, Changsha, People's Republic of China.,National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Central South University, Changsha, People's Republic of China
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22
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Assander S, Bergström A, Eriksson C, Meijer S, Guidetti S. ASSIST: a reablement program for older adults in Sweden - a feasibility study. BMC Geriatr 2022; 22:618. [PMID: 35879678 PMCID: PMC9316332 DOI: 10.1186/s12877-022-03185-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 06/01/2022] [Indexed: 12/03/2022] Open
Abstract
Background Western countries emphasise the provision of assistive home care by implementing reablement services. Reablement services are offered to a limited degree in Sweden, and systematic research regarding outcomes and how reablement can be tailored to maximize benefits for older adults has been lacking. This study aimed to evaluate the feasibility of a novel reablement program (ASSIST 1.0) regarding study design and outcome measures, as well as fidelity, adherence, and acceptability of the program in a Swedish context. Method A non-randomised, quasi-experimental, mixed-method, pre/post-test design was applied with an intervention group receiving ASSIST 1.0 (n = 7) and a control group receiving regular home care (n = 10). ASSIST 1.0 was developed to empower older adults to increase their perceived performance and satisfaction of performing activities in everyday life as well as increase their perceived health, self-efficacy, and well-being. ASSIST 1.0 was founded on the concept of reablement and included three components: i) goal setting with The Canadian Occupational Performance Measure (COPM), ii) provided support to home care staff to enhance their provision of reablement, and iii) explored the incorporation and use of an information- and communication technology (ICT) to facilitate information transfer. Results Using COPM for goal setting with older adults and providing support to the staff via workshops were valuable components in the delivery of ASSIST 1.0. The ICT product encountered several challenges and could not be evaluated. COPM and EQ-5D were deemed the most important instruments. Organisational and political barriers affected the feasibility. Although, the fidelity and adherence were complied the staff perceived the program to be acceptable. Conclusion The ASSIST 1.0 program was feasible in regard of study design, delivering the intervention, and evaluating instruments that detected a change. A logical progression would be to conduct a full-scale trial. In addition, a usability study to evaluate the technological component is also recommended. With minor improvements, the ASSIST 1.0 program has the potential to contribute to the development of a home care organisation that could enhance older adults possibility to age in place at home. Trial registration number NCT03505619
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Affiliation(s)
- Susanne Assander
- Department of Neurobiology, Caring Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden.
| | - Aileen Bergström
- Department of Neurobiology, Caring Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden
| | - Christina Eriksson
- Department of Neurobiology, Caring Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden.,Academic Primary Health Care Centre, Stockholm, Sweden
| | - Sebastiaan Meijer
- Department of Biomedical Engineering and Health Systems, Kungliga Tekniska Högskolan, Stockholm, Sweden
| | - Susanne Guidetti
- Department of Neurobiology, Caring Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden.,Medical Unit Occupational Therapy and Physiotherapy, Theme Women´S Health and Allied Health Professionals, Karolinska University Hospital, Stockholm, Sweden
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Yoshimatsu K, Nakatani H. Attitudes of home-visiting nurses toward risk management of patient safety incidents in Japan. BMC Nurs 2022; 21:139. [PMID: 35668490 PMCID: PMC9169385 DOI: 10.1186/s12912-022-00905-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 05/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In situations of home care, patients and their family members must address problems and emergencies themselves. For this reason, home-visiting nurses (HVNs) must practice risk management to ensure that patients can continue receiving care in the comfort of their homes. The purpose of this study was to examine HVNs' attitudes toward risk management. METHODS This study adopted a qualitative description approach. Semi-structured interviews were conducted to collect information on HVNs' risk management behavior and their attitudes toward it. Participants comprised 11 HVNs working at home-visiting nursing agencies in a prefecture of Japan. Transcribed interviews were analyzed using content analysis. RESULTS Nurses' attitudes toward risk management comprised the following themes: (i) predicting and avoiding risks, (ii) ensuring medical safety in home settings, (iii) coping with incidents, and (iv) playing the role of administrators in medical safety, which was answered only by administrators. CONCLUSIONS When practicing risk management, home-visiting nurses should first assess the level of understanding of the patient and family, followed by developing safety measures tailored to their everyday needs. These results further suggest that administrators should take actions to foster a working environment conducive to risk management. These actions include coordinating duties to mitigate risk and improve the process of reporting risks. This study provides a baseline for future researchers to assist patients and families requiring medical care services of this nature.
