title: Home mechanical ventilation and specialised health care in the community: Between a rock and a hard place.
abstract: BACKGROUND
  Home mechanical ventilation probably represents the most advanced and complicated type of medical treatment provisioned outside a hospital setting. The aim of this study was both to explore the challenges experienced by health care professionals in community health care services when caring for patients dependent on home mechanical ventilation, continual care and highly advanced technology, and their proposed solutions to these challenges.
  
  
  METHODS
  Using qualitative research methods, a grounded theory influenced approach was used to explore the respondents' experiences and proposed solutions. A total of 34 multidisciplinary respondents from five different communities in Norway were recruited for five focus groups.
  
  
  RESULTS
  The core category in our findings was what health care professionals in community health care services experience as "between a rock and a hard place," when working with hospitals, family members, and patients. We further identified four subcategories, "to be a guest in the patient's home," "to be accepted or not," "who decides," and "how much can we take." The main background for these challenges seems to stem from patients living and receiving care in their private homes, which often leads to conflicts with family members. These challenges can have a negative effect on both the community health caregivers' work environment and the community health service's provision of professional care.
  
  
  CONCLUSIONS
  This study has identified that care of individuals with complex needs and dependent on home mechanical ventilation presents a wide range of immense challenges for community health care services. The results of this study point towards a need to define the roles of family caregivers and health care professionals and also to find solutions to improve their collaboration. The need to improve the work environment for caregivers directly involved in home-care also exists. The study also shows the need for more dialogue concerning eligibility requirements, rights, and limitations of patients in the provision and use of ventilatory support in private homes.
authors: Department of Anesthesiology, Nordland Hospital, N-8092 Bodø, Norway. kdybwik@gmail.com
authors: Knut
authors: K
authors: Dybwik
authors: Erik W
authors: EW
authors: Nielsen
authors: Berit S
authors: BS
authors: Brinchmann
references: Health Soc Care Community. 2007 Jan;15(1):45-55
references: 17212625
references: Br J Community Nurs. 2004 Jul;9(7):302-4
references: 15284673
references: Qual Health Res. 2006 Sep;16(7):881-901
references: 16894222
references: Health Soc Care Community. 1999 Sep;7(5):350-357
references: 11560651
references: Tidsskr Nor Laegeforen. 2009 Oct 22;129(20):2094-7
references: 19855446
references: Pediatrics. 2006 Jan;117(1):e48-60
references: 16396848
references: Int J Nurs Stud. 2002 Aug;39(6):625-35
references: 12100874
references: Qual Health Res. 2008 Apr;18(4):501-8
references: 18354049
references: J Adv Nurs. 1998 Aug;28(2):370-81
references: 9725735
references: Respir Care. 2007 Aug;52(8):1056-62
references: 17715560
references: Pediatr Int. 2007 Dec;49(6):801-5
references: 18045275
references: Chest. 2007 Aug;132(2):671-6
references: 17699139
references: Nurs Sci Q. 2005 Oct;18(4):301-3
references: 16210743
references: Rehabil Nurs. 1994 Jan-Feb;19(1):6-11
references: 8159867
references: J Adv Nurs. 2005 Sep;51(5):456-64
references: 16098162
references: J Adv Nurs. 2001 Jun;34(5):593-602
references: 11380727
references: BMJ. 1995 Jul 29;311(7000):299-302
references: 7633241
references: Chron Respir Dis. 2010;7(2):67-73
references: 20015913
references: Nurs Ethics. 2008 May;15(3):371-83
references: 18388171
references: J Health Soc Policy. 1994;6(2):51-70
references: 10141131
references: J Pediatr Nurs. 1994 Apr;9(2):98-106
references: 8027945
references: J Adv Nurs. 2009 Feb;65(2):425-34
references: 19191941
references: Nurs Inq. 2003 Mar;10(1):19-27
references: 12622801
references: Am J Phys Med Rehabil. 2001 Jun;80(6):439-46
references: 11399005
references: Child Care Health Dev. 2004 May;30(3):209-18; discussion 219
references: 15104576
references: J Pediatr Nurs. 1998 Jun;13(3):175-84
references: 9640011