Collaboration between relatives of frail elderly patients and nurses in acute hospital wards. Dimensions, prerequisites and outcome

• The aim was to investigate collaboration between relatives of frail elderly patients and nurses in acute hospital wards, and to develop and test an instrument to investigate, from the relatives? perspective, dimensions of collaboration in this context and the association between collaboration and satisfaction with the hospital care trajectory. The underpinning assumption for the study was that relatives hold knowledge of the patients? situation, which is important for nurses to make a relevant and sufficient care plan. The first two studies were qualitative, investigating relatives? and nurses? experiences of the collaboration with each other. Eight relatives of elderly patients ³ 75 years of age, living at home and dependent on formal and informal help participated. Eight nurses (6 RN + 2 LPN) who conducted the discharge of the elderly patient participated in the second study. In the third study an instrument was developed for measuring collaboration, its prerequisites and outcomes from the relatives? perspective, and put through psychometric testing. In this study, and in the fourth study, which investigated the association between collaboration and satisfaction with the hospital care trajectory, 156 relatives of elderly patients participated. The context was acute medical and geriatric wards in two Danish hospitals. The lived experience of being a relative to a frail elderly patient revealed itself in two main essences: The history reflected the relationship and care history and was the frame of reference in which the hospital admission was interpreted and understood. The constituents were: The adult child, Parent for my mother, It is always in the back of my mind and A full time job. The essence Standing Guard encompassed the encounter with the hospital system and the constituents were: My God, is it now?, Powerless, If you relax, you fail, Watchdog and case manager and Those poor, poor people. The main theme in the interviews with nurses was Encountering relatives ? To be caught between ideals and practice and reflected that the nurses seemingly held two sets of conflicting attitudes towards relatives and the collaboration with them: One ideal and in accordance with their professional values, and another seemingly governing collaboration in practice. Themes were: The coincidental encounter ? the collaboration, which reflected that though ideally described as a structured process, collaboration appeared to be coincidental and rare; and Relatives ? a demanding resource. The sub themes were: Flee or fight ? the nurses? response, A matter of prioritising ? Barriers and promoters, The unwritten rules and The new relatives ? the demanding and unrealistic relatives. A model for collaboration was developed from literature and constituted the basis for development of instrument variables and items. In the factor analysis (PCA) five factors were extracted: ?Influence on decisions?, ?Quality of contact with nurses?, ?Trust and its prerequisites?, ?Achieved information level? and ?Influence on discharge?. The factor analysis supported the assumption that collaboration was a multi-dimensional construct characterised by shared decision-making and exchange of knowledge and information, with prerequisites such as quality of the contact and communication based on trust and respect. The instrument was mainly reliable and valid, although caution should be made due to the sample being small, and the design being cross sectional. Systematic dropout indicated that the study might have missed the most strained, the oldest and the least educated relatives. Further testing after a reduction of items as well as revising of the wording in some items is warranted. Dimensions of collaboration were predictors for the relatives? satisfaction with the hospital care trajectory, and lower ratings of collaboration were significantly associated with lower level of satisfaction. Further, powerlessness, guilt, having provided help less than one year and not providing psychosocial help were predictors for relatives? satisfaction with the hospital care trajectory. Whereas relatives rated poorly on influence on decisions and exchange of knowledge and information, the contact and relationship qualities with nurses were seemingly more satisfactory, although accessibility of nurses appeared to be a problem.

