Home health care for mechanical ventilation-dependent patients: A grounded theory study

The number of people requiring home mechanical ventilation is increasing. Both family and patients experience a quite different situation. There is a significant knowledge gap about the caring process, families and health care team responsibilities, challenges they face, and how they manage. This study aimed to discover the process of home health care (HHC) to mechanical ventilation-dependent patients. The Straus and Corbin version of the grounded theory method was used. The preliminary study was conducted in 2015, and then for updating the theory, a complementary study was done in 2019. Sampling began purposefully and then was followed by theoretical sampling. A total of 28 participants, including 14 professional health care workers, 12 family members, and two improved patients were interviewed. Data were analysed using MAXQDA 2010 with constant comparative analysis method. After this step and the formation of concepts, structure, and the relation between them and exploring the process, the related theory was presented. The data analysis revealed 64 primary categories, that have been clustered into eight categories, and finally in three main concepts of "challenging care with stress and ambivalence", "step-by-step care delegation", and "professional and limited". After organising the memos, drawing the diagrams, and writing the storyline, "challenging care with stress and ambivalence" emerged as the main concern. Families tend to provide care without reducing quality. So, using the "step-by-step care delegation" strategy they delegate the care from professional to unprofessional caregivers. This strategy could lead to the "supported independence" of families and "professional development" of nurses. Families experience a challenging situation during care delivery to mechanical ventilation-dependent patients at home. The most important challenge is insufficient insurance coverage and an inappropriate legal framework for service delivery. Hence, the study results could be used by policymakers to improve HHC policies.