Cremers Milou, Wendt Benjamin, Huisman-de Waal Getty, van Bodegom-Vos Leti, van Dulmen Simone A, Schipper Elise, van Dijk Monique, Ista Erwin
Department of Internal Medicine, Section of Nursing Science, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands.
J Adv Nurs. 2024 Aug 22. doi: 10.1111/jan.16381.
To explore barriers and facilitators for reducing low-value home-based nursing care.
Qualitative exploratory study.
Seven focus group interviews and two individual interviews were conducted with homecare professionals, managers and quality improvement staff members within seven homecare organizations. Data were deductively analysed using the Tailored Implementation for Chronic Diseases checklist.
Barriers perceived by homecare professionals included lack of knowledge and skills, such as using care aids, interactions between healthcare professionals and general practitioners creating expectations among clients. Facilitators perceived included reflecting on provided care together with colleagues, clearly communicating agreements and expectations towards clients. Additionally, clients' and relatives' behaviour could potentially hinder reduction. In contrast, clients' motivation to be independent and involving relatives can promote reduction. Lastly, non-reimbursement and additional costs of care aids were perceived as barriers. Support from organization and management for the reduction of care was considered as facilitator.
Understanding barriers and facilitators experienced by homecare professionals in reducing low-value home-based nursing care is crucial. Enhancing knowledge and skills, fostering cross-professional collaboration, involving relatives and motivating clients' self-care can facilitate reduction of low-value home-based nursing care. Implications for profession and patient care: De-implementing low-value home-based nursing care offers opportunities for more appropriate care and inclusion of clients on waitlists.
Addressing barriers with tailored strategies can successfully de-implement low-value home-based nursing care.
The Consolidated Criteria for Reporting Qualitative Research checklist was used. No patient or public contribution.
探讨减少低价值居家护理的障碍和促进因素。
定性探索性研究。
对7个居家护理机构的居家护理专业人员、管理人员和质量改进工作人员进行了7次焦点小组访谈和2次个人访谈。使用慢性病定制实施清单对数据进行演绎分析。
居家护理专业人员认为的障碍包括缺乏知识和技能，如使用护理辅助工具、医护专业人员与全科医生之间的互动在客户中产生期望。认为的促进因素包括与同事一起反思所提供的护理、向客户清晰传达协议和期望。此外，客户及其亲属的行为可能会阻碍减少。相比之下，客户的独立动机和亲属的参与可以促进减少。最后，护理辅助工具的不予报销和额外费用被视为障碍。组织和管理层对减少护理的支持被视为促进因素。
了解居家护理专业人员在减少低价值居家护理方面所经历的障碍和促进因素至关重要。提高知识和技能、促进跨专业协作、让亲属参与并激发客户的自我护理可以促进减少低价值居家护理。对专业和患者护理的影响：减少低价值居家护理为提供更合适的护理以及将客户纳入等候名单提供了机会。
采用定制策略解决障碍可以成功减少低价值居家护理。
使用了定性研究报告的综合标准清单。无患者或公众参与。
