Australian Centre For Evidence Based Aged Care, La Trobe University, Bundoora, Australia.
La Trobe University, Bundoora, Australia.
Health Soc Care Community. 2020 Sep;28(5):1459-1467. doi: 10.1111/hsc.12967. Epub 2020 Feb 28.
Australians want to live at home as they age and seek support from health and social care services to achieve this. The consumer driven market-based approach to community services in Australia has resulted in an increases in user's expectations of quality. What constitutes a quality service from the consumer's perspective is an important agenda to understand as the focus of care delivery moves to the domiciliary setting. This paper presents one aspect from a grounded theory PhD study, the aim of which was to understand the lived experience of receiving services in the home and its impact on the meaning of home. Participants were 11 people with dementia and 18 family supporters living in the state of Victoria, Australia. Data were collected between 2015 and 2017 through multiple interviews, photographic images, field notes and memos. NVIVO 10 qualitative analysis software program was used to support constant comparative analysis. Using a grounded theory approach, this study found that the decision to engage with community services was driven by the need to maintain autonomy, self-identity and home life. Participants sought quality services but discovered a dichotomy of positive and negative aspects in the way services were delivered. The most common reaction to the experience of poor-quality care was to reflect on their expectations for care quality; and manage the reality of what was delivered. Team work and service responsiveness were positive characteristics but were offset by service limitations and inefficiencies caused by poor communication and poor staff retention. The interpersonal relationships that participants developed with staff was highlighted; trust was an important factor whereas unreliable, task orientated and poorly trained staff would be rejected. The implications for policy and practice are described.
澳大利亚人希望在年老时能够居家生活，并寻求医疗和社会保健服务的支持来实现这一目标。在澳大利亚，以消费者为导向的社区服务市场模式导致用户对服务质量的期望增加。从消费者的角度来看，什么样的服务才算是高质量的服务，这是一个需要理解的重要议题，因为护理服务的重点已经转移到了家庭环境中。本文展示了扎根理论博士研究的一个方面，该研究的目的是了解在家庭中接受服务的实际体验及其对家庭意义的影响。参与者是居住在澳大利亚维多利亚州的 11 名痴呆症患者和 18 名家庭支持者。研究数据是在 2015 年至 2017 年期间，通过多次访谈、照片、实地记录和备忘录收集的。使用 NVIVO 10 质性分析软件程序支持持续比较分析。通过扎根理论方法，本研究发现，参与社区服务的决定是由维持自主性、自我认同和家庭生活的需求驱动的。参与者寻求高质量的服务，但发现服务提供方式存在积极和消极的两面性。对服务质量差的体验最常见的反应是反思他们对服务质量的期望，并管理所提供服务的现实情况。团队合作和服务响应能力是积极的特点，但服务的局限性和沟通不畅以及员工流失率高导致的效率低下抵消了这些特点。参与者与工作人员发展的人际关系受到了关注；信任是一个重要因素，而不可靠、任务导向和培训不足的员工则会被拒绝。还描述了政策和实践的影响。
