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Carruthers H, Derry D, Astin F. Becoming partners in rehabilitation with patients in intensive care: physiotherapists' perspectives. Disabil Rehabil 2024; 46:4194-4204. [PMID: 37818631 DOI: 10.1080/09638288.2023.2266993] [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: 06/15/2023] [Revised: 09/28/2023] [Accepted: 09/30/2023] [Indexed: 10/12/2023]
Abstract
PURPOSE Person-centred care is widely accepted as being central to high quality care, but little is known about how physiotherapists implement person centred rehabilitation in Intensive Care. This study explores the self-reported experiences and interpretations of physiotherapists delivering person-centred rehabilitation in this setting. METHODS A qualitative study using Interpretative Phenomenological Analysis explored the lived experiences of physiotherapists and students who have worked in Intensive Care. Three focus groups, with four participants in each, were conducted. Data were fully transcribed, analysed and managed using NVivo software. RESULTS Participants shared similar interpretations about the principles of person-centred care. Operationalising person-centred rehabilitation during early recovery was not easily achievable. As the person's clinical condition improved, participants moved away from routine physiotherapy and their practice became more person-centred through the development of a partnership. Participants connected as humans to understand the person and respond to their needs within a culture that valued person-centred care. CONCLUSIONS Physiotherapists aspire to develop a partnership with their patients by connecting on a human level with them and addressing their biopsychosocial needs. Physiotherapists with experience of developing patient partnerships influence the culture of the Intensive Care team and are role-models to facilitate collaborative person-centred activity in others.
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Affiliation(s)
- Helen Carruthers
- School of Health and Society, University of Salford, Salford, UK
| | - David Derry
- Long-Term Ventilation Unit, Wythenshawe Hospital, Manchester Foundation NHS Trust, Manchester, UK
| | - Felicity Astin
- School of Health, Wellbeing and Social Care, The Open University, Milton Keynes, UK
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Humphreys L, Myers A, Frith G, Thelwell M, Pickering K, Mills GH, Kerr K, Fisher P, Kidder J, Keen C, Hodson S, Phillips G, Smith R, Evans L, Thornton S, Dale E, Maxwell L, Greenfield DM, Copeland R. The Development of a Multi-Modal Cancer Rehabilitation (Including Prehabilitation) Service in Sheffield, UK: Designing the Active Together Service. Healthcare (Basel) 2024; 12:742. [PMID: 38610164 PMCID: PMC11011813 DOI: 10.3390/healthcare12070742] [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: 01/31/2024] [Revised: 03/22/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Cancer patients undergoing major interventions face numerous challenges, including the adverse effects of cancer and the side effects of treatment. Cancer rehabilitation is vital in ensuring cancer patients have the support they need to maximise treatment outcomes and minimise treatment-related side effects and symptoms. The Active Together service is a multi-modal rehabilitation service designed to address critical support gaps for cancer patients. The service is located and provided in Sheffield, UK, an area with higher cancer incidence and mortality rates than the national average. The service aligns with local and regional cancer care objectives and aims to improve the clinical and quality-of-life outcomes of cancer patients by using lifestyle behaviour-change techniques to address their physical, nutritional, and psychological needs. This paper describes the design and initial implementation of the Active Together service, highlighting its potential to support and benefit cancer patients.
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Affiliation(s)
- Liam Humphreys
- Academy of Sport and Physical Activity, Sheffield Hallam University, Sheffield S1 1WB, UK; (A.M.); (G.F.); (M.T.); (K.P.)
- Advanced Well-Being Research Centre, Sheffield Hallam University, Sheffield S1 1WB, UK; (J.K.); (G.P.); (R.C.)
| | - Anna Myers
- Academy of Sport and Physical Activity, Sheffield Hallam University, Sheffield S1 1WB, UK; (A.M.); (G.F.); (M.T.); (K.P.)
- Advanced Well-Being Research Centre, Sheffield Hallam University, Sheffield S1 1WB, UK; (J.K.); (G.P.); (R.C.)
| | - Gabriella Frith
- Academy of Sport and Physical Activity, Sheffield Hallam University, Sheffield S1 1WB, UK; (A.M.); (G.F.); (M.T.); (K.P.)
- Advanced Well-Being Research Centre, Sheffield Hallam University, Sheffield S1 1WB, UK; (J.K.); (G.P.); (R.C.)
| | - Michael Thelwell
- Academy of Sport and Physical Activity, Sheffield Hallam University, Sheffield S1 1WB, UK; (A.M.); (G.F.); (M.T.); (K.P.)
- Advanced Well-Being Research Centre, Sheffield Hallam University, Sheffield S1 1WB, UK; (J.K.); (G.P.); (R.C.)
| | - Katie Pickering
- Academy of Sport and Physical Activity, Sheffield Hallam University, Sheffield S1 1WB, UK; (A.M.); (G.F.); (M.T.); (K.P.)
- Advanced Well-Being Research Centre, Sheffield Hallam University, Sheffield S1 1WB, UK; (J.K.); (G.P.); (R.C.)
| | - Gary H. Mills
- Critical Care Directorate, Sheffield Teaching Hospitals NHS Foundation Trust, University of Sheffield, Sheffield S1 1WB, UK; (G.H.M.)
| | - Karen Kerr
- Critical Care Directorate, Sheffield Teaching Hospitals NHS Foundation Trust, University of Sheffield, Sheffield S1 1WB, UK; (G.H.M.)
| | - Patricia Fisher
- Specialised Cancer Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK; (P.F.); (D.M.G.)
| | - John Kidder
- Advanced Well-Being Research Centre, Sheffield Hallam University, Sheffield S1 1WB, UK; (J.K.); (G.P.); (R.C.)
| | - Carol Keen
- Therapeutics and Palliative Care Directorate, Combined Community and Acute Care Group, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK; (C.K.); (S.H.); (R.S.); (L.E.)
| | - Suzanne Hodson
- Therapeutics and Palliative Care Directorate, Combined Community and Acute Care Group, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK; (C.K.); (S.H.); (R.S.); (L.E.)
| | - Gail Phillips
- Advanced Well-Being Research Centre, Sheffield Hallam University, Sheffield S1 1WB, UK; (J.K.); (G.P.); (R.C.)
| | - Rachel Smith
- Therapeutics and Palliative Care Directorate, Combined Community and Acute Care Group, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK; (C.K.); (S.H.); (R.S.); (L.E.)
| | - Laura Evans
- Therapeutics and Palliative Care Directorate, Combined Community and Acute Care Group, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK; (C.K.); (S.H.); (R.S.); (L.E.)
| | - Sarah Thornton
- Dietetic Service, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK;
| | - Emma Dale
- Department of Psychological Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK;
| | - Louise Maxwell
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK;
| | - Diana M. Greenfield
- Specialised Cancer Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK; (P.F.); (D.M.G.)
