‘We just have to make it work’: a qualitative study on assistant nurses’ experiences of patient safety performance in home care services using forum play scenarios

Abstract

ObjectiveSafety is essential to support independent living among the rising number of people with long-term healthcare and social care needs. Safety performance in home care leans heavily on the capacity of unlicensed staff to respond to problems and changes in the older patients’ functioning and health. The aim of this study is to explore assistant nurses’ adaptive responses to everyday work to ensure safe care in the home care context.DesignA qualitative approach using the drama-based learning and reflection technique forum play with subsequent group interviews. The audio-recorded interviews were transcribed and analysed with thematic analysis.SettingHome care services organisations providing care to older people in their private homes in two municipalities in southern Sweden.ParticipantsPurposeful sampling of 24 assistant nurses and three managers from municipal home care services and a local geriatric hospital clinic.ResultsHome care workers’ adaptive responses to provide safe home care were driven by an ambition to ‘make it work in the best interests of the person’ by adjusting to and accommodating care recipient needs and making autonomous decisions that expanded the room for manoeuvrability, while weighing risks of a trade-off between care standards and the benefits for the community-dwelling older people’s independent living. Adaptations to ensure information transfer and knowledge acquisition across disciplines and borders required reciprocity.ConclusionsSafety performance in home care service is dependent on the staff closest to the older people, who deal with safety risks and ethical dilemmas on a day-to-day basis and their access to information, competence, and resources that fit the demands. A proactive leadership characterised by mutual trust and adequate support for decision making is suggested. Managers and decision-makers across healthcare and social care need to consider how they can develop interprofessional collaborations and adaptive routines supporting safety from a broader perspective.

Concept analysis of patient safety in home care: a hybrid model

“…The cooperation of members involved in care is one of the main components of defining patient safety at home 34. Patient safety depends on family involvement and the relationship between members involved in care 35 36. In some definitions, patient safety at home is defined as prevention by evaluating and intervening in a timely manner, provided that all those involve in home care attempt to maintain safety 27 37.…”

“…By reviewing the literature and the content analysis conducted on it, five categories of attributes of patient safety in home care were extracted, including evaluative and preventive process,25–29 32 34 37 multidimensional and complex process,26 30–33 participatory care30 32–37 and patient safety culture25 27 32 34 38 39 in home care. The categories and subcategories obtained from this phase are listed in table 3 along with some concepts from the studies.…”

“…According to text analysis in the theoretical phase, the consequences of this concept include increasing the ability of all members involved in care,30 32 35 37–39 maintaining environmental safety,26 28 32 33 37 reducing injury, death and injury to the patient,27 29 34 40 ensuring the safety of the patient and other members,13 25 26 28 30 32 35 36 38 39 reducing stress and pressure on all members involved in care33 34 36–38 and quality and safe care 26 27 30–34 37 38. More details are given in table 1.…”

“…Attributes related to the concept of patient safety in home care Lang et al32 stated that patients played an essential role in self-care and therefore should be part of the patient's safety discourse Lang et al32 mentioned that healthcare providers should involve clients, families and caregivers in deciding the type, amount and time of home care required to provide appropriate and responsive care Mirjam et al35 mentioned that the safety performance of home care services depends on the closest family members to the elderly Culture of patient safety in home careBerland et al29 referred to culture of patient safety in home care as the existence of care routines, updating procedures and knowledge and training among healthcare workers and implementation in care Ree and Wiig 39 considered culture of patient safety as the product of values, attitudes, perceptions, competencies and patterns of individual and group behaviour Gershon et al28 considered training home healthcare professionals to increase their knowledge and skills for home care Lang et al32 mentioned human resource challenges and competency as key issues for home care safety copyright.…”

Ferramentas Digitais Para Prevenção De Infecção Relacionada À Assistência Nas Unidades De Terapia Intensiva: Revisão Integrativa

“…Para tanto, faz-se necessária uma liderança proativa caracterizada pela confiança mútua e suporte adequado para a tomada de decisões. (EKSTEDT et al, 2022).…”