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Rosa D, Peverelli M, Poliani A, Villa G, Manara DF. Exploring Hypertension Patient Engagement Using mHealth. A Scoping Review. High Blood Press Cardiovasc Prev 2024:10.1007/s40292-024-00656-y. [PMID: 38913296 DOI: 10.1007/s40292-024-00656-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 06/01/2024] [Indexed: 06/25/2024] Open
Abstract
INTRODUCTION Widespread use of smartphone applications has opened new perspectives for home Blood Pressure monitoring based on mobile health (mHealth) technologies. Patient engagement has been dubbed 'the silver bullet of the century'. AIM The aim was to identify the impact of engagement in patients with blood pressure using mHealth. METHODS This scoping review was conducted in accordance with the Ark0sey and O'Malley framework. DATABASE Pubmed, CINAHL, Scopus and PsycInfo. This review considered both qualitative and quantitative primary searches. We excluded articles belonging to grey literature, secondary literature and paediatric setting. Between September and November 2023, the review was carried out. RESULTS A total of 569 documents were retrieved from the four databases. After the deduplication process, five articles were removed. The selection process based on titles and abstracts included 133 records. Ten studies were selected and analysed. The reviewers identified the following themes: device type and mobile applications, engagement, blood pressure control, health behaviours and hypertension knowledge. Self-management using digital technologies in the home is strongly linked to engagement, reduction and control of Blood Pressure, improved health practices and increased knowledge of hypertension. Healthcare interventions using IT platforms have had a significant impact on the health outcomes of patients diagnosed with hypertension. CONCLUSIONS The review findings suggest the value of these technologies in improving patient engagement and, consequently, adherence to antihypertensive treatment and achieving blood pressure control rates, potentially reducing cardiovascular risk.
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Affiliation(s)
- Debora Rosa
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, Via Olgettina, 58, Milan, Italy
| | - Matteo Peverelli
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, Via Olgettina, 58, Milan, Italy
| | - Andrea Poliani
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, Via Olgettina, 58, Milan, Italy
| | - Giulia Villa
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, Via Olgettina, 58, Milan, Italy.
| | - Duilio Fiorenzo Manara
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, Via Olgettina, 58, Milan, Italy
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Byrne AL, Harvey C, Baldwin A. The discourse of delivering person-centred nursing care before, and during, the COVID-19 pandemic: Care as collateral damage. Nurs Inq 2024; 31:e12593. [PMID: 37583275 DOI: 10.1111/nin.12593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 08/17/2023]
Abstract
The global COVID-19 pandemic challenged the world-how it functions, how people move in the social worlds and how government/government services and people interact. Health services, operating under the principles of new public management, have undertaken rapid changes to service delivery and models of care. What has become apparent is the mechanisms within which contemporary health services operate and how services are not prioritising the person at the centre of care. Person-centred care (PCC) is the philosophical premise upon which models of health care are developed and implemented. Given the strain that COVID-19 has placed on the health services and the people who deliver the care, it is essential to explore the tensions that exist in this space. This article suggests that before the pandemic, PCC was largely rhetoric, and rendered invisible during the pandemic. The paper presents an investigation into the role of PCC in these challenging times, adopting a Foucauldian lens, specifically governmentality and biopolitics, to examine the policies, priorities and practical implications as health services pivoted and adapted to changing and acute demands. Specifically, this paper draws on the Australian experience, including shifting nursing workforce priorities and additional challenges resulting from public health directives such as lockdowns and limitations. The findings from this exploration open a space for discussion around the rhetoric of PCC, the status of nurses and that which has been lost to the pandemic.
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Affiliation(s)
- Amy-Louise Byrne
- School of Nursing Midwifery and Social Sciences, Central Queensland University, Townsville, Queensland, Australia
| | - Clare Harvey
- School of Nursing, Massey University, Wellington, New Zealand
| | - Adele Baldwin
- School of Nursing Midwifery and Social Sciences, Central Queensland University, Townsville, Queensland, Australia
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Parry M, Owadally T, O’Hara A, Nickerson N, Hart D. Community- and Patient-Partner Engagement in Women's Cardiovascular Disease Research: A Rapid Review of the Evidence. CJC Open 2024; 6:485-502. [PMID: 38487065 PMCID: PMC10935688 DOI: 10.1016/j.cjco.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 12/13/2023] [Indexed: 03/17/2024] Open
Abstract
The primary objective of this rapid review is to describe community-partner and patient-partner engagement in women's cardiovascular disease (CVD) research. Secondary objectives are to: (i) describe the phase of the research in which community and patient partners were engaged; (ii) define the level of engagement at each research phase; and (iii) make recommendations for future engagement of community and/or patient partners in women's CVD research. Rapid review guidelines recommended by the Cochrane Rapid Reviews Methods Group and Tricco et al. were used to search 5 databases using medical subject headings (MeSH) and/or keywords. Participants included women (cis and trans) aged > 18 years who had ischemic heart disease, heart failure, or stroke. A risk of bias assessment was not undertaken. Findings are summarized and/or clustered as community-based participatory research, or patient-oriented and/or patient-partner research. Our search yielded 39,998 titles and abstracts. Of these, 35 were included in a final narrative synthesis, comprising data from 474 community and/or patient partners, including 417 (88%) women. Over 85% of community partners collaborated in the design and/or planning and implementation of women's CVD research; most originated in the US; only one originated in Canada. Most patient-oriented and patient-partner research originated in Canada. However, less than 50% of patient partners collaborated in any phase of research. Sex, gender, race, and ethnicity were rarely reported. Results suggest negligible community and inadequate patient-oriented and/or patient-partner engagement in women's CVD research in Canada. Improved CVD outcomes for women may be achieved with better community- and patient-partner collaboration across all phases of research, genders, race, and ethnicities.