- Department of Oncology and Metabolism, University of Sheffield, Medical School Beech Hill Road, Sheffield S10 2RX, UK
| | - Robert Copeland
- Advanced Well-Being Research Centre, Sheffield Hallam University, Sheffield S1 1WB, UK; (J.K.); (G.P.); (R.C.)
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Kattouw CE, Aase K, Viksveen P. How do the existing homecare services correspond with the preferred service ecosystem for senior citizens living at home? A qualitative interview study with multiple stakeholders. FRONTIERS IN HEALTH SERVICES 2024; 4:1294320. [PMID: 38577152 PMCID: PMC10991764 DOI: 10.3389/frhs.2024.1294320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 03/11/2024] [Indexed: 04/06/2024]
Abstract
Introduction Often, homecare services are task-focused rather than person-based and fragmented instead of integrated. Consequently, several stakeholders have requested a transformation of the service ecosystem for senior citizens living at home. This transformation may be facilitated by an idealized design approach. However, few studies have applied such an approach. Moreover, previous research did not assess the ways in which the existing homecare services correspond with the preferred service ecosystem for senior citizens living at home. Therefore, the purpose of this study is to gain an understanding of how the existing homecare services correspond with the preferred service ecosystem for senior citizens living at home, according to different stakeholders. Methods Four stakeholder groups (n = 57) from a Norwegian municipality participated in an interview study (2019-2020): senior citizens, carers, healthcare professionals and managers. A directed qualitative content analysis was applied, guided by a four-category framework for the preferred service ecosystem. Results All stakeholder groups highlighted several limitations that hindered continuity of the services. There was also agreement on deficiencies in professionals' competence, yet professionals themselves did not focus on this as a significant aspect. Managers emphasised the importance of professionals' reablement competence, which was also considered to be deficient in the current homecare services. Contrary to the other stakeholder groups, most senior citizens seemed satisfied with the practical and social support they received. Together with carers, they also explained why they thought some professionals lack compassion. Their dependency on professionals may limit them in sharing honestly their opinions and preferences during care provision. Involvement of senior citizens in improvement of the current services was limited. Insufficient time and resources, as well as a complex organisation impacted the existing homecare services, and therefore served as barriers to the preferred service ecosystem. Discussion In this study there were different degrees of correspondence between the existing homecare services and the preferred service ecosystem according to four stakeholder groups. To develop the preferred service ecosystem, aspects such as predictability, adaptivity, and relationships are key, as well as continuous involvement of senior citizens and other stakeholders. The four-category framework applied in this study served as a tool to assess the existing homecare services.
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Affiliation(s)
- Christophe Eward Kattouw
- SHARE—Centre for Resilience in Healthcare, Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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Hodge O, Rasekaba T, Blackberry I, Steer CB. Age-friendly healthcare: integrating the 4Ms to enable age-friendly cancer care. Curr Opin Support Palliat Care 2024; 18:9-15. [PMID: 38252057 DOI: 10.1097/spc.0000000000000687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
PURPOSE OF REVIEW There is a growing movement towards person-centred, age-friendly healthcare in the care of older adults, including those with cancer. The Age-Friendly Health Systems (AFHS) initiative uses the 4Ms framework to enable this change. This review documents the utility and implications of 4Ms implementation across different settings, with a particular focus on cancer care. RECENT FINDINGS The AFHS initiative 4Ms framework uses a set of core, evidence-based guidelines (focussing on What Matters, Medication, Mentation and Mobility) to improve person-centred care. The successful implementation of the 4Ms has been documented in many different healthcare settings including orthopaedics primary care, and cancer care. Implementation of the 4Ms framework into existing workflows complements the use of geriatric assessment to improve care of older adults with cancer. Models for implementation of the 4Ms within a cancer centre are described. Active engagement and education of healthcare providers is integral to success. Solutions to implementing the What Matters component are addressed. SUMMARY Cancer centres can successfully implement the 4Ms framework into existing workflows through a complex change management process and development of infrastructure that engages healthcare providers, facilitating cultural change whilst employing quality improvement methodology to gradually adapt the status quo to age-friendly processes.
