PDF(Pubmed)
Abstract：
OBJECTIVE: Homecare is a critical component of the ongoing restructuring of healthcare worldwide, given the shift from institution- to home-based care. The homecare evidence base still contains significant gaps: There is a lack of knowledge regarding quality and safety work and interventions. This study explores how home healthcare professionals perceive and use the concept of risk to guide them in providing high-quality healthcare while maintaining resilience.
METHODS: The study design is a qualitative multiple case study. The phenomena explored were risk perception, sensemaking and adaptations of care delivered to patients in their homes. Inductive content analysis was conducted.
METHODS: The study was conducted in three Norwegian municipalities. Each municipality was defined as a single case.
METHODS: Interviews with healthcare professionals were performed both individually and in focus groups of three to five persons. 19 interviews with 35 informants were conducted: 11 individual semistructured interviews and 8 focus groups.
RESULTS: Four themes were identified: \'professionalism is constantly prioritising and aligning care based on here-and-now observations\' \'teamwork feels safe and enhances quality\' \'taking responsibility for system risk\' and \'reluctantly accepting the extended expectations from society\'.
CONCLUSIONS: To make sense of risk when aspiring for high-quality care in everyday work, the healthcare professionals in this sample mainly used their clinical gaze, gut feeling and experience to detect subtle changes in the patients\' condition. Assessing risk information, not only individually but also as a team, was reportedly crucial for high-quality care. Healthcare professionals emphasised the well-being, safety and soundness of the patients when acting on risk information. They felt obliged to act on their gut feeling, moral compass and clinical understanding of quality.
METHODS: The study design is a qualitative multiple case study. The phenomena explored were risk perception, sensemaking and adaptations of care delivered to patients in their homes. Inductive content analysis was conducted.
METHODS: The study was conducted in three Norwegian municipalities. Each municipality was defined as a single case.
METHODS: Interviews with healthcare professionals were performed both individually and in focus groups of three to five persons. 19 interviews with 35 informants were conducted: 11 individual semistructured interviews and 8 focus groups.
RESULTS: Four themes were identified: \'professionalism is constantly prioritising and aligning care based on here-and-now observations\' \'teamwork feels safe and enhances quality\' \'taking responsibility for system risk\' and \'reluctantly accepting the extended expectations from society\'.
CONCLUSIONS: To make sense of risk when aspiring for high-quality care in everyday work, the healthcare professionals in this sample mainly used their clinical gaze, gut feeling and experience to detect subtle changes in the patients\' condition. Assessing risk information, not only individually but also as a team, was reportedly crucial for high-quality care. Healthcare professionals emphasised the well-being, safety and soundness of the patients when acting on risk information. They felt obliged to act on their gut feeling, moral compass and clinical understanding of quality.
摘要：
目标：家庭医疗是全球医疗保健正在进行的重组的重要组成部分，考虑到从机构护理到家庭护理的转变。家庭护理证据基础仍然存在巨大差距：缺乏有关质量和安全工作以及干预措施的知识。这项研究探讨了家庭保健专业人员如何看待和使用风险的概念，以指导他们提供高质量的医疗保健，同时保持弹性。
方法：研究设计是定性的多案例研究。探索的现象是风险感知，在家中为患者提供护理的感知和适应性。进行了归纳内容分析。
方法：该研究在挪威的三个城市进行。每个城市都被定义为一个案例。
方法：对医疗保健专业人员进行了单独的访谈，也对3至5人的焦点小组进行了访谈。对35名举报人进行了19次采访：11次个人半结构化采访和8个焦点小组。
结果：确定了四个主题：\'专业精神不断根据当前的观察来优先考虑和调整护理\'\'团队合作感到安全并提高质量\'\'承担起系统风险\'和\'不情愿地接受社会的扩展期望\'。
结论：在日常工作中渴望获得高质量护理时，要了解风险，这个样本中的医疗保健专业人员主要使用他们的临床凝视，肠道感觉和经验，以检测患者病情的微妙变化。评估风险信息，不仅个人，而且作为一个团队，据报道，对高质量护理至关重要。医疗保健专业人员强调福祉，根据风险信息采取行动时患者的安全性和健全性。他们觉得有义务根据自己的直觉采取行动，道德指南针和临床对质量的理解。
方法：研究设计是定性的多案例研究。探索的现象是风险感知，在家中为患者提供护理的感知和适应性。进行了归纳内容分析。
方法：该研究在挪威的三个城市进行。每个城市都被定义为一个案例。
方法：对医疗保健专业人员进行了单独的访谈，也对3至5人的焦点小组进行了访谈。对35名举报人进行了19次采访：11次个人半结构化采访和8个焦点小组。
结果：确定了四个主题：\'专业精神不断根据当前的观察来优先考虑和调整护理\'\'团队合作感到安全并提高质量\'\'承担起系统风险\'和\'不情愿地接受社会的扩展期望\'。
结论：在日常工作中渴望获得高质量护理时，要了解风险，这个样本中的医疗保健专业人员主要使用他们的临床凝视，肠道感觉和经验，以检测患者病情的微妙变化。评估风险信息，不仅个人，而且作为一个团队，据报道，对高质量护理至关重要。医疗保健专业人员强调福祉，根据风险信息采取行动时患者的安全性和健全性。他们觉得有义务根据自己的直觉采取行动，道德指南针和临床对质量的理解。