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Affiliation(s)
- Keiko Yoshimatsu
- Department of Nursing, Faculty of Nursing and Nutrition, The University of Shimane, 151 Nisihayasigi-cho, Izumo-shi, Shimane-ken, 693-8550, Japan.
| | - Hisae Nakatani
- Department of Community and Public Health Nursing, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima City, 734-8551, Japan
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Ekstedt M, Schildmeijer K, Backåberg S, Ljungholm L, Fagerström C. 'We just have to make it work': a qualitative study on assistant nurses' experiences of patient safety performance in home care services using forum play scenarios. BMJ Open 2022; 12:e057261. [PMID: 35580971 PMCID: PMC9114954 DOI: 10.1136/bmjopen-2021-057261] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Safety is essential to support independent living among the rising number of people with long-term healthcare and social care needs. Safety performance in home care leans heavily on the capacity of unlicensed staff to respond to problems and changes in the older patients' functioning and health. The aim of this study is to explore assistant nurses' adaptive responses to everyday work to ensure safe care in the home care context. DESIGN A qualitative approach using the drama-based learning and reflection technique forum play with subsequent group interviews. The audio-recorded interviews were transcribed and analysed with thematic analysis. SETTING Home care services organisations providing care to older people in their private homes in two municipalities in southern Sweden. PARTICIPANTS Purposeful sampling of 24 assistant nurses and three managers from municipal home care services and a local geriatric hospital clinic. RESULTS Home care workers' adaptive responses to provide safe home care were driven by an ambition to 'make it work in the best interests of the person' by adjusting to and accommodating care recipient needs and making autonomous decisions that expanded the room for manoeuvrability, while weighing risks of a trade-off between care standards and the benefits for the community-dwelling older people's independent living. Adaptations to ensure information transfer and knowledge acquisition across disciplines and borders required reciprocity. CONCLUSIONS Safety performance in home care service is dependent on the staff closest to the older people, who deal with safety risks and ethical dilemmas on a day-to-day basis and their access to information, competence, and resources that fit the demands. A proactive leadership characterised by mutual trust and adequate support for decision making is suggested. Managers and decision-makers across healthcare and social care need to consider how they can develop interprofessional collaborations and adaptive routines supporting safety from a broader perspective.
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Affiliation(s)
- Mirjam Ekstedt
- Faculty of Life and Health Sciences, Linnaeus University, Kalmar, Sweden
- Department of Learning Informatics Management and Ethics, Karolinska Institute, Stockholm, Sweden
| | | | - Sofia Backåberg
- Faculty of Life and Health Sciences, Linnaeus University, Kalmar, Sweden
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Linda Ljungholm
- Faculty of Life and Health Sciences, Linnaeus University, Kalmar, Sweden
| | - Cecilia Fagerström
- Faculty of Life and Health Sciences, Linnaeus University, Kalmar, Sweden
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Aase I, Ree E, Strømme T, Wiig S. Behind the Scenes of a Patient Safety Leadership Intervention in Nursing Homes and Homecare: Researchers' Tips for Success. J Patient Saf 2022; 18:e368-e372. [PMID: 33009183 PMCID: PMC8719495 DOI: 10.1097/pts.0000000000000786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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Sabetsarvestani P, Mohammadi F, Tehranineshat B, Bijani M, Fereidouni Z. Barriers to efficient management of in-home care: A qualitative content analysis. Nurs Open 2021; 9:1200-1209. [PMID: 34908248 PMCID: PMC8859078 DOI: 10.1002/nop2.1161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 11/12/2021] [Accepted: 12/01/2021] [Indexed: 11/25/2022] Open
Abstract
Aim Inefficient management is one of the major barriers to development of in‐home care in the society. Accordingly, the present study aims to identify the barriers to efficient management of home care nursing using a qualitative approach. Design The present study is a qualitative‐descriptive work of research. Method Data were collected using semi‐structured, in‐depth, individual interviews with 19 nurses from November 2020 to May 2021. The collected data were analysed using Graneheim and Lundman's method. Results The findings of the study were categorized into four main themes, namely lack of effective standards, ineffective interactions, inappropriate cultural/social context and professional issues, and 15 subthemes. Conclusion In‐home care nurses in Iran experience various problems in their practice. Creating an appropriate cultural/social context in Iranian societies, providing the necessary infrastructure, including insurance, providing comprehensive, clear guidelines for in‐home care, encouraging teamwork and organizing workshops to promote effective interactions between the personnel and patients can improve the quality of in‐home care nursing.
