传播与维持老年人居家照护的最佳实践：一项扎根理论研究

Spreading and sustaining best practices for home care of older adults: a grounded theory study.

作者信息

Ploeg Jenny, Markle-Reid Maureen, Davies Barbara, Higuchi Kathryn, Gifford Wendy, Bajnok Irmajean, McConnell Heather, Plenderleith Jennifer, Foster Sandra, Bookey-Bassett Sue

机构信息

School of Nursing, Faculty of Health Sciences, Aging, Community and Health Research Unit, Department of Health, Aging and Society, McMaster University, 1280 Main Street West, Room HSc3N25C, Hamilton L8S 4K1, ON, Canada.

出版信息

Implement Sci. 2014 Nov 7;9:162. doi: 10.1186/s13012-014-0162-4.

DOI:10.1186/s13012-014-0162-4

PMID:25377627

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4225037/

Abstract

BACKGROUND

Improving health care quality requires effective and timely spread of innovations that support evidence-based practices. However, there is limited rigorous research on the process of spread, factors influencing spread, and models of spread. It is particularly important to study spread within the home care sector given the aging of the population, expansion of home care services internationally, the high proportion of older adult users of home care services, and the vulnerability of this group who are frail and live with multiple chronic conditions. The purpose of this study was to understand how best practices related to older adults are spread within home care organizations.

METHODS

Four home care organizations in Ontario, Canada that had implemented best practices related to older adults (falls prevention, pain management, management of venous leg ulcers) participated. Using a qualitative grounded theory design, interviews were conducted with frontline providers, managers, and directors at baseline (n = 44) and 1 year later (n = 40). Open, axial, and selective coding and constant comparison analysis were used.

RESULTS

A model of the process of spread of best practices within home care organizations was developed. The phases of spread included (1) committing to change, (2) implementing on a small scale, (3) adapting locally, (4) spreading internally to multiple users and sites, and (5) disseminating externally. Factors that facilitated progression through these phases were (1) leading with passion and commitment, (2) sustaining strategies, and (3) seeing the benefits. Project leads, champions, managers, and steering committees played vital roles in leading the spread process. Strategies such as educating/coaching and evaluating and feedback were key to sustaining the change. Spread occurred within the home care context of high staff and manager turnover and time and resource constraints.

CONCLUSIONS

Spread of best practices is optimized through the application of the phases of spread, allocation of resources to support spread, and implementing strategies for ongoing sustainability that address potential barriers. Further research will help to understand how best practices are spread externally to other organizations.

摘要

背景

提高医疗保健质量需要有效且及时地推广支持循证实践的创新举措。然而，关于推广过程、影响推广的因素以及推广模式的严谨研究有限。鉴于人口老龄化、家庭护理服务在国际上的扩展、家庭护理服务老年使用者的高比例以及该群体体弱且患有多种慢性病的脆弱性，研究家庭护理领域内的推广尤为重要。本研究的目的是了解与老年人相关的最佳实践在家庭护理组织中是如何传播的。

方法

加拿大安大略省的四家实施了与老年人相关最佳实践（预防跌倒、疼痛管理、下肢静脉溃疡管理）的家庭护理组织参与了研究。采用定性扎根理论设计，在基线时（n = 44）和1年后（n = 40）对一线提供者、管理人员和主任进行访谈。使用了开放式、轴心式和选择性编码以及持续比较分析。

结果

建立了家庭护理组织内最佳实践传播过程的模型。传播阶段包括：（1）致力于变革；（2）小规模实施；（3）本地调整；（4）在内部向多个用户和地点传播；（5）外部传播。促进这些阶段进展的因素包括：（1）满怀激情和承诺地引领；（2）维持策略；（3）看到益处。项目负责人、倡导者、管理人员和指导委员会在引领传播过程中发挥了至关重要的作用。诸如教育/培训以及评估和反馈等策略是维持变革的关键。传播发生在员工和管理人员流动率高以及时间和资源受限的家庭护理环境中。