Introduction
Background
Method
Participants
Row | Code | Qualitative research technique | Gender | Participant | Age (year) | Marital status | Level of education | History of participation in home care |
---|---|---|---|---|---|---|---|---|
1 | A | Interview | Female | Nurse | 51 | Married | MS | 20 years |
2 | B | Interview | Male | Nurse | 36 | Married | MS | 10 years |
3 | C | Interview | Female | Nurse | 32 | Single | BS | 8 years |
4 | D | Interview | Female | Nurse | 37 | Single | BS | 7 years |
5 | E | Interview | Male | Nurse | 37 | Married | BS | 9 years |
6 | H | Interview | Male | Nurse(supervisor) | 45 | Married | BS | 12 years |
7 | N | Interview | Male | Nurse | 40 | Married | BS | 5 years |
8 | Q | Interview | Female | Nurse(supervisor) | 48 | Married | MS | 20 years |
9 | R | Interview | Female | Home care inspector | 42 | Married | BS | 12 years |
10 | S | Interview | Male | Nurse | 26 | Single | BS | 2 years |
11 | T | Interview | Female | Nursing assistant | 32 | Single | BS- Nursing assistance course | 6 years |
12 | U | Interview | Male | Nursing assistant | 28 | Married | BS- Nursing assistance course | 2 years |
13 | F | Interview | Male | Patient's son | 41 | Married | MS | 3 months |
14 | O | Interview | Male | Patient's spouse | 39 | Single | BS | 3 years |
15 | P | Interview | Female | Patient's daughter | 35 | Single | High school diploma | 1 year and two months |
16 | W | Interview | Male | Home care physician | 51 | Married | Anesthesiologist and special care specialist | 8 years |
17 | G | Observation | Female | Nurse | 32 | Married | BS | 6 years |
Female | Patient's spouse | 55 | Married | High school diploma | 6 months | |||
Male | Patient (ALS) | 69 | Married | MS | 6 months | |||
18 | I | Observation | Female | Nurse | 47 | Single | BS | 10 years |
Male | Patient's spouse | 79 | Married | High school diploma | 9 months | |||
Female | Patient (CVA) | 76 | Married | MS | 9 months | |||
19 | J | Observation | Male | Nurse | 37 | Married | BS | 11 years |
Male | Patient's son | 51 | Married | MS | 1 months | |||
Female | Patient (Lung Cancer) | 86 | Married | High school diploma | 1 months | |||
20 | M | Observation | Male | Nurse | 45 | Single | MS | 10 years |
Female | Patient's daughter | 41 | Married | MS | 1 year | |||
Male | Patient (DM) | 79 | Married | MS | 1 year |
Data collection method
Interview
Observation
Data analysis
Stages | Description (Action) |
---|---|
1. Analyzing the data for concepts | In this stage, the interviews and observations were transcribed by the researcher (S.K.) within 24 h after each interview to maintain the data integrity. The transcripts were analyzed using the Comment option in the Microsoft Word software with active participation of the research team. Then, codes were assigned to the transcripts. In fact, the data were broken into the smallest possible components. Codes that implied the same meaning and concept were placed in a single conceptual category. In this stage, note-taking, constant comparison, field note and theoretical sampling were used as part of the analysis process |
2. Elaborating the analysis | In this stage, events that were conceptually similar to previously coded events were placed in the same category. Each new event that was placed in the same category added to its general characteristics and dimensions and enriched is diversity. Then, the concepts were placed in more abstract categories according to their characteristics and dimensions. Here, the researcher constantly used the constant comparison method and compared different parts of an interview with other parts, as well as the codes and categories resulting from one interview with other interviews. This process continued until reaching a complete description of each category in terms of its dimensions and characteristics. All members of the research team commented on and discussed the emerging codes and categories in weekly meetings |
3. Analyzing data for context | In this stage, the researchers identified different conditions in which the studied phenomenon occurred. They also considered the conditions affecting the phenomenon and identified the situations that led to emergence of a safe care model. The structural/contextual factors affecting the process were also identified |
4. Bring process into the analysis | In this stage, the researchers investigated the participants' strategies and behaviors. They further immersed themselves in the categories while simultaneously performing constant comparison. They sought to discover the process of patient safety in home health care as the main theme |
5. Integrating concepts around a core category | In this stage, the main category was identified. Besides, the subcategories of the main category were identified and a theory was developed. Notes were reread, story lines were created, and diagrams were drawn to achieve final integration. In addition, a reflective coding matrix was used to describe the main category more precisely and determine its characteristics, dimensions, process, context and outcomes. Data saturation occurred when no new codes were identified and categories were coherent and logically relevant |
Trustworthiness and rigor
Results
Main category | Sub-category | Primary categories |
---|---|---|
Prevention-based assessment | Primary assessment | Examining the requirements for safe patient transfer to home (first entry) |
Assessment during patient handover to next shift | ||
Assessment for self-protection | ||
Secondary assessment | Comprehensive patient examination | |
Checking all connections | ||
History taking | ||
Checking the equipment and facilities | ||
Checking the drug storage | ||
Checking the patient environment and position | ||
Dynamic assessment | Continuous assessment of the patient's condition | |
Continuous assessment of the patient's medication and equipment function | ||
Foresight | Predicting problems | Estimating the possible risks and problems |
Predicting and estimating the deficiencies | ||
Organization and supply (facilities) | Eliminating deficiencies | |
Organizing the environment around the patient | ||
Establishment of safety | Environmental safety | Redesigning the environment |
Adaptation to the environment | ||
Targeted safety | Safe nutrition | |
Providing safe personal hygiene | ||
Controlling infection | ||
Controlling immobility complications | ||
