Department of Public Health, University of Massachusetts Lowell, Lowell, Massachusetts.
Am J Ind Med. 2020 Apr;63(4):368-378. doi: 10.1002/ajim.23082. Epub 2019 Dec 13.
Home care (HC) aide is among the fastest-growing jobs. Aides often work in long-term care relationships with elders or people with disabilities in clients' homes, assisting with daily activities. The purpose of this mixed-methods paper is to elucidate aides' experiences around the boundary-challenging behaviors of clients asking for services beyond aides' job duties and to identify possible interventions.
A cross-sectional survey of HC aides in Massachusetts (n = 1249) provided quantitative data. Post-survey qualitative data were collected from nine HC aide focus groups (n = 70) and seven in-depth interviews with HC industry and labor representatives.
Quantitatively, aides who reported often being asked to do tasks outside their job duties were more likely to report abuse (prevalence ratio [PR] = 1.93; 95%CI: 1.47-2.52 for verbal, PR = 1.81; 95%CI: 1.13-2.91 for physical/sexual) and pain/injury with lost work time or medical care (PR = 1.58; 95%CI: 1.11-2.25). They were also less likely to want to remain in their job (PR = 0.94; 95%CI: 0.89-1.00) or recommend it to others (PR = 0.94; 95%CI: 0.90-0.98). Qualitative data showed that clients' requests for tasks beyond job duties were frequent and can lead to injuries, abuse, and psychosocial stress. Yet, requests often reflected genuine need. Helping clients stay at home, compassion, and feeling appreciated contributed to job satisfaction; therefore, aides can feel conflicted about refusing requests.
Client task requests outside HC services are a complex problem. Employer support, training, care plans, and feeling part of a care team can help aides navigate professional boundaries while delivering high quality care.
家庭保健助手是增长最快的职业之一。助手通常在客户家中与老年人或残疾人士建立长期护理关系，协助完成日常活动。本文采用混合方法，旨在阐明助手在客户要求提供超出工作职责的服务时的体验，并确定可能的干预措施。
对马萨诸塞州的家庭保健助手进行了横断面调查（n=1249），提供了定量数据。在调查后，从 9 个家庭保健助手焦点小组（n=70）和 7 个与家庭保健行业和劳动力代表的深入访谈中收集了定性数据。
在定量方面，报告经常被要求从事工作职责外任务的助手更有可能报告虐待（口头报告的患病率比 [PR]=1.93；95%CI：1.47-2.52；身体/性虐待报告的 PR=1.81；95%CI：1.13-2.91）以及因工作时间损失或医疗护理而遭受疼痛/伤害（PR=1.58；95%CI：1.11-2.25）的情况也更常见。他们也更不愿意继续从事这份工作（PR=0.94；95%CI：0.89-1.00）或向他人推荐这份工作（PR=0.94；95%CI：0.90-0.98）。定性数据显示，客户要求完成工作职责外的任务非常频繁，这可能导致受伤、虐待和心理社会压力。然而，这些请求往往反映了真正的需求。帮助客户留在家里、同情心和被欣赏有助于工作满意度；因此，助手在拒绝请求时可能会感到矛盾。
客户对家庭保健服务以外的任务的请求是一个复杂的问题。雇主的支持、培训、护理计划以及作为护理团队的一员的感觉，可以帮助助手在提供高质量护理的同时，应对专业界限问题。
