Tensions between infection control regulations and the home care working environment: An interview study with health care providers early during the COVID-19 pandemic

Background: Therefore, the objective of this study was to elucidate caregivers\u27 experiences of ordinary homes as a working environment in home care and home health care during the COVID-19 pandemic. At the beginning of the pandemic, hospital care was in focus and the care of older adults was criticized around the world. Design and methods: Semi-structured qualitative interviews were conducted in two municipalities in Sweden between March 2020 and May 2021. One large municipality (population 155,000) with experience of care recipients with COVID-19, and a smaller municipality (population 32,000) were included; both had a focus on preventing the spread of the infection. A total of 27 participants working in home care were interviewed; these were occupational therapists, physical therapists, nurses, and assistant nurses. The interview material was analyzed using content analysis. Results: The interviews provided a comprehensive insight into the complex work environment in municipal home care during the pandemic. The staff had to deal with constantly changing information and new guidelines. They were also given new tasks and work routines that demanded more planning and were time-consuming. The staff experienced higher workload and pressure during the pandemic and did not have enough time to recover. Conclusions: During a pandemic situation, the information must be comprehensive and gathered in one place, and the managers must ensure sufficient staffing levels, time for reflection, and support for prioritization. The managers must also ensure the mental health of staff and meet their needs for recovery, both at and outside work

“We Are Here for You All the Way”—Patients’ and Relatives’ Experiences of Receiving Advanced Home Care

Background: It is of great importance to understand how patients and their close relatives experience the pros and cons of advanced home care so as to further develop this quickly growing choice of care. Objective: The aim of this study was to explore the experiences of receiving advanced home care among patients affected by life-threatening illness and their close relatives. Design: The study was an interview study conducted with patients in their homes. Some patient interviews were conducted together with a close relative participating. Setting/Participants: Patients registered in advanced home care in 2017 were offered the opportunity to participate in the study. The selection criteria were that the patient was within grade 3 of the Eastern Cooperative Oncology Group’s Performance Status, older than 18 years, able to orient to time and place, and not newly registered. Analysis: The interviews were recorded and transcribed verbatim and analyzed with qualitative content analysis. Results: A total of 11 interviews were conducted: 8 with patients and 1 or 2 close relatives together; and 3 with the patient alone. It resulted in 3 main categories: create a safe environment, see the person, and better to manage care at home. Conclusion: The results of this study show that patients and close relatives perceived that advanced home care was a safe and secure form of caring during advanced as well as end-of-life care

Perceptions of providing safe care for frail older people at home: A qualitative study based on focus group interviews with home care staff

Background: Providing safe care is a core competence in healthcare. The concept usually refers to hospitals but, consistent with the increasing importance of integrated care, the provision of safe care needs to be extended to the context of home care, and more research is needed concerning home healthcare providers’ perspectives in this context. Aim: The aim of this study was to describe care providers’ perceptions of providing safe care for frail older persons living at home. Method: A qualitative methodology was chosen. In total, 30 care providers agreed to participate. Data were collected through five focus group interviews and analysed using a phenomenographic approach. Results: Three themes regarding care providers’ perceptions of providing safe care emerged from the data: ‘safe care is created in the encounter and interaction with the older person’, ‘safe care requires responsibility from the caregiver’ and ‘safe care is threatened by insufficient organisational resources’. The findings show that providing safe care is an endeavour that requires a holistic view among the care providers as well as effective collaboration within the team, but insufficient competence or a lack of time can make it difficult to safeguard the psychological and existential needs of older persons. Conclusion: Providing safe care in home environments encompasses more than just risk reduction. The findings highlight the importance of establishing and integrating team-based and person-centred care into home care settings. Traditional communication structures for inpatient care also need to be adapted to the cross-disciplinary work in municipalities. Care providers should be given the opportunity to develop and maintain their competences and to prioritise relationship-oriented care

Struggling for access to appropriate healthcare services: A qualitative content analysis of patient complaints

