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1.
BMC Geriatr ; 21(1): 480, 2021 09 04.
Artigo em Inglês | MEDLINE | ID: mdl-34481476

RESUMO

BACKGROUND: Older adults prefer to age in place. Social network change and health decline challenge ageing in place, as stressors that make age-related advantages disappear. The aim of this study was to explore social network change and health decline and its impact on older adults who are ageing in place. METHOD: In-depth interviews (n = 16) were conducted with older adults who were ageing in place and who were experiencing health decline and social network change. Procedures for grounded theory building were followed to analyse the interviews with respondents who were discharged from the hospital less than 4 months ago (n = 7). Narrative analysis was conducted to reach a deeper understanding of the expected complexity of experiences of this targeted sample. RESULTS: Results encompass a typology with four types of impact: A. Sneak preview of old age, B. Disruptive transition into old age, C. Drastically ageing, and D. Steadily ageing. Additionally, indications were found that older adults should be able to move along the four types of impact and ideally could end up in quartile D, experiencing little or no impact at all (anymore). CONCLUSION: The results present an optimistic view on the possibilities of older adults to continue ageing in place despite experiencing unavoidable and uncontrollable stressors in life. Also, the results provide leads for practice, to develop an action perspective for home care nurses and gerontological social workers to determine and reduce the impact of social network change and health decline on older adults who are ageing in place. Suggestions for further research would be to unravel how to detect temporal setbacks in successful ageing in place.


Assuntos
Serviços de Assistência Domiciliar , Vida Independente , Idoso , Envelhecimento , Humanos , Pesquisa Qualitativa , Rede Social
2.
BMC Health Serv Res ; 21(1): 962, 2021 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-34521407

RESUMO

BACKGROUND: The need for home care workers (HCWs) is rapidly growing in Norway due to the increasingly growing elderly population. HCWs are exposed to a number of occupational hazards and physically demanding work tasks. Musculoskeletal disorders, stress, exhaustion, high sick leave rates and a high probability of being granted a disability pension are common challenges. This qualitative study explored the views of HCWs on how working conditions affect their safety, health, and wellbeing. METHODS: A descriptive and explorative design was utilised using semi-structured individual interviews with eight HCWs from three home care units in a middle-sized Norwegian city. Interviews were conducted in the Norwegian language, audio-recorded, and transcribed verbatim. The data was analysed by systematic text condensation. Key data quotes were translated into English by the authors. RESULTS: HCWs reported that meaningful work-related interactions and relationships contributed to their improved wellbeing. Challenging interactions, such as verbal violence by consumers, were deemed stressful. The unpredictable work conditions HCWs encounter in users' homes contributed to their exposure to environmental hazards and unhealthy physical workloads. This was the case, although the employer promoted ergonomic work practices such as ergonomic body mechanics when mobilising and handling of clients, using safe patient handling equipment. HCWs perceived high level of individual responsibility for complying with company safety policies and practices, representing a health barrier for some. Organisational frameworks created unhealthy work conditions by shift work, time pressure and staffing challenges. Performing tasks in accordance with HCWs professional skills and identity was perceived as health-promoting. CONCLUSIONS: This study suggests that unpredictable working conditions at users' home can adversely affect the safety, health, and wellbeing of HCWs. The interaction between the unpredictable environment at users' homes, HCWs' perceived high level of individual responsibility for complying with company safety policies and practices, and staffing challenges due to sickness-related absences upon the workplace creates tense work conditions with a negative influence on HCWs health.


Assuntos
Serviços de Assistência Domiciliar , Visitadores Domiciliares , Saúde do Trabalhador , Idoso , Humanos , Pesquisa Qualitativa , Local de Trabalho
3.
Crit Care Nurs Q ; 44(4): 379-386, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34437316

RESUMO

The number of patients with chronic diseases requiring invasive mechanical ventilation at home is increasing. Thus, identifying the challenges of this valuable type of care can be an elective step for achieving health-related goals. This study was conducted to determine the challenges faced by home health care providers. Three themes emerged from the data analysis: (1) hospital-based challenges with 2 subthemes: the family unpreparedness for home care and the lack of continuous education; (2) home health care agency challenges with 2 subthemes: home health care workers and the deficiency in organizational policies; and (3) economic challenges. Three themes of hospital-related challenges, home health care agency challenges, and economic challenges that emerged in the study showed that support from the insurance system, improvement of home care agency policies, and holistic care for patients through a multidisciplinary team approach are essential for addressing the current challenges of care for patients under invasive mechanical ventilation at home.