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Affiliation(s)
- Oliver Hodge
- UNSW School of Clinical Medicine, Rural Clinical Campus, Albury Campus, NSW
| | | | - Irene Blackberry
- John Richards Centre for Rural Ageing Research
- Care Economy Research Institute, La Trobe University, Wodonga, VIC
| | - Christopher B Steer
- UNSW School of Clinical Medicine, Rural Clinical Campus, Albury Campus, NSW
- John Richards Centre for Rural Ageing Research
- Border Medical Oncology and Haematology, Albury Wodonga Regional Cancer Centre, Albury, NSW, Australia
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Kvæl LAH, Bergland A, Eldh AC. Preference-based patient participation in intermediate care: Translation, validation and piloting of the 4Ps in Norway. Health Expect 2024; 27:e13899. [PMID: 37934200 PMCID: PMC10726279 DOI: 10.1111/hex.13899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/09/2023] [Accepted: 10/17/2023] [Indexed: 11/08/2023] Open
Abstract
INTRODUCTION The implementation and evaluation of patient participation to obtain high-quality transitional care for older people is an international priority. Intermediate care (IC) services are regarded as an important part of the patient's pathway from the specialist to the primary care levels, bridging the gap between the hospital and the home. Patients may experience varying capacities and conditions for patient participation. Yet, few tools for evaluating patients' preferences for patient participation within IC services are at hand. Accordingly, further knowledge is needed to understand and scaffold processes for patient participation in IC. Therefore, the aim of this project was to translate, validate and pilot test the Patient Preferences for Patient Participation (the 4Ps) with patients in IC services in Norway. METHODS This project comprised two phases: (1) a careful translation and cultural adaptation process, followed by a content validity trial among 15 patients and staff in Norwegian IC and (2) a cross-sectional survey of the instrument with 60 patients admitted to IC. RESULTS The translation between Swedish and Norwegian required no conceptual or contextual adaptations. The subsequent cross-sectional study, designed as a dialogue between the patients and staff, revealed that only 50% of the participants received a sufficient level of patient participation based on their preferences, mostly indicating that patients were receiving less-than-preferred conditions for engaging in their health and healthcare issues. CONCLUSION The 4Ps instrument was deemed suitable for measuring patient participation based on patient preferences in the IC context and was feasible for both healthcare professionals and patients to complete in an interview when arriving at and leaving services. This may support person-centred communication and collaboration, calling for further research on what facilitates patient participation and the implementation of person-centred services for patients in IC. PATIENT OR PUBLIC CONTRIBUTION First, the current paper is part of the IPIC study (i.e., the implementation of patient participation in IC). Influenced by a James Lind Alliance process, the study addresses research uncertainties identified by patients, next of kin, staff and researchers in the cocreation process. Second, cognitive interviewing was conducted with 15 representatives of the target population: seven patients receiving IC services, one home-dwelling previous IC patient (altogether four women and four men, most of them 80 years or older) and seven healthcare staff working in IC services. The interviews determined the relevance, comprehensiveness and clarity of the 4Ps. Finally, 60 patients admitted to IC took part in the cross-sectional study.
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Affiliation(s)
- Linda A. H. Kvæl
- Department of Rehabilitation Science and Health TechnologyFaculty of Health Sciences, Oslo Metropolitan UniversityOsloNorway
- Norwegian Social Research—NOVAOslo Metropolitan UniversityOsloNorway
| | - Astrid Bergland
- Department of Rehabilitation Science and Health TechnologyFaculty of Health Sciences, Oslo Metropolitan UniversityOsloNorway
| | - Ann C. Eldh
- Department of Health, Medicine and Caring SciencesFaculty of Medicine and Health Sciences, Linköping UniversityLinköpingSweden
- Department of Public Health and Caring SciencesUppsala UniversityUppsalaSweden
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Roberts A. A Two-Phase Qualitative Enquiry Into Storytelling's Potential to Support Palliative Care Patient-Led Change, Using a Systematic Review Approach. OMEGA-JOURNAL OF DEATH AND DYING 2024:302228231223270. [PMID: 38194348 DOI: 10.1177/00302228231223270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
A terminal diagnosis can diminish an individual's sense of agency and identity. Leading change appears to restore a sense of agential self. The first phase of this literature review explores factors influencing patient-led change across the palliative care ecosystem. The second phase illuminates how storytelling can support palliative care patients in leading ecosystem-wide change. 35 studies were identified in Phase 1 and 36 in Phase 2. This research highlights the need to situate patient leadership activity within a palliative care ecosystem to understand factors likely to support or hinder patient leadership activity within it. The evidence indicates the potential use of storytelling to support patients with a life-limiting illness to lead change across the palliative care ecosystem. This challenges current conceptualisations of such patients and offers them instead as an additional source of palliative care support.
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Affiliation(s)
- Amanda Roberts
- Department of Education, University of Hertfordshire Schools of Law and Education, Hatfield, UK
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Volungholen Sollid MI, Slaaen M, Danielsen S, Eilertsen G, Kirkevold Ø. Patient-Reported Experiences and Associated Factors in a Norwegian Radiotherapy Setting: An Explorative Cross-Sectional Study. SAGE Open Nurs 2024; 10:23779608241233868. [PMID: 38406180 PMCID: PMC10893778 DOI: 10.1177/23779608241233868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 01/04/2024] [Accepted: 01/25/2024] [Indexed: 02/27/2024] Open
Abstract
Introduction Radiotherapy is the main treatment modality in cancer. There is sparse knowledge on how patients with cancer experience their radiotherapy trajectory, and which factors might be associated with patients' experiences. Objectives The aim of the present study was to explore how adults with cancer receiving radiotherapy evaluate the quality of their care, utilizing a patient-reported experience measure, and how patient- and service-related characteristics are associated with their evaluation. Methods An explorative cross-sectional study using a self-completed questionnaire to assess patients' radiotherapy experiences was performed. Participants were recruited consecutively, within their last week of treatment, from two different hospitals in Norway from January 2021 to January 2022. Four hundred and eighty paper questionnaires were distributed to recruited patients, 240 at each hospital. Questionnaires were self-completed at home and returned by mail. The instrument person-centered coordinated care experience questionnaire (P3CEQ) was used. In addition to this, participants completed the European Organization of Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30) and The Sense of Coherence 13 scale (SOC-13). Data were analyzed using descriptive statistics, parametric tests, and unadjusted/adjusted linear regression models were estimated. Results The study included 373 patients. Patients evaluated quality of care in terms of P3CEQ scores, with a mean score of 19.5 (standard deviation = 5.4). Lowest scores were identified in areas concerning person-centeredness and service coordination. There were no significant differences in P3CEQ scores between the younger and older groups. Having a partner and better SOC-13 scores were independently associated with the overall patient-reported experience score, whereas age was not. Conclusion Patient-reported experience scores indicate that improvements are needed in some areas, such as informing and involving patients in the planning and coordination of their care. Findings suggest paying special attention to patients without a partner to offer patients the best possible care.
