A systematic review of observational studies of adult home care

Abstract

The home‐care workforce is in high demand globally. Home‐care workers provide care for people at home, including practical and personal care, as well as other tasks such as medication management. We conducted a systematic review with the aims of understanding methods of observation that have been employed to study home care and to explore how these methods have enabled researchers to understand the quality of home care. We searched the literature using PubMed and CINAHL databases in May 2018, with no limits applied to date of publication. We searched for MeSH terms of ‘Home Care Services’, ‘Home Health Care’, ‘Home Nursing’ and ‘Observation*’. Across 15 eligible studies, the types of observation methods employed were categorised as structured, guided and unstructured. The characteristics of these methods, such as the level of participation adopted by the observer, varied across the studies. Three themes were developed through a narrative synthesis of the included studies’ findings: ‘The impact of care delivery and organisational factors’, ‘Observing relationships and communications’, and ‘People and places behind closed doors’. We conclude that methods of observation are a fairly novel, yet rich and meaningful way of exploring home‐care practice. Researchers undertaking observations should consider elements such as the number of researchers observing and the potential for variations, how and when to record the observations, possible triangulation of data, the researcher's reflective stance as an observer, as well as ethical considerations.

Supporting independence at home for people living with dementia: a qualitative ethnographic study of homecare

“…Homecare for people living with dementia should continue to be explored through inclusive methods of data collection. Our study, in addition to previous research [ 16 ], found ethnographic participant observations were well-suited to capturing the lived-experiences of people living with dementia, including people who lack decision-making capacity, in the private setting of their home. Participant observations of care delivered in the home highlighted important considerations about the home environment itself and the way homecare workers interact with the home.…”

“…The participant observations were guided by our earlier methodological review of observational studies of homecare [ 16 ]. Three researcher-observers (ML, AB and JBD) from psychology and sociology backgrounds conducted naturalistic observations of homecare workers, guided by a semi-structured observation guide ( Appendix B ) intended to enhance consistency of fieldnotes across observers and prompt reflexivity.…”

Exploring how people with dementia can be best supported to manage long-term conditions: a qualitative study of stakeholder perspectives

“…29 The balancing of roles is complex for carers especially involving boundaries between advocating for independence and the implementation of medical advice. 30 Our findings demonstrate this dilemma extends to the management of long-term conditions in dementia. Future research is required to understand how calculated risks in care decision-making can enable freedom for people with dementia while managing carer safety concerns.…”

Perspectives on “Novel” Techniques for Designing Age-Friendly Homes and Neighborhoods with Older Adults

“…In addition to participant feedback, observation was used to examine and evaluate the different techniques. Observation is an established and valuable method for examining and evaluating practices, services, and behaviors [38][39][40]. For example, in education, peer observation and critical self-reflection are employed to evaluate teaching technique and student engagement [41,42], while, in health research, observation is used to assess diverse items such as nature-based therapeutic interventions [43], dementia care and dementia care services in different settings [39,44,45], and the allocation of pre-hospital medical assistance and resources [46].…”