Assuntos
Países em Desenvolvimento , Serviços de Assistência Domiciliar , Pessoal de Saúde , Humanos , Pesquisa Qualitativa , Tecnologia
4.
BMC Health Serv Res ; 21(1): 893, 2021 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-34461894

RESUMO

BACKGROUND: The growing number of people living with dementia (PlwD) implies an increase in the demand for eldercare services in Sweden like in many other countries. Few studies have analyzed the use of eldercare services for PlwD. The aim of the present study is to investigate the association between demographic factors (age, sex, cohabiting status) and the use of municipal eldercare services (including both home care and residential care) for older adults with dementia compared to older adults without dementia in Sweden. METHODS: This study used several nationwide Swedish registers targeting all individuals aged 65 and above living in Sweden in 2014 and still alive 31st of March 2015 (n = 2,004,409). The primary outcomes variables were different types of eldercare service, and all participants were clustered based on age, sex, cohabiting status, and dementia diagnosis. In addition to descriptive statistics, we performed multivariate logistic regression models for binary outcomes and linear regression models for continuous outcomes. RESULTS: Results showed that (1) older age is a significantly strong predictor for the use of eldercare services, although PlwD start using eldercare at an earlier age compared with people without dementia; (2) women tend to receive more eldercare services than men, especially in older age, although men with dementia who live alone are more likely than women living alone to receive eldercare; (3) having a dementia diagnosis is a strong predictor for receiving eldercare. However, it was also found that a substantial proportion of men and women with dementia did not receive any eldercare services. CONCLUSIONS: We found that people with a dementia diagnosis use more as well as start to use eldercare services at an earlier age than people without dementia. However, further research is needed to investigate why a substantial part of people with a dementia diagnosis does not have any eldercare at all and what the policy implications of this might be.


Assuntos
Demência , Serviços de Assistência Domiciliar , Idoso , Demência/diagnóstico , Demência/epidemiologia , Demência/terapia , Feminino , Humanos , Modelos Logísticos , Masculino , Sistema de Registros , Suécia/epidemiologia
5.
Rev Bras Enferm ; 74(4): e20201240, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34346977

RESUMO

OBJECTIVES: to understand the meaning of aging for caregivers of senile elderly people. METHODS: qualitative study carried out with 12 caregivers of elderly people registered in the Home Care Service, adopting the Explanatory Model of Kleinman's Disease as a theoretical framework. Data were collected from April to June 2019, through semi-structured, audio-recorded interviews, carried out at home and submitted to content analysis. RESULTS: taking care of senile elderly people triggers reflections on aging that sometimes lead to a new meaning of this process, besides stimulating the recognition of the factors that influence it, with emphasis on the life history, occupation and deleterious behaviors adopted throughout life. FINAL CONSIDERATIONS: the care experience influences the meaning attributed to aging, favoring: the identification of modifiable and non-modifiable aspects and behaviors that make it healthy; reflection on aging itself, with a new meaning of habits and behaviors to be adopted.


Assuntos
Cuidadores , Serviços de Assistência Domiciliar , Idoso , Envelhecimento , Nível de Saúde , Humanos , Pesquisa Qualitativa
6.
Hu Li Za Zhi ; 68(4): 89-95, 2021 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-34337707

RESUMO

Hard-to-heal wounds (HHW) represent wound beds that are at high risk of stagnating during the inflammatory or proliferative phase because of various internal or external factors. A wound area reduction of less than 40% in 4 weeks is an indicator of HHW. With the acceleration of population aging, an increasing number of older adults are developing various chronic diseases with comorbidities. Although many older adults are affected by HHW, patients are regularly expected to recuperate at home or in long-term care institutions rather than in hospitals because of shortened hospitalization periods and changes in the medical insurance system. The provision of healthcare to patients with HHW in home settings is currently complicated by the lack of systematic nursing education on wound care, the lack of evidence-based guidelines for home wound care, and the inadequate wound care skills of nurses. HHW have major physical, psychological, and economic impacts on patients and their families and increase stress and frustration in nurses. Inappropriate wound care interventions increase medical expenditures and have multifaceted effects that are largely ignored by the medical care system. This phenomenon, which encompasses HHW, has been called a silent epidemic. In this paper, HHW are defined, the current status of home wound healing worldwide is analyzed, the relevant challenges and strategy implementations are discussed, and recommendations for the home care of HHW are provided.