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Affiliation(s)
- Monica Parry
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Tasneem Owadally
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Arland O’Hara
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | | | - Donna Hart
- Patient Partner, Milton, Ontario, Canada
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Caffrey A, Botticello J, Quarshie PE, Ali L, Watts P, Cathala X, Ferrante J. Student nurses' experiences of discrimination and racism on work placements: What can higher education institutions do? NURSE EDUCATION TODAY 2023; 131:105980. [PMID: 37857100 DOI: 10.1016/j.nedt.2023.105980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 05/31/2023] [Accepted: 09/19/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND There is persistent interpersonal, institutional and structural racism within the health sector and higher education. Such anti-Black and anti-Brown racisms are experienced by nursing students, nursing apprentices and fully qualified nurses. This discrimination intersects with other characteristics, namely gender and student status, which can make the nursing profession an unsafe environment for many. OBJECTIVES To understand student nurses' experiences of racism and intersecting oppressions, at university and on work placement. DESIGN A qualitative descriptive study with individual interviews and focus groups. SETTINGS A widening participation higher education institution in London, UK. PARTICIPANTS Twenty-four student nurses and nurse apprentices studying on an adult nursing programme. METHODS Students were recruited through purposive sampling. In-depth data relating to student nurses' perspectives and experiences were gathered through two focus groups and three individual interviews conducted by student nurse peers. Interviews were transcribed verbatim and open coding was used to analyse transcripts using comparison and thematic analysis. RESULTS Three key themes arose: safety and support in the university space; hierarchical treatment in work placements due to intersecting race and 'student' identities, and; direct racism by patients and staff in work placements. CONCLUSIONS Student nurses expressed their vulnerability to discrimination and racism whilst on placement in the National Health Service. More opportunities within university curricula are needed for student nurses to learn about, reflect on, and gain support for managing experiences of discrimination in the health system.
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Affiliation(s)
- Anna Caffrey
- University of East London, School of Health Sport and Bioscience, University Way, E16 2RD London, United Kingdom..
| | - Julie Botticello
- University of East London, School of Health Sport and Bioscience, University Way, E16 2RD London, United Kingdom
| | - Philomena Esinam Quarshie
- University of East London, School of Health Sport and Bioscience, University Way, E16 2RD London, United Kingdom
| | - Luul Ali
- University of East London, School of Health Sport and Bioscience, University Way, E16 2RD London, United Kingdom
| | - Paul Watts
- University of East London, School of Health Sport and Bioscience, University Way, E16 2RD London, United Kingdom
| | - Xabi Cathala
- City, University of London, Northampton Square, London EC1V 0HB, University of London
| | - Joshua Ferrante
- University of East London, School of Health Sport and Bioscience, University Way, E16 2RD London, United Kingdom
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Turcotte PL, Holmes D, Murray SJ. The shiny new object: Deconstructing the patient-oriented paradigm in health sciences. J Eval Clin Pract 2023. [PMID: 36880981 DOI: 10.1111/jep.13823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 03/08/2023]
Abstract
RATIONALE A 'patient-oriented' research paradigm, also known as patient and public engagement, has infiltrated the field of health sciences and continues to spread. At first blush, it is difficult to reprove anything labelled 'patient-oriented'; however, the patient-oriented paradigm may easily become an ideological 'good', leading to unintended consequences that may well prove more detrimental than beneficial. While patient-oriented research has its roots in more radical forms of patient and public engagement, its recent instantiation betrays its roots and forecloses on more radical forms of engagement, such as critical participatory research. AIM AND OBJECTIVES The objective of this article is to deconstruct the patient-oriented research narrative and to demonstrate how such a discourse imposes itself as a dominant approach in health sciences. APPROACH Following Derrida's deconstructive approach, we bring to light the unexamined presuppositions, false pretences, and presumed 'goodness' and 'naturalness' of patient-oriented discourse. DISCUSSION By deconstructing the patient-oriented narrative we demonstrate how pre-existing power structures (biomedical, economic, etc.) shape the conduct of the approach and serve to depoliticize the truly participatory aspects of research. Rather than being modelled on the evidence-based movement or seen as its natural 'evolution', patient-oriented research should resist by affirming itself as a radical form that is both participatory and emancipatory.
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Affiliation(s)
- Pier-Luc Turcotte
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Dave Holmes
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ontario, Ottawa, Canada
| | - Stuart J Murray
- Department of English Language and Literature, Carleton University, Ottawa, Ontario, Canada
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Stjernswärd S, Glasdam S. The European Standard EN 17398:2020 on Patient Involvement in Health Care - a Fairclough-Inspired Critical Discourse Analysis. Policy Polit Nurs Pract 2022; 23:130-141. [PMID: 35306903 PMCID: PMC9014666 DOI: 10.1177/15271544221088250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The concept of ‘patient involvement’ is highlighted in healthcare. However, hindrances
can prevent its implementation. This article explored how ‘patient involvement’ is
understood and on what ideas this understanding is based through a critical textual
analysis of the European document on patient involvement in health systems using a
Fairclough-inspired critical discourse analysis. The findings showed that the document
arose from a social discourse based on a mix of a neoliberal ideology, with a
marketisation of care focusing on a cost-effective and evidence-based logic of care,
and a humanistic ideology of patient involvement. It had the form of a
normative, consensus-based standard, supported by European organisations. The document
incorporated a visionary, well-intentioned abstract guide to promote patient involvement
across European care contexts, however without addressing hindrances nor differences
across the contexts in which it ought to be implemented. It raises questions about its
usability, inviting further research into empirical applications.