Aim: This study aimed to describe circumstances concerning access for patients and relatives to take part in patient health and safety in a hospital setting. Design: This study used a qualitative descriptive design and was conducted at a Swedish university hospital. Method: The 79 complaints reported by patients and relatives included in this study were registered between January 2017 and June 2019. These complaints were classified as concerning access to healthcare services. Data were analysed using qualitative content analysis. Results: The overarching theme, struggling for access as a human being in the healthcare system, encompassed three themes describing patients\u27 and relatives\u27 needs. The three themes were (1) navigating through the healthcare organization, (2) making sense of self and what is going on and (3) being acknowledged as having needs. Conclusion: Patients and relatives continuously participate in various ways in healthcare to promote health and prevent patient harm. Our findings contribute important knowledge about the meaning of access from a broad healthcare system perspective. Access was restricted in terms of appropriateness in how patients\u27 needs were met. This restriction of access risked the deterioration of patient health and safety. Impact: Patients and relatives play an active part in patient health and safety, although their attempts are sometimes hindered. Restrictions in the appropriateness of access prevented patients and relatives from taking part in patient health and safety, which appeared to mean that they had to adapt and expend effort to the point that it negatively affected their health and everyday life. These findings concern all patients, relatives and healthcare professionals in hospital-associated settings. Patient or Public Contribution: No patient or public contribution

Claiming and Reclaiming Settings, Objects, and Situations: A Microethnographic Study of the Sociomaterial Practices of Everyday Life at Swedish Youth Homes

The aim of this study is to explore social interactions in the spatial and material environment within everyday life at special youth homes in Sweden, where youths with psychosocial problems, or criminal behavior are cared for involuntary. A microethnographic approach was chosen, and data was collected through participant observation. A theory integrating analysis, using Burke’s (1969) dramatistic pentad as a tool for structuring the data and Goffman’s (1956; 1961) dramaturgical perspective was undertaken. The findings demonstrate that the staff’s control over settings and objects also means control over the definition of what kind of place the special youth home is, and what takes place there. This is shown through a decorous behavior of sociomaterial control practices, rather than care practices, by the staff. This study contributes to knowledge on spaces and objects as crucial parts of care practices highlighting the intentions inscribed in institutional design and objects

Oral assessment and preventive actions within the swedish quality register senior alert: Impact on frail older adults’ oral health in a longitudinal perspective

Poor oral health is common among older people in nursing homes. To identify and prevent oral health problems among the residents, ROAG-J (Revised Oral Assessment Guide–J\uf6nk\uf6ping), a risk-assessment instrument, is used by nursing staff routinely, and the outcome is registered in the web-based Swedish quality register Senior Alert. This study aims to investigate the preventive actions registered when oral health problems are identified and the effect of these actions longitudinally. ROAG-J data registered at nursing homes in Sweden during 2011–2016 were obtained from the Senior Alert database. Out of 52,740 residents (≥65 years), 41% had oral health problems, of whom 62% had preventive actions registered. The most common action was “Assistance with cleaning teeth”. Longitudinally, during the five-year observation period, a slight increase in oral health problems assessed with ROAG-J was found. Registered preventive actions, however, led to significant improvement in the subsequent assessment for the ROAG items lips, tongue, and dentures. Standardised risk assessments like ROAG-J provide an opportunity to detect problems early and establish preventive actions. The study, however, indicates a further need for structured education and a continuous follow-up in ROAG-J. Moreover, increased collaboration between nursing and dental care to improve oral health for older residents at nursing homes is needed

Actions taken affecting lead time in the care pathway for low-priority patients with a suspected stroke: A critical incident study

Background: The time delay from alerted ambulance to arrival at the stroke unit is crucial for patients suffering a suspected stroke. This is a recognized problem why additional explorative knowledge regarding actions taken are needed. Aim: To explore actions taken by nurses that affect lead times in the care pathway from the alerted ambulance to the stroke unit, for low-priority patients suffering a suspected stroke. Method: The design of the study was explorative and descriptive and used a qualitative approach based on Critical Incident Technique (CIT). Twenty-two nurses involved in the stroke care pathway at an university hospital in western Sweden were interviewed about their actions that affected the lead time. Results: Actions undertaken affected lead time in the stroke care pathway for low-priority patients related to “promoting the care chain process” and “taking control of the situation”. Conclusions: The staff within all parts of the care pathway affected the lead time, individually as well as via interaction between departments. This calls for the need of further collaboration and consensus concerning how to facilitate a smooth care pathway

