Becoming an expert carer: the process of family carers learning to manage technical health procedures at home.

AIMS: To describe the learning process of family carers who manage technical health procedures (such as enteral tube feeding, intravenous therapy, dialysis or tracheostomy care) at home. BACKGROUND: Increasingly, complex procedures are being undertaken at home but little attention has been paid to the experiences of family carers who manage such procedures. DESIGN: Grounded theory, following Charmaz's constructivist approach. METHODS: Interviews with 26 family carers who managed technical health procedures and 15 health professionals who taught carers such procedures. Data collection took place in New Zealand over 19 months during 2011-2013. Grounded theory procedures of iterative data collection, coding and analysis were followed, with the gradual development of theoretical ideas. FINDINGS: The learning journey comprised three phases: (1) an initial, concentrated period of training; (2) novice carers taking responsibility for day-to-day care of procedures while continuing their learning; and (3) with time, experience and ongoing self-directed learning, the development of expertise. Teaching and support by health professionals (predominantly nurses) was focussed on the initial phase, but carers' learning continued throughout, developed through their own experience and using additional sources of information (notably the Internet and other carers). CONCLUSION: Further work is needed to determine the best educational process for carers, including where to locate training, who should teach them, optimal teaching methods and how structured or individualized teaching should be. Supporting carers well also benefits patient care.

How family carers engage with technical health procedures in the home: a grounded theory study.

OBJECTIVES: To explore the experiences of family carers who manage technical health procedures at home and describe their learning process. DESIGN: A qualitative study using grounded theory. PARTICIPANTS: New Zealand family carers (21 women, 5 men) who managed technical health procedures such as enteral feeding, peritoneal dialysis, tracheostomy care, a central venous line or urinary catheter. In addition, 15 health professionals involved in teaching carers were interviewed. METHODS: Semistructured interviews were coded soon after completion and preliminary analysis influenced subsequent interviews. Additional data were compared with existing material and as analysis proceeded, initial codes were grouped into higher order concepts until a core concept was described. Interviewing continued until no new ideas emerged and concepts were well defined. RESULTS: The response of carers to the role of managing technical health procedures in the home is presented in terms of five dispositions: (1) Embracing care, (2) Resisting, (3) Reluctant acceptance, (4) Relinquishing and (5) Being overwhelmed. These dispositions were not static and carers commonly changed between them. Embracing care included cognitive understanding of the purpose and benefits of a procedure; accepting a 'technical' solution; practical management; and an emotional response. Accepting embrace is primarily motivated by perceived benefits for the recipient. It may also be driven by a lack of alternatives. Resisting or reluctant acceptance results from a lack of understanding about the procedure or willingness to manage it. Carers need adequate support to avoid becoming overwhelmed, and there are times when it is appropriate to encourage them to relinquish care for the sake of their own needs. CONCLUSIONS: The concept of embracing care encourages health professionals to extend their attention beyond simply the practical aspects of technical procedures to assessing and addressing carers' emotional and behavioural responses to health technology during the training process.

Análise das formações coletivas ofertadas aos trabalhadores de um hospital público o caso do Grupo Hospitalar Conceição / Analysis of collective training offered to workers of a public hospital: the case of Grupo Hospitalar Conceição

Este estudo buscou analisar e descrever atividades de formação coletivas ofertadas aos trabalhadores do GHC, verificando quais tecnologias do cuidado se associam à formação de 2013. Tem-se como pressuposto que as atividades de formação refletem o modelo tecnoassistencial da instituição. Buscouse caracterizar oferta de atividades considerando: responsáveis que as desenvolvem, analisar a oferta para as áreas meio e assistencial, e distinguir entre aquelas oferecidas institucionalmente e pelas equipes; categorias profissionais atuantes no GHC que realizaram formação; tipologias das atividades formativas ofertadas e as temáticas ofertadas e sua relação com as tecnologias do cuidado, modos de produção e modelagens tecnoassistenciais em saúde. Este estudo caracterizou-se como Estudo de Caso descritivo de análise documental com abordagem quanti-qualitativa.1 Observamos que as equipes foram as maiores responsáveis pela formação, ofertando atividades voltadas para o segmento assistência/fim. Já as institucionais foram atividades caracterizadas pela participação significativa do segmento apoio/meio. Percebeuse, a tentativa de proporcionar atividades integrativas entre esses segmentos. Verficouse que os trabalhadores assistenciais foram os maiores beneficiados e que trabalhadores de alguns cargos apresentam poucos concluintes considerando sua representação no GHC. As atividades mais realizadas são: Treinamento ou Capacitação, possuindo características de transmissão de conhecimento, sendo antagonista às características da educação permanente, refletindo nos resultados das tecnologias do cuidado. Os resultados tecnologias leve/duras, representaram o maior quantitativo das formações, seguida pelas tecnologias duras, o que reflete o modelo tecnoassistencial hegemônico na instituição. Espera-se que este estudo possa servir de reflexão para contribuir para qualificar os processos de formação coletivos realizados no GHC.

This study aimed to analyze and describe collective training activities offered to workers of GHC, checking which technologies of healthcare are associated with the formation of 2013. It has been assumptioned that the training activities reflect the technical healthcare model of the institution. We sought to characterize supply activities considering: responsibles for its development, analyze the offer to the essencial and assistance areas, and to distinguish between those offered by the institution and those by the teams; professional categories active in GHC and trained ones; typologies of the training activities offered and theme issues offered and their relationship with care technology, production modes and modeling technical healthcare in health. This study characterized as a descriptive study of documentary analysis case with quantitative and qualitative approach. Were observed that teams are most responsible for training, offering activities aimed for the assistance/end segment. On the other hand, institutional activities were characterized for significant participation on the support/ essential segment. It was noticed an attempt to provide activities of integrative processes between these segments. It was pointed that the assistance workers were the most beneficiaries and that workers from some posts had few graduates considering their roles at GHC. The most activities carried out are: training or capacity building, possessing characteristics of knowledge transmission, being antagonistic of continued education, reflecting at healthcare technologies results. Results technologies lightweight/ hard, represented the major quantitative of formation, followed by hard technologies, that reflects that the technical healthcare hegemonic model in the institution. It is expected that this study can serve as a reflection to contribute to qualify the collective training processes done at GHC.