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Affiliation(s)
- May Ingvild Volungholen Sollid
- Research Centre for Age Related Functional Decline and Diseases, Innlandet Hospital Trust, Ottestad, Norway
- Department of Health Sciences, Norwegian University of Science and Technology (NTNU) Gjøvik, Faculty of Medicine and Health Sciences, Gjøvik, Norway
| | - Marit Slaaen
- Research Centre for Age Related Functional Decline and Diseases, Innlandet Hospital Trust, Ottestad, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Blindern, Oslo, Norway
| | - Signe Danielsen
- Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Physics, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Grethe Eilertsen
- USN Research Group of Older Peoples' Health, Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen G, Norway
- Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen G, Norway
| | - Øyvind Kirkevold
- Research Centre for Age Related Functional Decline and Diseases, Innlandet Hospital Trust, Ottestad, Norway
- Department of Health Sciences, Norwegian University of Science and Technology (NTNU) Gjøvik, Faculty of Medicine and Health Sciences, Gjøvik, Norway
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
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Liao L, Feng M, You Y, Chen Y, Guan C, Liu Y. Experiences of older people, healthcare providers and caregivers on implementing person-centered care for community-dwelling older people: a systematic review and qualitative meta-synthesis. BMC Geriatr 2023; 23:207. [PMID: 37003992 PMCID: PMC10067217 DOI: 10.1186/s12877-023-03915-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 03/21/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Person-centered care (PCC) is a critical approach to improving the quality of care for community-dwelling older people. Old-age care services could be provided according to older peoples' choices, needs, and preferences. The purpose of this study was to synthesize research evidence on the experiences of older people, healthcare providers, and caregivers with PCC and to identify the enablers and barriers to implementing PCC for community-dwelling older people. METHODS A meta-synthesis of qualitative research design was adopted. Data searches were performed using CINAHL (EBSCOhost), PubMed (OvidSP), Embase (Ovid), Cochrane Database, and PsycINFO (Ovid) in published articles and were reviewed from the earliest date to February 2023. The Qualitative Method Appraisal Tool was used to conduct a quality appraisal on selected articles. Data were extracted based on the capacity, opportunity, and motivation-behavior model (COM-B model), and the findings were synthesized using the meta-aggregative approach. RESULTS Twelve included articles were analyzed to identify 122 findings that were organized into 11 categories and combined into three synthesized findings-capacities of older people, healthcare providers, and caregivers; opportunities in the implementation of PCC; motivation in implementing PCC. Capacities consisted of a lack of person-centered knowledge and skills, negative attitudes toward shared decision-making, and a lack of formal training to enhance capabilities among HCPs. Opportunities included a lack of coordination in resource allocation, strengthening multidisciplinary teamwork, establishing a desirable environment, and time constraints. Motivation in implementing PCC included encouraging self-reflection and regulation, respecting the autonomy of older people, lack of clear reward and empowerment mechanisms, and being resilient and optimistic. CONCLUSIONS The findings of this research provide a reference for implementing successful PCC in the community. The researchers identified barriers and facilitators of implementing PCC, facilitating through stakeholder's person-centered knowledge and skills being valued and respecting the autonomy of older people. Establishing a positive environment and strengthening multidisciplinary team members also promotes the implementation of PCC. However, additional studies are required to explore the influencing factors and address the barriers.
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Affiliation(s)
- Lulu Liao
- Department of Nursing, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Mingjiao Feng
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yanjie You
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yuqin Chen
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chunyan Guan
- Department of Otolaryngology Head and Neck Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| | - Yilan Liu
- Department of Nursing, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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Sun M, Qian Y, Liu L, Wang J, Zhuansun M, Xu T, Rosa RD. Transition of care from hospital to home for older people with chronic diseases: a qualitative study of older patients' and health care providers' perspectives. Front Public Health 2023; 11:1128885. [PMID: 37181713 PMCID: PMC10174044 DOI: 10.3389/fpubh.2023.1128885] [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: 12/21/2022] [Accepted: 03/29/2023] [Indexed: 05/16/2023] Open
Abstract
Background Transitional care is a critical area of care delivery for older adults with chronic illnesses and complex health conditions. Older adults have high, ongoing care needs during the transition from hospital to home due to certain physical, psychological, social, and caregiving burdens, and in practice, patients' needs are not being met or are receiving transitional care services that are unequal and inconsistent with their actual needs, hindering their safe, healthy transition. The purpose of this study was to explore the perceptions of older adults and health care providers, including older adults, about the transition of care from hospital to home for older patients in one region of China. Objective To explore barriers and facilitators in the transition of care from hospital to home for older adults in China from the perspectives of older patients with chronic diseases and healthcare professionals. Methods This was a qualitative study based on a semi-structured approach. Participants were recruited from November 2021 to October 2022 from a tertiary and community hospital. Data were analyzed using thematic analysis. Results A total of 20 interviews were conducted with 10 patients and 9 medical caregivers, including two interviews with one patient. The older adult/adults patients included 4 men and 6 women with an age range of 63 to 89 years and a mean age of 74.3 ± 10.1 years. The medical caregivers included two general practitioners and seven nurses age range was 26 to 40 years with a mean age of 32.8 ± 4.6 years. Five themes were identified: (1) attitude and attributes; (2) better interpersonal relationships and communication between HCPs and patients; (3) improved Coordination of Healthcare Services Is Needed; (4) availability of resources and accessibility of services; and (5) policy and environment fit. These themes often serve as both barriers and facilitators to older adults' access to transitional care. Conclusions Given the fragmentation of the health care system and the complexity of care needs, patient and family-centered care should be implemented. Establish interconnected electronic information support systems; develop navigator roles; and develop competent organizational leaders and appropriate reforms to better support patient transitions.
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Affiliation(s)
- Mengjie Sun
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Yumeng Qian
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Lamei Liu
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Jianan Wang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Mengyao Zhuansun
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Tongyao Xu
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Ronnell Dela Rosa
- School of Nursing, Philippine Women's University, Manila, Philippines
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Lai B, Shen L, Ye S, Shen X, Zhou D, Guo X, Zhou H, Pan Y, Tong J. Influence of continuity of care on self-management ability and quality of life in outpatient maintenance hemodialysis patients. Ther Apher Dial 2022; 26:1166-1173. [PMID: 35043556 PMCID: PMC9790337 DOI: 10.1111/1744-9987.13800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 10/26/2021] [Accepted: 12/02/2021] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The objective of this study was to evaluate the effect of continuity of care on self-management ability and quality of life (QOL) in patients undergoing maintenance hemodialysis (MHD). METHODS One hundred patients were randomly assigned to the observation group and the control group. In the observation group, patients received a 12-month continuity of care. In the control group, patients were given with routine nursing. Evaluate the patients' self-management ability and QOL between two groups 1 week before discharge and 6 and 12 months outpatient MHD. RESULTS Observation group had higher Hemodialysis Self-Management Instrument (HD-SMI) scores and Kidney Disease Quality of Life-Short Form (KDQOL-SF™) scores than control group at 6 and 12 months outpatient MHD. But patients in observation group had a much lower systolic blood pressure than those in control group at 12 months outpatient MHD. CONCLUSIONS Our study suggested that continuity of care in the form of online education, telephone visit, and outpatient visit could improve self-management ability and QOL of patients undergoing MHD.
