Dementia and patient safety in the community: a qualitative study of family carers' protective practices and implications for services
Dementia and patient safety in the community: a qualitative study of family carers' protective practices and implications for services
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DOI：
10.1186/s12913-019-4478-2
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发表时间：
2019-09-05
影响因子：
2.8
通讯作者：
Rugkasa, Jorun
中科院分区：
文献类型：
--
作者：
Haikio, Kristin;Sagbakken, Mette;Rugkasa, Jorun
痴呆症是一种残疾和依赖性的原因，与对卫生服务的高需求相关，预计会对资源产生重大影响。世界各地的护理政策越来越依赖家庭护理人员为老年人提供服务，国际卫生保健政策的大方向是在社区提供护理，这意味着大多数人将在那里接受服务。因此，初级保健中的患者安全对未来的护理很重要，但在患者家中提供服务时尚未进行充分调查。特别是，我们对家庭照顾者如何体验社区老年痴呆症患者的安全知之甚少。方法采用探索性研究，对23名疑似或确诊为痴呆的老年人的家庭照顾者进行定性深入访谈。家庭照顾者主要通过从事痴呆症护理的卫生专业人员获得信息后参加。以灵活的方式使用了半结构化的专题指南，以收集与会者的经验。一个四步归纳分析的成绩单是由解释学现象学分析。结果我们的参与者寻求解决风险和安全问题的方式可以理解为构成保护性实践，旨在预防或减少伤害风险和/或减轻发生的伤害造成的损害。保护性做法涉及四个方面：身体伤害、经济伤害、情感伤害和关系伤害。这些保护性做法是相互关联的，家庭照料者有时会优先考虑其中一种做法，而由于它们是家庭做法的一部分，服务提供者并不总是能看到它们。因此，这些做法可能会使与卫生专业人员的互动复杂化，甚至无意中隐藏症状或护理需求。结论当家庭照顾者预防伤害并满足需求时，某些需求可能被卫生专业人员隐藏或不可见。为了认识到所有需求并提供有效、安全和以人为本的护理，卫生专业人员需要认识到这些预防措施，并寻求与家庭护理人员建立牢固的伙伴关系。
Background Dementia is a cause of disability and dependency associated with high demands for health services and expected to have a significant impact on resources. Care policies worldwide increasingly rely on family caregivers to contribute to service delivery for older people, and the general direction of health care policy internationally is to provide care in the community, meaning most people will receive services there. Patient safety in primary care is therefore important for future care, but not yet investigated sufficiently when services are carried out in patients' homes. In particular, we know little about how family carers experience patient safety of older people with dementia in the community. Methods This was an explorative study, with qualitative in-depth interviews of 23 family carers of older people with suspected or diagnosed dementia. Family carers participated after receiving information primarily through health professionals working in dementia care. A semi-structured topic guide was used in a flexible way to capture participants' experiences. A four-step inductive analysis of the transcripts was informed by hermeneutic-phenomenological analysis. Results The ways our participants sought to address risk and safety issues can be understood to constitute protective practices that aimed to prevent or reduce the risk of harm and/or alleviate damage from harm that occurs. The protective practices relate to four areas: physical harm, economic harm, emotional harm, and relational harm. The protective practices are interlinked, and family carers sometimes prioritize one over another, and as they form part of family practice, they are not always visible to service providers. As a result, the practices may complicate interactions with health professionals and even inadvertently conceal symptoms or care needs. Conclusions When family caregivers prevent harm and meet needs, some needs may be concealed or invisible to health professionals. To recognize all needs and provide effective, safe and person-centered care, health professionals need to recognize these preventive practices and seek to build a solid partnership with family carers.