Clemens E L, Hayes H E
Gerontology Institute, University of Massachusetts, Boston 02125, USA.
Home Health Care Serv Q. 1997;16(3):3-20. doi: 10.1300/J027v16n03_02.
Diverse professionals assess and manage risk with frail elderly yet no standard practice guidelines are used across the care continuum. This qualitative study provides new understanding of how eldercare workers conceptualize and assess risk with frail elderly clients. Fifteen professionals were interviewed using the Long-Interview Method of McCracken (1988) and Crabtree and Miller (1991). Respondents included home care case managers, visiting nurses and hospital discharge social workers. This paper reports on two key decision-making styles identified through multidisciplinary analysis of transcripts: the "snap decision-makers" and the "agonizers." Labeling strategies are identified that may assist eldercare workers with the dissonance between professional training and the realities of practice. Variable thresholds for risk tolerance among diverse professionals were found. These findings suggest that risk assessment often reflects the values of the individual practitioner's profession and agency culture. Standardized training and ethical practice guidelines are needed to reduce extreme variability in professionals' judgments; and to better assist staff with assessing and balancing elder risk, safety and autonomy.
不同专业人员对体弱老年人进行风险评估和管理，但在整个护理过程中并未采用标准的实践指南。这项定性研究为老年护理工作者如何理解和评估体弱老年客户的风险提供了新的认识。采用麦卡肯（1988年）以及克拉布特里和米勒（1991年）的长访谈法对15名专业人员进行了访谈。受访者包括家庭护理个案经理、上门访视护士和医院出院社会工作者。本文报告了通过对访谈记录进行多学科分析确定的两种关键决策风格：“快速决策者”和“苦苦思索者”。确定了一些标签策略，这些策略可能有助于老年护理工作者应对专业培训与实践现实之间的不一致。研究发现，不同专业人员的风险承受阈值各不相同。这些发现表明，风险评估往往反映了个体从业者的职业价值观和机构文化。需要标准化培训和道德实践指南，以减少专业人员判断中的极端差异；并更好地帮助工作人员评估和平衡老年人的风险、安全和自主性。
