The Family Perspective on Hospital to Home Transitions: A Qualitative Study
The Family Perspective on Hospital to Home Transitions: A Qualitative Study
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DOI：
10.1542/peds.2015-2098
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发表时间：
2015-12-01
期刊：
影响因子：
8
通讯作者：
Sherman, Susan N.
中科院分区：
文献类型：
--
作者：
Solan, Lauren G.;Beck, Andrew F.;Sherman, Susan N.
背景与目的：对于患者和家人来说，从医院到家的过渡可能很困难。了解家庭对这一脆弱时期的特征，可能有助于确定改善家庭过渡的干预措施。我们的目标是制定一个全面的了解从家庭的角度来看，医院到家庭的过渡：采用定性的方法，焦点小组和个人访谈与照顾者出院的儿童在过去的30天。焦点小组根据社会经济地位分层。开放式，半结构化的问题指南包括沟通和理解的护理计划，过渡家庭，和出院后的事件的问题。使用归纳专题分析，调查人员编码的成绩单，解决分歧通过consensus.RESULTS：61照顾者参加了11个焦点小组和4个单独的采访。参与者中87%为女性，46%为非白人; 38%是家中唯一的成年人，56%居住在人口普查区，其中超过15%的居民生活在贫困中。参与者的反应产生了一个概念模型，描述了家庭从医院到家庭过渡的经验的关键要素。产生了四个主要概念：（1）“一头雾水”（处理信息和采取行动的障碍），（2）“我希望我有什么”（期望的信息和改进建议），（3）“我准备好回家了吗？（准备出院），（4）“我回家了，现在怎么办？”结论：从医院到家庭的过渡影响家庭的生活，可能会影响患者出院后的结果。照顾者是成功过渡的关键，家庭观点可以为支持家庭和促进更容易重返家庭的干预措施提供信息。
BACKGROUND AND OBJECTIVE: Transitions from the hospital to home can be difficult for patients and families. Family-informed characterization of this vulnerable period may facilitate the identification of interventions to improve transitions home. Our objective was to develop a comprehensive understanding of hospital-to-home transitions from the family perspective.METHODS: Using qualitative methods, focus groups and individual interviews were held with caregivers of children discharged from the hospital in the preceding 30 days. Focus groups were stratified based upon socioeconomic status. The open-ended, semistructured question guide included questions about communication and understanding of care plans, transition home, and postdischarge events. Using inductive thematic analysis, investigators coded the transcripts, resolving differences through consensus.RESULTS: Sixty-one caregivers participated across 11 focus groups and 4 individual interviews. Participants were 87% female and 46% nonwhite; 38% were the only adult in their household, and 56% resided in census tracts with >= 15% of residents living in poverty. Responses from participants yielded a conceptual model depicting key elements of families' experiences with hospital-to-home transitions. Four main concepts resulted: (1) "In a fog" (barriers to processing and acting on information), (2) "What I wish I had" (desired information and suggestions for improvement), (3) "Am I ready to go home?" (discharge readiness), and (4) "I'm home, now what?" (confidence and postdischarge care).CONCLUSIONS: Transitions from hospital to home affect the lives of families in ways that may affect patient outcomes postdischarge. The caregiver is key to successful transitions, and the family perspective can inform interventions that support families and facilitate an easier re-entry to the home.