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Affiliation(s)
- Sigrid Stjernswärd
- Department of Health Sciences, 59568Lund University Faculty of Medicine, Lund, Sweden
| | - Stinne Glasdam
- Department of Health Sciences, 59568Lund University Faculty of Medicine, Lund, Sweden
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Byrne AL, Harvey C, Baldwin A. Health (il)literacy: Structural vulnerability in the nurse navigator service. Nurs Inq 2021; 29:e12439. [PMID: 34237182 DOI: 10.1111/nin.12439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/30/2021] [Accepted: 06/02/2021] [Indexed: 12/29/2022]
Abstract
Health literacy is a contemporary term used in health services, often used to describe individuals requiring additional support to access, understand and implement health service information. It is used as a measure of self-efficacy in chronic disease models of care such as the nurse navigator service. The aim of the research was to investigate the concept of health literacy in the nurse navigator service, particularly in relation to the defined role objective of person-centred care. Fairclough's critical discourse analysis was used to analyse the experiential, relational and expressive elements of texts, investigating the hidden truths which are represented in discourse. Texts from a variety of health service micro-, meso- and macro-hierarchical sources were selected for analysis using the nurse navigator evaluation data set and other associated texts. Health literacy in the nurse navigator service is a technology of government used to increase participation of individuals in their own health and well-being. The discourse suggests that health literacy responsibilises both individuals and nurses and is discursively formed within a matrix of rational choice. In this context, health literacy contributes to structural vulnerability.
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Affiliation(s)
- Amy-Louise Byrne
- Midwifery and Social Science, Central Queensland University School of Nursing, Townsville, QLD, Australia
| | - Clare Harvey
- Midwifery and Social Science, Central Queensland University School of Nursing, Townsville, QLD, Australia.,School of Nursing, Massey University, Palmerston North, New Zealand
| | - Adele Baldwin
- Midwifery and Social Science, Central Queensland University School of Nursing, Townsville, QLD, Australia
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Glasdam S, Jacobsen CB, Boelsbjerg HB. Nurses' refusals of patient involvement in their own palliative care. Nurs Ethics 2020; 27:969733020929062. [PMID: 32627661 PMCID: PMC7564292 DOI: 10.1177/0969733020929062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Ideas of patient involvement are related to notions of self-determination and autonomy, which are not always in alignment with complex interactions and communication in clinical practice. AIM To illuminate and discuss patient involvement in routine clinical care situations in nursing practice from an ethical perspective. METHOD A case study based on an anthropological field study among patients with advanced cancer in Denmark. ETHICAL CONSIDERATIONS Followed the principles of the Helsinki Declaration. FINDINGS Two cases illustrated situations where nurses refused patient involvement in their own case. DISCUSSION Focus on two ethical issues, namely 'including patients' experiences in palliative nursing care' and 'relational distribution of power and knowledge', inspired primarily by Hannah Arendt's concept of thoughtlessness and a Foucauldian perspective on the medical clinic and power. The article discusses how patients' palliative care needs and preferences, knowledge and statements become part of the less significant background of nursing practice, when nurses have a predefined agenda for acting with and involvement of patients. Both structurally conditioned 'thoughtlessness' of the nurses and distribution of power and knowledge between patients and nurses condition nurses to set the agenda and assess when and at what level it is relevant to take up patients' invitations to involve them in their own case. CONCLUSION The medical and institutional logic of the healthcare service sets the framework for the exchange between professional and patient, which has an embedded risk that 'thoughtlessness' appears among nurses. The consequences of neglecting the spontaneous nature of human action and refusing the invitations of the patients to be involved in their life situation call for ethical and practical reflection among nurses. The conditions for interaction with humans as unpredictable and variable challenge nurses' ways of being ethically attentive to ensure that patients receive good palliative care, despite the structurally conditioned logic of healthcare.
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Hartford W, Backman C, Li LC, McKinnon A, Nimmon L. Appropriating and asserting power on inflammatory arthritis teams: A social network perspective. Health Expect 2020; 23:813-824. [PMID: 32185848 PMCID: PMC7495070 DOI: 10.1111/hex.13051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 03/02/2020] [Accepted: 03/03/2020] [Indexed: 11/27/2022] Open
Abstract
Background Therapeutic interventions for people with inflammatory arthritis (IA) increasingly involve multidisciplinary teams and strive to foster patient‐centred care and shared decision making. Participation in health‐care decisions requires patients to assert themselves and negotiate power in encounters with clinicians; however, clinical contexts often afford less authority for patients than clinicians. This disadvantage may inhibit patients' involvement in their own health care. Objective To identify communication attributes, IA patients use to influence and negotiate their treatment with members of their health‐care network. Method A qualitative social network approach was used to analyse data from a larger study that investigated IA patients' overall experiences of multidisciplinary care. Fourteen patients with IA attended individual semi‐structured interviews. Researchers used thematic analysis to identify patterns of assertiveness and influence in the data. Results Participants experienced loss of identity, control and agency in addition to the physical symptoms of IA. However, they had a sense of personal responsibility for managing their health care. Perceptions of health‐care team support enhanced patients' influence in treatment negotiations. Notably, there appeared to be an underlying tension between being empowered or disempowered. Discussion and conclusions The findings have significant implications for treatment decision communication approaches to IA care. A social network perspective may provide a pathway for clinicians to better understand the complexities of communication with their patients. This approach may reduce unequal power dynamics that occur within clinician/patient interactions and afford people with IA agency, control and affirmation of identity within their health‐care network.
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Affiliation(s)
- Wendy Hartford
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Catherine Backman
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Linda C Li
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Annette McKinnon
- Arthritis Research Canada's Patient Advisory Board, Vancouver, BC, Canada
| | - Laura Nimmon
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Centre for Health Education Scholarship, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Glasdam S, Bjerström C, Engberg de Carvalho C. Coping strategies among patients with malignant lymphoma- a qualitative study from the perspectives of Swedish patients. Eur J Oncol Nurs 2019; 44:101693. [PMID: 31783326 DOI: 10.1016/j.ejon.2019.101693] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 11/13/2019] [Accepted: 11/16/2019] [Indexed: 01/07/2023]
Abstract
PURPOSE There is a dearth of research on coping strategies of patients with malignant lymphoma. The aim of this article is to explore how these patients cope with cancer in everyday life. METHOD Semi-structured interviews were conducted with nine patients in Sweden. A thematic analysis was made, inspired by Antonovsky's theory of sense of coherence. The SRQR checklist was used. RESULTS Patient's coping strategies are shown within three themes: 'Life experiences supported coping strategies during treatment', 'Between completed treatment and (possible) cure', and 'Illness brought closeness and distance in social relationships'. Three different coping strategies were identified during treatment: trying to control the situation, seeing opportunities in difficulties, and doing other activities to limit thoughts about disease and treatment. Four different coping strategies were identified after treatment ended, namely projecting responsibility and anger onto the healthcare system, maintaining the outer facade as a strong person who had control over the situation, talking about disease, side effects and emotions and putting the focus on the future, and managing life by anticipating death. Family =and friends were a part of patients' coping strategies, but to different extents and in different ways. Diagnosis and treatment for malignant lymphoma brought closeness and distance in social relationships. CONCLUSION Patients with malignant lymphoma cope with cancer in different ways in everyday life influenced by their life experiences and life conditions. Further research should focus on cancer patients' coping strategies in a relational perspective, as coping and coping opportunities are embedded in social context and social relationships.