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Affiliation(s)
- Bihong Lai
- Department of Nursing, Shanghai Pudong HospitalFudan University Pudong Medical CenterShanghaiChina
| | - Li Shen
- Department of Nursing, Shanghai Pudong HospitalFudan University Pudong Medical CenterShanghaiChina
| | - Shuiying Ye
- Department of Nursing, Shanghai Pudong HospitalFudan University Pudong Medical CenterShanghaiChina
| | - Xia Shen
- Department of Nursing, Shanghai Pudong HospitalFudan University Pudong Medical CenterShanghaiChina
| | - Dongchi Zhou
- Department of NephrologyShanghai Pudong Hospital, Fudan University Pudong Medical CenterShanghaiChina
| | - Xiaocui Guo
- Department of Nursing, Shanghai Pudong HospitalFudan University Pudong Medical CenterShanghaiChina
| | - Huaxian Zhou
- Department of Nursing, Shanghai Pudong HospitalFudan University Pudong Medical CenterShanghaiChina
| | - Yangbin Pan
- Department of NephrologyShanghai Pudong Hospital, Fudan University Pudong Medical CenterShanghaiChina
| | - Jindong Tong
- Department of Vascular SurgeryShanghai Pudong Hospital, Fudan University Pudong Medical CenterShanghaiChina
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11
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Jensen CB, Norbye B, Dahlgren MA, Iversen A. Getting real in interprofessional clinical placements: patient-centeredness in student teams' collaborative learning. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022:1-17. [PMID: 36342638 PMCID: PMC9638371 DOI: 10.1007/s10459-022-10182-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 10/31/2022] [Indexed: 06/16/2023]
Abstract
Collaboration between healthcare providers helps tackle the increasing complexity of healthcare. When learning teamwork, interprofessional students are expected to work patient-centered; recognizing the patient's expertise and partnering with them. Research on interprofessional education (IPE) for undergraduates has illuminated learning outcomes, organization of learning activities, change in attitudes, etc. But, we know little about the interaction between patients and interprofessional student teams. This study aimed to explore how interprofessional student teams and patients interact in interprofessional clinical placements. With a focused ethnographic approach, participant observation and qualitative interviews were conducted in two contexts; a physical and an online arrangement. Central ideas in Goffman's dramaturgy constituted a theoretical lens. A reflexive thematic analysis generated three themes: (1) Preparing safe and comfortable encounters with patients, (2) Including and excluding the patient in the encounter, and (3) Adjusting to the patient's situation. We identified students' intentions of patient-centeredness when preparing encounters, but patients did not always feel included and listened to in encounters. After encountering patients, student teams adjusted their teamwork, by changing the team composition or the planned clinical interventions to better meet the patients' needs. Notably, team-based patient encounters led to a different view of the patient, their health issues, and how to collaborate. Our findings can inform educators of the importance of addressing patient-centered care in interprofessional learning arrangements. Today, clinical interprofessional placements may not exploit the potential for learning about patient-centeredness. A thematization of this, e.g., in supervision in future clinical placements can ensure an enhanced focus on this in interprofessional teamwork.
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Affiliation(s)
- Catrine Buck Jensen
- Centre for Faculty Development, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
| | - Bente Norbye
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, 9037, Tromsø, Norway
| | - Madeleine Abrandt Dahlgren
- Centre for Faculty Development, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Anita Iversen
- Centre for Faculty Development, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
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12
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Kvael LAH, Olsen CF. Assuring patient participation and care continuity in intermediate care: Getting the most out of family meetings using the four habits model. Health Expect 2022; 25:2582-2592. [PMID: 35999673 PMCID: PMC9615078 DOI: 10.1111/hex.13591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 07/27/2022] [Accepted: 08/12/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction As a transitional care intervention, intermediate care (IC) bridges the pathway for older patients from hospital to home. Within family meetings in IC, the older patient, his or her relatives, the interdisciplinary team and the municipal case manager come together to discuss goals and interventions during the IC stay, including follow‐up services after discharge. Although family meetings are a common aspect of teamwork in IC, it is unclear how the voices of older people and their relatives are coming across. The aim of this study is to explore how patient participation is framed and negotiated within family meetings in IC. Methods This study is based on qualitative data from the observation of 14 interdisciplinary family meetings in Norwegian IC services. As a theoretical framework, the authors have used the four habits model developed by Frankel and Stein as a lens to understand the interrelated sequence of events that typically takes place during a family meeting and the importance of communication skills to promote patient participation. Results The thematic analysis resulted in 16 categories and 4 main themes related to the 4 habits model: (i) grounding the family meetings, (ii) what matters to you?, (iii) being empathically present and (iv) the power of a final closure. Conclusion There was considerable variation in the way current family meetings were conducted. It seemed crucial to start the meeting with a proper introduction and explanation of the purpose of the meeting to establish trust and to be able to successfully move to the next stage of eliciting the patients' preferences, views and goals via the ‘what matters to you?’ question. There were examples of empathetic communication among meeting participants perceived to facilitate patient participation. Finally, to successfully end the meeting and agree on a shared plan, it seemed crucial for case managers who held the decision‐making power to attend the meetings. Framing family meetings in line with the four habits sequential approach may have the potential to assure patient participation and care continuity in IC services. Patient or Public Contribution This article is part of a larger project based on a James Lind Alliance process that brings patients, relatives, health care professionals and researchers together in priority setting partnerships to identify and prioritize evidence uncertainties that they agree are the most important. Accordingly, the design and content of this article have been initiated and discussed in the project's stakeholder group consisting of one patient representative, one relative representative, two health care professionals from IC settings, two representatives from the Norwegian Health Association and two representatives from the Agency of Health in Norway.
