Barriers to Timely Care of Acute Infections in Nursing Homes: A Preliminary Qualitative Study
| Autor: | David R. Mehr, Jake Young, Lucille D. Salerno, Erik J Lindbloom, Daniel R. Longo |
|---|---|
| Rok vydání: | 2002 |
| Předmět: |
Male
medicine.medical_specialty Infections Nursing Health care medicine Humans Nurse education Qualitative Research Primary nursing General Nursing Aged Aged 80 and over Patient Care Team Missouri business.industry Communication Health Policy Process Assessment Health Care Professional-Patient Relations General Medicine Focus Groups Focus group Ambulatory care nursing Nursing Homes Nursing Outcomes Classification Team nursing Family medicine Acute Disease Female Geriatrics and Gerontology business Qualitative research |
| Zdroj: | Journal of the American Medical Directors Association. 3:360-365 |
| ISSN: | 1525-8610 |
| DOI: | 10.1016/s1525-8610(04)70527-7 |
| Popis: | Background and Objectives During a large prospective study of lower respiratory infections in nursing home residents, project staff observed that in some facilities there was consistent difficulty in obtaining timely identification of potential subjects. Starting with this motivation, we conducted a preliminary qualitative study to investigate the process of illness identification and initiating management in episodes of acute infection. We sought factors promoting timely or delayed identification and treatment of acute infections among nursing home residents. Design Qualitative study using focus groups and in-depth semi-structured interviews of residents, nurses, and physicians involved in episodes of acute-illness care in nursing home residents. Setting Four nursing homes participating in a longitudinal study of the course and outcomes of lower respiratory infection. Participants Focus groups included nurses and physicians with experience in nursing home care. Interviews were conducted with those involved in six episodes of acute illness. Interviewees included four nursing home residents (two others were not cognitively intact), seven nurses, and six physicians or their staff. Data Analysis Identifying themes from focus group contributions and content analyses of interviews. Results We identified a four-stage model describing illness identification and management. Content analysis of interview transcripts revealed 22 factors that influenced timeliness of effective care with communication problems commanding the central focus. Barriers included: (1) failure of the communication medium; (2) evening or weekend illness onset with concomitant difficulty in contacting an on-call physician; (3) clinical decision-makers who interact through intermediaries; (4) the communication of inappropriate or inaccurate information; (5) inadequate information transfer at shift changes; and (6) prior relationship between staff nurse and physician. Conclusion Effective identification and management of acute infections requires successful communication at multiple levels; however, breakdowns are common. Our model provides a framework for improving acute illness care in nursing homes, which offers important insights potentially useful in quality improvement activities in nursing homes and may facilitate further research. |
| Databáze: | OpenAIRE |
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