Stark Susanne, Lehmann Yvonne
Berlin Institute of Health at Charité - Universitätsmedizin Berlin, QUEST Center for Responsible Research, Berlin, Deutschland; Charité - Universitätsmedizin Berlin, Institut für Gesundheits- und Pflegewissenschaft, Berlin, Deutschland.
BBG Berliner Bildungscampus für Gesundheitsberufe gGmbH, Berlin, Deutschland; Charité - Universitätsmedizin Berlin, Institut für Gesundheits- und Pflegewissenschaft, Berlin, Deutschland.
Z Evid Fortbild Qual Gesundhwes. 2023 Dec;182-183:53-62. doi: 10.1016/j.zefq.2023.09.004. Epub 2023 Nov 4.
Maintaining safety is critical in home mechanical ventilation (HMV). It is co-determined by the availability of reliable technical aids and their correct application. Ensuring safe aid supply is part of the aid providers'́ legal mandate. However, whether and how this is achieved is largely unknown. Therefore, the tasks of technical aid providers, associated requirements and challenges with special regards to educational and safety aspects were investigated.
For this purpose, episodic interviews were conducted between July and December 2020 with a purposive sample of field representatives of eleven technical aid providers. Between one and six persons participated in each of the interviews, resulting in a total sample of 25 persons (14 field representatives without management function, ten with management function, one director). Given the conditions during the COVID-19 pandemic, six interviews took place face-to-face and five as web meetings. Interviews were analysed using qualitative content analysis.
From the interviewees'́ perspective, the most important safety-related measure is the legally required and individually tailored initial instruction in a safe aid application. Additional safety-related tasks comprise counselling, e. g. for prescribing physicians and users (patients, relatives, nursing service employees), regular home visits, and the provision of a technical emergency service. Interviewees indicate that safety risks emerge primarily from a lack of skills and a high staff turnover among professional caregivers. This, they state, challenges building up and maintaining competencies among nursing staff. Other safety risks arise from healthcare fragmentation, lacking coordination, cooperation, and accountability of the professionals involved. Respondents address these challenges pragmatically by providing additional services, like ongoing caregiver training, care coordination and support roles.
Maintaining safety in ventilation-associated technical aid supply must be considered a crucial component of the overall HMV care processes, in which safety currently cannot be taken for granted. Field representatives of technical aid providers address the existing challenges with selective and intuitive strategies, some of which exceed their legal mandate.
Improving safety in home care can be supported by establishing Advanced Nursing Practice roles in nursing services. The systematic further development of roles and tasks of staff of technical aid providers should be clarified within an overarching discourse on viable approaches to cross-sectoral and interprofessional HMV care.
在家庭机械通气（HMV）中，维持安全至关重要。这取决于可靠技术辅助设备的可用性及其正确应用。确保安全的辅助设备供应是辅助设备供应商法定职责的一部分。然而，这一点是否以及如何实现很大程度上尚不清楚。因此，对技术辅助设备供应商的任务、相关要求以及在教育和安全方面的特殊挑战进行了调查。
为此，在2020年7月至12月期间，对11家技术辅助设备供应商的现场代表进行了有目的抽样的情景访谈。每次访谈有1至6人参加，共25人（14名无管理职能的现场代表、10名有管理职能的现场代表、1名主任）。鉴于新冠疫情期间的情况，6次访谈为面对面进行，5次为网络会议。采用定性内容分析法对访谈进行分析。
从受访者的角度来看，最重要的安全相关措施是依法进行且针对安全辅助设备应用的个性化初始指导。其他安全相关任务包括咨询，例如为开处方的医生和使用者（患者、亲属、护理服务员工）提供咨询、定期家访以及提供技术应急服务。受访者指出，安全风险主要源于专业护理人员技能不足和人员流动率高。他们表示，这对护理人员能力的培养和维持构成了挑战。其他安全风险来自医疗保健碎片化、相关专业人员缺乏协调、合作和问责。受访者通过提供额外服务，如实时护理人员培训、护理协调和支持角色等，务实地应对这些挑战。
在通风相关技术辅助设备供应中维持安全必须被视为整体家庭机械通气护理过程的关键组成部分，而目前安全不能被视为理所当然。技术辅助设备供应商的现场代表通过选择性和直观的策略应对现有挑战，其中一些策略超出了他们的法定职责。
在护理服务中设立高级护理实践角色有助于提高家庭护理的安全性。应在关于跨部门和跨专业家庭机械通气护理可行方法的总体讨论中，明确技术辅助设备供应商工作人员角色和任务的系统进一步发展。
