Jones Sarahjane
Birmingham City University, Edgbaston, UK.
J Adv Nurs. 2016 Oct;72(10):2536-46. doi: 10.1111/jan.13006. Epub 2016 May 20.
The aim of this study was to discover and describe how patients, carers and case management nurses define safety and compare it to the traditional risk reduction and harm avoidance definition of safety.
Care services are increasingly being delivered in the home for patients with complex long-term conditions. However, the concept of safety remains largely unexplored.
A sequential, exploratory mixed method design.
A qualitative case study of the UK National Health Service case management programme in the English UK National Health Service was deployed during 2012. Thirteen interviews were conducted with patients (n = 9) and carers (n = 6) and three focus groups with nurses (n = 17) from three community care providers. The qualitative element explored the definition of safety. Data were subjected to framework analysis and themes were identified by participant group. Sequentially, a cross-sectional survey was conducted during 2013 in a fourth community care provider (patient n = 35, carer n = 19, nurse n = 26) as a form of triangulation.
Patients and carers describe safety differently to case management nurses, choosing to focus on meeting needs. They use more positive language and recognize the role they have in safety in home-delivered health care. In comparison, case management nurses described safety similarly to the definitions found in the literature. However, when offered the patient and carer definition of safety, they preferentially selected this definition to their own or the literature definition.
Patients and carers offer an alternative perspective on patient safety in home-delivered health care that identifies their role in ensuring safety and is more closely aligned with the empowerment philosophy of case management.
本研究旨在发现并描述患者、护理人员及个案管理护士如何定义安全，并将其与传统的降低风险和避免伤害的安全定义进行比较。
针对患有复杂长期病症的患者，居家护理服务日益增多。然而，安全概念在很大程度上仍未得到充分探索。
采用顺序性、探索性混合方法设计。
2012年对英国国家医疗服务体系（NHS）在英国的个案管理项目进行了定性案例研究。对患者（n = 9）和护理人员（n = 6）进行了13次访谈，并与来自三个社区护理机构的护士（n = 17）进行了三次焦点小组讨论。定性部分探究了安全的定义。对数据进行框架分析，并按参与群体确定主题。随后，2013年在第四个社区护理机构进行了横断面调查（患者n = 35，护理人员n = 19，护士n = 26），作为一种三角验证形式。
患者和护理人员对安全的描述与个案管理护士不同，他们选择关注需求的满足。他们使用更积极的语言，并认识到自己在居家医疗保健安全中的作用。相比之下，个案管理护士对安全的描述与文献中的定义相似。然而，当提供患者和护理人员对安全的定义时，他们优先选择该定义而非自己的或文献中的定义。
患者和护理人员对居家医疗保健中的患者安全提供了另一种视角，该视角确定了他们在确保安全中的作用，并且与个案管理的赋权理念更为契合。
