Kvæl Linda Aimée Hartford, Bergland Astrid
Department of Physiotherapy, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway.
Norwegian Social Research (NOVA), OsloMet - Oslo Metropolitan University, Oslo, Norway.
BMC Health Serv Res. 2021 Feb 25;21(1):180. doi: 10.1186/s12913-021-06175-z.
Intermediate care (IC) bridges the clinical pathway of older patients transitioning from the hospital to home. Currently, there is a strong consensus that the practice environment is an important factor in helping older people overcome their limitations and regain function after illness or injury. Regardless of the arising attention related to person-centred care, the practice environment is yet to be recognised as a vital part of care, and a small extent of focus has been given the environmental dimensions of IC services. Thus, more research is required regarding the complex relationships between older people and the practice environment. This study explores the perspectives of older patients, their relatives and healthcare professionals related to the practice environment's influence on patient participation among older people in the context of intermediate healthcare services.
Using purposive sampling and theoretical approaches, including frameworks of patient participation, the practices environment and person-centred care, semi-structured interviews were conducted with 15 older patients, 12 relatives and 18 healthcare professionals from three different IC institutions in Norway to discuss their experiences and preferences regarding patient participation. A thematic analysis was used to explore patterns across the interviews.
Three main themes were identified: 'location and access to physical facilities', 'symbolic expression of patients' and professionals' possibilities' and 'participating in meaningful activities'. The findings show that both the physical and the psychosocial environments influenced older patients' various types of participation in IC services.
To optimise rehabilitation care for older people, the ward configuration should focus on supportive environments that facilitate patient participation and provide options for the patients and relatives to independently access the facilities, balancing the personal capabilities with the environmental demands. To foster patient participation, the practice environment should thus align with the model of person-centred rehabilitation.
过渡护理（IC）在老年患者从医院过渡到家庭的临床路径中起到桥梁作用。目前，人们已形成强烈共识，即实践环境是帮助老年人克服自身局限并在患病或受伤后恢复功能的重要因素。尽管以患者为中心的护理受到越来越多关注，但实践环境尚未被视为护理的重要组成部分，对过渡护理服务的环境层面也仅有少量关注。因此，需要开展更多关于老年人与实践环境之间复杂关系的研究。本研究探讨了老年患者、其亲属及医疗保健专业人员对于在过渡医疗服务背景下实践环境对老年患者参与度影响的看法。
采用目的抽样法和理论方法，包括患者参与、实践环境和以患者为中心的护理等框架，对挪威三个不同过渡护理机构的15名老年患者、12名亲属和18名医疗保健专业人员进行了半结构式访谈，以讨论他们在患者参与方面的经历和偏好。采用主题分析法探究访谈中的模式。
确定了三个主要主题：“物理设施的位置与可达性”、“患者与专业人员可能性的象征性表达”以及“参与有意义的活动”。研究结果表明，物理环境和社会心理环境均影响老年患者在过渡护理服务中的各类参与度。
为优化老年人的康复护理，病房布局应注重营造支持性环境，以促进患者参与，并为患者及其亲属提供独立使用设施的选择，在个人能力与环境需求之间取得平衡。因此，为促进患者参与，实践环境应与以患者为中心的康复模式保持一致。