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Affiliation(s)
- Stinne Glasdam
- Department of Health Sciences, Faculty of Medicine, Lund University, Margaretavägen 1 B, S-222 41, Lund, Sweden.
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Madjar B, Shachaf S, Zlotnick C. Changing the current health system's vision for disease prevention and health promotion. Int Nurs Rev 2019; 66:490-497. [PMID: 31309558 DOI: 10.1111/inr.12535] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM Using the case of Israel, we examine the confluence of current philosophies of health care along with the historical trends of health promotion/disease prevention services to consider strategies for increasing inclusiveness and for updating and improving their service delivery. BACKGROUND Health services in Israel are at a crossroads. Plans to integrate the historic, nurse-operated, nationwide programme, providing health promotion/disease prevention services to pregnant women and young children for all residents (Tipat Halav) into the National Health Service System's existing Sickness Funds are under discussion. SOURCES OF EVIDENCE Using a discourse approach, this paper examines the current and historical context of health promotion/disease prevention services. Our history shows an increasingly treatment-based perspective and dwindling support for inclusive services. In the current health system, Tipat Halav nurses solely provide inclusive health promotion/disease prevention services to pregnant women and young children. Informed by the World Health Organization, a reorientation to health promotion/disease prevention is essential in an ageing society where chronic rather than infectious diseases are the reigning health problems. CONCLUSION Israel needs to reorganize the health system using a public health approach that both incorporates existing structures and establishes new ones, such as creating a network to elicit community input, and instituting nurse-operated clinics designed to provide health promotion/disease prevention services for all ages and all residents. IMPLICATIONS FOR HEALTH AND NURSING POLICY The newly created health system framework demands activism among all health professionals to legislate for an inclusive, holistic orientation. Master's level clinical programmes in community health nursing are vital to ensure the provision of optimal health promotion/disease prevention services.
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Affiliation(s)
- B Madjar
- Israel Ministry of Health, Haifa, Israel
| | - S Shachaf
- Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - C Zlotnick
- Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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Glasdam S, Oute J. Professionals’ involvement of relatives – only good intentions? JOURNAL OF ORGANIZATIONAL ETHNOGRAPHY 2019. [DOI: 10.1108/joe-01-2018-0003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to explore how, and under what conditions, professionals involve relatives in clinical practice.
Design/methodology/approach
Two cases were constructed from two studies in Denmark, theoretically inspired by Bourdieu’s concepts of doxa and position and analyzed with focus on the involvement of relatives from the perspective of professionals.
Findings
Support to relatives in practice is rarely included in the way that treatment and care are organized in healthcare. Professionals’ views of the involvement of relatives were characterized by the values of neoliberal ideology and medical-professional rationality, in which relatives are not regarded as a subject of care and support in clinical practice. The involvement of relatives aimed to ensure patients’ participation in randomized clinical trial and to help professionals to care for patients when the professionals were not absolutely needed. Professionals were relatively higher positioned in the clinic than relatives were, which allowed professionals to in – and exclude relatives. Neoliberal ideology and medical-professional rationality go hand in hand when it comes to patient treatment, care and the involvement of relatives; it is all about efficiency, treatment optimization and increased social control of the diagnosed patient. These neoliberal, organizational values consolidate doxa of the medical field and the positions that govern the meeting with patients’ relatives – if it takes place at all.
Originality/value
The results put into perspective how the combination of neoliberalism and medical logic work as an organizing principle in contemporary healthcare systems, and challenge a normative, humanistic view on involving patients’ relatives in the medical clinic.
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Jepsen LØ, Friis LS, Hansen DG, Marcher CW, Høybye MT. Living with outpatient management as spouse to intensively treated acute leukemia patients. PLoS One 2019; 14:e0216821. [PMID: 31091285 PMCID: PMC6519813 DOI: 10.1371/journal.pone.0216821] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 04/29/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Spouses have a key position in the treatment of patients with acute leukemia (AL) who are increasingly managed in an outpatient setting. Patients live at home but appear at the hospital every second day for follow-up visits. Patients must adhere to specific precautions due to an impaired immune system, which challenges and influence the life of the whole family. This qualitative study, based on individual and group interviews with spouses to AL patients in curative intended treatment, elucidates how the intense and substantial caregiver role affects the everyday lives of spouses to AL patients in curative intended treatment. METHODS Qualitative semi-structured group interviews (n = 6) and individual interviews (n = 5) with spouses to AL patients were conducted at different time points during the whole course of treatment. Theories of everyday life served as the theoretical framework. RESULTS The spouses described their life as a constant state of vigilance and attention as a consequence of the responsibility they felt arising from the treatment in the outpatient setting. These made them experience their role as a burden. The social life of the spouses and the families suffered substantially due to the precautions that were instated in the home. However, many experienced that relations in the family were developed positively. CONCLUSIONS Close relatives experience additional psychosocial burdens instigated by the outpatient management regimens. This is important knowledge for the health care system to include in future development of AL outpatient settings, to prioritize and support offers to the relatives that recognize their sense of burden. This could apply not only to relatives of AL patients but to the relatives of other severely ill patients as well.
