PDF(Pubmed)
Abstract：
Low birth weight (LBW) is associated with short and long-term consequences including neonatal mortality and disability. Effective linkages in the continuum of care (CoC) for newborns at the health facility, community (primary care) and home care levels have a high tendency of minimizing adverse events associated with LBW. But it is unclear how these linkages work and what factors influence the CoC process in Ghana as literature is scarce on the views of health professionals and families of LBW infants regarding the CoC. Therefore, this study elicited the drivers influencing the CoC for LBW infants in Ghana and how linkages in the CoC could be strengthened to optimize quality of care.
A constructivist grounded theory study design was used. Data was collected between September 2020 to February 2021. A total of 25 interviews were conducted with 11 family members of LBW infants born in a secondary referral hospital in Ghana, 9 healthcare professionals and 7 healthcare managers. Audio recordings were transcribed verbatim, analyzed using initial and focused coding. Constant comparative techniques, theoretical memos, and diagramming were employed until theoretical saturation was determined.
Emerging from the analysis was a theoretical model describing ten major themes along the care continuum for LBW infants, broadly categorized into health systems and family-systems drivers. In this paper, we focused on the former. Discharge, review, and referral systems were neither well-structured nor properly coordinated. Efficient dissemination and implementation of guidelines and supportive supervision contributed to higher staff motivation while insufficient investments and coordination of care activities limited training opportunities and human resource. A smooth transition between care levels is hampered by procedural, administrative, logistics, infrastructural and socio-economic barriers.
A coordinated care process established on effective communication across different care levels, referral planning, staff supervision, decreased staff shuffling, routine in-service training, staff motivation and institutional commitment are necessary to achieve an effective care continuum for LBW infants and their families.
A constructivist grounded theory study design was used. Data was collected between September 2020 to February 2021. A total of 25 interviews were conducted with 11 family members of LBW infants born in a secondary referral hospital in Ghana, 9 healthcare professionals and 7 healthcare managers. Audio recordings were transcribed verbatim, analyzed using initial and focused coding. Constant comparative techniques, theoretical memos, and diagramming were employed until theoretical saturation was determined.
Emerging from the analysis was a theoretical model describing ten major themes along the care continuum for LBW infants, broadly categorized into health systems and family-systems drivers. In this paper, we focused on the former. Discharge, review, and referral systems were neither well-structured nor properly coordinated. Efficient dissemination and implementation of guidelines and supportive supervision contributed to higher staff motivation while insufficient investments and coordination of care activities limited training opportunities and human resource. A smooth transition between care levels is hampered by procedural, administrative, logistics, infrastructural and socio-economic barriers.
A coordinated care process established on effective communication across different care levels, referral planning, staff supervision, decreased staff shuffling, routine in-service training, staff motivation and institutional commitment are necessary to achieve an effective care continuum for LBW infants and their families.
摘要：
背景：低出生体重（LBW）与包括新生儿死亡率和残疾在内的短期和长期后果有关。在医疗机构为新生儿提供连续护理（CoC）的有效联系，社区(初级保健)和家庭护理水平在减少与LBW相关的不良事件方面有很高的趋势.但是，目前尚不清楚这些联系是如何工作的，以及哪些因素会影响加纳的CoC过程，因为有关卫生专业人员和LBW婴儿家庭关于CoC的观点的文献很少。因此,这项研究引出了影响加纳LBW婴儿CoC的驱动因素,以及如何加强CoC中的联系以优化护理质量.
方法：采用建构主义扎根理论研究设计。数据收集时间为2020年9月至2021年2月。共对加纳一家二级转诊医院出生的低出生体重婴儿的11名家庭成员进行了25次访谈，9名医疗保健专业人员和7名医疗保健经理。录音被逐字转录，使用初始和集中编码进行分析。恒定的比较技术，理论备忘录，并使用图表直到确定理论饱和度。
结果：从分析中得出的是一个理论模型，描述了LBW婴儿护理连续体的十个主要主题，大致分为卫生系统和家庭系统驱动因素。在本文中,我们专注于前者。放电,review,转介系统既没有良好的结构，也没有适当的协调。准则的有效传播和执行以及支持性监督有助于提高工作人员的积极性，而护理活动的投资和协调不足限制了培训机会和人力资源。护理水平之间的平稳过渡受到程序的阻碍，行政,物流,基础设施和社会经济障碍。
结论：在不同护理级别之间建立有效沟通的协调护理流程，转诊计划，员工监督,员工洗牌减少，常规在职培训，员工的积极性和机构的承诺是必要的，以实现一个有效的护理连续的LBW婴儿和他们的家庭。
方法：采用建构主义扎根理论研究设计。数据收集时间为2020年9月至2021年2月。共对加纳一家二级转诊医院出生的低出生体重婴儿的11名家庭成员进行了25次访谈，9名医疗保健专业人员和7名医疗保健经理。录音被逐字转录，使用初始和集中编码进行分析。恒定的比较技术，理论备忘录，并使用图表直到确定理论饱和度。
结果：从分析中得出的是一个理论模型，描述了LBW婴儿护理连续体的十个主要主题，大致分为卫生系统和家庭系统驱动因素。在本文中,我们专注于前者。放电,review,转介系统既没有良好的结构，也没有适当的协调。准则的有效传播和执行以及支持性监督有助于提高工作人员的积极性，而护理活动的投资和协调不足限制了培训机会和人力资源。护理水平之间的平稳过渡受到程序的阻碍，行政,物流,基础设施和社会经济障碍。
结论：在不同护理级别之间建立有效沟通的协调护理流程，转诊计划，员工监督,员工洗牌减少，常规在职培训，员工的积极性和机构的承诺是必要的，以实现一个有效的护理连续的LBW婴儿和他们的家庭。