“You Should Just Keep Your Mouth Shut and Do As We Say”: Forensic Psychiatric Inpatients’ Experiences of Risk Assessments

This study presents findings of forensic inpatients’ experiences of their role in the risk assessment process. Eleven patients, recruited from two forensic psychiatric clinics in Sweden, participated in semi-structured interviews which were analyzed using qualitative content analysis. The analysis of their experiences resulted in the information of three categories: Taking responsibility for one’s own situation, in terms of taking responsibility for aspects of one’s care, taking charge of the present, emphasizing potential challenges in grasping reality, and being involved and having impact, which concerns feelings of being involved in discussions related to one’s care and treatment versus feelings of being an outsider

The impact of implementing a person-centred pain management intervention on resistance to change and organizational culture

Background: Resistance to change and organizational culture are essential factors to consider in change management in health care settings. Implementation of structural change remains a challenge. There is a lack of studies providing information on the impact of implementation processes on the organization. The aim of this study was to describe the impact of implementing a systematic change process concerning postoperative person-centred pain management on resistance to change and organizational culture in an orthopaedic spine surgery unit. Methods: The study was set in an orthopaedic spine surgery unit at a university hospital. Person-centred bundles of care for postoperative pain management of spine surgery patients were developed in co-creation by a multi-professional expert group and implemented throughout the care pathway. The intervention was underpinned by theories on organizational culture and inspired by principles of person-centred care. Quantitative data were collected using the Resistance to Change Scale and the Organizational Culture Assessment Instrument and analysed using descriptive statistics. Results: The findings showed a low resistance to change decreasing during the study. The organizational culture shifted from a result-oriented to a formalized and structured culture after the implementation. The culture preferred by the staff was team-oriented and participation-focused throughout the study. The discrepancy between the current and preferred cultures remained extensive over time. Conclusion: It is challenging to describe the influence of the development and implementation of a postoperative pain management program on organizational culture as well as in terms of resistance to change, in a complex health care setting. In the current study the unit was under organizational strain during the implementation. Albeit, the important discrepancy between the current and preferred organizational culture could imply that structural changes aren’t enough when implementing person-centred pain management structures and needs to be combined with relational aspects of change

The Perceived Support From Light and Color Before and After an Evidence-Based Design Intervention in an Emergency Department Environment: A Quasi-Experimental Study

Aim: To evaluate patients’ and family members’ perceived support from light and color before, compared with after an evidence-based design (EBD) intervention at an emergency department (ED) using a validated instrument—the Light and Color Questionnaire (LCQ). Background: EDs offer acute care day and night. Thus, a supportive physical environment where light and color is crucial for how the milieu is experienced is vital. Research is limited on how care settings are perceived as supportive by users. Methods: Quasi-experimental evaluation of the refurbishing and remodeling of an ED by an expert group of nurse managers, nursing staff, nursing researchers and architects in south Sweden. LCQ includes dimensions “maximizing awareness and orientation,” “maximizing safety and security,” “supporting functional abilities,” “providing privacy,” “opportunities for personal control” (not for LCQ-Color), and “regulation and quality of stimulation.” LCQ was analyzed and compared in 400 surveys from 100 patients and 100 family members before the intervention and 100 patients and 100 family members after the intervention. Results: The LCQ total score significantly improved after the intervention for both patients and family members. Four of the six dimensions of LCQ Light subscale scores were significantly higher for family members, and three of the six dimensions were significantly higher for patients after the intervention. The LCQ Color subscale score showed significant improvements for all five dimensions for both patients and family members after the intervention. Conclusion: This study showed improved perceived support from light and color in the physical environment for patients and family members after an EBD intervention at an emergency department using a validated instrument—the Light and Color Questionnaire