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Affiliation(s)
| | | | - Dorte Gilså Hansen
- Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| | | | - Mette Terp Høybye
- Interdisciplinary Research Unit, Elective Surgery Center, Silkeborg Regional Hospital, Silkeborg, Denmark
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14
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Beedholm K, Frederiksen K. Patient involvement and institutional logics: A discussion paper. Nurs Philos 2018; 20:e12234. [PMID: 30592122 DOI: 10.1111/nup.12234] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 11/26/2018] [Accepted: 11/26/2018] [Indexed: 11/30/2022]
Abstract
The research into patient involvement is seldom concerned with the significance of cultural and structural factors. In this discussion paper, we illustrate our considerations on some of the challenges in implementing the ideal of patient involvement by showing how such factors take part in shaping the ways in which the intentions to involve patients are converted to practical interventions. The aim was to contribute to the approach dealing with contextual and structural factors of significance for patient involvement. With the idea of "institutional logics," borrowed from the Danish scholar, Erik Riiskjaer, we first demonstrate, with examples from our own research, how patient involvement is interpreted differently within the different logics. Then, we show how the different interpretations of patient involvement meet and conflict in mutual competition as the ideals are sought to be converted to practical interventions. At last, we argue that an adequate theoretical model for the development in the future health care system should be expanded with a "patient logic."
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Affiliation(s)
- Kirsten Beedholm
- Department of Public Health, Section for Nursing, Aarhus University, Aarhus C, Denmark
| | - Kirsten Frederiksen
- Department of Public Health, Section for Nursing, Aarhus University, Aarhus C, Denmark
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15
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Øye C, Jacobsen FF. Informal use of restraint in nursing homes: A threat to human rights or necessary care to preserve residents' dignity? Health (London) 2018; 24:187-202. [PMID: 30207186 DOI: 10.1177/1363459318800175] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Use of restraint in nursing homes is highly controversial and fundamentally transgresses human rights and freedom of movement and choice. While different forms of formal restraint use in nursing homes are broadly delineated, the use of informal restraint is less understood. The aim of this article is to identify different kinds of informal restraint, and how staff use informal restraint under which circumstances. This article illuminates informal restraint use based on an ethnographic study in four nursing homes in the Western part of Norway. We have identified five different forms of informal restraint use which are as follows: (1) diversion of residents' attention; (2) white lies; (3) persuasion and interpersonal pressure; (4) offers and finally (5) threats. These different forms of informal restraint are actions by staff against residents' will, limiting residents' freedom of movement and their personal preferences. In addition, we have identified 'grey-zone restraint' which comprises actions by staff towards residents which lie in-between formal and informal restraint. The use of informal restraint can be explained by institutional circumstances such as location, architecture and institutional collectivist constraints in relation to care work. Moreover, and paradoxically, informal restraint can be explained as a consequence of neo-liberal policies with establishment of extended premises for freedom of movement and practices of resident preferences in nursing homes. Informal restraint practices call into question whether these practices are compatible with fundamental human rights and the preservation of residents' dignity.
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Affiliation(s)
- Christine Øye
- Western Norway University of Applied Sciences (HVL), Norway
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16
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Jensen CM, Overgaard S, Wiil UK, Smith AC, Clemensen J. Bridging the gap: A user-driven study on new ways to support self-care and empowerment for patients with hip fracture. SAGE Open Med 2018; 6:2050312118799121. [PMID: 30210796 PMCID: PMC6130081 DOI: 10.1177/2050312118799121] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 08/13/2018] [Indexed: 12/14/2022] Open
Abstract
Objectives In future healthcare systems, individuals are expected to be more involved in managing their health and preventing illness. A previous study of patient empowerment on a hip fracture pathway uncovered a gap between what the healthcare system provided and patients' needs and wishes. The aim of this study was to investigate whether a user-driven approach and a participatory design could provide a solution that would bridge this gap. Methods Four workshops and a laboratory test were conducted with healthcare professionals to co-create a final prototype. This was performed in iterative processes through continuous interviews and face-to-face evaluation with patients, together with field studies in patients' homes, to maintain relevance to end-users, that is, patients and healthcare professionals. The data were analysed according to the plan, act, observe and reflect methodology of iterative processes in participatory design. Results Our results contribute to a key research area within patient involvement. By using participatory design, patients and healthcare professionals gained a mutual understanding and collaborated to create a technological solution that would encompass needs and wishes. Patient empowerment also involved giving healthcare professionals a means of empowerment, by providing them with a platform to support patient education. We found that one solution to bridging the aforementioned gap could be an app, including a range of educational features that would accommodate different learning styles. Conclusion In developing a technological solution, user involvement in a participatory design ensures usability and inclusion of the requested functionalities. This can help bridge the gap between what the healthcare system provided and patients' needs and wishes and support patients' individual empowerment needs and self-care capacity. Together with the tools and techniques, the setting in which PD unfolds should be thoughtfully planned.
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Affiliation(s)
- Charlotte Myhre Jensen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark.,Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
| | - Soren Overgaard
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
| | - Uffe Kock Wiil
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark.,The Maersk Mc-Kinney Moller Institute, University of Southern Denmark, Odense, Denmark
| | - Anthony C Smith
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark.,Centre for Online Health, The University of Queensland, Brisbane, QLD, Australia
| | - Jane Clemensen
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark.,Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
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17
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Jones M, Pietilä I. Expertise, advocacy and activism: A qualitative study on the activities of prostate cancer peer support workers. Health (London) 2018; 24:21-37. [PMID: 29974804 DOI: 10.1177/1363459318785711] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Peer support workers are now working with patients in a variety of settings, coming into close contact and even work alongside health professionals. Despite the potentially influential position peer support workers hold in relation to those engaged in support activities, their role, duties and their relationship to peers and health professionals lack clarity and is often defined by other actors. This study explores how peer support workers interpret and define the activities, responsibilities and knowledge associated with their work. Using methods of membership categorisation analysis, we analysed interview materials generated by conducting individual semi-structured interviews during the autumn of 2016 with prostate cancer peer support workers (n = 11) who currently volunteer as support workers in Finland. Although the peer support workers acknowledged the psychosocial aspects of the work, we argue that their interpretations extend far beyond this and encompass expertise, advocacy and activism as central features of their work. These can be used to strengthen their position as credible commentators and educators on issues relating to cancer and men's health; raise awareness and represent the 'patient's voice' and attempt to influence both policy and clinical practice. These findings suggest that by categorising their work activities in different ways, voluntary sector actors such as peer support workers can attempt to portray themselves as legitimate authorities on a range of issues and influence decision-making ranging from individual level treatment decisions all the way to health policy.
