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‘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
Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linnaeus University, Linnaeus Knowledge Environments, Sustainable Health. Karolinska Institutet, Sweden. (ReAction)ORCID iD: 0000-0002-4108-391x
Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. (ReAction)ORCID iD: 0000-0002-0895-674x
Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. University of Calgary, Canada. (ReAction)ORCID iD: 0000-0001-9687-7242
Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. (ReAction)ORCID iD: 0000-0003-0338-7610
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2022 (English)In: BMJ Open, E-ISSN 2044-6055, Vol. 12, no 5, article id e057261Article in journal (Refereed) Published
Abstract [en]

Objective Safety 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.

Design A 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.

Setting Home care services organisations providing care to older people in their private homes in two municipalities in southern Sweden.Participants Purposeful sampling of 24 assistant nurses and three managers from municipal home care services and a local geriatric hospital clinic.

Results Home 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.

Conclusions Safety 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.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2022. Vol. 12, no 5, article id e057261
Keywords [en]
Safety performance, Resilience, Home care, Assistant nurses, Continuity of care, Forum Play
National Category
Nursing Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Health and Caring Sciences; Health and Caring Sciences, Nursing
Identifiers
URN: urn:nbn:se:lnu:diva-112915DOI: 10.1136/bmjopen-2021-057261ISI: 000797594300001PubMedID: 35580971Scopus ID: 2-s2.0-85130131212OAI: oai:DiVA.org:lnu-112915DiVA, id: diva2:1658926
Funder
The Kamprad Family Foundation, Dnr 20190249Forte, Swedish Research Council for Health, Working Life and Welfare, Dnr 2017-00202Available from: 2022-05-18 Created: 2022-05-18 Last updated: 2023-08-28Bibliographically approved

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Ekstedt, MirjamSchildmeijer, KristinaLjungholm, LindaFagerström, Cecilia

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