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1 – 10 of 873Isabelle Latham, Dawn Brooker and Kay de Vries
This paper describes a model of “Learning to care” derived from a study exploring how care workers in care homes learn to care for people living with dementia. The “Learning to…
Abstract
Purpose
This paper describes a model of “Learning to care” derived from a study exploring how care workers in care homes learn to care for people living with dementia. The “Learning to care” model is primarily informal in nature in which influences such as formalised training and organisational culture impact care outcomes indirectly rather than directly.
Design/methodology/approach
This study used a focused, critical ethnographic approach in two care homes in England resulting in 63 h of observation of care of people living with advanced dementia, 15 semi-structured interviews and 90 in-situ ethnographic interviews with care staff.
Findings
The findings reveal a three-level model of learning to care. At the level of day-to-day interactions is a mechanism for learning that is wholly informal and follows the maxim “What Works is What Matters”. Workers draw on resources and information within this process derived from their personal experiences, resident influences and care home cultural knowledge. Cultural knowledge is created through a worker’s interactions with colleagues and the training they receive, meaning that these organisational level influences affect care practice only indirectly via the “What Works is What Matters” mechanism.
Originality/value
This study makes an original contribution by explaining the nature of day-to-day informal learning processes as experienced by care workers and those living with dementia in care homes. In particular, it illuminates the specific mechanisms by which organisational culture has an effect on care practice and the limitations of formal training in influencing such practice.
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Bonnie Poksinska and Malin Wiger
Providing high-quality and cost-efficient care of older people is an important development priority for many health and social care systems in the world. This paper suggests a…
Abstract
Purpose
Providing high-quality and cost-efficient care of older people is an important development priority for many health and social care systems in the world. This paper suggests a shift from acute, episodic and reactive hospital-centered care toward longitudinal, person-centered and proactive home-centered care. The purpose of this paper is to contribute to the knowledge of a comprehensive development strategy for designing and providing home-centered care of older people.
Design/methodology/approach
The study design is based on qualitative research with an inductive approach. The authors study development initiatives at the national, regional and local levels of the Swedish health and social care system. The data collection methods included interviews (n = 54), meeting observations (n = 25) and document studies (n = 59).
Findings
The authors describe findings related to policy actions and system changes, attempts to achieve collaboration, integration and coordination, new forms of care offerings, characteristics of work settings at home and differences in patients' roles and participation at home and in the hospital.
Practical implications
The authors suggest home-centered care as a solution for providing person-centered and integrated care of older people and give examples of how this can be achieved.
Originality/value
The authors outline five propositions for research and development related to national policies, service modularity as a solution for customized and coordinated care, developing human resources and infrastructure for home settings, expanding services that enable older people living at home and patient co-creation.
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Patricia Yocie Hierofani and Micheline van Riemsdijk
As populations are ageing and the global average life expectancy is rising, the provision of care for older people is an increasingly salient issue. This paper aims to focus on…
Abstract
Purpose
As populations are ageing and the global average life expectancy is rising, the provision of care for older people is an increasingly salient issue. This paper aims to focus on family-provided care for older immigrants, examining how older immigrants and care providers experience and construct family caregiving.
Design/methodology/approach
Based on interviews with care recipients, family care providers, municipal staff and representatives for migrant organisations in Sweden, this study presents a typology of family caregiving for older immigrants.
Findings
The authors found three caregiving types, namely, solely family-provided care and a combination of family care and public care (predominantly one or the other). The decision to select family-provided or publicly-funded care depends on personal and institutional factors.
Originality/value
The paper makes three empirical contributions to the literature on care provision for older immigrants. Firstly, this study provides insights into the structural and personal factors that shape care-giving arrangements for older immigrants. Secondly, this study examines the perspectives of care recipients and care providers on family-provided care. Care expectations differ between both groups and sometimes result in intergenerational disagreement. Thirdly, in terms of institutional support, this study finds that the Swedish state’s notion of individual needs does not match the needs of immigrant elderly and their caregivers. The paper places the care types in a broader discussion about eldercare provision in the Swedish welfare state, which has experienced a decline in publicly funded care services and an increase in family caregiving in the past 30 years. In addition, it addresses questions of dignified ageing from a minority perspective.