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18
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Jørgensen K, Rendtorff JD, Holen M. How patient participation is constructed in mental health care: a grounded theory study. Scand J Caring Sci 2018; 32:1359-1370. [PMID: 29732600 DOI: 10.1111/scs.12581] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 03/20/2018] [Indexed: 11/30/2022]
Abstract
AIM The aim of the study was to explore how patient participation is constructed in social interaction processes between nurses, other health professionals and service users, and which structures provide a framework for the participation of service users in a psychiatric context? METHODOLOGICAL DESIGN Ten tape-recorded interviews of nurses and observations of interactions between nurses, other health professionals and service users reflected differing constructed views of patient participation. Charmaz's interpretation of the grounded theory method was used, and the data were analysed using constant comparative analysis. ETHICAL ISSUES AND APPROVAL The study was designed in accordance with the ethical principles of the Helsinki Declaration (1) and Danish law (2). Each study participant in the two psychiatric departments gave informed consent after verbal and written information. FINDINGS The articulation of patient participation emphasises the challenge between, on the one side, orientations of ethical care, and, on the other, paternalism and biomedicine. The core category was generated from four inter-related categories: (i) taking care of the individual needs; (ii) the service user as expert; and (iii) biomedicine, and (iv) paternalism, and their 13 subcategories. CONCLUSIONS This study illuminates the meaning of patient participation in a psychiatric context based on social interaction between nurses, other health professionals and service users. This can contribute to dealing with the challenges of incorporating patient participation as an ideology in all service users in a psychiatric context and is therefore important knowledge for health professionals.
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Affiliation(s)
- Kim Jørgensen
- Department of Nursing, University College Copenhagen, Hillerod, Denmark
| | - Jacob Dahl Rendtorff
- Department of Social Sciences and Business, Roskilde University, Roskilde, Denmark
| | - Mari Holen
- Department of People and Technology, Research Centre in Health Promotion, Roskilde University, Roskilde, Denmark
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19
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Gandsman A. Paradox of choice and the illusion of autonomy: The construction of ethical subjects in right-to-die activism. DEATH STUDIES 2018; 42:329-335. [PMID: 29279002 DOI: 10.1080/07481187.2017.1396646] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The right to die is an issue is predicated on larger cultural understandings of autonomy. Autonomy, in turn, is centered around assumptions of choice, that individuals are able to make health-related decisions based on a rational calculation. In such a way, a medically assisted death is differentiated from suicide. Through an ethnographic study of right-to-die activists in North America and Australia and how they understand ideals of "good deaths," this article will complicate this view by examining the ethical subject constructed by such activism that reveals autonomy to be a useful guiding fiction that mask larger ethical relationships.
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Affiliation(s)
- Ari Gandsman
- a School of Sociological and Anthropological Studies , University of Ottawa , Ottawa , Ontario , Canada
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20
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Schoper YG, Wald A, Ingason HT, Fridgeirsson TV. Projectification in Western economies: A comparative study of Germany, Norway and Iceland. INTERNATIONAL JOURNAL OF PROJECT MANAGEMENT 2018. [DOI: 10.1016/j.ijproman.2017.07.008] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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21
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Leach MJ, Wiese M, Thakkar M, Agnew T. Integrative health care - Toward a common understanding: A mixed method study. Complement Ther Clin Pract 2017; 30:50-57. [PMID: 29389479 DOI: 10.1016/j.ctcp.2017.12.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 10/22/2017] [Accepted: 12/05/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To generate a multidisciplinary stakeholder-informed definition of integrative health care (IHC). METHODS A mixed-method study design was used, employing the use of focus groups/semi-structured interviews (phase-1) and document analysis (phases 2 and 3). Phase-1 recruited a purposive sample of Australian health consumers/health providers. Phase-2 interrogated websites of international IHC organisations for definitions of IHC. Phase-3 systematically searched bibliographic databases for articles defining IHC. Data were analysed using thematic analysis. RESULTS Data were drawn from 54 health consumers/providers (phase-1), 23 IHC organisation webpages (phase-2) and 23 eligible articles (phase-3). Seven themes emerged from the data. Consensus was reached on a single, 65-word definition of IHC. CONCLUSION An unambiguous definition of IHC is critical to establishing a clearer identity for IHC, as well as providing greater clarity for consumers, health providers and policy makers. In recognising the need for a clearer description, we propose a scientifically-grounded, multi-disciplinary stakeholder-informed definition of IHC.
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Affiliation(s)
- Matthew J Leach
- Department of Rural Health, University of South Australia, Adelaide, South Australia, Australia.
| | - Marlene Wiese
- Southgate Institute for Health, Society & Equity, Flinders University of SA, Bedford Park, South Australia, Australia.
| | - Manisha Thakkar
- Department of Bioscience, Endeavour College of Natural Health, Adelaide, South Australia, Australia.
| | - Tamara Agnew
- Health Economics & Social Policy Group, University of South Australia, Adelaide, South Australia, Australia.
