Centre for Health Services Studies (CHSS), University of Kent, Canterbury, UK.
Health Soc Care Community. 2020 Nov;28(6):2431-2440. doi: 10.1111/hsc.13066. Epub 2020 Jun 17.
This aim of this study was to explore the decision-making process of Care Navigators in prescribing Telecare for older people living at home. The study took place in the South of England. A structured model of decision-making was used as the theoretical framework and a qualitative approach was employed. Care Navigators (n = 7), acting on behalf of the Local Authority as 'external trusted assessors' were interviewed according to a semi-structured interview schedule. Documentary evidence of decision-making (Telecare Reasoning Forms) (n = 10), were also analysed and added to the interview data. The main themes identified were the process of decision-making, training needs, and the support of Care Navigators and partnership working. Care Navigators adopted a complex decision-making process involving information gathering, information synthesis, consideration of alternatives to Telecare and implementation. Decision-making has a strong ethical dimension, especially around funding. Training focused on the functioning and technical aspects of equipment. However, other training needs were identified in order to support decision-making, for example, assessing mental capacity. Peer support networks were valuable to Care Navigators and they developed good relationships with social care and Telecare provider staff. However, professionals making referrals to the Care Navigators for Telecare often did not understand their role or funding eligibility. In conclusion, Care Navigators are well-placed to prescribe Telecare in terms of knowledge and decision-making skills. Comprehensive training is necessary in order to support decision-making. Peer support and education of professionals referring for Telecare is also advocated.
本研究旨在探讨居家照护导航员在为老年人开Telecare 服务时的决策过程。研究地点在英格兰南部。决策的结构化模型被用作理论框架，采用定性方法。根据半结构化访谈大纲，对代表地方当局作为“外部可信赖评估员”的居家照护导航员（n=7）进行了访谈。还分析了决策的文件证据（Telecare 推理表）（n=10），并将其添加到访谈数据中。确定的主要主题是决策过程、培训需求、居家照护导航员的支持和伙伴关系。居家照护导航员采用了涉及信息收集、信息综合、考虑 Telecare 替代方案和实施的复杂决策过程。决策具有强烈的道德维度，特别是在资金方面。培训侧重于设备的功能和技术方面。然而，为了支持决策，还确定了其他培训需求，例如评估精神能力。同行支持网络对居家照护导航员很有价值，他们与社会照护和 Telecare 提供商的工作人员建立了良好的关系。然而，向居家照护导航员转介 Telecare 的专业人员往往不了解他们的角色或资金资格。总之，就知识和决策技能而言，居家照护导航员非常适合开 Telecare。为了支持决策，需要进行全面的培训。还提倡同行支持和对 Telecare 转诊专业人员的教育。