Assuntos
Serviços de Assistência Domiciliar , Cicatrização , Idoso , Doença Crônica , Atenção à Saúde , Humanos
7.
Zhongguo Yi Liao Qi Xie Za Zhi ; 45(4): 406-409, 2021 Jul 30.
Artigo em Chinês | MEDLINE | ID: mdl-34363367

RESUMO

Ventilator is an indispensable emergency medical equipment in hospitals. The global outbreak of the coronavirus disease 2019 (COVID-19) has highlighted the importance of the ventilator, which has attracted the attention and research on ventilators of all countries in the world. This article reviews the development history of the ventilator, briefly introduces the main air circuit structure and working principle of the ventilator, and then deeply analyzes the key technologies of this device. In addition, it compares some major brands of ventilators from several aspects in the market. Finally, the development trend and perspective of ventilators are presented.


Assuntos
COVID-19 , Serviços de Assistência Domiciliar , Desenho de Equipamento , Humanos , Respiração Artificial , SARS-CoV-2 , Ventiladores Mecânicos
8.
Soins ; 66(857): 40-41, 2021 Jul.
Artigo em Francês | MEDLINE | ID: mdl-34366073

RESUMO

Every year in France, thousands of victims file a complaint for violence against their partner. These acts of violence are committed in the family environment, behind closed doors. Through her practice, the home care nurse can be a witness, support or a resource.


Assuntos
Vítimas de Crime , Violência Doméstica , Serviços de Assistência Domiciliar , Enfermeiros de Saúde Comunitária , Violência Doméstica/prevenção & controle , Feminino , França , Humanos , Relações Interpessoais , Violência
9.
East Mediterr Health J ; 27(7): 656-664, 2021 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-34369579

RESUMO

Background: Efforts to reduce inappropriate hospital stay, including alternatives such as homecare, are important to improve patient care and reduce health care costs. Aims: This study evaluated inappropriate hospital stay in Shiraz, Islamic Republic of Iran and the extent to which these stays were due to lack of homecare services and others factors needed for homecare. Methods: This cross-sectional study was conducted between January 2018 and September 2019 at two public hospitals in Shiraz. All adult patients hospitalized in these two hospitals in the study period were included, except patients in mental care wards. Appropriateness of patients' hospital stay was assessed on a daily basis using the Iranian version of the Appropriateness Evaluation Protocol. The chi-squared test was used to assess association between need for homecare and patient characteristics. Results: Of 6458 hospitalization days assessed (for 1954 patients), 710 (11.0%) days were inappropriate. The greatest proportion of causes of inappropriate stay were physician-related (32.9%). Of the 710 inappropriate hospitalization days, 231 were due to lack of homecare services. Most patients who were inappropriately hospitalized because of lack of homecare services were insured through Salamat insurance (64.0%). A statistically significant relationship was found between the need for homecare services and the type of health insurance (P = 0.01). Of the patients admitted to hospital because of lack of homecare services, 36.8% had endocrine diseases, especially diabetes, and 21.8% needed oxygen services. Conclusion: Institutionalizing home health care in the Iranian health system could encourage more home health care referral and reduce inappropriate hospitalization, especially for diabetes.


Assuntos
Serviços de Assistência Domiciliar , Hospitalização , Adulto , Estudos Transversais , Hospitais Públicos , Humanos , Irã (Geográfico)/epidemiologia , Tempo de Internação
10.
Int J Chron Obstruct Pulmon Dis ; 16: 2217-2226, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34349507

