Understanding Taiwanese home healthcare nurse managers' empowerment and international learning experiences: Community-based participatory research approach using a US home healthcare learning tour

Abstract

Home healthcare is an essential service for frail, aged, and disabled persons. Taiwan has a rapidly aging population. Consequently, there is an urgent need to expand the home healthcare system in Taiwan. Home healthcare nurse managers play a critical role not only in delivering home healthcare but also in improving the quality of care. The purpose of this dissertation was twofold. The first purpose was to examine the perspectives of Taiwanese nurse managers who participated in a US home healthcare learning tour regarding the development of home healthcare for the elderly in Taiwan. The second purpose was to describe the views of Taiwanese home healthcare nurse managers on empowerment and powerlessness within the context of home healthcare.

A community-based participatory research approach was used in the context of a US home healthcare learning tour as the study methodology. Eleven Taiwanese home healthcare nurse managers who signed up for a 2007 US home healthcare learning tour were the study participants. This descriptive study involved data from before, during, and after the tour. Four data collection methods were employed, including focus groups, self-reflective diaries, individual interviews, and participant observations. Conventional content analysis was used to analyze the data. Various strategies were used to promote scientific rigor and trustworthiness of the study results.

Following the learning tour, participants reported their views on the similarities and differences of home healthcare in the US and Taiwan. Their reports were then grouped into three categories: (a) regulations and reimbursement, (b) home health practice, and (c) quality management. The participants' accounts of their empowered and powerless experiences within the home healthcare context were grouped as attributes of empowerment, attributes of powerlessness, and factors affecting both. The findings indicated that the nurse managers felt empowered on the individual and interpersonal levels but powerless on the system level. Evidence of what the nurse managers wanted and gained for their professional development from taking an international learning tour was also documented.