"That's not my job": A mixed methods study of challenging client behaviors, boundaries, and home care aide occupational safety and health
"That's not my job": A mixed methods study of challenging client behaviors, boundaries, and home care aide occupational safety and health
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DOI：
10.1002/ajim.23082
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发表时间：
2019-12-13
影响因子：
3.5
通讯作者：
Quinn, Margaret M.
中科院分区：
文献类型：
--
作者：
Karlsson, Nicole D.;Markkanen, Pia K.;Quinn, Margaret M.
家庭护理（HC）助理是增长最快的工作之一。助手经常在客户家中与老年人或残疾人建立长期护理关系，协助日常活动。这混合方法的文件的目的是阐明助手的经验，围绕边界的挑战性行为的客户要求服务超出助手的工作职责，并确定可能的干预措施。方法对马萨诸塞州1249名HC助手进行横断面调查，提供定量数据。调查后的定性数据收集从9个HC援助焦点小组（n = 70）和7个深入的采访HC行业和劳工代表。结果在数量上，报告经常被要求做工作职责之外的任务的助手更有可能报告虐待（言语患病率[PR] = 1.93; 95%CI：1.47-2.52，身体/性患病率PR = 1.81; 95%CI：1.13-2.91）和疼痛/损伤，并失去工作时间或医疗护理（PR = 1.58; 95%CI：1.11-2.25）。他们也不太可能想继续工作（PR = 0.94; 95%CI：0.89-1.00）或推荐给其他人（PR = 0.94; 95%CI：0.90-0.98）。定性数据显示，客户经常要求完成工作职责以外的任务，可能导致伤害、虐待和心理压力。然而，请求往往反映了真正的需要。帮助客户呆在家里，同情心，并感到赞赏有助于工作满意度;因此，助手可能会对拒绝请求感到矛盾。结论HC服务之外的客户端任务请求是一个复杂的问题。雇主的支持，培训，护理计划和感觉护理团队的一部分可以帮助助手导航专业界限，同时提供高质量的护理。
Introduction Home care (HC) aide is among the fastest-growing jobs. Aides often work in long-term care relationships with elders or people with disabilities in clients' homes, assisting with daily activities. The purpose of this mixed-methods paper is to elucidate aides' experiences around the boundary-challenging behaviors of clients asking for services beyond aides' job duties and to identify possible interventions. Methods A cross-sectional survey of HC aides in Massachusetts (n = 1249) provided quantitative data. Post-survey qualitative data were collected from nine HC aide focus groups (n = 70) and seven in-depth interviews with HC industry and labor representatives. Results Quantitatively, aides who reported often being asked to do tasks outside their job duties were more likely to report abuse (prevalence ratio [PR] = 1.93; 95%CI: 1.47-2.52 for verbal, PR = 1.81; 95%CI: 1.13-2.91 for physical/sexual) and pain/injury with lost work time or medical care (PR = 1.58; 95%CI: 1.11-2.25). They were also less likely to want to remain in their job (PR = 0.94; 95%CI: 0.89-1.00) or recommend it to others (PR = 0.94; 95%CI: 0.90-0.98). Qualitative data showed that clients' requests for tasks beyond job duties were frequent and can lead to injuries, abuse, and psychosocial stress. Yet, requests often reflected genuine need. Helping clients stay at home, compassion, and feeling appreciated contributed to job satisfaction; therefore, aides can feel conflicted about refusing requests. Conclusion Client task requests outside HC services are a complex problem. Employer support, training, care plans, and feeling part of a care team can help aides navigate professional boundaries while delivering high quality care.