Exploring Pictorial Health Education Tools for Long-Term Home Care: A Qualitative Perspective
Abstract
:1. Introduction
2. Literature Review
2.1. Health Literacy of Long-Term Home Caregivers
2.2. Pictorial Health Education Tools
2.3. AAC Is Applied to Doctor-Patient Communication
2.4. Grounded Theory
3. Materials and Methods
3.1. Study design and Structure
3.2. In-Depth Interview and Observation Method
3.3. Participants
3.4. Content Analysis
3.5. Research Ethics and Limitations
4. Results
4.1. Open Coding and Axial Coding
4.2. The Quantities Relationship between Facts and Axial Coding in Interdisciplinary Cooperation
- ●
- Researchers can follow them on the front line, the research topic may change, the data will be more refined. (Researcher: We need to come over frequently for our investigation). When doing research, patients are involved and there will be patient privacy, so relevant regulations should be adhered to (CA01-54).
- ●
- (Researcher: Let’s start with the case today). Learn as much as you can from nurses, observe their problems and help solve them. The design of the icon registration section has been developed and published before (CA01-58).
- ●
- (The design background researcher explained that the ethical review of the study had been done and suggested that the study would not involve patients. In the study, the researcher showed uncertainty about the health education tools in the interdisciplinary cooperation process and asked the nurses to give relevant advice) If you want to take pictures (as the record), you may have to match our(the nurses) time and then you can take pictures beside us when we are working. That step will slowly decompose (CB02-15).
- ●
- So, let’s start with three-tube care, which is to give you the video and the paperwork. Map out the steps and bring them up when we visit the home. Most of the body cleaning is fine, only the technical aspects, such as turning the patient over and getting them in and out of bed (CB02-65).
- ●
- (The nurses suggested that the intubation procedure should be photographed and the researcher confirmed if the photography and video were available). Yes, but we need the consent of the patient and the family first (CB02-18).
- ●
- (The researchers asked about the origin of the foreign caregivers). Indonesia predominates, as does the Philippines. (The researcher asked about the language of the health education tool, whether a simulation demonstration could be conducted). We can start with a medical dummy. But we need to know the structure of the medical dummy first. Whether the nasogastric tube can be inserted is uncertain (CB02-37).
- ●
- We could look for a similar standard movie for your reference or we could try to send you a video. It is mainly about our technology of placing tubes and care. (Researcher: We are probably going to bother you if you have to teach them what to prepare beforehand and then you have to do the homework. After all, we are non-professional majors, but we will watch relevant videos first to understand. If there are any questions, we will ask you again. Have you used videos to teach foreign caregivers in the past?) There is no video, just direct on-the-spot demonstrations (CB02-49).
- ●
- (Researcher: During direct demonstration, in which cycle did the problem appear?) The nurse replied: Communication. (According to the interview, the researcher further proposed drawing a step-by-step diagram after watching the video to see if a wall chart could be adopted. If there was any problem, it could be adjusted). So, let’s start with three-tube care, which is to give you the video and the paperwork. Map out the steps and bring them up when we visit the home (CB02-57).
- ●
- What if it’s A4 size? Wall charts are not convenient in case there is no place to hang them (CB02-148).
- ●
- Most of the body cleaning is fine, only the technical aspects, such as turning the patient over and getting them in and out of bed. (In terms of studying, researchers suggested there was very little data on the operation of basic nursing skills and caregivers would not buy such material. However, home caregivers’ skills are important and improper operation may result in injured patients. Practical demonstration may be easier to understand, the video still has disparity compare with the fact operation, and then the researcher consulted the nurse commonly the method of communication with the intubation patient at present). Written on paper, Chinese characters (CB02-83).
- ●
- (The researcher asked about preparing the consent form and nurses told them to prepare it by themselves as they needed to know the language used by foreign home caregivers). Indonesia predominates, as does the Philippines (CB02-26).
