Home care for patients in need of advanced care and technology : a challenge for patients and their caregivers

摘要: Background and aim: There is an ongoing trend of advanced care ‘moving out’ from hospitals into patients' homes. In Sweden, caregivers with limited training, employed by municipalities or private agencies take 24-hour responsibility for patient support healthcare professionals. The aim this thesis was to explore gain new broadened understanding home patients in need technology. Material methods: A multi method approach used. Studies I II resulted a field study using grounded theory methodology. Interviews observations were performed the homes four adult (study I) their 19 II). Participants III IV (n=128) caring mechanical ventilation (HMV). study-specific questionnaire, including questions accordance Demand-Control model, Caregivers’ socio-demographic workplace data, perceived competence III), working conditions IV) investigated. Descriptive statistics logistic regression analyses performed. comparison conducted population-based survey general (n= 585). Results: qualitative studies, found compensatory processes when work not suited needs, illustrated two theoretical models: 1. strived control safety taking control, seeking safe hands navigating system. strivings, they selected could trust, instructed unskilled coordinated themselves. 2. compensated day-by-day learning, balancing relations patient, self-managing system strivings combine good conditions. Actively employing processes, some adopted ‘inclusive approach’, compensating own barriers as well those colleagues, overall workplace. Among HMV investigated, 55% (n=70) lacked formal health training. 27% (n=34) reported shorter courses, 19% (n=24) had training equivalent licensed practical nurse exam (LPN). Regardless, 80% rated high, 59% high. On-the-job significantly associated high ratings on competence, control. Being clinically supervised psychological demand. Seventy-six intended stay jobs next years, 29% experienced bullying and/or discrimination at Female more felt competent stimulated than males. Compared group, no differences except demand, where lower. Conclusion: Despite lack support, managed compensating, on-the-job one-patient care, caregivers. However, results suggest that improved quality are needed ensure These can contribute continued development caregiver role care.