Lehtoaro Salla, Josefsson Kim, Sinervo Timo
National Institute for Health and Welfare, Box 30, 00271, Helsinki, Finland.
BMC Health Serv Res. 2018 Nov 26;18(1):896. doi: 10.1186/s12913-018-3705-6.
In the future, elderly care workers need to have competence of various different conditions due to greater amount of multimorbid elderly. Further, knowledge of national level guidelines is important since they are closely linked to improving quality of care and implementing better practices at work places. The impact of national level guidelines on quality of care at care units is, however, not widely examined in the Finnish context. In this study, the aim was to find out if worker's experience of his/her own competence is associated with quality of care. Secondly, we aimed to see how common is addressing national guidelines and policies at workplaces, and if they are associated with quality of care. Thirdly, we aimed to see whether there are differences between different occupational statuses in competence and addressing national guidelines and policies.
Total number of respondents was 1997 from 273 different units. Xtreg procedure was used for examining the associations of age, occupational status, unit type, professional competence and addressing the guidelines and policies with quality of care.
Higher grade for QoC was associated with age, supervisor position, working in institutionalized care, better competence in supporting the self-determination of a person with memory disorders and falls prevention and addressing the act for elderly care and memory policy.
This study demonstrated that national policies and guidelines are not widely addressed among Finnish elderly care workers. The study also showed that experienced competence of workers and discussion of policies and guidelines are related to quality of care. Especially competence related to memory disorders was associated with higher QoC. However, the relationship between quality of care and things influencing it seems complex and a major part of the variation in QoC remained unexplained. Although the relationships between guidelines, competences and quality of care are weak, national policies and competences seem to have impact on actual care provided. Therefore, sufficient time to address the guidelines should be provided at workplace and competences developed, which can be seen as a supervisor's task. With knowledge about the guidelines, workers are able to change their practices at work places.
未来，由于患有多种疾病的老年人数量增加，老年护理工作者需要具备应对各种不同情况的能力。此外，了解国家层面的指南很重要，因为它们与提高护理质量和在工作场所实施更好的做法密切相关。然而，在芬兰的背景下，国家层面的指南对护理单位护理质量的影响尚未得到广泛研究。在本研究中，目的是找出工作人员对自身能力的体验是否与护理质量相关。其次，我们旨在了解在工作场所提及国家指南和政策的情况有多普遍，以及它们是否与护理质量相关。第三，我们旨在了解不同职业地位在能力以及提及国家指南和政策方面是否存在差异。
来自273个不同单位的1997名受访者参与了调查。使用Xtreg程序来研究年龄、职业地位、单位类型、专业能力以及提及指南和政策与护理质量之间的关联。
较高的护理质量评分与年龄、主管职位、在机构化护理机构工作、在支持记忆障碍患者的自我决定权和预防跌倒方面具有更好的能力以及提及老年护理法案和记忆政策相关。
本研究表明，芬兰老年护理工作者中并未广泛提及国家政策和指南。该研究还表明，工作人员的经验能力以及对政策和指南的讨论与护理质量相关。特别是与记忆障碍相关的能力与较高的护理质量评分相关。然而，护理质量与其影响因素之间的关系似乎很复杂，护理质量评分的很大一部分变化仍无法解释。尽管指南、能力与护理质量之间的关系较弱，但国家政策和能力似乎对实际提供的护理有影响。因此，工作场所应提供足够的时间来提及指南并培养能力，这可视为主管的任务。有了关于指南的知识，工作人员能够在工作场所改变他们的做法。