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Affiliation(s)
| | - Fateme Mohammadi
- Chronic Diseases (Home Care) Research Center and Autism Spectrum Disorders Research Center, Department of Nursing, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Banafsheh Tehranineshat
- Community-based Psychiatric Care Research Center, Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mostafa Bijani
- School of Nursing, Fasa University of Medical Sciences, Fasa, Iran
| | - Zhila Fereidouni
- School of Nursing, Fasa University of Medical Sciences, Fasa, Iran
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Curtis F, Jayawickrama WIU, Laparidou D, Weligamage D, Kumarawansha WKWS, Ortega M, Siriwardena AN. Perceptions and experiences of residents and relatives of emergencies in care homes: a systematic review and metasynthesis of qualitative research. Age Ageing 2021; 50:1925-1934. [PMID: 34591971 PMCID: PMC8581376 DOI: 10.1093/ageing/afab182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 07/05/2021] [Indexed: 11/30/2022] Open
Abstract
Background the perceptions and experiences of care home residents and their families are important for understanding and improving the quality of emergency care. Methods we conducted a systematic review and metasynthesis to understand the perceptions and experiences of care home residents and their family members who experienced medical emergencies in a care home setting. The review protocol was registered in PROSPERO (CRD42020167018). We searched five electronic databases, MEDLINE, CINAHL, PubMed, Cochrane Library and PsycINFO, supplemented with internet searches and forward and backward citation tracking from included studies and review articles. Data were synthesised thematically following the Thomas and Harden approach. The Critical Appraisal Skills Programme qualitative checklist was used to assess the quality of studies included in this review. Results of the 6,140 references retrieved, 10 studies from four countries (Australia, Canada, UK and USA) were included in the review and metasynthesis. All the included studies were assessed as being of good quality. Through an iterative approach, we developed six analytical themes: (i) infrastructure and process requirements in care homes to prevent and address emergencies; (ii) the decision to transfer to hospital; (iii) experiences of transfer and hospitalisation for older patients; (iv) good communication is vital for desirable outcomes; (v) legal, regulatory and ethical concerns and (vi) trusting relationships enabled residents to feel safe. Conclusions the emergency care experience for care home residents can be enhanced by ensuring resources, staff capacity and processes for high quality care and trusting relationships between staff, patients and relatives, underpinned by good communication and attention to ethical practice.