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Affiliation(s)
- Linda A H Kvael
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.,Department of Ageing Research and Housing Studies, Norwegian Social Research-NOVA, Oslo Metropolitan University, Oslo, Norway
| | - Cecilie F Olsen
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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13
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Balancing standardisation and individualisation in transitional care pathways: a meta-ethnography of the perspectives of older patients, informal caregivers and healthcare professionals. BMC Health Serv Res 2022; 22:430. [PMID: 35365140 PMCID: PMC8974038 DOI: 10.1186/s12913-022-07823-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Transitional care implies the transfer of patients within or across care settings in a seamless and safe way. For frail, older patients with complex health issues, high-quality transitions are especially important as these patients typically move more frequently within healthcare settings, requiring treatment from different providers. As transitions of care for frail people are considered risky, securing the quality and safety of these transitions is of great international interest. Nevertheless, despite efforts to improve quality in transitional care, research indicates that there is a lack of clear guidance to deal with practical challenges that may arise. The aim of this article is to synthesise older patients, informal caregivers and healthcare professionals' experiences of challenges to achieving high-quality transitional care. METHODS We used the seven-step method for meta-ethnography originally developed by Noblit and Hare. In four different but connected qualitative projects, the authors investigated the challenges to transitional care for older people in the Norwegian healthcare system from the perspectives of older patients, informal caregivers and healthcare professionals. In this paper, we highlight and discuss the cruciality of these challenging issues by synthesising the results from twelve articles. RESULTS The analysis resulted in four themes: i) balancing person-centred versus efficient care, ii) balancing everyday patient life versus the treatment of illness, iii) balancing user choice versus "What Matters to You", and iv) balancing relational versus practical care. These expressed challenges represent tensions at the system, organisation and individual levels based on partial competing assumptions on person-centred-care-inspired individualisation endeavours and standardisation requirements in transitional care. CONCLUSIONS There is an urgent need for a clearer understanding of the tension between standardisation and individualisation in transitional care pathways for older patients to ensure better healthcare quality for patients and more realistic working environments for healthcare professionals. Incorporating a certain professional flexibility within the wider boundary of standardisation may give healthcare professionals room for negotiation to meet patients' individual needs, while at the same time ensuring patient flow, equity and evidence-based practice.
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14
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Fakha A, de Boer B, van Achterberg T, Hamers J, Verbeek H. Fostering the implementation of transitional care innovations for older persons: prioritizing the influencing key factors using a modified Delphi technique. BMC Geriatr 2022; 22:131. [PMID: 35172760 PMCID: PMC8848680 DOI: 10.1186/s12877-021-02672-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 11/26/2021] [Indexed: 12/03/2022] Open
Abstract
Background Transitions in care for older persons requiring long-term care are common and often problematic. Therefore, the implementation of transitional care innovations (TCIs) aims to improve necessary or avert avoidable care transitions. Various factors were recognized as influencers to the implementation of TCIs. This study aims to gain consensus on the relative importance level and the feasibility of addressing these factors with implementation strategies from the perspectives of experts. This work is within TRANS-SENIOR, an innovative research network focusing on care transitions. Methods A modified Delphi study was conducted with international scientific and practice-based experts, recruited using purposive and snowballing methods, from multiple disciplinary backgrounds, including implementation science, transitional care, long-term care, and healthcare innovations. This study was built on the findings of a previously conducted scoping review, whereby 25 factors (barriers, facilitators) influencing the implementation of TCIs were selected for the first Delphi round. Two sequential rounds of anonymous online surveys using an a priori consensus level of > 70% and a final expert consultation session were performed to determine the implementation factors’: i) direction of influence, ii) importance, and iii) feasibility to address with implementation strategies. The survey design was guided by the Consolidated Framework for Implementation Research (CFIR). Data were collected using Qualtrics software and analyzed with descriptive statistics and thematic analysis. Results Twenty-nine experts from 10 countries participated in the study. Eleven factors were ranked as of the highest importance among those that reached consensus. Notably, organizational and process-related factors, including engagement of leadership and key stakeholders, availability of resources, sense of urgency, and relative priority, showed to be imperative for the implementation of TCIs. Nineteen factors reached consensus for feasibility of addressing them with implementation strategies; however, the majority were rated as difficult to address. Experts indicated that it was hard to rate the direction of influence for all factors. Conclusions Priority factors influencing the implementation of TCIs were mostly at the organizational and process levels. The feasibility to address these factors remains difficult. Alternative strategies considering the interaction between the organizational context and the outer setting holds a potential for enhancing the implementation of TCIs. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02672-2.
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Affiliation(s)
- Amal Fakha
- CAPHRI Care and Public Health Research Institute, Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands. .,Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands. .,KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Kapucijnenvoer 35, 3000, Leuven, Belgium.
| | - Bram de Boer
- CAPHRI Care and Public Health Research Institute, Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.,Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - Theo van Achterberg
- KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Kapucijnenvoer 35, 3000, Leuven, Belgium
| | - Jan Hamers
- CAPHRI Care and Public Health Research Institute, Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.,Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - Hilde Verbeek
- CAPHRI Care and Public Health Research Institute, Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.,Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
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15
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Kvæl LAH. Helhetlige pasientforløp: brukernes erfaringer med pasientdeltakelse og personsentrert omsorg i kommunal korttidsrehabilitering i overgangen mellom sykehus og hjem. TIDSSKRIFT FOR OMSORGSFORSKNING 2021. [DOI: 10.18261/issn.2387-5984-2021-02-03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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16
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Sogstad MKR, Bergland A. Sårbar sammenheng i helse- og omsorgstjenesten til eldre pasienter. TIDSSKRIFT FOR OMSORGSFORSKNING 2021. [DOI: 10.18261/issn.2387-5984-2021-02-02] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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17
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Mate K, Fulmer T, Pelton L, Berman A, Bonner A, Huang W, Zhang J. Evidence for the 4Ms: Interactions and Outcomes across the Care Continuum. J Aging Health 2021; 33:469-481. [PMID: 33555233 PMCID: PMC8236661 DOI: 10.1177/0898264321991658] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objectives: An expert panel reviewed and summarized the literature related to the evidence for the 4Ms-what matters, medication, mentation, and mobility-in supporting care for older adults. Methods: In 2017, geriatric experts and health system executives collaborated with the Institute for Healthcare Improvement (IHI) to develop the 4Ms framework. Through a strategic search of the IHI database and recent literature, evidence was compiled in support of the framework's positive clinical outcomes. Results: Asking what matters from the outset of care planning improved both psychological and physiological health statuses. Using screening protocols such as the Beers' criteria inhibited overprescribing. Mentation strategies aided in prevention and treatment. Fall risk and physical function assessment with early goals and safe environments allowed for safe mobility. Discussion: Through a framework that reduces cognitive load of providers and improves the reliability of evidence-based care for older adults, all clinicians and healthcare workers can engage in age-friendly care.