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22
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Jørgensen K, Rendtorff JD. Patient participation in mental health care - perspectives of healthcare professionals: an integrative review. Scand J Caring Sci 2017; 32:490-501. [PMID: 28940229 DOI: 10.1111/scs.12531] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 09/03/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND In contemporary Western liberal society, patient participation has become a key goal in psychiatric healthcare treatment. Health professionals must encourage patients to play an active and involved part in their treatment. According to Danish health law, patients have the right to participate in their treatment, and the mental health system therefore needs to be reformed in order to ensure that treatment is based on individual, liberal, values. However, patient participation is not clearly defined, and it is therefore a challenge to transfer it to clinical practice. AIMS This integrative review's aims are to explore how professionals perceive the challenges regarding patient participation in the treatment course in mental health care. DESIGN An integrative review. FINDINGS Seven studies met the inclusion criteria: six employed qualitative methodologies and one utilised a mixed-methods approach. The empirical studies took place in Norway, the UK and Australia, all in a mental health setting. Three themes were identified: 'Patient participation as collaboration between the healthcare professional and patient', 'Challenges to participation' and 'From a professional's perspective - what expectations do patients have when participating in decision-making?' CONCLUSION Different synonymous terms describing the patient's active role during treatment - user participation, collaboration, partnership, user involvement and patient participation - are linked to a recovery-oriented approach, shared decision-making, shared ownership and care plans. This integrative review achieves specific knowledge around patient participation, comparing the situation for adult patients with various mental disorders. However, upon reflecting on the included studies, patient participation is not clearly defined, and it is therefore difficult to transfer it to clinical practice.
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Affiliation(s)
- Kim Jørgensen
- The Department of Nursing, University College Capital, Hilleroed, Denmark
| | - Jacob Dahl Rendtorff
- Department of Social Sciences and Business, Roskilde University, Roskilde, Denmark
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23
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Joergensen K, Praestegaard J. Patient participation as discursive practice-A critical discourse analysis of Danish mental healthcare. Nurs Inq 2017; 25:e12218. [PMID: 28940834 DOI: 10.1111/nin.12218] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2017] [Indexed: 12/21/2022]
Abstract
Patient participation is one of the most prevalent focus areas in the Danish healthcare debate. Patient participation is generally presented as a fundamental democratic right, and is stated in an objective language with legal requirements for healthcare professionals to ensure that patients systematically participate in their own courses of care and treatment. In the research literature, it is not clear what is meant by 'patient participation', and several discourses on patient participation exist side by side. This study explores how discourses of patient participation unfold and are at play in the articulations in official legal and political documents and patient records relating to a Danish psychiatric context. The documents and patient records have been analyzed using a Fairclough-inspired critical discourse approach which is concerned with how power is exercised through language. The research findings show that patient participation within Danish psychiatric healthcare is governed within a neoliberal discourse where underlying discourses; discourse of biomedicine, paternalism, management, evidence and ethics of care are embedded, and a discourse that seems to ascribe stigmatizing traits to mentally ill patients.
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Affiliation(s)
- Kim Joergensen
- Department of Nursing, University College Capital, Copenhagen, Denmark
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24
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Palenius KG, Nyman PC. Expectations and experiences of physiotherapeutic practice among patients with shoulder problems. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2017. [DOI: 10.1080/21679169.2017.1363283] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Kaj Göran Palenius
- Faculty of Education and Welfare Studies, Åbo Akademi University, Jakobstad, Finland
| | - Pia Carola Nyman
- Department of Social Services and Health Care, City of Jakobstad, Jakobstad, Finland
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25
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Ågotnes G, Øye C. Facilitating resident community in nursing homes: a slippery slope? An analysis on collectivistic and individualistic approaches. Health (London) 2017; 22:469-482. [PMID: 28537093 DOI: 10.1177/1363459317708825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Residents in nursing homes are old and frail and are dependent on constant care, medical, or otherwise, by trained professionals. But they are also social beings, secluded in an institutional setting which is both total and foreign. In this setting, most of the residents most of the time must relate to other residents: other residents are the nursing home residents' peers, companions, and perhaps even significant others. In this article, we will discuss how resident communities in nursing homes are influenced by the approaches of nursing home staff. Two nursing homes have been included in this article-one from Canada and one from Norway. Participant observation was conducted at these two nursing homes, predominantly focusing on everyday-life activities. The cases from Norway and Canada are illustrative of two very different general approaches to residents: one collectivistic and one individualistic. These general approaches produce different contexts for the formation and content of resident communities, greatly affecting nursing home residents. The significance of these approaches to resident community is profound and also somewhat unanticipated; the approaches of staff provide residents with different opportunities and limitations and also yield unintended consequences for the social life of residents. The two different general approaches are, we suggest, "cultural expressions," conditioned by more than official preferences and recommendations. The difference between the institutions is, in other words, anchored in ideas and ideologies that are not explicitly addressed.
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Affiliation(s)
| | - Christine Øye
- Stord/Haugesund University College, Norway; Bergen University College, Norway
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26
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Norlyk A, Haahr A, Dreyer P, Martinsen B. Lost in transformation? Reviving ethics of care in hospital cultures of evidence-based healthcare. Nurs Inq 2017; 24. [DOI: 10.1111/nin.12187] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Annelise Norlyk
- Section for Nursing; Department of Public Health; Aarhus University; Aarhus Denmark
- Faculty of Health Sciences; VIA University College; Skejby Denmark
| | - Anita Haahr
- Faculty of Health Sciences; VIA University College; Skejby Denmark
| | - Pia Dreyer
- Section for Nursing; Department of Public Health; Aarhus University; Aarhus Denmark
- Department of Anaesthesiology and Intensive Care; Aarhus University Hospital; Aarhus C Denmark
| | - Bente Martinsen
- Section for Nursing; Department of Public Health; Aarhus University; Aarhus Denmark
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27
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Määttä S, Lützén K, Öresland S. Contract theories and partnership in health care. A philosophical inquiry to the philosophy of John Rawls and Seyla Benhabib. Nurs Philos 2016; 18. [PMID: 28009093 DOI: 10.1111/nup.12164] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 10/11/2016] [Accepted: 11/14/2016] [Indexed: 11/27/2022]
Abstract
Over the last 20 years, a paternalistic view in health care has been losing ground. The question about less asymmetrical positions in the healthcare professional-patient relationship is, for example, being addressed by the increased emphasis on person-centred care, promoted in disciplines such as medicine and nursing. Partnership is considered as a key component in person-centred care. Although the previous studies have addressed the attributes inherent in partnership, there is still potential for further discussion on how the various interpretations of partnership influence their use in healthcare literature. A vague understanding might also affect education and evaluation. As we see it, the philosophical underpinnings of the idea of partnership have not been sufficiently explored and discussed. The study reveals that partnership originates in the term "partener" defined as a relationship between individuals or groups characterized by cooperation and responsibility. Etymologically speaking, partnership is hence bound by a contract, which in this study is discussed in the frame of Rawls' contract theory, which in turn intersects with Benhabib and her distinction between "the abstract" and "the concrete Other." Further, the expression "equal partnership," which often appears in the context of person-centredness, is explored in relation to the philosophies of Rawls and Benhabib. The opportunity for partnership, as well as the risk of partnership becoming a tempting magnet with a vague and imprecise meaning, is discussed. Without exploration, reflection and discussion of the philosophical underpinnings, partnership carries a substantial risk of becoming an indistinct idea used in health care.