Airway protection | ||
Establishing safe activity and relaxation | ||
Safety during emergencies | Basic resuscitation safety | |
Quick patient transfer to the hospital | ||
Medication safety | Adhering to the principles of prescribing emergency drugs (consulting a doctor or supervisor over the phone) | |
Adhering to the principles of prescribing common medicines | ||
Remote/ participatory safety | Safety by educating the family | |
Safety by delegation | ||
Safety by reassuring and building trust | ||
Direct consultation | ||
Remote consultation | ||
Verification | Assessment | Gaining confidence through assessment |
Gaining confidence by taking and presenting reports | ||
Monitoring and control | Direct supervision | |
Remote supervision | ||
Direct reporting | ||
Remote reporting |
Categories and sub-categories
Prevention-based assessment
"I always go to the patient's home before the patient, and I check all the equipment and supplies previously prepared by the medical team at home." (Nurse Supervisor H)
"During patient handover, I first assess the patient to see if there are any problems so that hey do not pose a danger to them later." (Nurse B)
"The first time my patient wanted to go home, as the center supervisor had told me, I started to check whether all the items of the checklist were prepared, for example, I checked the cupboard." (Patient F's spouse)
"After arriving at the patient’s house, I first check my patient from head to toe." (Nurse A)
"The very first time I start evaluation, I even check the position of my patient's bed, for example to make sure it is not in the middle of the living room." (Nurse C)
"I check the patient's ventilator and oxygen concentrator to make sure it's working because their breathing depends on it." (Nurse D)
"After checking the oxygen concentrator, the nurse took the patient's medicine card, went to the patient's medicine cabinet and checked the drug storage for the next 24 hours" (Observation I)
"While the nurse is sitting writing down her/his report, (s)he is looking at the patient's monitor at the same time, and is constantly evaluating the patient’s condition. Sometimes the nurse stands up and touches the oxygen concentrator to see if it is hot or not." (Observation G)
“Well, the patient's consciousness is something that we are constantly evaluating during a 24-hour period. We will definitely check their consciousness and their oxygen capsule constantly." (Nurse E)
Foresight
"A really good nurse who can predict must be able to predict the problem before it occurs." (Nurse B)
"One is I saw that a patient with tracheostomy did not have an Ambu bag. I predicted what would occur if he had a breathing problem, so I quickly called the center to prepare it." (Nurse A)
"I always keep these drawers of the patient's supplies and medicines in their right place so that if there is a problem, I can find it as soon as possible." (Nurse D)
"...the nurse turned to the supervisor and said, “I think the patient may have shortness of breath. Can you get me a salbutamol spray? Because I found that there is not any.”" (Observation J)
"The nurse asked the patient's son to move his father's bed, which was attached to the wall, to the middle of the room so that the nurse could easily move around the patient in case a problem occurred." (Observation J)
Establishment of safety
"Once I went to the patient's home. I saw that the patient’s bed was at the kitchen door, I asked the family to vacate a room to relocate the patient." (Nurse E)
"When the window was open, it was above my father's head and could have hurt him, so I bought sliding windows." (Patient F' son)
"Prior to each meal, the nurse checked the patient's vital signs and suctioned the patient's mouth for excessive secretions. After that, (s)he asked the family to raise the bed head to 30°." (Observation I)
"The nurse told the family that due to the unstable condition of the patient, it is not possible to transfer him/her to the bathroom, and they should bathe the patient in bed". (Observation G)
"I always ask the nurses to disinfect their hands when they enter our home." (Patient G's spouse)
"I always help the nurses to change my father's position on time. I am very careful that he doesn't get a bed sore. Sometimes, when he is better, we help him to sit in a chair with the nurse's permission." (Patient F's son)
"Suddenly the patient developed bradycardia and cardiac arrest. I immediately told the family to call 911. I told the patient's son to perform heart massage so that I could administer the drugs." (Nurse B)
"We noticed that the patient had shortness of breath. The nurse immediately asked the family to call 911 and started Ambu ventilation." (Observation J)
"I always consult with the doctor or supervisor over the phone or in person, depending on the circumstances, to start a new medication for my patient." (Nurse E)
"Home medication is no different from the hospital medication; we must follow exactly the same eight medicine administration rights." (Nurse E)
"If the supervisor is home and I need advice, I ask him/her in person. If it's midnight, for example, I would call him/her." (Nurse B)
"While the nurse turned the patient to her side, the patient's spouse spread the patient's sheets on the other side and straightened them completely." (Observation G)
Verification
"I always reassess the patient and the condition after doing my tasks and in my free time to make sure my patient is safe." (Nurse E)
"The nurse began reassessing the patient, vital signs, connections, and equipment before the next nurse entered the home." (Observation G)
"The supervisor always makes periodic home visits and asks for reports during these visits. We also try to give him/her a complete report of what happened.” (Nurse C)
"Well, if the supervisor comes with the doctor for a visit, we will report to them and ask for their advice." (Nurse E)
"If the patient is in an acute condition and there is no resuscitation equipment, I will quickly call the supervisor or the doctor and report the condition to them, but if, for example, a patient's test is normal, I will take a picture and send it in the WhatsApp group." (Nurse A)
"The supervisor entered the home for a home visit at a due hour. He first talked with the family, and then went to the patient's room to monitor the patient, equipment, and medications." (Observation I)