Development of Care Guidelines for Bed-ridden Patients without a Family Caregiver through Community Participation

Abstract

This action research aimed to develop guidelines for caring for bed-ridden patients living alone at home in the community through community participation in the Suwannaphum District of Roi Et province, Thailand. The study sample of sixty participants included five bed-ridden patients who did not have a family caregiver and fifty-five patient care contributors comprised of a physician, six nurses or other multidisciplinary healthcare team members, five village health workers, five community leaders, twenty village health volunteers, five village caregiver volunteers, three Municipal officials, and ten of the patients’ neighbors. This action research’s methodology consisted of two cycles, each of which followed four steps that were focused on the practice area’s circumstances, specifically: Step 1, assessment of the bed-ridden patients’ situations. Step 2, developing a patient care plan and guidelines using a community forum. Step 3, implementation of the patient care plan based on of the role assignments and caregiver guidelines, Step 4, evaluation of the guidelines using after action reviews and reflections based on the care plan’s outputs and outcomes. Qualitative data were collected by researcher via field recordings, focus group discussions, in-depth interviews, home visits, the community forum, and direct observations and the data obtained were analyzed using content analysis.

The study found that guidelines for caring for home alone bed-ridden patients in the community through community participation were composed of: 1) comprehensive discharge planning by multidisciplinary care-team partners and community networks; 2) care planning and caring for bedridden patients based case-specific issues and circumstances which take into account the patient’s resources, the communities’ participation, and the network collaborations across all processes; 3)  guideline evaluation using after action reviews and member check processes to provide information regarding the data and results to the participants in order to check the data’s accuracy and that it resonates with their experiences in order to improve the guidelines so they are better fit to the community.             After the guidelines were implemented, the care situation of the bed-ridden patients living alone in their home in the community has improved in four areas: 1) patients’ received good and suitable care; 2) the community was continuously involved in patient care from the start of discharge planning and care-related  information was provided to the community t facilitate the care planning by the community; 3) the capacity of the village health workers and village health volunteers to care for the bedridden patients was improved; and 4) the health team had obtained the case management skills to deliver care to the patients based on their specific needs.