Interprofessional collaboration in the home care setting: perspectives of people receiving home care, relatives, nurses, general practitioners, and therapists-results of a qualitative analysis

BACKGROUND

About one million people in need of home care in Germany are assisted by 15,400 home care services. Home healthcare is mostly a complex endeavour because interprofessional collaboration is often challenging. This might negatively impact patient safety. The project interprof HOME aims to develop an interprofessional person-centred care concept for people receiving home care in a multistep approach. In one of the work packages we explored how people receiving home care, relatives, nurses, general practitioners, and therapists (physiotherapists, occupational therapists, and speech therapists) perceive collaboration in this setting.

METHODS

Semi-structured interviews were conducted with 20 people receiving home care and with 21 relatives. Additionally, we worked with nine monoprofessional focus groups involving nurses of home care services (n = 17), general practitioners (n = 14), and therapists (n = 21). The data were analysed by content analysis.

RESULTS

Three main categories evolved: "perception of interprofessional collaboration", "means of communication", and "barriers and facilitators". People receiving home care and relatives often perceive little to no interprofessional collaboration and take over a significant part of the organisational coordination and information exchange. Interprofessional collaboration in steady care situations does exist at times and mostly occurs in coordination tasks. Contact and information exchange are rare, however, interprofessional personal encounters are sporadic, and fixed agreements and permanent contact persons are not standard. These trends increase with the complexity of the healthcare situation. Joint collaborations are often perceived as highly beneficial. Means of communications such as telephone, fax, or e-mail are used differently and are often considered tedious and time-consuming. No interprofessional formal written or electronic documentation system exists. Personal acquaintance and mutual trust are perceived as being beneficial, while a lack of mutual availability, limited time, and inadequate compensation hinder interprofessional collaboration.

CONCLUSIONS

Interprofessional collaboration in home care occurs irregularly, and coordination often remains with people receiving home care or relatives. While this individual care set-up may work sufficiently well in low complex care situations, it becomes vulnerable to disruptions with increasing complexity. Close interactions, joint collaboration, and fixed means of communication might improve healthcare at home. The findings were integrated into the development of the person-centred interprofessional care concept interprof HOME.

TRIAL REGISTRATION

This study is registered on the International Clinical Trails registry platform ClinicalTrials.gov as NCT05149937 on 03/11/2021.

Die Sichtweise von Pflegefachpersonen auf ihre mögliche Rolle bei Advance Care Planning in der ambulanten Pflege

Zusammenfassung. Hintergrund: Beratung zu Advance Care Planning (ACP) ist als Aufgabenbereich der „Gesundheitlichen Versorgungsplanung“ unter anderem für Pflegefachpersonen in der stationären Langzeitversorgung in Deutschland vorgesehen. In der StAdPlan-Studie (DRKS0016886) wurde eine ACP-Intervention in die ambulante Pflege implementiert und evaluiert: Geschulte Pflegefachpersonen führten Beratung zu ACP mit Patient_innen durch. Teil der Studie war eine umfassende Prozessevaluation. Ziel: Ein Teilergebnis der Prozessevaluation war die Analyse der Sichtweise von Pflegefachpersonen auf ihre mögliche Rolle als ACP-Berater_innen. Methode: Leitfadengestützte Interviews mit Pflegefachpersonen und Pflegedienstleitungen ( n = 42) wurden vor der Implementierung der ACP-Intervention durchgeführt und inhaltsanalytisch ausgewertet. Ergebnis: Die Teilnehmenden schilderten die Bedeutung von ACP in der ambulanten Pflege, ihre persönliche Motivation und Kompetenz sowie notwendige Rahmenbedingungen. Pflegefachpersonen möchten Beratungen von Patient_innen anbieten, um sie nach deren Wünschen versorgen zu können. Für eine gute Beratung halten sie zusätzliches Wissen und zeitliche Ressourcen zu ACP sowie Gesprächskompetenz für notwendig. ACP-Beratung kann ein geeignetes Handlungsfeld für Pflegefachpersonen sein, da sie den Zugang und ein etabliertes Vertrauensverhältnis zu den Patient_innen haben. Schlussfolgerung: Die Rolle von Pflegefachpersonen als Beratende für ACP in der ambulanten Versorgung wurde als machbar und sinnvoll eingeschätzt. Voraussetzung sind die Finanzierung der Leistung sowie eine Schulung der Pflegefachpersonen.

Contextual factors influencing advance care planning in home care: process evaluation of the cluster-randomised controlled trial STADPLAN

Background

The STADPLAN study is a cluster-randomised controlled trial including 27 home care services in Germany. It assesses the effect of an advance care planning (ACP) intervention delivered by trained nurses to older care-dependent patients. Patients received two ACP conversations and an information brochure. Nurses were educated through a two-day programme and topic guides structuring the conversations.

Objectives of the process evaluation were to determine: [1] whether the intervention was implemented as planned, [2] which change mechanisms were observed, [3] whether targeted process outcomes were achieved and [4] in which way contextual factors influenced the implementation process.

Methods

The process evaluation is based on a mixed methods approach following the recommendations of the UK-MRC framework for the development and evaluation of complex interventions. Qualitative and quantitative assessments were developed and analysed guided by a logic model comprising intervention, participants, mechanisms of change and context factors. The results of the main trial will be published elsewhere.

Results

Educational programme and topic guides were mostly implemented as planned and resulted in motivation, knowledge, and perceived competencies to facilitate ACP conversations in nurses. Deviances in the performance of ACP conversations indicated patients’ varied individual needs, but also obstacles like reluctance of patients and caregivers to participate actively and time constraints of nurse facilitators. Patients and caregivers reported increased awareness of ACP, planning and other activities indicating that targeted process outcomes could be achieved. The relevance of multifaceted contextual factors acting as barriers or facilitators for the engagement in ACP interventions on the individual, organisational and macro level was evident.

Conclusions

The process evaluation elicits obstacles and achievements of the ACP intervention. The logic model organised a plethora of mixed methods data into a holistic picture of multifaceted results. Nurses as ACP facilitators in home care can fulfil a crucial initiating role based on a trusting relationship with their patients. To support older care-dependent people’s ACP engagement, access should be simplified.

Furthermore, education for nurse facilitators and sufficient resources for service provision are needed. Independent of monetary reimbursement, healthcare providers must respect patients’ choice for or against any ACP intervention.

Ethics and trial registration

Approved by the Ethics Committees of Martin Luther University Halle-Wittenberg (Ref.-No. 2019–045), Carl von Ossietzky University Oldenburg (Ref.-No. 2019–024), and University of Lübeck (Ref.-No. 19–080).

German Clinical Trials Register: DRKS00016886. Registered retrospectively 04/06/2019, first participant included 29/05/2019.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03026-2.

Paediatric respite care: a literature review from New Zealand

This paper reviews relevant international and New Zealand literature, policy documents and reports on respite provision for children who are dying and their families. The literature describes why respite care for children is necessary, and evaluates present respite services in accord with recent reports and literature. The service provisions needed for dying children and their families are explored, including suggestions for the improvement of services and future research. The literature reveals that, although respite care for terminally ill children and their families is necessary, service provisions are uncoordinated, not always culturally sensitive and very limited for children and their families. Improvement in paediatric respite services is necessary and research needs to be conducted in this area to facilitate the development of more appropriate respite services for children and their families.