Patients in 24-hour home care striving for control and safety

Abstract

BackgroundThis article concerns Swedish patients receiving 24-hour home care from health care assistants (HC assistants) employed by the municipality. Home care is a complex interactive process involving the patient, family, HC assistants as well as professional care providers. Previous studies exploring patient perspectives on home care have been based mainly on patient interviews. In contrast, the present study took a broad perspective on patients’ experiences and thoughts by combining field observations on care situations with patient and HC assistant interviews. The aim of the study presented in this article was to promote a new and broadened understanding of patients receiving 24-hour home care by constructing a theoretical model to illuminate their main concern.MethodsField observations and semi-structured interviews were conducted with four patients receiving 24-hour home care and their HC assistants. Grounded theory methodology was used.ResultsThe core process identified was Grasping the lifeline, which describes compensatory processes through which patients strived for control and safe care when experiencing a number of exposed states due to inadequate home care. Patients tried to take control by selecting their own HC assistants and sought safe hands by instructing untrained HC assistants in care procedures. When navigating the care system, the patients maintained contacts with professional care providers and coordinated their own care. When necessary, a devoted HC assistant could take over the navigating role. The results are illuminated in a theoretical model.ConclusionsThe results accentuate the importance to patients of participating in their own care, especially in the selection of HC assistants. The model illustrates some challenging areas for improvement within the organisation of 24-hour home care, such as personnel continuity and competence, collaboration, and routines for acute care. Furthermore, it may be used as a basis for reflection during the planning of care for individual patients within home care.

From risky to safer home care: health care assistants striving to overcome a lack of training, supervision, and support

“…Thus, the main finding of a grounded theory study, which typically is a basic social process illustrated through a theoretical model, is regarded as a construction by the researcher in interaction with data (Blumer, 1986; Charmaz, 2005). The approach is in agreement with Hallberg (2006) and Guvå and Hylander (2003) and has been presented in several articles, for example, Swedberg et al (2012), Hylander (2003), and Barimani and Hylander (2012). …”

“…The HC assistants in the present study navigated the patient care system by maintaining all contacts and coordinating patient care themselves. The assumption of the navigating role by patients and/or HC assistants, is supported by a previous study (Swedberg et al, 2012) where the patients’, when experiencing a poor continuity in their care, felt the need to navigate, either by themselves or by a competent HC assistant.…”

“…A recent study (Swedberg, Hammar Chiriac, Törnkvist, & Hylander, 2012), based on the same data sample as the present study, revealed that patients striving for safety in 24-h home care, selected certain caregivers to perform advanced procedures as well as instructed their new caregivers. However productive for the patients, these strategies seemed to create several challenges for the caregivers and could influence their work situation in a negative way.…”

“…In a previous study by (Swedberg et al, 2012), patients’ in 24-h home care, when experiencing a lack of competence among the HC assistants, actively selected competent ones and instructed the new HC assistants in their efforts to establish safe care. When the HC assistants in the present study felt they lacked competence, they took responsibility for self-learning, by using previous experience and by identifying self-learning situations themselves.…”

Perceived Feeling of Security: A Candidate for Assessing Remission in Borderline Patients?

“…Security may for example be associated with personal safety in studies of environmental investigations [14]. In studies focusing on quality of care and treatment relationships, security is often associated with patient safety [15,16]. Furthermore, the contents of the concept and its relation to quality of care may be defined in terms of predictability and consistency in the process of the patient [17].…”