The Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway.
Department of Health and Nursing Science, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, INN University, Elverum, Norway.
BMC Health Serv Res. 2024 Sep 19;24(1):1102. doi: 10.1186/s12913-024-11544-5.
Frail people receiving home care services face an increased risk of developing crisis, which can result in adverse events, coercive measures, and acute institutionalisation. The prevalence of frailty is expected to increase due to the ageing population in most countries. However, our knowledge of the process leading to crises among frail community-dwelling patients remains limited. The aim of our study was to explore how users of home care services and their next of kin experienced crises and how these crises were approached by home care services.
A qualitative explorative design with 21 interviews was conducted. We explored crises within the last year that had led to an acute institutionalisation (hospital or nursing home) or to an unstable situation with high risk of institutionalisation. Systematic text condensation (STC) was used to analyse the data.
Our findings are summarised into one overarching theme; an organisation working mainly reactively instead of proactively, which is supported by four subthemes: (1) insufficient communication-a determinant of crises, (2) the lack of a holistic approach, (3) a sense of being a burden, and (4) the complexity of crises. The reactive approach is demonstrated in the participant's experience of insufficient communication and the lack of a holistic approach from the service, but also in the user's sense of being a burden, which seems to be reinforced by the experienced busyness from the staff in the home care services. This reactive approach to crises seems to have contributed to difficulties in detecting the various stressors involved in the complex process leading to crisis.
Our findings suggest that home care services tend to be characterised by a reactive approach to rising instability and the development of crises for users. This can be interpreted as an emergent property of the organisation and the adaptation towards exceeding demands due to insufficient capacity in health care services. We recommend the use of multicomponent care programmes comprising interdisciplinary case conferences in home care services to implement a cultural change that can shift the service from a reactive, fragmented, and task-oriented approach to a more proactive approach.
接受家庭护理服务的体弱人群面临着危机风险增加的问题，这可能导致不良事件、强制措施和急性住院治疗。由于大多数国家人口老龄化，虚弱的发病率预计会增加。然而，我们对导致社区居住的虚弱患者发生危机的过程知之甚少。我们的研究旨在探讨家庭护理服务使用者及其家属如何体验危机，以及家庭护理服务如何应对这些危机。
采用 21 次访谈的定性探索性设计。我们探讨了过去一年中导致急性住院（医院或疗养院）或不稳定状态、高住院风险的危机。采用系统文本压缩（STC）分析数据。
我们的发现总结为一个总体主题：一个主要是被动反应而非主动反应的组织，由四个子主题支持：（1）沟通不足——危机的决定因素，（2）缺乏整体方法，（3）负担感，以及（4）危机的复杂性。这种被动反应体现在参与者对沟通不足和服务缺乏整体方法的体验中，也体现在使用者感到自己是负担的感觉中，这似乎因家庭护理服务人员忙碌而加剧。这种对危机的被动反应似乎导致了在检测导致危机的复杂过程中涉及的各种压力源方面的困难。
我们的研究结果表明，家庭护理服务往往以对使用者不稳定和危机发展的被动反应为特征。这可以被解释为组织的一个新兴特性，以及医疗保健服务能力不足导致的适应过度需求的反应。我们建议在家庭护理服务中使用多组分护理计划，包括跨学科案例会议，以实施文化变革，将服务从被动、分散和任务导向的方法转变为更主动的方法。
