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      Comparing the quality of care for long-term ventilated individuals at home versus in shared living communities: a convergent parallel mixed-methods study

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          Abstract

          Background

          People on home mechanical ventilation (HMV) belong to a heterogeneous population with complex care needs. In Germany, outpatient intensive care is provided in people's private home (PH) or in shared living communities (SLC). Increasing patient numbers have led to criticism of the quality of care in recent years. Since quality deficits from the perspective of those affected are largely unclear, the following research question emerged: How do interviews with ventilated individuals and family caregivers explain any differences or similarities in the quality of care between PH and SLC?

          Methods

          This study used a mixed-methods convergent parallel design, where quantitative and qualitative components were separately collected and analysed. The quantitative component (structured interviews and online survey) included ventilation characteristics, health-related resource use, health-related quality of life (HRQL) measured with the Severe Respiratory Insufficiency Questionnaire (SRI; range 0-100; higher scores indicated higher HRQL) and the Burden Scale of the Family Caregivers short version (BSFC-s; range 0-30; higher scores indicated higher burden). The qualitative component (semi-structured interviews) focused on people's experience of person-centred care. Data were merged using a weaving method and the Picker framework of Person-Centred Care.

          Results

          The quantitative component revealed that ventilated individuals living in PHs were on average 20 years younger than participants living in SLCs ( n = 46; PH: 46.86 ±15.40 years vs. SLC: 65.07 ±11.78 years; p = .001). HRQL ( n = 27; PH: 56.62 ±16.40 vs. SLC: 55.35 ±12.72; p > .999) and the burden of family caregivers ( n = 16; PH: 13.20 ±10.18 vs. SLC: 12.64 ±8.55; p > .999) were not significantly different between living situation. The qualitative component revealed that person-centred care is possible in both care settings (ventilated individuals: n = 13; family caregivers: n = 18).

          Conclusion

          This study describes a care situation that is as heterogeneous as the population of people with HMV. HRQL and the burden of family caregivers are highly individual and, like person-centred care, independent of the living situation. Policy decisions that facilitate person-centred care need to recognise that quality of care is highly individual and starts with the free choice of the care setting.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12912-022-00986-z.

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          Most cited references60

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          The qualitative content analysis process.

          This paper is a description of inductive and deductive content analysis. Content analysis is a method that may be used with either qualitative or quantitative data and in an inductive or deductive way. Qualitative content analysis is commonly used in nursing studies but little has been published on the analysis process and many research books generally only provide a short description of this method. When using content analysis, the aim was to build a model to describe the phenomenon in a conceptual form. Both inductive and deductive analysis processes are represented as three main phases: preparation, organizing and reporting. The preparation phase is similar in both approaches. The concepts are derived from the data in inductive content analysis. Deductive content analysis is used when the structure of analysis is operationalized on the basis of previous knowledge. Inductive content analysis is used in cases where there are no previous studies dealing with the phenomenon or when it is fragmented. A deductive approach is useful if the general aim was to test a previous theory in a different situation or to compare categories at different time periods.
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            Using the framework method for the analysis of qualitative data in multi-disciplinary health research

            Background The Framework Method is becoming an increasingly popular approach to the management and analysis of qualitative data in health research. However, there is confusion about its potential application and limitations. Discussion The article discusses when it is appropriate to adopt the Framework Method and explains the procedure for using it in multi-disciplinary health research teams, or those that involve clinicians, patients and lay people. The stages of the method are illustrated using examples from a published study. Summary Used effectively, with the leadership of an experienced qualitative researcher, the Framework Method is a systematic and flexible approach to analysing qualitative data and is appropriate for use in research teams even where not all members have previous experience of conducting qualitative research.
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              Achieving integration in mixed methods designs-principles and practices.

              Mixed methods research offers powerful tools for investigating complex processes and systems in health and health care. This article describes integration principles and practices at three levels in mixed methods research and provides illustrative examples. Integration at the study design level occurs through three basic mixed method designs-exploratory sequential, explanatory sequential, and convergent-and through four advanced frameworks-multistage, intervention, case study, and participatory. Integration at the methods level occurs through four approaches. In connecting, one database links to the other through sampling. With building, one database informs the data collection approach of the other. When merging, the two databases are brought together for analysis. With embedding, data collection and analysis link at multiple points. Integration at the interpretation and reporting level occurs through narrative, data transformation, and joint display. The fit of integration describes the extent the qualitative and quantitative findings cohere. Understanding these principles and practices of integration can help health services researchers leverage the strengths of mixed methods. © Health Research and Educational Trust.
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                Author and article information

                Contributors
                Hanna.Klingshirn@ksh-m.de
                laura.gerken@uni-a.de
                katharina.hofmann@rwth-aachen.de
                E_Heuschma_P@ukw.de
                E_Haas_K1@ukw.de
                Schutzmeie_M@ukw.de
                Brandstett_L@ukw.de
                Wurmb_T@ukw.de
                Kippnich_M@ukw.de
                Bernd.Reuschenbach@ksh-m.de
                Journal
                BMC Nurs
                BMC Nurs
                BMC Nursing
                BioMed Central (London )
                1472-6955
                11 August 2022
                11 August 2022
                2022
                : 21
                : 224
                Affiliations
                [1 ]GRID grid.466275.4, ISNI 0000 0001 0532 1477, Catholic University of Applied Sciences Munich, ; Preysingstraße 95, D-81667 München, Germany
                [2 ]GRID grid.8379.5, ISNI 0000 0001 1958 8658, Institute for Clinical Epidemiology and Biometry, , Julius-Maximilian University Würzburg, ; Josef-Schneider-Straße 2, D-97080 Würzburg, Germany
                [3 ]GRID grid.411760.5, ISNI 0000 0001 1378 7891, Clinical Trial Center Würzburg, , University Hospital Würzburg, ; Josef-Schneider-Straße 2, D-97080 Würzburg, Germany
                [4 ]GRID grid.411760.5, ISNI 0000 0001 1378 7891, Comprehensive Heart Failure Center Würzburg, , University and University Hospital Würzburg, ; Am Schwarzenberg 15, D-97078 Würzburg, Germany
                [5 ]GRID grid.411760.5, ISNI 0000 0001 1378 7891, Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, , University Hospital Würzburg, ; Oberdürrbacher Straße 6, D-97080 Würzburg, Germany
                Article
                986
                10.1186/s12912-022-00986-z
                9368695
                35953810
                502c5049-c445-4f8d-b86e-4f6cf72b5dde
                © The Author(s) 2022

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 17 January 2022
                : 18 July 2022
                Funding
                Funded by: Katholische Stiftungshochschule für angewandte Wissenschaften München (3411)
                Categories
                Research
                Custom metadata
                © The Author(s) 2022

                Nursing
                home mechanical ventilation,quality of care,living situation,person-centred care,mixed-methods

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