• Popular Abstract in Swedish Formålet var at undersøge samspillet mellem pårørende til svækkede ældre patienter og sygeplejepersonalet i akutte hospitalsafdelinger, samt at udvikle og teste et instrument til at undersøge, udfra pårørendes perspektiv, samspillets dimensioner i denne kontekst og associationen mellem samspil og tilfredshed med patientforløbet. Den underliggende antagelse for studiet var at pårørende har viden om patientens situation, som er vigtig for at plejepersonalet kan lægge en relevant og sufficient plejeplan. De to første studier var kvalitative og undersøgte pårørendes og plejepersonalets oplevelse af samspillet med hinanden. Otte pårørende til ældre patienter ³ 75 år, som boede i eget hjem og var afhængig af formel og uformel hjælp, deltog. Seks sygeplejersker og to social- og sundhedsassistenter (underskötersker), som varetog udskrivelsen af den ældre patient deltog i delstudie to. I det tredje studie blev et instrument til at score pårørendes vurdering af samspillet, dets forudsætninger og resultat udviklet og testet. I dette samt i det fjerde delstudie, som undersøgte sammenhængen mellem samspillet og pårørendes tilfredshed med patientforløbet, deltog 156 pårørende. Konteksten var akut medicinsk og geriatrisk afdeling i to danske hospitaler. Resultater Delstudie 1: Den oplevede erfaring af at være pårørende til en svækket ældre patient viste sig i to hovedessenser: Historien som reflekterede forholdets og omsorgens historie og var referencerammen for den måde hospitalsopholdet blev fortolket og forstået. Delessenserne var: Det voksne barn, Forælder for min mor, Det er altid i mit baghoved og Et fuldtidsjob. Den anden hovedessens var At stå vagt, hvilket omfattede mødet med hospitalsvæsenet. Delessenserne var: Min Gud, er det nu?, Magtesløs, Hvis man slapper af, så svigter man, Vagthund og case manager og De stakkels, stakkels mennesker. Delstudie 2: Hovedtemaet i interviewene med plejepersonalet var Mødet med pårørende ? at være fanget mellem ideal og praksis. Det reflekterede at deltagerne tilsyneladende havde to set holdninger til pårørende og samspillet med dem, og disse holdninger var i konflikt med hinanden. Det ene sæt var ideelle og i overensstemmelse med deres professionelle værdier, det andet var ikke og så ud til at være styrende for samspillet i praksis. Temaer var: Det tilfældige møde ? samspillet, hvilket reflekterede at selvom samspillet ideelt blev beskrevet som en struktureret proces, så var samspil tilsyneladende tilfældigt og sjældent forekommende; og Pårørende ? en krævende ressource. Undertemaer var: Flygt eller kæmp ? plejepersonalets respons, Et spørgsmål om prioritering ? barrierer og fremmere, De uskrevne regler og De nye pårørende ? de krævende og urealistiske pårørende. Delstudie 3: En model for samspil blev udviklet på basis af litteraturstudier og var udgangspunktet for udviklingen af variabler og spørgsmål i et instrument. En faktoranalyse (principal component analysis) resulterede i fem faktorer: ?Indflydelse på beslutninger?, ?Kvaliteten af kontakten med plejepersonalet?, ?Tillid og forudsætninger for den?, ?Opnået informationsniveau? samt ?Indflydelse på udskrivelsen?. Faktoranalysen gav støtte til antagelsen om at samspil er en multidimensional konstruktion karakteriseret af delt beslutningstagning og udveksling af viden og information med forudsætninger som kontaktens kvalitet og kommunikation baseret på tillid og respekt. Instrumentet var hovedsageligt reliabelt og validt, selvom man skal være opmærksom på at udvalget var lille og studiet baseret på et tværsnitsdesign. Systematisk bortfald indikerede at studiet mangler de mest belastede, de ældste og de mindst uddannede pårørende. Yderligere testning er påkrævet efter en reduktion af antallet af spørgsmål samt omformulering af visse spørgsmål. Delstudie 4: Dimensioner af samspil var prædiktorer for tilfredshed med patientforløbet blandt pårørende og lavt scoret samspil var signifikant associeret med lav tilfredshed. Videre var magtesløshed, skyld, at have hjulpet den ældre i mindre end ét år, og det ikke at give psykosocial hjælp prædiktorer for lav tilfredshed med patientforløbet. Pårørende scorede dårligt, når det gjaldt indflydelse på beslutninger og udveksling af viden og information, hvorimod kontakten med plejepersonalet og relationens kvalitet tilsyneladende var mere tilfredsstillende, selvom plejepersonalets tilgængelighed var et problem.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Hälsovetenskap -- Omvårdnad (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Health Sciences -- Nursing (hsv//eng)

Nyckelord

Socialmedicin

Gerontologi

Humanities

Humaniora

Social medicine

Gerontology

Content analysis

Phenomenology

Powerlessness

Guilt

Outcome

Instrument development and validation

Acute care facility

Frail elderly

Family care

Collaboration

Decision-making

samhällsmedicin

Questionnaire

Publikations- och innehållstyp

dok (ämneskategori)

vet (ämneskategori)