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Home health care professionals’ experiences of working in integrated teams during the COVID-19 pandemic: a qualitative thematic study
Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). School of Health Sciences, University of Skövde, Skövde, Sweden.ORCID iD: 0000-0001-6484-9239
School of Health Sciences, University of Skövde, Skövde, Sweden.
School of Health Sciences, University of Skövde, Skövde, Sweden; College of Nursing, University of Rhode Island, Kingston, RI, United States.
2022 (English)In: BMC Primary Care, E-ISSN 2731-4553, Vol. 23, no 1, article id 325Article in journal (Refereed) Published
Abstract [en]

Background: Since COVID-19 emerged, over 514 million COVID-19 cases and 6 million COVID-19-related deaths have been reported worldwide. Older persons receiving home health care often have co-morbidities that require advanced medical care, and are at risk of becoming severely ill or dying from COVID-19. In Sweden, over 10,000 COVID-19-related deaths have been reported among persons receiving municipal home health and social care. Home health care professionals have been working with the patients most at risk if infected. Most research has focused on the experiences of professionals in hospitals and assistant nurses in a home care setting. It is therefore valuable to study the experiences of the registered nurses and physicians working in home health care during the COVID-19 pandemic to learn lessons to inform future work.

Method: A thematic qualitative study design using a semi-structured interview guide.

Results: The health care professionals experienced being forced into changed ways of working, which disrupted building and maintaining relationships with other health care professionals, and interrupted home health care. The health care professionals described being forced into digital and phone communication instead of in-person meetings, which negatively influenced the quality of care. The COVID-19 pandemic brought worry about illness for the health care professionals, including worrying about infecting patients, co-workers, and themselves, as well as worry about upholding the provision of health care because of increasing sick leave. The health care professionals felt powerless in the face of their patients’ declining health. They also faced worry and guilt from the patients’ next of kin.

Conclusion: Home health care professionals have faced the COVID-19 pandemic while working across organizational borders, caring for older patients who have been isolated during the pandemic and trying to prevent declining health and feelings of isolation. Due to the forced use of digital and phone communication instead of in-person visits, the home health care professionals experienced a reduction in the patients’ quality of care and difficulty maintaining good communication between the professions. 

Place, publisher, year, edition, pages
BioMed Central (BMC), 2022. Vol. 23, no 1, article id 325
Keywords [en]
COVID-19, Home health care, Home health care physician, Municipal care, Qualitative, Registered nurse, Thematic analysis
National Category
Nursing
Identifiers
URN: urn:nbn:se:hj:diva-59260DOI: 10.1186/s12875-022-01934-1ISI: 000899229300002PubMedID: 36517792Scopus ID: 2-s2.0-85144217881Local ID: GOA;;850557OAI: oai:DiVA.org:hj-59260DiVA, id: diva2:1722769
Funder
The Kamprad Family Foundation, 20190175Available from: 2022-12-30 Created: 2022-12-30 Last updated: 2024-05-16Bibliographically approved
In thesis
1. Within an integrated home health care model: Registered nurses’, physicians’, patients’ and their next of kin’s perspectives
Open this publication in new window or tab >>Within an integrated home health care model: Registered nurses’, physicians’, patients’ and their next of kin’s perspectives
2024 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Many older patients receive health care from several different healthcare organizations, which may lead uncertainty about the responsibility for their healthcare needs. Integrated care has been argued to aid the healthcare system by addressing the challenge of the complex care needs of older patients with multiple health problems. Previous research has stated that integrated care models often have been developed with a focus on a single diagnosis, which risks overlooking the extensive and complex care needs of older patients. Prior research has also expressed the need to deepen knowledge about how integrated care models influence health care professionals, patients and their next of kin. Moreover, it is important to understand how the COVID-19 pandemic affected integrated care models which may expand knowledge about integrated home health care in crisis situations.

The overall aim is to study expectations, perceptions and experiences of integrated home health care through the perspective of registered nurses, physicians, patients and their next of kin.

Inductive qualitative designs where data was collected through interviews and field notes in the setting of the mobile integrated care model with a home health care physician (MICM) with registered nurses, physicians and patients and next of kin. Analysis was conducted using qualitative content analysis, phenomenography, and thematic analysis.

The emphasis on person-centered care in the MICM was evident in the perceptions of the healthcare professionals about the patients and their next of kin, whom they viewed as persons, not simply recipients of health care. Differences were found in the health care provided in the MICM and in comparison, to other healthcare organizations which did not align with the person-centered care ethics. However, providing health care to patients in their own home benefited the provision of person-centered care – the value base of the MICM. The MICM was created with the goal of implementing individually tailored and coherent health care with increased continuity. The healthcare professionals viewed individual medical healthcare plans as co-created with each patient, and yet no patient could recall participating in this co-creation. The coherency of the MICM was regarded as having been improved by teamwork between the registered nurse and the home healthcare physician. Collaborations with other healthcare professionals rarely occurred and should be improved in the future. Participants reported varying experiences of continuity in the MICM, which influenced the possibility of building relationships. Providing continuity with a home healthcare physician for patients is therefore preferable. The work described in this thesis was conducted during the COVID-19 pandemic. The thesis provides unique insights into an integrated care model during a crisis situation, which the healthcare system may face in similar or different ways in the future. The MICM was upheld as the best way to work in home health care, especially as patients and their next of kin regarded the model as making their daily lives easier.

Place, publisher, year, edition, pages
Jönköping: Jönköping University, School of Health and Welfare, 2024. p. 104
Series
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 136
Keywords
home health care, home health care physician, municipality nursing, integrated care, person-centered care, qualitative content analysis, phenomenography, thematic analysis
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-64232 (URN)978-91-88669-47-6 (ISBN)978-91-88669-48-3 (ISBN)
Public defence
2024-06-05, G110, University of Skövde, Skövde, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2024-05-16 Created: 2024-05-16 Last updated: 2024-06-04Bibliographically approved

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