Despite the benefits of utilising community-based care services (CBS) for people with dementia and their caregiver being well established, people with dementia and caregivers use fewer services in comparison to other people in need of care. While societal, cultural and logistical factors effecting caregiver use of CBS are frequently studied, research of internal emotional barriers, mental limitations created by one's own self that prevents open communication of thoughts and feelings, and their effect on CBS use is limited. This paper explores internal emotional barriers on caregivers' use of CBS within the Irish Healthcare System. Professional Healthcare Providers were also interviewed as a preliminary indicator of their awareness of these internal emotional barriers and their impact on caregivers' use of CBS. Using interpretive description methodology, interviews with 20 caregivers and fourteen dementia professional healthcare providers were transcribed and a thematic analysis methodology applied to illuminate themes/patterns within participants’ subjective perceptions of caregivers emotional barriers to using CBS. Four themes emerge: reluctance to question general practitioner (GP) authority; embarrassment during level of care requirement reviews; sense of obligation to provide all care; and fear of stigma. Caregivers interviewed were reluctant to communicate concerns with professional healthcare providers (PHPs), thereby reducing the PHP’s awareness of these barriers and delaying/preventing use of CBS. As key gatekeepers within the care pathway, GPs should address the uneven power dynamic with the caregiver through user-centred models of care, which actively encourage open dialogue, and receive training to identify the indicative behaviours of internal emotional barriers and empower the caregiver to communicate their feelings/concerns directly.

中文翻译：

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在爱尔兰获得社区痴呆症护理服务：护理人员的情感障碍

尽管利用社区护理服务 (CBS) 为痴呆症患者及其照顾者提供了良好的好处，但与其他需要照顾的人相比，痴呆症患者和照顾者使用的服务较少。虽然经常研究影响护理人员使用 CBS 的社会、文化和后勤因素，但对内部情绪障碍、由自己造成的阻碍思想和感受的开放交流的精神限制及其对 CBS 使用的影响的研究是有限的。本文探讨了爱尔兰医疗保健系统中看护人使用 CBS 的内部情感障碍。专业医疗保健提供者也接受了采访，作为他们对这些内部情绪障碍的认识及其对护理人员使用 CBS 的影响的初步指标。使用解释性描述方法，转录了对 20 名护理人员和 14 名痴呆症专业医疗保健提供者的访谈，并应用了主题分析方法来阐明参与者对护理人员使用 CBS 的情感障碍的主观看法中的主题/模式。出现了四个主题：不愿质疑全科医生 (GP) 的权威；护理水平要求审查期间的尴尬；提供所有照顾的义务感；和害怕耻辱。接受采访的护理人员不愿与专业医疗保健提供者 (PHP) 交流担忧，从而降低了 PHP 对这些障碍的认识并延迟/阻止了 CBS 的使用。作为护理路径中的关键看门人，全科医生应通过以用户为中心的护理模式解决与护理人员之间的权力不平衡问题，