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Affiliation(s)
- Ffion Curtis
- Lincoln International Institute of Rural Health, University of Lincoln, Lincoln, Lincolnshire, UK
| | - Withanage Iresha Udayangani Jayawickrama
- Community and Health Research Unit and Lincoln Clinical Trials Unit, School of Health and Social Care, University of Lincoln, Lincoln, Lincolnshire, UK
- Postgraduate Institute of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Despina Laparidou
- Community and Health Research Unit and Lincoln Clinical Trials Unit, School of Health and Social Care, University of Lincoln, Lincoln, Lincolnshire, UK
| | - Dedunu Weligamage
- Community and Health Research Unit and Lincoln Clinical Trials Unit, School of Health and Social Care, University of Lincoln, Lincoln, Lincolnshire, UK
- Postgraduate Institute of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Weerapperuma Kankanamge Wijaya Sarathchandra Kumarawansha
- Community and Health Research Unit and Lincoln Clinical Trials Unit, School of Health and Social Care, University of Lincoln, Lincoln, Lincolnshire, UK
- Postgraduate Institute of Medicine, University of Colombo, Colombo, Sri Lanka
| | | | - Aloysius Niroshan Siriwardena
- Community and Health Research Unit and Lincoln Clinical Trials Unit, School of Health and Social Care, University of Lincoln, Lincoln, Lincolnshire, UK
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Zhao B, Zhang X, Huang R, Yi M, Dong X, Li Z. Barriers to accessing internet-based home Care for Older Patients: a qualitative study. BMC Geriatr 2021; 21:565. [PMID: 34663218 PMCID: PMC8522081 DOI: 10.1186/s12877-021-02474-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/17/2021] [Indexed: 11/18/2022] Open
Abstract
Background Due to the increasingly ageing society and the shortage of nursing human resources in China, the imbalance between the home care needs of older patients and the inadequate supply of nursing services is increasing. Based on this medical situation, China is implementing internet-based home care (with the nurses who provide this care called online nurses or sharing nurses) based on the concept of the sharing economy, internet technology and knowledge from the home care experience in other countries. Internet-based home care follows an online application/offline service model. Patients place orders through an app, nurses grab orders instantly, and managers dispatch orders through a web platform based on various factors such as nurses’ qualifications, professionalism and distance from the patient. In this way, home care is provided for patients with limited mobility, such as older or disabled patients, patients in rehabilitation and terminal patients. Only by fully understanding the barriers to accessing internet-based home care can we provide quality nursing services to older patients and achieve the sustainable development of internet-based home care. Objective The goal of this study was to use qualitative methods to explore barriers to accessing internet-based home care for older patients. Methods Based on Levesque’s access to health care framework, semi-structured personal interviews were conducted with 19 older patients in a descriptive qualitative study using directed content analysis. Results We identified four barriers to accessing internet-based home care for older patients: barriers to perceiving, seeking, paying for, and engaging in internet-based home care. Specific barriers included traditional perceptions, barriers to internet use, high payment costs, uneven quality of services, and concerns about privacy and patient safety. Conclusions Internet-based home care brings new risks and challenges. In order to enable older patients to better enjoy it, it is necessary to strengthen publicity, optimize the network application process, improve the health insurance system, formulate unified nursing service standards, and address safety risks. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02474-6.
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Affiliation(s)
- Baosheng Zhao
- Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, No. 324 Jingwu Weiqi Road, Jinan, Shandong Province, 250021, China
| | - Xiaoman Zhang
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Weiqi Road, Jinan, 250021, Shandong Province, China
| | - Rendong Huang
- School of Nursing, Hangzhou Medical College, No. 8 Yikang Road, Hangzhou, Zhejiang Province, 311399, China
| | - Mo Yi
- School of Nursing and Rehabilitation Shandong University, No. 44 Wenhuaxi Road, Jinan, Shandong Province, 250012, China
| | - Xiaofei Dong
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Weiqi Road, Jinan, 250021, Shandong Province, China
| | - Zhenxiang Li
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Weiqi Road, Jinan, 250021, Shandong Province, China.
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Asante BL, Zúñiga F, Favez L. Quality of care is what we make of it: a qualitative study of managers' perspectives on quality of care in high-performing nursing homes. BMC Health Serv Res 2021; 21:1090. [PMID: 34645441 PMCID: PMC8515763 DOI: 10.1186/s12913-021-07113-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 10/01/2021] [Indexed: 11/24/2022] Open
Abstract
Background Leadership has a vital role regarding quality of care in nursing homes. However, few studies have explored upper-level managers’ views on how to assure that residents receive high quality of care. Therefore, this study’s aim was to examine how managers of top-quality nursing homes define, develop and maintain high-quality of care. Method We used interpretive description, an inductive, qualitative approach. Our research included 13 semi-structured interviews with 19 managers. We analyzed their input using reflexive thematic analysis, which is an iterative approach. Results Quality development and maintenance are cyclic processes. Managers in high-performing nursing homes lead with high commitment towards a person-centred quality of care, creating appropriate working conditions and continuously co-creating a vision and the realization of quality of care together with employees. Conclusions This study confirms that, in high-performing nursing homes, a person-centered approach—one where both residents and employees are at the center—is essential for quality development and maintenance. The most effective managers exemplify “person centeredness”: they lead by example and promote quality-focused working conditions. Such strategies motivate employees to provide person-centered care. As this means focusing on residents’ needs, it results in high care quality.
