Task-shifting in Home Health Care - Multiple case study of health care tasks shifted to patients.: Multiple case study of health care tasks shifted to patients.
Translated title
Task-shifting in Home Health Care - Multiple case study of health care tasks shifted to patients.
Author
Jacobsen, Anja Marie Lundin
Term
4. term
Education
Publication year
2021
Submitted on
2021-06-04
Pages
60
Abstract
Denne afhandling undersøger, hvad der sker, når behandlingsopgaver flyttes fra sundhedsprofessionelle til patienter, og udføres i patienters eget hjem. Tre cases blev udvalgt for at vise forskellige grader af opgaveflytning. Projektet er et fler-casestudie baseret på semistrukturerede interviews med både patienter og sundhedsprofessionelle. Analysen fokuserede på, hvordan ansvar for behandling og forståelse af kvalitet fordeles og praktiseres i hjemmet. Som teoretisk ramme blev der inddraget idéer om hjemmet (Winther, Heidegger, Douglas), omsorgsteorier (Mol og Pols) om aktive, tilpassende patienter, der “tinkerer” (afprøver og justerer), og om pleje-/omsorgsteams, samt begrebet “stilladsering” (scaffolding) hos Botin, der beskriver støtte og opbygning af kompetencer og netværk omkring patienten. På tværs af cases var der både forskelle og fælles træk i, hvordan behandlingskvalitet og ansvar blev håndteret. Uanset hvilke opgaver der var flyttet, havde klare instruktioner stor betydning for patienters forståelse af kvalitetssikring. Patienter tager kalkulerede risici i hverdagen, mens sundhedsprofessionelle afvejer risikoen for utilsigtede hændelser mod fordelene ved at sende patienter hjem. En central drivkraft er livskvalitet (QoL), som opleves af både patienter og fagfolk, og rapportering af utilsigtede hændelser er en vigtig mekanisme til at sikre kvaliteten i hjemmebehandling. Livskvaliteten øges ofte gennem den mobilitet, som bærbare teknologier giver. Ansvarsbyrden kan føles tung, især når patienter møder sundhedsprofessionelle, der ikke kender eller forsøger at forstå deres specialiserede behandling. Mange patienter påtager sig det rolleansvar, der kræves for at håndtere hjemmebehandlingen. Når ansvar afvises eller vurderes placeret for uansvarligt, kan primærsektoren inddrages. Nogle patienter oplever et moralsk ansvar for at sikre medicinkvalitet og undgå ressourcespild. Hjemmet kan ombygges og tilpasses med hjælpemidler, samtidig med at man prøver at undgå, at det ligner et hospital; det kræver planlægning sammen med samboende. Sundhedsprofessionelle, familie og teknologi indgår på forskellige måder som vigtige medlemmer af omsorgsteamet, og netværk kan bruges til at styrke teamets samlede indsats.
This thesis examines what happens when treatment tasks are shifted from health care professionals to patients and carried out in patients’ homes. Three cases were selected to represent different levels of task-shifting. The project used a multiple case study design with semi-structured interviews of both patients and health care professionals. The analysis focused on how treatment responsibility and perceptions of quality are distributed and practiced at home. The theoretical frame drew on ideas about the home (Winther, Heidegger, Douglas), care theories (Mol and Pols) about active, “tinkering” patients who adjust and try things out, and care teams, as well as Botin’s concept of scaffolding to describe how support and competence networks are built around patients. Across the cases, there were both differences and common patterns in how quality and responsibility were handled. Regardless of which tasks were shifted, clear instruction was crucial for patients’ understanding of quality assurance. Patients take calculated risks in everyday life, while professionals balance the risk of adverse events against the benefits of discharging patients to home. A key incentive is quality of life (QoL), as experienced by both patients and clinicians, and reporting adverse events is an important mechanism to safeguard quality in home-based care. QoL often improves through the mobility enabled by portable technologies. The burden of responsibility can feel heavy, especially when communicating with professionals who do not understand the patient’s specialized treatment. Many patients assume the role-responsibility needed to manage home treatment; when responsibility is refused or viewed as inappropriately placed, primary care can be engaged. Some patients feel a moral responsibility to ensure medicine quality and avoid wasting resources. Homes can be adapted to accommodate treatment-related equipment and aids while avoiding a hospital-like feel; this requires planning with co-dwellers. Health professionals, family members, and devices each contribute as important parts of the care team, and broader networks can be consulted to strengthen the team.
[This summary has been rewritten with the help of AI based on the project's original abstract]
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