Abstract：
BACKGROUND: Implantation of a left ventricular assist device (LVAD) requires extensive aftercare. It is largely unclear how aftercare should be designed from the patients\' perspective. Implications can be developed based on an examination of the healthcare context. Its main components are mapped on five tiers in the Human Factors of Home Health Care Model by Henriksen, Joseph, and Zayas-Caban (2009). Using this model, the present study explores the patient perspective on the context of healthcare after an LVAD implantation.
METHODS: We employed a qualitative cross-sectional study, in which LVAD patients participated in semi-structured interviews. The transcribed interviews were analyzed using content analysis. First, relevant meaning units were identified and deductively categorized into the model. Then, categories of care-related aspects were developed inductively within each of the model tiers.
RESULTS: We interviewed 18 patients aged 33 to 78 years who had been living with the LVAD between a few weeks and more than 10 years. Twenty-eight categories related to care aspects were developed within the model tiers: 3 categories on patient characteristics (e.g., self-management skills), 3 on caregiver characteristics (e.g., professionalism), 11 healthcare-related tasks and requirements (e.g., wound management), 8 on factors of the physical environment (e.g., controllability), medical devices and technologies (e.g., carrying systems for external components), and cultural, social and community environment (e.g., interaction with peers), as well as 3 on external environmental factors (e.g., healthcare infrastructure).
CONCLUSIONS: The present study represents the first investigation focusing on aspects of the healthcare context influencing healthcare quality and safety from the perspective of LVAD patients in Germany. LVAD aftercare covers a broad and complex range of tasks. For this, patients, caregivers and healthcare professionals need specific knowledge, which is lacking in various respects. In the first place, this is compensated by the patients\' own initiative and the personal care provided by the VAD outpatient clinics.
CONCLUSIONS: Three key recommendations to optimize aftercare from the patient perspective are derived: Patients would benefit from a more flexible and decentralized aftercare concept, to which telemedicine could contribute. LVAD-specific expertise among general healthcare providers is perceived as insufficient by patients and could be strengthened through training and counseling services. The broad scope of tasks and the high level of responsibilities in LVAD aftercare pose challenges for patients and their families, which could be addressed through continuous information and training programs.
METHODS: We employed a qualitative cross-sectional study, in which LVAD patients participated in semi-structured interviews. The transcribed interviews were analyzed using content analysis. First, relevant meaning units were identified and deductively categorized into the model. Then, categories of care-related aspects were developed inductively within each of the model tiers.
RESULTS: We interviewed 18 patients aged 33 to 78 years who had been living with the LVAD between a few weeks and more than 10 years. Twenty-eight categories related to care aspects were developed within the model tiers: 3 categories on patient characteristics (e.g., self-management skills), 3 on caregiver characteristics (e.g., professionalism), 11 healthcare-related tasks and requirements (e.g., wound management), 8 on factors of the physical environment (e.g., controllability), medical devices and technologies (e.g., carrying systems for external components), and cultural, social and community environment (e.g., interaction with peers), as well as 3 on external environmental factors (e.g., healthcare infrastructure).
CONCLUSIONS: The present study represents the first investigation focusing on aspects of the healthcare context influencing healthcare quality and safety from the perspective of LVAD patients in Germany. LVAD aftercare covers a broad and complex range of tasks. For this, patients, caregivers and healthcare professionals need specific knowledge, which is lacking in various respects. In the first place, this is compensated by the patients\' own initiative and the personal care provided by the VAD outpatient clinics.
CONCLUSIONS: Three key recommendations to optimize aftercare from the patient perspective are derived: Patients would benefit from a more flexible and decentralized aftercare concept, to which telemedicine could contribute. LVAD-specific expertise among general healthcare providers is perceived as insufficient by patients and could be strengthened through training and counseling services. The broad scope of tasks and the high level of responsibilities in LVAD aftercare pose challenges for patients and their families, which could be addressed through continuous information and training programs.
摘要：
背景：左心室辅助装置（LVAD）的植入需要大量的后期护理。目前还不清楚如何从患者的角度设计善后护理。可以基于对医疗保健背景的检查来开发含义。它的主要组成部分在Henriksen的《家庭保健模式的人为因素》中绘制了五个层次，约瑟夫,和Zayas-Caban（2009）。使用这个模型，本研究探讨了患者对LVAD植入后医疗保健背景的看法.
方法：我们采用了定性横断面研究，LVAD患者参加半结构化访谈.使用内容分析对转录的访谈进行了分析。首先,确定了相关的含义单位，并将其演绎分类到模型中。然后，护理相关方面的类别在每个模型层中进行归纳开发。
结果：我们采访了18名年龄在33至78岁之间生活在LVAD中几周至10年以上的患者。在模型层中开发了与护理方面相关的28个类别：关于患者特征的3个类别(例如，自我管理技能)，3关于护理人员特征(例如，敬业精神),11与医疗保健相关的任务和要求(例如，伤口处理)，8关于物理环境因素(例如，可控性)，医疗设备和技术(例如，外部组件的运载系统)，文化,社会和社区环境(例如，与同行的互动)，以及3关于外部环境因素(例如，医疗保健基础设施)。
结论：本研究代表了从德国LVAD患者的角度关注影响医疗保健质量和安全性的医疗保健环境方面的首次调查。LVAD后期护理涵盖了广泛而复杂的任务范围。为此，病人,护理人员和医疗保健专业人员需要特定的知识，这在各个方面都是缺乏的。首先,这是由患者主动和VAD门诊提供的个人护理补偿。
结论：从患者角度出发，得出了优化善后护理的三个关键建议：患者将受益于更灵活和分散的善后护理概念，远程医疗可以做出贡献。患者认为一般医疗保健提供者中LVAD特定的专业知识不足，可以通过培训和咨询服务来加强。LVAD善后护理的广泛任务和高度责任给患者及其家属带来了挑战，可以通过持续的信息和培训计划来解决。
方法：我们采用了定性横断面研究，LVAD患者参加半结构化访谈.使用内容分析对转录的访谈进行了分析。首先,确定了相关的含义单位，并将其演绎分类到模型中。然后，护理相关方面的类别在每个模型层中进行归纳开发。
结果：我们采访了18名年龄在33至78岁之间生活在LVAD中几周至10年以上的患者。在模型层中开发了与护理方面相关的28个类别：关于患者特征的3个类别(例如，自我管理技能)，3关于护理人员特征(例如，敬业精神),11与医疗保健相关的任务和要求(例如，伤口处理)，8关于物理环境因素(例如，可控性)，医疗设备和技术(例如，外部组件的运载系统)，文化,社会和社区环境(例如，与同行的互动)，以及3关于外部环境因素(例如，医疗保健基础设施)。
结论：本研究代表了从德国LVAD患者的角度关注影响医疗保健质量和安全性的医疗保健环境方面的首次调查。LVAD后期护理涵盖了广泛而复杂的任务范围。为此，病人,护理人员和医疗保健专业人员需要特定的知识，这在各个方面都是缺乏的。首先,这是由患者主动和VAD门诊提供的个人护理补偿。
结论：从患者角度出发，得出了优化善后护理的三个关键建议：患者将受益于更灵活和分散的善后护理概念，远程医疗可以做出贡献。患者认为一般医疗保健提供者中LVAD特定的专业知识不足，可以通过培训和咨询服务来加强。LVAD善后护理的广泛任务和高度责任给患者及其家属带来了挑战，可以通过持续的信息和培训计划来解决。