RESUMO

Purpose: Home mechanical ventilation (HMV) use in chronic obstructive pulmonary disease (COPD) is becoming increasingly widespread. The aim of this study was to provide an accurate description of the current practices and clinical characteristics of COPD patients on HMV in Portugal. Methods: The study was designed as a cross-sectional, multicenter real-life study of COPD patients established on HMV for at least 30 days. Data related to clinical characteristics, adaptation and ventilatory settings were collected. Results: The study included 569 COPD patients on HMV from 15 centers. The majority were male, with a median age of 72 years and a high prevalence of obesity (43.2%) and sleep apnea (45.8%). A high treatment compliance was observed (median 8h/day), 48.7% with inspiratory positive airway pressure ≥20 cmH2O and oronasal masks were the preferred interface (91.7%). There was an equal distribution of patients starting HMV during chronic stable condition and following an exacerbation. Patients in stable condition were initiated in the outpatient setting in 92.3%. Despite the differences in criteria and setting of adaptation and a slightly lower BMI in patients starting HMV following an exacerbation, we found no significant differences regarding age, gender, ventilation pressures, time on HMV, usage, severity of airflow obstruction or current arterial blood gas analysis (ABGs) in relation to patients adapted in stable condition. Conclusion: Patients were highly compliant with the therapy. In agreement with most recent studies and recommendations, there seems to be a move towards higher ventilation pressures, increased use of oronasal masks and an intent to obtain normocapnia. This study shows that chronic hypercapnic and post exacerbation patients do not differ significantly regarding patient characteristics, physiological parameters or ventilatory settings with one exception: chronic hypercapnic patients are more often obese and, subsequently, more frequently present OSA.


Assuntos
Serviços de Assistência Domiciliar , Ventilação não Invasiva , Doença Pulmonar Obstrutiva Crônica , Idoso , Estudos Transversais , Feminino , Humanos , Hipercapnia , Masculino , Ventilação não Invasiva/efeitos adversos , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/terapia , Respiração Artificial/efeitos adversos
11.
BMC Health Serv Res ; 21(1): 804, 2021 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-34384407

RESUMO

BACKGROUND: This study seeks to explore how social workers have perceived and experienced a medical home model for children and adolescents in out-of-home care in Uppsala County, Sweden. METHOD: A qualitative explorative study was conducted, which involved ten semi-structured individual telephone interviews with social workers. The study sample included employees within the social service, working in a specialised case unit who had experience of referring children and/or adolescents to the medical home model called Hälsofam. Data were analysed inductively using thematic analysis. RESULTS: The findings of the current study indicated that working with Hälsofam has offered social workers a way into the health care sector and an active collaborative working situation, with focus on organised work across the 'silos' of care services. However, the findings raised the question of whether or not all children and adolescents have the same possibility to receive care from Hälsofam. CONCLUSION: The findings indicated that the Hälsofam model had a positive impact on the interrelations between the social service and the health care sector. Yet, findings showed that personal views of the social worker and the societal situation in which they operate create limitations for providing care for every child and adolescent. This study adds to the extant literature for it addresses the limitations within the work of children and adolescents in out-of-home care.


Assuntos
Serviços de Assistência Domiciliar , Assistentes Sociais , Adolescente , Criança , Humanos , Assistência Centrada no Paciente , Pesquisa Qualitativa , Serviço Social
12.
PLoS One ; 16(8): e0254347, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34347785

RESUMO

Clinical presentation, outcomes, and duration of COVID-19 has ranged dramatically. While some individuals recover quickly, others suffer from persistent symptoms, collectively known as long COVID, or post-acute sequelae of SARS-CoV-2 (PASC). Most PASC research has focused on hospitalized COVID-19 patients with moderate to severe disease. We used data from a diverse population-based cohort of Arizonans to estimate prevalence of PASC, defined as experiencing at least one symptom 30 days or longer, and prevalence of individual symptoms. There were 303 non-hospitalized individuals with a positive lab-confirmed COVID-19 test who were followed for a median of 61 days (range 30-250). COVID-19 positive participants were mostly female (70%), non-Hispanic white (68%), and on average 44 years old. Prevalence of PASC at 30 days post-infection was 68.7% (95% confidence interval: 63.4, 73.9). The most common symptoms were fatigue (37.5%), shortness-of-breath (37.5%), brain fog (30.8%), and stress/anxiety (30.8%). The median number of symptoms was 3 (range 1-20). Amongst 157 participants with longer follow-up (≥60 days), PASC prevalence was 77.1%.


