Abstract
Abstract
Background
China’s demographic shifts and evolving family structures have increased healthcare demand. The National Health Commission has promoted the Healthcare Assistant (HCA) system to reduce reliance on family caregivers. However, most existing studies examine this service from single-stakeholder perspectives.
Objective
To explore real-world experiences of unaccompanied care from the perspectives of patients, family members, nursing administrators, and HCA company managers, and to provide evidence for service optimization.
Methods
A phenomenological qualitative study was conducted from January to April 2026 in a tertiary Class-A hospital in Xi'an. Purposive sampling recruited 25 participants. Data were collected through semi-structured interviews and analyzed using thematic analysis. This study specifically explored participants' perspectives on multiple dimensions of unaccompanied care, including trust relationships, HAs competency, attitude change, service experience, emotional support, and model evaluation.
Results
A total of 25 participants were recruited via purposive sampling, including 9 patients, 4 family members, 8 nursing administrators, and 4 nursing assistant company managers. Three core themes were extracted: (1) Perceived value and barriers to acceptance: participants acknowledged the benefits of unaccompanied care for reducing family care burdens and meeting patients' daily care needs, but identified traditional cultural norms and out-of-pocket payment costs as major obstacles; (2) The gap between ideal and actual competency of healthcare assistants: while all stakeholders shared consistent expectations for competent HAs, nursing administrators reported that practicing HAs generally have widespread deficiencies in communication skills, clinical observation ability, and the capacity to provide proactive care; (3) Collaboration patterns and challenges in the service system: currently, hospitals and third-party service agencies operate under a divided responsibility framework, which leads to insufficient quality oversight and high turnover rates for HAs.
Conclusion
From a multi-stakeholder perspective, unaccompanied care alleviates family burden and meets daily needs, yet faces cultural and economic constraints. A significant gap exists between idealised and actual HCA competency, which affects both care quality and patient-provider trust. Future efforts should prioritise improving HCA competency and workforce stability for sustainable service development.