Experiences of Home Health Care Workers in New York City During the Coronavirus Disease 2019 Pandemic: A Qualitative Analysis
Experiences of Home Health Care Workers in New York City During the Coronavirus Disease 2019 Pandemic: A Qualitative Analysis
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DOI：
10.1001/jamainternmed.2020.3930
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发表时间：
2020-11-01
影响因子：
39
通讯作者：
Dell, Nicola
中科院分区：
文献类型：
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作者：
Sterling, Madeline R.;Tseng, Emily;Dell, Nicola
家庭卫生保健工作者照顾社区居住的成年人，并在支持家中确诊和疑似2019冠状病毒病（COVID-19）患者方面发挥重要作用。这些工人大多是中年妇女和少数民族，他们的工资通常很低。尽管这些工作人员是病人护理不可或缺的一部分，但他们往往被医学界和整个社会所忽视；因此，要建立一个能够应对COVID-19危机和未来大流行的卫生保健系统，就需要更好地了解家庭卫生保健工作者的经验。目的了解2019冠状病毒病（COVID-19）大流行期间纽约市家庭医护人员护理患者的经验。设计、环境和参与者2020年3月至4月，与1199SEIU家庭护理行业教育基金合作，对纽约市33名家庭护理工作者进行了1对1半结构化访谈的定性研究，该基金是美国最大的医疗保健工会1199SEIU家庭护理行业教育基金的一个福利基金。有目的的抽样用于确定和招募家庭卫生保健工作者。主要结果和测量方法录音访谈被专业地转录并使用扎根理论进行分析。确定了主要主题和次级主题。结果共有33名来自纽约市5个区的24家独特的家庭护理机构的家庭保健工作者参与了调查。参与者的平均（SD）年龄为47.6（14.0）岁，32名（97%）为女性，21名（64%）为黑人参与者，6名（18%）为西班牙裔参与者。出现了五大主题：家庭卫生保健工作者(1)站在COVID-19大流行的第一线，但感觉自己被忽视；(2)报告病毒传播风险增高的；(3)从家庭护理机构获得不同数量的信息、用品和培训；(4)依赖非代理机构的替代支持，包括信息和供应；(5)被迫在工作和个人生活中做出艰难的权衡。在这一定性分析中，家庭卫生保健工作者报告说，在COVID-19大流行期间，他们往往冒着个人风险提供一线基本护理。他们所经历的挑战加剧了他们作为边缘化劳动力所面临的不平等。迫切需要干预措施和政策，以更好地支持这些一线卫生保健专业人员。
IMPORTANCE Home health care workers care for community-dwelling adults and play an important role in supporting patients with confirmed and suspected coronavirus disease 2019 (COVID-19) who remain at home. These workers are mostly middle-aged women and racial/ethnic minorities who typically earn low wages. Despite being integral to patient care, these workers are often neglected by the medical community and society at large; thus, developing a health care system capable of addressing the COVID-19 crisis and future pandemics requires a better understanding of the experiences of home health care workers.OBJECTIVE To understand the experiences of home health care workers caring for patients in New York City during the COVID-19 pandemic.DESIGN, SETTING, AND PARTICIPANTS From March to April 2020, a qualitative study with 1-to-1 semistructured interviews of 33 home health care workers in New York City was conducted in partnership with the 1199SEIU Home Care Industry Education Fund, a benefit fund of the 1199 Service Employees International Union United Healthcare Workers East, the largest health care union in the US. Purposeful sampling was used to identify and recruit home health care workers.MAIN OUTCOMES AND MEASURES Audio-recorded interviews were professionally transcribed and analyzed using grounded theory. Major themes and subthemes were identified.RESULTS In total, 33 home health care workers employed by 24 unique home care agencies across the 5 boroughs of New York City participated. Participants had a mean (SD) age of 47.6 (14.0) years, 32 (97%) were women, 21 (64%) were Black participants, and 6 (18%) were Hispanic participants. Five major themes emerged: home health care workers (1) were on the front lines of the COVID-19 pandemic but felt invisible; (2) reported a heightened risk for virus transmission; (3) received varying amounts of information, supplies, and training from their home care agencies; (4) relied on nonagency alternatives for support, including information and supplies; and (5) were forced to make difficult trade-offs in their work and personal lives.CONCLUSIONS AND RELEVANCE In this qualitative analysis, home health care workers reported providing frontline essential care, often at personal risk, during the COVID-19 pandemic. They experienced challenges that exacerbated the inequities they face as a marginalized workforce. Interventions and policies to better support these frontline health care professionals are urgently needed.