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Affiliation(s)
- Kedar Mate
- Institute for Healthcare Improvement, Cambridge, MA, USA
| | - Terry Fulmer
- The John A. Hartford Foundation, New York, NY, USA
| | - Leslie Pelton
- Institute for Healthcare Improvement, Cambridge, MA, USA
| | - Amy Berman
- The John A. Hartford Foundation, New York, NY, USA
| | - Alice Bonner
- Institute for Healthcare Improvement, Cambridge, MA, USA
| | - Wendy Huang
- Columbia University Mailman School of Public Health, New York, NY, USA
| | - Jinghan Zhang
- Columbia University Mailman School of Public Health, New York, NY, USA
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18
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Olsen CF, Bergland A, Debesay J, Bye A, Langaas AG. Patient Flow or the Patient's Journey? Exploring Health Care Providers' Experiences and Understandings of Implementing a Care Pathway to Improve the Quality of Transitional Care for Older People. QUALITATIVE HEALTH RESEARCH 2021; 31:1710-1723. [PMID: 34010082 DOI: 10.1177/10497323211003861] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Internationally, the implementation of care pathways is a common strategy for making transitional care for older people more effective and patient-centered. Previous research highlights inherent tensions in care pathways, particularly in relation to their patient-centered aspects, which may cause dilemmas for health care providers. Health care providers' understandings and experiences of this, however, remain unclear. Our aim was to explore health care providers' experiences and understandings of implementing a care pathway to improve transitional care for older people. We conducted semistructured interviews with 20 health care providers and three key persons, along with participant observations of 22 meetings, in a Norwegian quality improvement collaborative. Through a thematic analysis, we identified an understanding of the care pathway as both patient flow and the patient's journey and a dilemma between the two, and we discuss how the negotiation of conflicting institutional logics is a central part of care pathway implementation.
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Affiliation(s)
| | | | | | - Asta Bye
- Oslo Metropolitan University, Oslo, Norway
- Oslo University Hospital, Oslo, Norway
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19
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Nilsen ER, Hollister B, Söderhamn U, Dale B. What matters to older adults? Exploring person-centred care during and after transitions between hospital and home. J Clin Nurs 2021; 31:569-581. [PMID: 34117673 DOI: 10.1111/jocn.15914] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/21/2021] [Accepted: 05/24/2021] [Indexed: 01/10/2023]
Abstract
AIMS AND OBJECTIVES To explore person-centred care provided to a group of older adults (65+) by understanding their experiences of care received, their participation in care and what matters to them during and after the transition process between hospital and home. BACKGROUND Although facilitating person-centred care (PCC) has gained increasing importance globally over the last few decades, its practical implementation has been challenging. This has caused difficulties in determining its core elements and best practices. Person-centred care aims to deliver healthcare services based on individuals' preferences. Several approaches have been developed to better implement person-centred care practices. The Norwegian transitional and follow-up model, 'Holistic Continuity of Patient Care', chooses the 'What Matters to You?' APPROACH Other approaches include 'Shared Decision Making' and 'Continuity of Care'. DESIGN This study employed a qualitative design. METHODS Individual repeated interviews were conducted among eight participants. A hermeneutic exploratory research method was chosen. The COREQ checklist was followed. RESULTS Three main themes related to person-centred care emerged: what matters in meetings with the individual healthcare worker, mobilising health-promoting capabilities and resources and what matters when being in the organisational healthcare system. CONCLUSION To participate in their own health issues, older people need to be empowered and better informed about the importance and scope of person-centred care. 'What Matters to You?' is a good focus for the direction of care but can lead to a simplified understanding of individuals' preferences. Increased focus on how care recipients' capabilities and resources affect their responding is needed. RELEVANCE TO CLINICAL PRACTICE Ensuring that person-centred aspects are incorporated into the entire healthcare system requires better methods of engaging and empowering older adults in healthcare settings; more focus on PCC competence and skills of healthcare professionals as well as better integration of PCC practices into healthcare administration and policies.
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Affiliation(s)
- Elin Rogn Nilsen
- Faculty of Health and Sport Sciences, Centre for Caring Research, South, University of Agder, Grimstad, Norway
| | - Brooke Hollister
- Faculty of Health and Sport Sciences, Centre for Caring Research, South, University of Agder, Grimstad, Norway.,Institute for Health & Aging, University of California, San Francisco, San Francisco, CA, USA
| | - Ulrika Söderhamn
- Faculty of Health and Sport Sciences, Centre for Caring Research, South, University of Agder, Grimstad, Norway
| | - Bjørg Dale
- Faculty of Health and Sport Sciences, Centre for Caring Research, South, University of Agder, Grimstad, Norway
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20
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Nygaard A, Halvorsrud L, Grov EK, Bergland A. 'What matters to you?'-a qualitative study on the views of nursing home residents with dementia regarding the health care they receive. J Clin Nurs 2021; 31:262-274. [PMID: 34096110 DOI: 10.1111/jocn.15904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/05/2021] [Accepted: 05/17/2021] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVE This study's aim is to examine what matters to nursing home residents with dementia by exploring their perceptions of nursing home health care through the conceptual lens of person-centred care. BACKGROUND Dementia is a major contributor to nursing home placement. To understand the meaning of living with dementia, the inclusion of persons with dementia in research studies is essential. METHODS In total, 35 in-depth qualitative interviews were conducted with people who have dementia and live in nursing homes. A thematic analysis was applied to analyse the data. Checklist for qualitative studies: Consolidated Criteria for Reporting Qualitative Research (COREQ) https://www.equator-network.org/reporting-guidelines/coreq/ RESULTS: The analysis revealed one overarching theme with four sub-themes. Different matchings of person-centred care and routines in health care being the overarching theme. The four sub-themes were as follows: (a) understanding of the interplay between disabilities and ageing; (b) participating based on one's own preferences and needs; (c) incongruence between the person with dementia's preferences and needs and health-care support; and (d) working conditions: the relationship between residents and health-care providers. Despite the substantive focus of researchers on person-centred care and the positive impact on the nursing home health care of those who receive it, the results showed that nursing home residents still want more person-centred care. CONCLUSIONS The results indicate that the incongruence between general routines and individual preferences and needs, as well as the demand to operationalise the person-centred dimensions of health-care behaviour in nursing homes, must be resolved. Health care in nursing homes must focus on enabling residents to participate in daily activities and sustain their personhood and sense of self. RELEVANCE TO CLINICAL PRACTICE Based on the residents' statements, the results contribute to the fields of dementia education, health-care provision and policy-making and may be used to achieve person-centredness and governance.