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Affiliation(s)
- Brigitte Lalude Asante
- Institute of Nursing Science, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
| | - Franziska Zúñiga
- Institute of Nursing Science, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland.
| | - Lauriane Favez
- Institute of Nursing Science, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
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Johannessen T, Ree E, Aase I, Bal R, Wiig S. Exploring managers' response to a quality and safety leadership intervention: findings from a multiple case study in Norwegian nursing homes and homecare services. BMJ Open Qual 2021; 10:bmjoq-2021-001494. [PMID: 34373250 PMCID: PMC8354257 DOI: 10.1136/bmjoq-2021-001494] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 07/25/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Improvement interventions would be easier to treat if they were stable and uninfluenced by their environment, but in practice, contextual factors may create difficulties in implementing and sustaining changes. Managers of healthcare organisations play an important role in quality and safety improvement. We need more research in the nursing home and homecare settings to support managers in their quality and safety improvement work. The aim of this study was to explore managers' response to a leadership intervention on quality and safety improvement. METHODS This study reports findings from the SAFE-LEAD intervention undertaken from April 2018 to March 2019. The research design was a multiple case study of two nursing homes and two homecare services in four municipalities in Norway. We used a combination of qualitative methods including interviews, workshops, observations, site visits and document analysis in our data collection that took place over a 1-year period. RESULTS Management continuity was key for the implementation process of the quality and safety leadership intervention. In the units where stable management teams were in place, the intervention was more rooted in the units, and changes in quality and safety practice occurred. The intervention served as an arena for managers to work with quality and safety improvement. We found that the workshops and use of the leadership guide contributed to a common understanding and commitment to quality and safety improvement among the managers. CONCLUSIONS This is a longitudinal study of managers' response to a leadership intervention targeted to improve quality and safety work in nursing home and homecare settings. Our research demonstrates how the mechanisms of stable management and established structures are crucial for quality and safety improvement activities. Management continuity is key for participating in interventions and for using the leadership guide in quality and safety work.
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Affiliation(s)
- Terese Johannessen
- SHARE- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Eline Ree
- SHARE- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Ingunn Aase
- SHARE- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Roland Bal
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Siri Wiig
- SHARE- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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Stokke R, Melby L, Isaksen J, Obstfelder A, Andreassen H. A qualitative study of what care workers do to provide patient safety at home through telecare. BMC Health Serv Res 2021; 21:553. [PMID: 34090450 PMCID: PMC8180066 DOI: 10.1186/s12913-021-06556-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 05/17/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND In health care, the work of keeping the patient safe and reducing the risk of harm is defined as safety work. In our digitised and technology-rich era, safety work usually involves a relationship between people and technologies. Telecare is one of the fastest-growing technology-domains in western health care systems. In the marketing of telecare, the expectation is that safety is implicit simply by the presence of technology in patients' homes. Whilst both researchers and health authorities are concerned with developing cost-benefit analyses and measuring effects, there is a lack of attention to the daily work needed to ensure that technologies contribute to patient safety. This paper aims to describe how patient safety in home care is addressed through and with telecare. We base our exploration on the social alarm, an established technology that care workers are expected to handle as an integrated part of their ordinary work. METHODS The study has a qualitative explorative design where we draw on empirical data from three case studies, involving five Norwegian municipalities that use social alarm systems in home care services. We analyse observations of practice and interviews with the actors involved, following King's outline of template analysis. RESULTS We identified three co-existing work processes that contributed to patient safety: "Aligning people and technologies"; "Being alert and staying calm"; and "Coordinating activities based on people and technology". Attention to these work processes exposes safety practices, and how safety is constructed in relational practices involving multiple people and technologies. CONCLUSIONS We conclude that the three work processes identified are essential if the safety alarm is to function for the end user's safety. The safety of home-dwelling patients is reliant on the person-technology interface. The efforts of care workers and their interface with technology are a central feature of creating safety in a patient's home, and in doing so, they utilise a repertoire of skills and knowledge.
