痴呆患者居家移民护理安排中良好护理的概念化与冲突——德国家庭照顾者的观点。
Conceptualisations of good care and conflicts in live-in migrant care arrangements for people with dementia - perspectives of family caregivers in Germany.
机构信息
Division of Prevention and Rehabilitation Research, Carl von Ossietzky Universität Oldenburg, Ammerländer Heerstrasse 140, D - 26111, Oldenburg, Oldenburg, Germany.
出版信息
BMC Geriatr. 2024 Aug 24;24(1):702. doi: 10.1186/s12877-024-05283-9.
BACKGROUND
In Germany, live-in migrant carers provide essential social, emotional and physical support to a growing number of community-dwelling people with dementia. However, opaque legal regulations and employment models as well as a lack of formal supervision for families employing live-in migrant carers contribute to the vulnerability of these already strained arrangements. This study analyses the family caregivers' perspective, their conceptualisations of good dementia live-in migrant care and conflicts that arise in live-in care arrangements.
METHODS
The study adopted a qualitative-explorative approach. We conducted focus groups with family caregivers (n = 15) to learn about their perspectives on and experiences with live-in care as a model of home-based dementia care. Due to the restrictions of the COVID-19 pandemic, data collection took place online, which enabled us to include participants from all over Germany in our sample. Data were analysed with qualitative content analysis.
RESULTS
In this paper, two main categories, Indicators of good live-in migrant care for people with dementia and perceived conflicts, are presented. We identified indicators applied by family caregivers to assess the quality of care provided by migrant live-in carers and its outcomes for the person with dementia. These relate primarily to interpersonal and emotional aspects and a person-centred attitude towards the person with dementia. Conflicts arise when the needs and personalities within the triad do not match, due to intransparent and unreliable work of and communication with the placement agencies, or permanent crisis as a result of the German model with alternating live-in carers.
CONCLUSION
Our findings point to the complex dynamics and relationships within live-in care triads and support the theoretical assumption that taking into account the needs of all actors involved is essential for good and stable care arrangements. The conceptualisations of family caregivers of good dementia live-in migrant care offer starting points for a scientific as well as a social and health policy debate about the future regulation of this model of care.
背景
在德国，住家移民护工为数以千计居住在社区中的痴呆症患者提供了重要的社会、情感和身体支持。然而，不透明的法律规定和就业模式，以及对家庭雇佣住家移民护工缺乏正式监督，使得这些本已紧张的安排更加脆弱。本研究分析了家庭护工的观点、他们对良好痴呆症住家移民护理的概念理解以及住家护理安排中出现的冲突。
方法
本研究采用定性探索方法。我们与家庭护工（n=15）进行了焦点小组讨论，以了解他们对住家护理模式作为家庭痴呆症护理模型的看法和经验。由于 COVID-19 大流行的限制，数据收集是在网上进行的，这使我们能够在样本中包括来自德国各地的参与者。数据采用定性内容分析法进行分析。
结果
在本文中，提出了两个主要类别，即痴呆症患者住家移民护理的良好指标和感知冲突。我们确定了家庭护工用来评估移民住家护工提供的护理质量及其对痴呆症患者的结果的指标。这些指标主要与人际关系和情感方面以及对痴呆症患者的以人为本的态度有关。当三角关系中的需求和个性不匹配时，就会出现冲突，原因是与安置机构的工作和沟通不透明且不可靠，或者由于德国模式下交替的住家护工导致永久危机。
结论
我们的研究结果指出了住家护理三角关系中的复杂动态和关系，并支持了这样一个理论假设，即考虑到所有相关方的需求对于良好和稳定的护理安排至关重要。家庭护工对良好痴呆症住家移民护理的概念理解为关于这种护理模式未来监管的科学、社会和卫生政策辩论提供了起点。
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