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Affiliation(s)
- Sylvia Määttä
- Associate Professor, Centre for Equity in Healthcare/Institute for Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Kim Lützén
- Senior professor, Department of Women's and Children's Health, Pediatric Oncology Research, Karolinska Institutet, Stockholm, Sweden
| | - Stina Öresland
- University College of Southeast Norway, Health and social work, Oslo, Norway
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28
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Niven DJ, Leigh JP, Stelfox HT. Les considérations éthiques relatives à la désadoption d'aspects inefficaces ou nuisibles des soins de santé. Healthc Manage Forum 2016; 29:218-222. [PMID: 27576859 DOI: 10.1177/0840470416666576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
La désadoption désigne l'abandon d'une pratique médicale ou d'un service de santé inefficace ou nuisible après une période d'adoption. Tandis que les dépenses croissantes en matière de santé menacent de paralyser les sociétés qui les financent, le fait de faciliter la désadoption peut faire partie intégrante de systèmes de santé durables qui prodiguent des soins de qualité. Le présent article explore des enjeux éthiques qui se rapportent à la désadoption, y compris les principes sous-jacents de bénéficience, de non-maléficience, de justice et d'autonomie.
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Affiliation(s)
- Daniel J Niven
- Département de soins intensifs, École de médecine Cumming, université de Calgary, Calgary (Alberta) Canada Département des sciences de la santé communautaire, École de médecine Cumming, université de Calgary, Calgary (Alberta) Canada O'Brien Institute for Public Health, École de médecine Cumming, université de Calgary (Alberta) Canada
| | - Jeanna Parsons Leigh
- Département de soins intensifs, École de médecine Cumming, université de Calgary, Calgary (Alberta) Canada Priorités et mise en œuvre de la recherche, Alberta Health Services, Calgary (Alberta) Canada
| | - Henry T Stelfox
- Département de soins intensifs, École de médecine Cumming, université de Calgary, Calgary (Alberta) Canada Département des sciences de la santé communautaire, École de médecine Cumming, université de Calgary, Calgary (Alberta) Canada O'Brien Institute for Public Health, École de médecine Cumming, université de Calgary (Alberta) Canada Département de médecine, École de médecine Cumming, université de Calgary, Calgary (Alberta) Canada
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29
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Niven DJ, Leigh JP, Stelfox HT. Ethical considerations in the de-adoption of ineffective or harmful aspects of healthcare. Healthc Manage Forum 2016; 29:214-217. [PMID: 27498394 DOI: 10.1177/0840470416646632] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
De-adoption refers to the discontinuance of a medical practice or health service found to be ineffective or harmful following a previous period of adoption. As growing healthcare budgets threaten to cripple the societies that fund them, facilitating de-adoption may be integral to sustainable healthcare systems that provide high-quality care. This article explores ethical issues pertinent to de-adoption including the underpinnings of beneficence, non-maleficence, justice, and autonomy.
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Affiliation(s)
- Daniel J Niven
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Jeanna Parsons Leigh
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Research Priorities & Implementation, Alberta Health Services, Calgary, Alberta, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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30
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Baczyńska AK, Rowiński T, Cybis N. Proposed Core Competencies and Empirical Validation Procedure in Competency Modeling: Confirmation and Classification. Front Psychol 2016; 7:273. [PMID: 27014111 PMCID: PMC4781851 DOI: 10.3389/fpsyg.2016.00273] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 02/12/2016] [Indexed: 11/13/2022] Open
Abstract
Competency models provide insight into key skills which are common to many positions in an organization. Moreover, there is a range of competencies that is used by many companies. Researchers have developed core competency terminology to underline their cross-organizational value. The article presents a theoretical model of core competencies consisting of two main higher-order competencies called performance and entrepreneurship. Each of them consists of three elements: the performance competency includes cooperation, organization of work and goal orientation, while entrepreneurship includes innovativeness, calculated risk-taking and pro-activeness. However, there is lack of empirical validation of competency concepts in organizations and this would seem crucial for obtaining reliable results from organizational research. We propose a two-step empirical validation procedure: (1) confirmation factor analysis, and (2) classification of employees. The sample consisted of 636 respondents (M = 44.5; SD = 15.1). Participants were administered a questionnaire developed for the study purpose. The reliability, measured by Cronbach's alpha, ranged from 0.60 to 0.83 for six scales. Next, we tested the model using a confirmatory factor analysis. The two separate, single models of performance and entrepreneurial orientations fit quite well to the data, while a complex model based on the two single concepts needs further research. In the classification of employees based on the two higher order competencies we obtained four main groups of employees. Their profiles relate to those found in the literature, including so-called niche finders and top performers. Some proposal for organizations is discussed.
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Affiliation(s)
| | - Tomasz Rowiński
- Institute of Psychology, Cardinal Stefan Wyszynski University in Warsaw Warsaw, Poland
| | - Natalia Cybis
- Institute of Psychology, Cardinal Stefan Wyszynski University in Warsaw Warsaw, Poland
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31
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Holm AL, Berland AK, Severinsson E. Older Patients’ Involvement in Shared Decision-Making—A Systematic Review. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/ojn.2016.63018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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