Assuntos
COVID-19/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Arizona/epidemiologia , COVID-19/diagnóstico , COVID-19/epidemiologia , COVID-19/patologia , COVID-19/reabilitação , Criança , Estudos de Coortes , Progressão da Doença , Feminino , Serviços de Assistência Domiciliar/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , SARS-CoV-2/fisiologia , Adulto Jovem
13.
Artigo em Inglês | MEDLINE | ID: mdl-34360249

RESUMO

There is evidence that training for strength and balance prevents decline in physical function in old age when the training is personally instructed. It is an open question whether interventions that deliver training via up-to-date technologies can achieve long-term effects. This study examined the effects of an 8-month fitness training program delivered via information and communication technology (ICT) on lower-body strength and balance in female home care users (n = 72) aged 75 years on average. For statistical analysis, the test group was divided into two subgroups, one who used the program at least 8 times per month (n = 26) and another one who used the program less often (n = 17) compared with a control group that received no exercise program (n = 29). It was found that regular ICT-exercisers exhibited positive effects over time on lower-body strength and balance compared to a decrease in both indicators in irregular exercisers and the control group. The authors see potential in offering exercise programs to people of advanced age via ICT to counteract physical decline in old age.


Assuntos
Serviços de Assistência Domiciliar , Equilíbrio Postural , Comunicação , Exercício Físico , Terapia por Exercício , Feminino , Humanos , Aptidão Física , Tecnologia
16.
BMJ Open ; 11(8): e046515, 2021 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-34344676

RESUMO

OBJECTIVES: The objective was to examine care willingness and demand of residents under 60 years of age after retirement. SETTING: The staged cluster sampling method was used between August and October 2018 in Dujiangyan, Sichuan Province, China. PARTICIPANTS: 2282 participants under 60 years of age were surveyed in 2018 by the staged cluster sampling method in China. PRIMARY AND SECONDARY OUTCOME MEASURES: The results of care willingness and demand were assessed by multiple comparisons of χ2 test and multivariable logistic regression. RESULTS: The respondents who preferred institution-based care, home-based care and community-based care accounted for 39.5%, 38.3% and 20.2% respectively, whereas only 2.1% preferred home-based self-care. The main reasons for the respondents to choose institution-based care included better medical care (31.9%), better daily care (27.0%), burden reduction for children (26.3%), better accommodation (22.8%), satisfied living environment (21.6%) and low consumption (12.3%). The factors that affected care willingness and demand included age, ethnicity, educational attainment, marital status, occupation and the current type of residence. CONCLUSIONS: The results revealed the care willingness and demand of residents under 60 years of age after retirement and relevant decision factors. This study provides a certain theoretical and practical significance for the development of the care willingness mode and promotes the cognition of policy-makers and researchers, and also provides the basis for decision-making.


Assuntos
Serviços de Assistência Domiciliar , Criança , China , Estudos Transversais , Humanos , Modelos Logísticos , Inquéritos e Questionários
17.
Medicine (Baltimore) ; 100(31): e26861, 2021 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-34397862

RESUMO

ABSTRACT: Cardiac rehabilitation (CR) can improve clinical indicators in patients with cardiovascular diseases. The literature reports a 20% reduction in all-cause mortality and a 27% reduction in heart-disease mortality following CR. Although its clinical efficacy has been established, there is uncertainty whether center-based (CBCR) is more effective than home-based (HBCR) programs in acute and subacute phases. We aimed to verify significant differences in their effectiveness for the improvement of cardiopulmonary function by analyzing cardiopulmonary exercise (CPX) with laboratory tests following both CR programs.A single-center cohort study of 37 patients, recently diagnosed with underlying cardiovascular diseases, underwent CBCR(18) and HBCR(19). CBCR group performed a supervised exercise regimen at the CR center, for 1 hour, 2 to 3 days a week, for a total of 12 to18 weeks. HBCR group completed a self-monitored exercise program at home under the same guidelines as CBCR. Participants were evaluated by CPX with laboratory tests at 1- and 6-month, following the respective programs.There was no statistical significance in clinical characteristics and laboratory findings. Pre-post treatment comparison showed significant improvement in VO2/kg, minute ventilation/carbon dioxide production slope, breathing reserve, tidal volume (VT), heart rate recovery, oxygen consumption per heart rate, low-density lipoprotein (LDL), LDL/HDL ratio, total cholesterol, ejection fraction (EF) (P < .05). CBCR approach showed greater improvement with significance in VO2/kg, metabolic equivalents, and EF on between groups analysis (P < .05).The time effect of CPX test and laboratory data showed improvement in cardiopulmonary function and serum indicators for both groups. VO2/kg, metabolic equivalents, and EF were among the variables that showed significant differences between groups. In the acute and subacute phases of 1 to 6 months, the CBCR group showed a greater cardiac output improvement than the HBCR group.


