6939 Central Queensland University, Australia.
1065 Flinders University, Australia.
Hum Factors. 2022 Feb;64(1):109-125. doi: 10.1177/00187208211010962. Epub 2021 Apr 28.
The strategies adopted by personal care attendants (PCAs) to deliver quality care when faced with challenges potentially impacting clinical outcomes were assessed using phenomenological methods.
In Australia, recent outcry of unsatisfactory standards of care in residential facilities has instigated a national public inquiry. This study investigated how PCAs adapted to challenges in stressful and ambiguous everyday work scenarios to deliver quality care.
A phenomenological approach was used to obtain insights into PCAs' experiences, perceptions, opinions, and decision processes for enacting care. Ten PCAs working in rural-based residential aged care were interviewed using a novel scenario construction task with thematic and co-occurrence network mapping applied to derive insights.
Seven themes were identified, revealing that participants formed close relationships with residents, influencing care provision but blurring personal boundaries. Key contextual factors in scenarios highlighted inadequate staffing and procedures, inadequate training, challenging residents, time poverty, and low support. Individually directed adaptive strategies were used to alleviate dissonance and maintain emotional resilience, including dynamic risk assessment involving rule breaking.
The findings suggest that in negotiating care delivery, PCAs strive to optimize rule-based compliance with safety, efficiency, and individualized attention to provide "good enough" care with fluidity. Implications for policy and practice are considered.
Findings have implications for workforce development in the context of ever-increasing industry pressures. Findings identified challenging scenarios and role complexity, with decision-making occurring as a fluid and ongoing process across a flexible boundary of risk assessment influencing interactions between PCAs, registered nurses, and clients.
采用现象学方法评估个人护理员（PCA）在面临潜在影响临床结果的挑战时采取的策略，以提供优质护理。
在澳大利亚，最近对住宅设施护理不满意标准的强烈抗议引发了全国性的公开调查。本研究调查了 PCA 如何适应压力大且模棱两可的日常工作环境中的挑战，以提供优质护理。
采用现象学方法深入了解 PCA 实施护理的经验、看法、意见和决策过程。使用新颖的情景构建任务对 10 名在农村地区住宅老年护理机构工作的 PCA 进行访谈，并应用主题和共现网络映射来得出见解。
确定了 7 个主题，揭示参与者与居民建立了密切的关系，影响了护理服务的提供，但模糊了个人界限。情景中的关键背景因素突出了人员配备和程序不足、培训不足、挑战性居民、时间贫困和支持不足。单独指导的适应性策略用于减轻不和谐并保持情绪弹性，包括涉及违反规则的动态风险评估。
研究结果表明，在协商护理服务时，PCA 努力优化基于规则的合规性，以确保安全、效率和个性化关注，从而提供“足够好”的护理，具有流畅性。考虑了对政策和实践的影响。
研究结果对不断增加的行业压力背景下的劳动力发展具有影响。研究结果确定了具有挑战性的情景和角色复杂性，决策是一个灵活的风险评估边界内的动态和持续过程，影响了 PCA、注册护士和客户之间的互动。
