Evde Parenteral Beslenme Uygulanan Hasta ve Yakınlarının Donabedian Modeline Göre Deneyimlerinin Belirlenmesi

Abstract

This study, which was conducted to determine the experiences, challenges and coping situations of the patients and their relatives who were discharged from a tertiary university hospital in order to perform home parenteral nutrition (HPN), was formed in the context of structure, process and outcome within the framework of the Donabedian Model. Semi-structured interview, observation and prospective follow-up methods were used in the research, which was carried out according to the phenomenological design, which is one of the qualitative research methods. The study was conducted with 11 adult patients who recieved HPN and 11 relatives who performed the practice. Data were analyzed through MAXQDA, a computer-aided qualitative data analysis program, in compliance with the content analysis method suggested by Colaizzi. In our study; a total of 12 themes were determined for the patients and their relatives. 3 of these themes were under the title of structure indicators (home care and follow-up support, need for support by a multidisciplinary team at home, and difficulty in supplying materials), 4 were under the title of process indicators (compliance with HPN, emotions related to HPN, problems experienced in HPN, coping skills and management in HPN), and 4 were under the title of outcome indicators (satisfaction, contribution to the continuity of life, complications due to HPN, physical and social limitations) and the last one was increased care burden for the relatives of the patients. As a result of our study; it was observed that the relatives of the patients did not fully comply with the EPB application steps and rules. Also it was determined that, the most important factors affecting compliance with the HPN process were financial burden, access to nutritional support team and home follow-up and multidisciplinary care support. It was determined that patients and their relatives were satisfied with HPN process and receiving support in their home environment. It can be concluded that; a well-structured HPN training prior to the discharge, repetition of these trainings at home, holistic follow-up of the patient by the multidisciplinary team at home and socio-economic support; are crucial to prevent complications of HPN, to enhance the results and quality of life of patient and it is recommended to establish care practices that meet the needs of patients and their relatives receiving HPN in order to provide these actions.