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Affiliation(s)
- Randi Stokke
- Centre for Care Research, NTNU Norwegian University of Science and Technology, P.O. Box 191, 2802, Gjøvik, Norway.
| | - Line Melby
- Centre for Care Research, NTNU Norwegian University of Science and Technology, P.O. Box 191, 2802, Gjøvik, Norway
| | - Jørn Isaksen
- Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Gudbrandsdalsvegen 350, 2624, Lillehammer, Norway
| | - Aud Obstfelder
- Centre for Care Research, NTNU Norwegian University of Science and Technology, P.O. Box 191, 2802, Gjøvik, Norway
| | - Hege Andreassen
- Centre for Care Research, NTNU Norwegian University of Science and Technology, P.O. Box 191, 2802, Gjøvik, Norway
- Centre for Women and Gender Research, UiT, The Arctic University of Norway, P.O Box 6050 Langnes, 9037, Tromsø, Norway
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Managers' role in supporting resilience in healthcare: a proposed model of how managers contribute to a healthcare system's overall resilience. INTERNATIONAL JOURNAL OF HEALTH GOVERNANCE 2021. [DOI: 10.1108/ijhg-11-2020-0129] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeTo discuss how managers contribute in promoting resilience in healthcare, and to suggest a model of managers' role in supporting resilience and elaborate on how future research and implementation studies can use this to further operationalize the concept and promote healthcare resilience.Design/methodology/approachThe authors first provide an overview of and discuss the main approaches to healthcare resilience and research on management and resilience. Second, the authors provide examples on how managers work to promote healthcare resilience during a one-year Norwegian longitudinal intervention study following managers in nursing homes and homecare services in their daily quality and safety work. They use this material to propose a model of management and resilience.FindingsThe authors consider managerial strategies to support healthcare resilience as the strategies managers use to engage people in collaborative and coordinated processes that adapt, enhance or reorganize system functioning, promoting possibilities of learning, growth, development and recovery of the healthcare system to maintain high quality care. The authors’ model illustrates how managers influence the healthcare systems ability to adapt, enhance and reorganize, with high quality care as the key outcome.Originality/valueIn this study, the authors argue that managerial strategies should be considered and operationalized as part of a healthcare system's overall resilience. They propose a new model of managers' role in supporting resilience to be used in practice, interventions and future research projects.
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Ree E, Aase I, Strømme T, Westbrook J, Wiig S. Lessons learnt from nursing home and homecare managers’ experiences with using the SAFE-LEAD guide. TIDSSKRIFT FOR OMSORGSFORSKNING 2020. [DOI: 10.18261/issn.2387-5984-2020-02-08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Ree E. What is the role of transformational leadership, work environment and patient safety culture for person-centred care? A cross-sectional study in Norwegian nursing homes and home care services. Nurs Open 2020; 7:1988-1996. [PMID: 33072384 PMCID: PMC7544868 DOI: 10.1002/nop2.592] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/03/2020] [Accepted: 07/23/2020] [Indexed: 11/08/2022] Open
Abstract
Aim To examine how transformational leadership, job demands, job resources and patient safety culture contribute in explaining person-centred care in nursing homes and home care services. Design Cross-sectional study. Methods Healthcare professionals in four Norwegian nursing homes (N = 165) and four home care services (N = 139) participated in 2018. Multiple regression analyses were used to examine to what degree transformational leadership, job demands, job resources and patient safety culture dimensions predicted person-centred care. Results Transformational leadership, job demands and job resources explained 41% of the variance in person-centred care, with work pace as the strongest predictor (β = 0.39 p < .001). The patient safety culture dimensions explained 57.5% of the variance in person-centred care, with staffing being the strongest predictor (β = 0.31 p < .001). There were small differences between nursing homes and home care. In total, transformational leadership, pace of work, staffing and factors related to communication were the strongest predictors for person-centred care.
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Affiliation(s)
- Eline Ree
- SHARE - Centre for Resilience in Healthcare Faculty of Health Sciences University of Stavanger Stavanger Norway
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