Ang Felicia Jia Ler, Chow Cristelle Chu-Tian, Chong Poh Heng, Tan Teresa Shu Zhen, Amin Zubair, Buang Siti Nur Hanim, Finkelstein Eric A
Lien Centre for Palliative Care, Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.
Department of Paediatrics, KK Women's & Children's Hospital, Singapore, Singapore.
Front Pediatr. 2023 Jul 28;11:1167757. doi: 10.3389/fped.2023.1167757. eCollection 2023.
Being responsive to end-users is essential to good care. Limited in-depth exploration of parental perspectives on care received by children over the course of serious illness has hindered the development of process measures to evaluate quality of care. Our objective was to identify the key process indicators prioritized by parents in the care of seriously ill young children and develop a framework to guide assessment of quality of care.
This qualitative study followed Charmaz's Constructivist Grounded Theory. In-depth semi-structured interviews were conducted with parents of young children with serious illness in Singapore. Participants were sampled across various healthcare settings, children's ages, and illness categories. Theoretical sampling and constant comparative analysis were used to generate initial, focused, and theoretical codes, which informed construction of a conceptual framework.
31 parents participated from July 2021 to February 2022. Initial and focused coding generated 64 quality of care indicators describing key care practices, interactions, and procedures. Indicators were categorized under four themes: (1) efficient healthcare structures and standards, (2) professional qualities of healthcare workers, 3. supporting parent-caregivers, and 4. collaborative and holistic care. Theoretical coding led to the development of the "PaRental perspectives on qualIty of care for Children with sErious iLlnESSes (PRICELESS)" framework which summarizes elements contributing to the parental perception of quality of care.
The identified process indicators will facilitate the development of standardised parent-reported measures for assessing service quality and benchmarking among providers. The framework provides overall guidance for conceiving quality improvement initiatives.
对终端用户做出响应是优质护理的关键。在重病患儿护理过程中，对家长观点的深入探索有限，这阻碍了评估护理质量的过程指标的发展。我们的目标是确定家长在照顾重病幼儿时优先考虑的关键过程指标，并制定一个框架来指导护理质量评估。
这项定性研究遵循了查马兹的建构主义扎根理论。对新加坡重病幼儿的家长进行了深入的半结构化访谈。参与者在不同的医疗环境、儿童年龄和疾病类别中进行抽样。理论抽样和持续比较分析被用于生成初始、重点和理论代码，这些代码为概念框架的构建提供了依据。
2021年7月至2022年2月期间，31位家长参与了研究。初始和重点编码产生了64个护理质量指标，描述了关键护理实践、互动和程序。这些指标被归类为四个主题：（1）高效的医疗结构和标准，（2）医护人员的专业素质，（3）支持家长照顾者，（4）协作和整体护理。理论编码促成了“重病患儿护理质量的家长视角（PRICELESS）”框架的发展，该框架总结了影响家长对护理质量认知的因素。
确定的过程指标将有助于制定标准化的家长报告措施，以评估服务质量并在提供者之间进行基准比较。该框架为构思质量改进举措提供了总体指导。