- ●
- You can’t read the text directly, but we can use a medical dummy, then provide written information while giving guidance. (Researcher: Are there any examples of how patients cannot communicate? Nurse: I have one here at the nursing home. Researcher: What do you use when you need to communicate with patients?) He (the patient) communicated with me using his hands and feet because he can only say a few words; the patient got angry. The patient can make breathing sounds, but I can probably understand them. In terms of communication, he only listens to what he wants to hear (CB02-173).
- ●
- (We) think you can use A4 size to make a small manual and then coil it into a book so it’s easy to turn pages. This will be easier than wall charts. (The researcher proposed preparing several forms of health education tools. Only after testing can we know which pictorials can be truly understood. The nurse’s assistance and modification may be needed in the drawing.) In my opinion, intubation should not be the main focus of carers, but care should be mainly about disinfection and how to observe the principle of sterility. It is mainly about the care of the tubes. We (nurses) have to change the tubes (CB02-156).
4.3. Home Caregivers’ Point of View
4.4. Theoretical Framework for Pictorial Processes in Long-Term Home Care and Communication Problem-Solving Strategies
In the past, if a caregiver had a poor memory, you gave them a video. The average person can’t remember so many steps and precautions. Nurses teach in Indonesian or Vietnamese using health education leaflets provided by existing institutions and as there are no graphics, they can only describe them orally. To see how well caregivers are learning, it would be better to have a pictorial manual.
5. Discussion
5.1. Assist Medical Staff to Solve Real Problems
5.2. Professional Norms and Forms in Interprofessional Cooperation
5.3. The Form of Health Education Tools Has to Meet the Needs of Medical Staff and Home Caregivers
5.4. Pay Attention to Communication Behaviour in the Nursing Process
6. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Empty Frame | Interview Questions |
---|---|
Interdisciplinary cooperative norms [6] | 1. Introduce research directions to seek cooperation and ask if the research can be conducted in the hospital. 2. What rules need to be adhered to? |
The manner of nurses’ communication [34] | 3. What are the basic conditions of the caregiver? 4. What cautions need to be taken when communicating with patients? 5. What are the basic communication methods between nurses and caregivers? |
Problems in home care procedures [35] | 6. What problems need to be solved in the process of home care? 7. What should the home caregivers do at home for intubated patients? 8. What methods does the nurse use to teach home caregivers skills? |
Expectations for developing health education tools [36] | 9. What specification of health education tools are more convenient to use? 10. From the nurse’s perspective, what are the requirements for the design of home care tools? |
Nursing care for intubated patients [37] | 11. What is the key content of nursing in the home care process? 12. What matters need attention in the home care process? |
Times | Researcher 1 | Researcher 2 | Researcher 3 | Common Sentence | Mutual Agreement | Reliability |
---|---|---|---|---|---|---|
1 | 20 | 26 | 21 | 2 | 0.090 | 0.228 |
2 | 23 | 22 | 22 | 20 | 0.896 | 0.962 |
Axial Coding | The Theme | Open Coding | Role | Source |
---|---|---|---|---|
Method of interdisciplinary cooperation (AC01) | Researchers and nurses need to work together | Researchers can follow them on the front line, the research topic may change, the data will be more refined. | Hospital manager | CA01-51 |
Help the nurse with real difficulties | Learn as much as you can from nurses, observe their problems and help solve them. The design of the icon registration section has been developed and published before. | Hospital manager | CA01-58 | |
Speaking right of cooperation | So, let’s start with three-tube care, which is to give you the video and paperwork. Map out the steps and bring them up when we visit the home. | Nurse | CB02-57 | |
Medical research ethics (AC02) | Observe research ethics and avoid disputes | When doing research, patients are involved and there will be patient privacy, so relevant regulations should be adhered to. | Hospital manager | CA01-54 |
Attitude of the patient and family | We need the consent of the patient and the family first. | Nurse | CB02-18 | |
Communication methods (AC03) | Communication is important in nursing and details need to be improved | (Researcher: During direct demonstration, in which cycle did the problem appear?) The nurse replied: Communication. | Nurse | CB02-51 |
