Communicative Competence: Responding to Residents' Health Changes in Assisted Living
Communicative Competence: Responding to Residents' Health Changes in Assisted Living
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DOI：
10.1093/geront/gnz119
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发表时间：
2020-05-15
期刊：
影响因子：
5.7
通讯作者：
Fitzroy, Andrea F.
中科院分区：
文献类型：
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作者：
Kemp, Candace L.;Ball, Mary M.;Fitzroy, Andrea F.
背景和目的包括辅助生活(AL)居民在内的虚弱和残疾个人被嵌入由正式和非正式护理伙伴动态网络组成的护理车队中。然而，人们对护理车队随着时间的推移是如何运作的知之甚少，特别是在健康发生变化的时候。因此，我们的目的是为了深入了解AL患者健康变化期间护理车队的沟通情况。研究设计与方法这项分析的数据来自一项扎根理论研究，该研究涉及来自8个不同AL社区的50名居民和他们的护理车队成员(n=169)，跟踪时间超过2年。研究人员进行了正式和非正式访谈、参与者观察和记录审查。结果“沟通能力”是指住院医师或护理伙伴在沟通和健康改变方面的能力、知识和行动的解释框架。个人和集体的能力是及时和适当护理的结果。涉及的沟通包括：确定；评估重要性；通知、咨询或与他人合作；以及对变化做出反应。沟通过程和性质(例如，速度和时机；顺序、时机、内容和沟通方式)的可变性取决于多种因素，包括改变的性质和居民、非正式和正式的照顾者、车队、AL社区和监管影响。讨论和影响正式和非正式护理伙伴需要支持，以建立、增强和保持沟通能力，以应对卫生变化。研究结果加强了及时沟通、有效的系统和记录良好的可获得的卫生保健指令的必要性，并具有适用于AL和其他保健环境的影响。
Background and Objectives Frail and disabled individuals, including assisted living (AL) residents, are embedded in care convoys composed of dynamic networks of formal and informal care partners. Yet, little is known about how care convoys operate over time, especially when health changes occur. Thus, our aim was to provide an in-depth understanding of care convoy communication during times of residents' health changes in AL. Research Design and Methods Data for this analysis come from a Grounded Theory study that involved 50 residents and their care convoy members (n = 169) from 8 diverse AL communities followed over 2 years. Researchers conducted formal and informal interviewing, participant observation, and record review. Results We identified "communicative competence" as an explanatory framework in reference to a resident's or care partner's ability, knowledge, and action pertaining to communication and health change. Individual and collective competencies were consequential to timely and appropriate care. Communication involved: identifying; assessing significance; informing, consulting or collaborating with others; and responding to the change. Variability in communication process and properties (e.g., pace and timing; sequencing, timing, content, and mode of communication) depended on multiple factors, including the nature of the change and resident, informal and formal caregiver, convoy, AL community, and regulatory influences. Discussion and Implications Formal and informal care partners need support to establish, enhance, and maintain communicative competence in response to health changes. Findings reinforce the need for timely communication, effective systems, and well-documented accessible health care directives and have implications that are applicable to AL and other care settings.