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Table 2 Additional examples of the various dimensions of safety risks

From: Client, caregiver, and provider perspectives of safety in palliative home care: a mixed method design

Dimensions of safety risks Clients Caregiver
Physical • Bringing the hospital to home -Diminished space and overcrowding in communal living areas because of equipment and supplies from hospital can result in risk of trips, slips, falls, from equipment like wheelchairs/walkers, lifting equipment, and tubing, which can cause unintentional physical injuries)  
• Limited training in medication storage, administration, side effects, and contraindications of narcotic medications and paraphernalia in the home, which is used in end of life care  
Emotional • Concern for caregiver well-being when taking on caring responsibilities, as well as implications associated with burden placed on caregivers • Fear of hurting the client when using equipment they do not feel adequately trained to use
• Disease trajectories with unpredictable setbacks and often with sudden changes and/or exacerbations of disease • Dealing with a multitude of intense life-altering situations that can change quickly, which are often urgent, unexpected and unpredictable
• Wish for a dignified death at home can result in either a conscious or unconscious failure to recognize safety risks for themselves or others in their home • Fatigue as a result of being on duty 24/7, constant change, & uncertainty, and a lack of routine
• Grief and emotional distress because of caring for a dying loved one
Social • Client’s terminal illness and minimal social network lead to a feeling of conscription and the expectation that spouses, ex-spouses, siblings, and children will help, leads to a renegotiation of roles  
• Pre-existing health challenges (physical & mental) are worsened when roles are renegotiated, leading to reciprocal roles being determined by who is the sickest at the time  
• Pre-existing tensions amongst client, family/friends, and old wounds re-opened
Functional • Client loss of dignity (due to incontinence) in public places • Compelled to take time away from work or other activities
• Diminished capacity for self-care, employment, engagement with family, friends, outside world • Learning to be a caregiver on the job with limited support
• Developing ‘home grown’ solutions placing both parties at risk
• Inability to recognize if something is wrong because never told what to look for