Safe care at home for frail older people. Perspectives of care receivers and care professionals

Abstract

The body of evidence regarding what is needed to ensure safe care is growing, but the ongoing movement of healthcare from inpatient contexts to primary care settings highlights how much knowledge we lack regarding safe care at home for frail older people while still needing to decrease the large number of adverse events in such settings. The overall aim of this thesis was therefore to illuminate the enablers and barriers to safe care at home for frail older people. Methods: Data were gathered through individual interviews with frail older people (Study I), focus group interviews with care professionals (Study II), a survey on patient safety culture among care professionals in home care (Study III) and individual interviews with nurses with overall responsibility for safe healthcare in a municipality (Study IV). The data were analysed using qualitative content analysis (Study I), a phenomenographic approach (Study II), statistical analyses (Study III) and thematic analysis (Study IV). Main findings: Safe care was associated with shared decision-making and the creation of trusting relationships between frail older people and care professionals, as well as with good collaboration within and between professional groups. These processes were facilitated by care professionals’ communication openness, common goals and individual approaches and competence. The greatest barriers to providing safe care were associated with organisational issues, such as strictly regulated schedules; the absence of functioning communication structures; staff turnover and loss of competence; insufficient staff involvement in patient safety work; and the sense of being punished. Conclusions: The findings illuminate care professionals’ constant need to prioritise between tasks and relationships and the pressure to make decisions under strenuous conditions by drawing on their individual competences and by taking more responsibility; they also show a clear connection between safe care and person-centred care. Nevertheless, a gap between ideology and practice indicates the need for support for care professionals in their endeavours to implement a person-centred approach.