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Affiliation(s)
- Agnete Nygaard
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.,Centre for Development of Institutional and Home Care Services, Lørenskog Municipality, Viken (Akershus), Norway
| | - Liv Halvorsrud
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Ellen Karine Grov
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Astrid Bergland
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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21
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Olsen CF, Bergland A, Bye A, Debesay J, Langaas AG. Crossing knowledge boundaries: health care providers' perceptions and experiences of what is important to achieve more person-centered patient pathways for older people. BMC Health Serv Res 2021; 21:310. [PMID: 33827714 PMCID: PMC8028726 DOI: 10.1186/s12913-021-06312-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/22/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Improving the transitional care of older people, especially hospital-to-home transitions, is a salient concern worldwide. Current research in the field highlights person-centered care as crucial; however, how to implement and enact this ideal in practice and thus achieve more person-centered patient pathways remains unclear. The aim of this study was to explore health care providers' (HCPs') perceptions and experiences of what is important to achieve more person-centered patient pathways for older people. METHODS This was a qualitative study. We performed individual semistructured interviews with 20 HCPs who participated in a Norwegian quality improvement collaborative. In addition, participant observation of 22 meetings in the quality improvement collaborative was performed. RESULTS A thematic analysis resulted in five themes which outline central elements of the HCPs' perceptions and experiences relevant to achieving more person-centered patient pathways: 1) Finding common ground through the mapping of the patient journey; 2) the importance of understanding the whole patient pathway; 3) the significance of getting to know the older patient; 4) the key role of home care providers in the patient pathway; and 5) ambiguity toward checklists and practice implementation. CONCLUSIONS The findings can assist stakeholders in understanding factors important to practicing person-centered transitional care for older people. Through collaborative knowledge sharing the participants developed a more shared understanding of how to achieve person-centered patient pathways. The importance of assuming a shared responsibility and a more holistic understanding of the patient pathway by merging different ways of knowing was highlighted. Checklists incorporating the What matters to you? question and the mapping of the patient journey were important tools enabling the crossing of knowledge boundaries both between HCPs and between HCPs and the older patients. Home care providers were perceived to have important knowledge relevant to providing more person-centered patient pathways implying a central role for them as knowledge brokers during the patient's journey. The study draws attention to the benefits of focusing on the older patients' way of knowing the patient pathway as well as to placing what matters to the older patient at the heart of transitional care.
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Affiliation(s)
- Cecilie Fromholt Olsen
- Department of Physiotherapy, Faculty of Health Sciences, OsloMet- Oslo Metropolitan University, Oslo, Norway.
| | - Astrid Bergland
- Department of Physiotherapy, Faculty of Health Sciences, OsloMet- Oslo Metropolitan University, Oslo, Norway
| | - Asta Bye
- Regional Advisory Unit in Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet- Oslo Metropolitan University, Oslo, Norway
| | - Jonas Debesay
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet- Oslo Metropolitan University, Oslo, Norway
| | - Anne G Langaas
- Department of Physiotherapy, Faculty of Health Sciences, OsloMet- Oslo Metropolitan University, Oslo, Norway
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22
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Glomsås HS, Knutsen IR, Fossum M, Halvorsen K. 'They just came with the medication dispenser'- a qualitative study of elderly service users' involvement and welfare technology in public home care services. BMC Health Serv Res 2021; 21:245. [PMID: 33740974 PMCID: PMC7977566 DOI: 10.1186/s12913-021-06243-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 03/04/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Public home care for the elderly is a key area in relation to improving health care quality. It is an important political goal to increase elderly people's involvement in their care and in the use of welfare technology. The aim of this study was to explore elderly service users' experience of user involvement in the implementation and everyday use of welfare technology in public home care services. METHOD This qualitative study has an explorative and descriptive design. Sixteen interviews of service users were conducted in five different municipalities over a period of six months. The data were analysed using reflexive thematic analysis. RESULTS Service users receiving public home care service are not a homogenous group, and the participants had different wishes and needs as regards user involvement and the use of welfare technology. The analysis led to four main themes: 1) diverse preferences as regards user involvement, 2) individual differences as regards information, knowledge and training, 3) feeling safe and getting help, and 4) a wish to stay at home for as long as possible. CONCLUSION The results indicated that user involvement was only to a limited extent an integral part of public home care services. Participants had varying insight into and interest in welfare technology, which was a challenge for user involvement. User involvement must be facilitated and implemented in a gentle way, highlighting autonomy and collaboration, and with the focus on respect, reciprocity and dialogue.
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Affiliation(s)
- Heidi Snoen Glomsås
- Faculty of Health Sciences, Institute of Nursing and health promotion, Oslo Metropolitan University, Postbox 4, St. Olavs plass, N-0130, Oslo, Norway.
| | - Ingrid Ruud Knutsen
- Faculty of Health Sciences, Institute of Nursing and health promotion, Oslo Metropolitan University, Postbox 4, St. Olavs plass, N-0130, Oslo, Norway
| | - Mariann Fossum
- Faculty of Health and Sport Sciences, Department of Health and Nursing Science, University of Agder, Postboks 509, N-4898, Grimstad, Norway
| | - Kristin Halvorsen
- Faculty of Health Sciences, Institute of Nursing and health promotion, Oslo Metropolitan University, Postbox 4, St. Olavs plass, N-0130, Oslo, Norway
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