Assuntos
Biomarcadores/sangue , Reabilitação Cardíaca , Doenças Cardiovasculares , Terapia por Exercício , Serviços de Assistência Domiciliar/estatística & dados numéricos , Centros de Reabilitação/estatística & dados numéricos , Reabilitação Cardíaca/métodos , Reabilitação Cardíaca/normas , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/fisiopatologia , Doenças Cardiovasculares/terapia , Pesquisa Comparativa da Efetividade , Teste de Esforço/métodos , Terapia por Exercício/métodos , Terapia por Exercício/organização & administração , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , República da Coreia/epidemiologia , Testes de Função Respiratória/métodos , Testes de Função Respiratória/estatística & dados numéricos , Resultado do Tratamento
19.
BMC Health Serv Res ; 21(1): 877, 2021 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-34445993

RESUMO

BACKGROUND: Reablement is a municipal service given to patients at home. The purpose of the service is to assist recovery after hospital discharges or other sudden changes in a patient's functional level. The service is often provided by a team of nurses, physiotherapists, and occupational therapists. The purpose of this paper is to compare users of this service to users who receive traditional home care services. Outcomes to be measured are risk of long-term care and mortality. METHODS: All users of health and care services in a Norwegian municipality were eligible for inclusion. Data was extracted from the local user administrative database. Users were divided in two groups: those who received reablement and those home care users who did not receive reablement service. Propensity score matching was used to match users based on age, sex, and level of functioning in activities of daily living (ADL). Survival analysis was deployed to test if the reablement users had different risk of becoming long-term care users, and whether the mortality rate differed for this group. RESULTS: 153 reablement users were included in the study. These were matched to 153 non-reablement home care users. The groups had similar distributions of age, sex, and level of functioning when starting their service trajectories. Regressions showed that reablement users had lower risk of using long-term care services in the study period (time at risk up to 4 years), and lower mortality. However, none of these estimates were statistically significant. CONCLUSIONS: The study indicates that the reablement users in one municipality had lower use of long -term care and lower mortality when properly estimated, but numbers were too small for statistical significance to be found.


Assuntos
Serviços de Assistência Domiciliar , Fisioterapeutas , Atividades Cotidianas , Humanos , Noruega/epidemiologia , Análise de Sobrevida
20.
BMC Health Serv Res ; 21(1): 878, 2021 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-34446000

RESUMO

BACKGROUND: The Covid-19 pandemic introduced a global crisis for the healthcare systems. Research has paid particular attention to hospitals and intensive care units. However, nursing homes and home care services in charge of a highly vulnerable group of patients have also been forced to adapt and transform to ensure the safety of patients and staff; yet they have not received enough research attention. This paper aims to explore how leaders in nursing homes and home care services used innovative solutions to handle the Covid-19 pandemic to ensure resilient performance during times of disruption and major challenges. METHODS: A qualitative exploratory case study was used to understand the research question. The selected case was a large city municipality in Norway. This specific municipality was heavily affected by the Covid-19 pandemic; therefore, information from this municipality allowed us to gather rich information. Data were collected from documents, semi-structured interviews, and a survey. At the first interview phase, informants included 13 leaders, Head of nursing home (1 participant), Head of Sec. (4 participants), Quality manager (4 participants), Head of nursing home ward (3 participants), and a Professional development nurse (1 participant), at 13 different nursing homes and home care services. At the second phase, an online survey was distributed at 16 different nursing homes and home care services to expand our understanding of the phenomenon from other leaders within the case municipality. Twenty-two leaders responded to the survey. The full dataset was analysed in accordance with inductive thematic analysis methodology. RESULTS: The empirical results from the analysis provide a new understanding of how nursing homes and home care leaders used innovative solutions to maintain appropriate care for infected and non-infected patients at their sites. The results showed that innovative solutions could be separated into technology for communication and remote care, practice innovations, service innovations, and physical innovations. CONCLUSION: This study offers a new understanding of the influence of crisis-driven innovation for resilience in healthcare during the Covid-19 pandemic. Nursing home and home care leaders implemented several innovative solutions to ensure resilient performance during the first 6-9 months of the pandemic. In terms of resilience, different innovative solutions can be divided based on their influence into situational, structural, and systemic resilience. A framework for bridging innovative solutions and their influence on resilience in healthcare is outlined in the paper.


Assuntos
COVID-19 , Serviços de Assistência Domiciliar , Atenção à Saúde , Humanos , Liderança , Casas de Saúde , Pandemias , SARS-CoV-2
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