McDonald Janet, McKinlay Eileen, Keeling Sally, Levack William
Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand.
Department of Medicine, University of Otago, Christchurch, New Zealand.
Scand J Caring Sci. 2017 Dec;31(4):850-858. doi: 10.1111/scs.12406. Epub 2017 Jan 25.
With more care taking place in the home, family carers play an important role in supporting patients. Some family carers undertake technical health procedures generally managed by health professionals in hospital settings (e.g. managing a tracheostomy or enteral feeding).
To explore how family carers learn to manage technical health procedures in order to help health professionals better understand and support this process.
A grounded theory study using data from interviews with 26 New Zealand family carers who managed technical health procedures including nasogastric or gastrostomy feeding, stoma care, urinary catheterisation, tracheostomy management, intravenous therapy, diabetes management and complex wound dressings. Most (20 participants) were caring for their child and the remaining six for their spouse, parent or grandparent. Following grounded theory methods, each interview was coded soon after completion. Additional data were compared with existing material, and as analysis proceeded, initial codes were grouped into higher order concepts until a core concept was developed. Interviewing continued until no new ideas emerged and concepts were well defined.
The core concept of 'wayfinding' indicates that the learning process for family carers is active, individualised and multi-influenced, developing over time as a response to lived experience. Health professional support was concentrated on the initial phase of carers' training, reducing and becoming more reactive as carers took responsibility for day-to-day management.
Wayfinding involves self-navigation by carers, in contrast to patient navigator models which provide continuing professional assistance to patients receiving cancer or chronic care services. Wayfinding by carers raises questions about how carers should be best supported in their initial and ongoing learning as the management of these procedures changes over time.
随着越来越多的护理工作在家庭中进行，家庭护理人员在支持患者方面发挥着重要作用。一些家庭护理人员承担着通常由医院环境中的卫生专业人员管理的技术健康程序（例如管理气管造口术或肠内喂养）。
探讨家庭护理人员如何学习管理技术健康程序，以帮助卫生专业人员更好地理解和支持这一过程。
一项扎根理论研究，使用对26名管理技术健康程序的新西兰家庭护理人员的访谈数据，这些程序包括鼻饲或胃造口喂养、造口护理、导尿、气管造口术管理、静脉治疗、糖尿病管理和复杂伤口敷料。大多数（20名参与者）是在照顾自己的孩子，其余6名是在照顾配偶、父母或祖父母。按照扎根理论方法，每次访谈结束后不久就进行编码。将额外的数据与现有材料进行比较，随着分析的进行，初始代码被分组为更高层次的概念，直到形成一个核心概念。访谈持续进行，直到没有新的想法出现且概念得到明确界定。
“寻路”这一核心概念表明，家庭护理人员的学习过程是积极的、个性化的且受到多种影响，随着时间的推移，作为对生活经历的一种反应而发展。卫生专业人员的支持集中在护理人员培训的初始阶段，随着护理人员负责日常管理，这种支持逐渐减少并变得更加被动。
与为接受癌症或慢性病护理服务的患者提供持续专业协助的患者导航模式不同，寻路涉及护理人员自我导航。随着这些程序的管理随时间变化，护理人员的寻路引发了关于如何在其初始和持续学习中为护理人员提供最佳支持的问题。
