Bell Sue Anne, Dickey Sarah, Rosemberg Marie-Anne
University of Michigan School of Nursing, 400 North Ingalls Building, Ann Arbor, MI, 48109, USA.
BMC Nurs. 2021 Aug 31;20(1):155. doi: 10.1186/s12912-021-00676-2.
Home based care is a vital, and growing, part of the health care system that allows individuals to remain in their homes while still receiving health care. During a disaster, when normal health care systems are disrupted, home based care remains a vital source of support for older adults. The purpose of this paper is to qualitatively understand the barriers and facilitators of both patients and providers that influence the provision of home based care activities in two hurricane affected communities.
Using qualitative inquiry informed by the social ecological model, five focus groups were conducted with home based care providers (n = 25) in two settings affected by Hurricane Irma and Hurricane Harvey. An open-source database of home health agencies participating in Centers for Medicare and Medicaid Services programs was used to identify participants. Data were manually coded and larger themes were generated from recurring ideas and concepts using an abductive analysis approach.
Twenty five participants were included in one of five focus groups. Of the 22 who responded to the demographic survey, 65 % were registered nurses, 20 % were Licensed Vocational Nurses (LVN), and 15 % were other types of health care providers. 12 % of the sample was male and 88 % was female. Five themes were identified in the analysis: barriers to implementing preparedness plans, adaptability of home based care providers, disasters exacerbate inequalities, perceived unreliability of government and corporations, and the balance between caring for self and family and caring for patients.
This study provides qualitative evidence on the factors that influence home based care provision in disaster-affected communities, including the barriers and facilitators faced by both patients and providers in preparing for, responding to and recovering from a disaster. While home based care providers faced multiple challenges to providing care during and after a disaster, the importance of community supports and holistic models of care in the immediate period after the disaster were emphasized. We recommend greater inclusion of home health agencies in the community planning process. This study informs the growing body of evidence on the value of home based care in promoting safety and well-being for older adults during a disaster.
居家护理是医疗保健系统中至关重要且不断发展的一部分，它使个人在接受医疗保健的同时能够留在家中。在灾难期间，当正常的医疗保健系统受到干扰时，居家护理仍然是老年人重要的支持来源。本文的目的是定性地了解患者和提供者在两个受飓风影响的社区中影响居家护理活动提供的障碍和促进因素。
采用基于社会生态模型的定性调查方法，在受飓风艾尔玛和哈维影响的两个地区，与居家护理提供者（n = 25）进行了五个焦点小组讨论。使用参与医疗保险和医疗补助服务中心项目的家庭健康机构的开源数据库来确定参与者。数据进行手动编码，并使用归纳分析方法从反复出现的想法和概念中生成更大的主题。
25名参与者被纳入五个焦点小组之一。在回复人口统计调查的22人中，65%是注册护士，20%是职业护士（LVN），15%是其他类型的医疗保健提供者。样本中12%为男性，88%为女性。分析中确定了五个主题：实施备灾计划的障碍、居家护理提供者的适应性、灾难加剧不平等、对政府和企业的不可靠感以及照顾自己和家人与照顾患者之间的平衡。
本研究提供了关于影响受灾社区居家护理提供的因素的定性证据，包括患者和提供者在为灾难做准备、应对灾难和从灾难中恢复时面临的障碍和促进因素。虽然居家护理提供者在灾难期间和之后提供护理面临多重挑战，但强调了灾难后即刻社区支持和整体护理模式的重要性。我们建议在社区规划过程中更多地纳入家庭健康机构。本研究为关于居家护理在灾难期间促进老年人安全和福祉的价值的越来越多的证据提供了参考。
