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Home care for patients with dirty homes: a qualitative study of the problems experienced by nurses and possible
Anke J E De Veer1, Kim De Groot2,3, Renate Verkaik2
1Netherlands Institute for Health Services Research (Nivel), PO Box 1568, 3500BN, Utrecht, The Netherlands. a.deveer@nivel.nl.
Background:
Home-care nurses are often the first care professionals to enter a dirty home. The perceived problems and support needs of home-care nurses in these situations are largely unknown.
Objective:
To examine the problems home-care nurses encounter in caring for patients living in dirty homes, and possible solutions for these problems.
Design:
Qualitative descriptive research.
Setting:
Communities across the Netherlands.
Participants:
Twenty-three participants to investigate the problems or needs experienced, and 20 participants to investigate solutions. Participants included patients, home-care nurses and other professionals working in the community.
Methods:
Semi-structured interviews were conducted with 23 participants and analysed according to the principles of deductive thematic analysis. Subsequently, in interviews with 4 (representatives of) patients and four focus-group sessions with 16 professionals, the problems found were validated and solutions to the problems discussed.
Results:
Ten subthemes emerged that were clustered into three main themes: 'dilemmas arise in choosing the right nursing care'; 'cooperation and an integrated approach are often necessary, but lacking'; 'home-care nurses have insufficient competencies'. Seven possible solutions were found: (1) strengthening collaboration between organizations in the community; (2) involving others sooner; (3) case management; (4) person-centred care; (5) taking more time; (6) providing home-care nurses with tools and support services; and (7) strengthening the competencies of nurses.
Conclusions:
Care for patients with a dirty home is complex. An integrated person-centred care approach is often necessary and home-care nurses need extra support to provide such care. Interventions should not only focus on patients, but address the nurses, the organization, and the collaboration between organizations in the community.
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