Scheffelaar Aukelien, Hendriks Michelle, Bos Nanne, Luijkx Katrien, van Dulmen Sandra
Nivel (Netherlands institute for health services research), PO Box 1568, 3500 BN, Utrecht, The Netherlands.
Radboud Institute for Health Sciences, Department of Primary and Community Care, Radboud university medical center, Nijmegen, The Netherlands.
BMC Health Serv Res. 2019 Jun 14;19(1):389. doi: 10.1186/s12913-019-4195-x.
The quality of the care relationship between a client and a professional is important in long-term care, as most clients depend on support for a lengthy period. The three largest client groups who receive long-term care in the Netherlands are older adults who are physically or mentally frail, people with mental health problems and people with intellectual disabilities. There is little clarity about how generic and variable the determinants of the quality of care relationships are across these client groups. The aim of this study is to explore and compare the determinants of the quality of care relationships in these three client groups in long-term care.
This participatory study involving clients as co-researchers was held in three healthcare organizations, each providing long-term care to one client group. The research was conducted by three teams consisting of researchers and co-researchers. We interviewed clients individually and professionals in focus groups. The focus was on care relationships with professionals where there is weekly recurring contact for at least 3 months. Clients and professionals were selected using a convenience sample. The interviews were coded in open, axial and selective coding. The outcomes were compared between the client groups.
The study sample consisted of 30 clients and 29 professionals. Determinants were categorized into four levels: client, professional, between client and professional, and context. The findings show that the majority of the determinants apply to the care relationships within all three client groups. At the professional level, eleven generic determinants were found. Eight determinants emerged at the client level of which two were found in two client groups only. At the level between a client and a professional, six determinants were found of which one applied to mental healthcare and disability care only. Five determinants were found at the contextual level of which two were specific for two client groups.
The study yielded a variety of determinants that came to the fore in all three client groups in long-term care. This suggests that including a homogenous client group from a single care setting is not necessary when studying the quality of long-term care relationships.
在长期护理中，服务对象与专业人员之间的照护关系质量至关重要，因为大多数服务对象在很长一段时间内都依赖他人的支持。在荷兰接受长期护理的三大主要服务对象群体是身体或精神虚弱的老年人、有心理健康问题的人以及有智力障碍的人。对于这些服务对象群体而言，照护关系质量的决定因素在多大程度上具有普遍性和变异性，目前尚不清楚。本研究的目的是探索和比较长期护理中这三个服务对象群体照护关系质量的决定因素。
这项参与性研究将服务对象作为共同研究者，在三个医疗保健机构中进行，每个机构为一个服务对象群体提供长期护理。研究由三个由研究人员和共同研究人员组成的团队进行。我们分别对服务对象进行了访谈，并对专业人员进行了焦点小组访谈。重点是与专业人员的照护关系，这种关系每周至少重复接触3个月。服务对象和专业人员采用便利抽样的方式选取。访谈采用开放式、轴心式和选择性编码进行编码。对不同服务对象群体的结果进行了比较。
研究样本包括30名服务对象和29名专业人员。决定因素分为四个层面：服务对象层面、专业人员层面、服务对象与专业人员之间的层面以及背景层面。研究结果表明，大多数决定因素适用于所有三个服务对象群体的照护关系。在专业人员层面，发现了11个一般性决定因素。在服务对象层面出现了8个决定因素，其中2个仅在两个服务对象群体中发现。在服务对象与专业人员之间的层面，发现了6个决定因素，其中1个仅适用于精神卫生保健和残疾护理。在背景层面发现了5个决定因素，其中2个特定于两个服务对象群体。
该研究得出了在长期护理的所有三个服务对象群体中都凸显出来的各种决定因素。这表明，在研究长期照护关系质量时，没有必要纳入来自单一照护环境的同质化服务对象群体。