How nurses teach and communicate with home caregivers | There is no video, all procedures are on-the-spot demonstrations. | Nurse | CB02-49 | |
The nurses explain the background of home caregivers | Indonesia predominates, as does the Philippines. | Nurse | CB02-26 | |
Existing communication tools are pen and paper | Written on paper, Chinese characters. | Nurse | CB02-83 | |
Nurses rely on personal experience to communicate and it is difficult for patients to express their true wishes | Guess with experience and then describe the meaning roughly to family members. The patient only nods and shakes their head. | Nurse | CB02-85 | |
There is a communication barrier between nurses and patients and it is very difficult for patients to express themselves, so nurses need to guess what patients think during communication. | He (the patient) communicated with me using his hands and feet because he can only say a few words; the patient got angry. The patient can make breathing sounds, but I can probably understand them. In terms of communication, he only listens to what he wants to hear. | Nurse | CB02-173 | |
Health education tools form (AC04) | Nurses’ expectations of health education tools | What if it’s A4 size? Wall charts are not convenient in case there is no place to hang them. | Nurse | CB02-148 |
Nurses use health education tools in the form of traditional printed products, but the size of the tools need to be easy to use | (We) think you can use A4 size to make a small manual and then coil it into a book, it’s easy to turn pages. This will be easier than wall charts. | Nurse | CB02-150 | |
Health education tools development (AC05) | The development of health educational tools requires recording of specific processes, but some steps may not be completed in a simulated environment | We can start with a medical dummy. But we need to know the structure of the medical dummy first. Whether the nasogastric tube can be inserted is uncertain. | Nurse | CB02-37 |
Uncertainty factors in the way health education tools are developed and it is important to find an appropriate way to demonstrate an operation | We could look for a similar standard movie for your reference, or we could try to send you a video. It is mainly about the technology of placing tubes and care. | Nurse | CB02-42 | |
Intubation home care operation (AC06) | A step-by-step demonstration of the operating process is required | That step will slowly decompose. | Nurse | CB02-15 |
Difficulties in the operation of home caregivers | Most of the body cleaning is fine, only the technical aspects, such as turning the patient over and getting them in and out of bed. | Nurse | CB02-65 | |
The main problems considered by nurses in home care is the aseptic operation of intubated patients | In my opinion, intubation should not be the main focus of carers, but care should be mainly about disinfection and how to observe the principle of sterility. | Nurse | CB02-156 | |
Operational considerations and concerns | For example, matters needing attention in terms of the nasogastric tube as it is so long. We will measure and cut a suitable length and insert it. Then how to teach the family members and carers to confirm the tube is in and how to avoid it slipping. | Nurse | CB02-159 | |
Nurses also realised that text might not be suitable for home care, so education tools were repeatedly proposed during operation | You can’t read the text directly, but we can use a medical dummy. Then provide written information while giving guidance. | Nurse | CB02-168 |
Intervention Tools: Communication Behaviours and Intervention of Communication Tools (Language, Text, Image, Body, etc.) | Hospital Staff: Doctors and Nurses | ||
---|---|---|---|
Known | Unknown | ||
Patient Side: Patients, family members and home caregivers | Known | Arena
| Blindspot
|
Unknown | Facade
| Unknown
|
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Lin, F.-S.; Shi, H.-C.; Fang, K.-T. Exploring Pictorial Health Education Tools for Long-Term Home Care: A Qualitative Perspective. Healthcare 2020, 8, 205. https://doi.org/10.3390/healthcare8030205
Lin F-S, Shi H-C, Fang K-T. Exploring Pictorial Health Education Tools for Long-Term Home Care: A Qualitative Perspective. Healthcare. 2020; 8(3):205. https://doi.org/10.3390/healthcare8030205
Chicago/Turabian StyleLin, Fang-Suey, Hong-Chun Shi, and Kwo-Ting Fang. 2020. "Exploring Pictorial Health Education Tools for Long-Term Home Care: A Qualitative Perspective" Healthcare 8, no. 3: 205. https://doi.org/10.3390/healthcare8030205