School of Health Sciences, Institute of Nursing, Zurich University of Applied Sciences (ZHAW), Winterthur, Switzerland.
FN Binka School of Public Health, Department of Family and Community Health, University of Health and Allied Sciences, Ho, Ghana.
BMC Pediatr. 2023 Oct 5;23(1):501. doi: 10.1186/s12887-023-04330-5.
Low birth weight (LBW) is associated with short and long-term consequences including neonatal mortality and disability. Effective linkages in the continuum of care (CoC) for newborns at the health facility, community (primary care) and home care levels have a high tendency of minimizing adverse events associated with LBW. But it is unclear how these linkages work and what factors influence the CoC process in Ghana as literature is scarce on the views of health professionals and families of LBW infants regarding the CoC. Therefore, this study elicited the drivers influencing the CoC for LBW infants in Ghana and how linkages in the CoC could be strengthened to optimize quality of care.
A constructivist grounded theory study design was used. Data was collected between September 2020 to February 2021. A total of 25 interviews were conducted with 11 family members of LBW infants born in a secondary referral hospital in Ghana, 9 healthcare professionals and 7 healthcare managers. Audio recordings were transcribed verbatim, analyzed using initial and focused coding. Constant comparative techniques, theoretical memos, and diagramming were employed until theoretical saturation was determined.
Emerging from the analysis was a theoretical model describing ten major themes along the care continuum for LBW infants, broadly categorized into health systems and family-systems drivers. In this paper, we focused on the former. Discharge, review, and referral systems were neither well-structured nor properly coordinated. Efficient dissemination and implementation of guidelines and supportive supervision contributed to higher staff motivation while insufficient investments and coordination of care activities limited training opportunities and human resource. A smooth transition between care levels is hampered by procedural, administrative, logistics, infrastructural and socio-economic barriers.
A coordinated care process established on effective communication across different care levels, referral planning, staff supervision, decreased staff shuffling, routine in-service training, staff motivation and institutional commitment are necessary to achieve an effective care continuum for LBW infants and their families.
低出生体重（LBW）与新生儿死亡和残疾等短期和长期后果相关。在卫生机构、社区（初级保健）和家庭护理各级新生儿连续护理（CoC）中建立有效的联系，有很大的可能性将与 LBW 相关的不良事件降到最低。但尚不清楚这些联系是如何运作的，以及在加纳，有哪些因素会影响 CoC 进程，因为关于 LBW 婴儿 CoC 的文献很少，主要集中在卫生专业人员和 LBW 婴儿家庭的观点上。因此，本研究探讨了影响加纳 LBW 婴儿 CoC 的驱动因素，以及如何加强 CoC 中的联系，以优化护理质量。
采用建构主义扎根理论研究设计。数据于 2020 年 9 月至 2021 年 2 月收集。共对加纳一家二级转诊医院出生的 11 名 LBW 婴儿的家庭成员、9 名医疗保健专业人员和 7 名医疗保健管理人员进行了 25 次访谈。音频记录逐字转录，使用初始和重点编码进行分析。采用恒定性比较技术、理论备忘录和图表绘制，直到确定理论饱和度。
分析结果产生了一个理论模型，描述了 LBW 婴儿护理连续体的十个主要主题，大致分为卫生系统和家庭系统驱动因素。在本文中，我们重点介绍了前者。出院、审查和转诊系统既没有很好地结构化，也没有得到适当的协调。指南的有效传播和实施以及支持性监督有助于提高员工的积极性，而投资和协调护理活动不足则限制了培训机会和人力资源。不同护理水平之间的顺利过渡受到程序、行政、后勤、基础设施和社会经济障碍的阻碍。
在不同护理水平之间建立有效的沟通、转诊计划、员工监督、减少员工流动、定期在职培训、员工激励和机构承诺的协调护理过程，对于为 LBW 婴儿及其家庭提供有效的护理连续体是必要的。
