Division of Nursing, Midwifery and Social Work, School of Health Sciences, The University of Manchester, Room 4.327a, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK; Center for Home Care Policy and Research, Visiting Nurse Service of New York, 5 Penn Plaza, 12th Floor, New York, NY 10001, USA; Columbia University School of Nursing, 560 West 168th Street, New York, NY 10032, USA.
Center for Home Care Policy and Research, Visiting Nurse Service of New York, 5 Penn Plaza, 12th Floor, New York, NY 10001, USA; Department of Sociology, Appalachian State University, ASU Box 32115, 209 Chapell Wilson Hall, 480 Howard Street, Boone, NC 28608, USA.
Int J Nurs Stud. 2020 Jul;107:103617. doi: 10.1016/j.ijnurstu.2020.103617. Epub 2020 May 8.
There is an increase in the number of individuals who receive care at home. A significant proportion of these patients acquire infections during their care episode. Whilst there has been significant focus on strategies for infection prevention and control in acute care environments, there is a lack of research into infection prevention in a home care setting.
To understand (1) if and how home care nurses identify patients at high risk of infection and (2) the strategies they use to mitigate that risk.
A qualitative descriptive study, using semi-structured interviews.
A large not for profit home care agency located in the New York region of the United States.
Fifty nurses with a range of experience in home care nursing.
Purposive and snowball sampling was used to recruit nurses from across the home care agency with varied years of work experience. Interviews were audio recorded and transcribed. The interviews explored how home care nurses evaluate their patients' risk of developing an infection and if/how they modify the plan of care based on that risk. Data were analysed using thematic analysis.
Three themes were derived from the data; assessing a patient's risk of infection, the risk assessment process, and strategies for mitigating infection risk. Factors identified by nurses as putting a patient at higher risk of infection included being older, having diabetes, inadequate nutrition; along with inadequate clinical information available at start of care. The patient's knowledge and understanding of infection prevention, and the availability and knowledge of caregivers were also important, as was the cleanliness of the home environment. Given the context of home care, where nurses have little control over the environment and care processes in-between visits, the main strategy for infection prevention was patient and caregiver education. Nurses also discussed the importance of their own infection prevention behaviours, and the ability to adjust a patient's plan of care according to their infection risk.
The study highlights the complexity of the risk assessment process in relation to infection. Existing guidelines for infection prevention and control do not adequately cover the home care environment and more research needs to determine which interventions (such as patient/caregiver education) would be most effective to prevent infections in the home care setting.
在家接受护理的人数不断增加。这些患者中有相当一部分在护理过程中感染。虽然人们已经非常关注急性护理环境中的感染预防和控制策略，但对于家庭护理环境中的感染预防研究还很缺乏。
了解（1）家庭护理护士是否以及如何识别高感染风险患者，以及（2）他们用来降低感染风险的策略。
使用半结构式访谈的定性描述性研究。
位于美国纽约地区的一家大型非营利性家庭护理机构。
50 名具有不同家庭护理护理经验的护士。
采用目的抽样和滚雪球抽样方法，从家庭护理机构中招募具有不同工作年限的护士。对访谈进行录音和转录。访谈内容探讨了家庭护理护士如何评估患者感染的风险，以及他们是否根据风险修改护理计划。使用主题分析对数据进行分析。
从数据中得出了三个主题；评估患者感染的风险、风险评估过程和降低感染风险的策略。护士认为使患者感染风险更高的因素包括年龄较大、患有糖尿病、营养不足；以及护理开始时可获得的临床信息不足。患者对感染预防的知识和理解、照顾者的可用性和知识，以及家庭环境的清洁度也很重要。考虑到家庭护理的背景，护士在访问之间几乎无法控制环境和护理过程，感染预防的主要策略是患者和照顾者的教育。护士还讨论了自己感染预防行为的重要性，以及根据患者感染风险调整护理计划的能力。
该研究强调了感染相关风险评估过程的复杂性。现有的感染预防和控制指南不能充分涵盖家庭护理环境，需要进一步研究确定哪些干预措施（如患者/照顾者教育）最能有效预防家庭护理环境中的感染。