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Märt Vesinurm, Inka Sylgren, Annika Bengts, Paulus Torkki and Paul Lillrank
This article aims to clarify the concepts used to understand, analyze and improve a patient’s progress through a health service system. A patient pathway describes plans and…
Abstract
Purpose
This article aims to clarify the concepts used to understand, analyze and improve a patient’s progress through a health service system. A patient pathway describes plans and intentions. Within it, we distinguish between the clinical pathway of decisions and interventions and the care pathway of supportive activities. As a patient pathway is implemented, it turns into a patient journey of what is done, what happens to a patient’s medical condition and what is experienced and felt. We introduce “patient journey disruption” (PJD) as a concept describing the events that need to be prevented from happening to accomplish integrated, coordinated and seamless care.
Design/methodology/approach
The method used in this paper is concept analysis. First, an expert steering group worked to refine the concept of PJDs; second, an analysis of similar concepts from related fields was done to root the concept into existing theories, and third, semi-structured interviews with professionals and patients were done to test the concept of PJDs in the home care context.
Findings
PJDs are agency-based harmful events in the execution of the care pathway that deviate the patient journey from what can be reasonably expected. PJDs are management failures, which is why they should be studied by healthcare operations management (HOM) and service science scholars with the intention to find ways to prevent them from happening.
Research limitations/implications
This study has limitations, including presenting conceptual ideas and preliminary results that are only indicative.
Practical implications
We believe that the introduction of the concept of PJDs into the literature provides a new, systematic way of approaching the different shortcomings in our healthcare production systems. Moreover, by systematically identifying different PJDs, interventions can be designed and targeted more appropriately.
Originality/value
Managerial challenges regarding healthcare processes have been studied but have not been well defined. The concept of PJDs is an original, well-thought-out definition.
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Ricardo Manuel Da Costa Melo, Eunice Cristina Ribeiro Lopes, José Luis Coelho Vilas Boas, Lúcia Batista Santos, Sandra Cristina Ferreira Amaro, João Miguel Almeida Ventura-Silva and Isabel de Jesus Oliveira
The impact of dependence on self-care on people’s lives is very significant, with consequences for the person and their caregivers. The purpose of this study is to map the…
Abstract
Purpose
The impact of dependence on self-care on people’s lives is very significant, with consequences for the person and their caregivers. The purpose of this study is to map the evidence on the factors that influence the empowerment of the person dependent on self-care on returning home.
Design/methodology/approach
Scoping review according to the criteria proposed by the Joanna Briggs Institute: population (people with a dependence on self-care), concept (factors that influence training) and context (return home after hospitalization in a medical-surgical context). The research was carried out from March 1 to April 30, 2022, in the databases CINAHL and MEDLINE (via EBSCO), Scielo, LILACS, Cuiden and MedicLatina; Gray literature searched RCAAP, DART-Europe and OpenGrey. Studies published in Portuguese, Spanish and English were included, with no time limit.
Findings
One hundred and eighty-one articles were obtained, which, after analysis according to the criteria, resulted in seven studies included for review, ranging from 2007 to 2021, with a level of evidence between 2. c and 4. a (according to Joanna Briggs Institute), and two thematic areas/four categories emerging.
Research limitations/implications
The need for information and training, the relationship and proximity with the health-care team, the design of nursing care targeted at the person’s level of dependence, education, gender, type of surgical intervention and postoperative period, physical space and lack of privacy and audiovisual media.
Originality/value
The perception of these factors proves to be important in the person’s training process, with the nurse’s role being highlighted due to their emphasis on the transition home.
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Teresa Atkinson and Rebecca Oatley
The purpose of this paper is to present the views of people living with dementia in extra care housing (ECH). This is a model of housing with care and support aiming to support…
Abstract
Purpose
The purpose of this paper is to present the views of people living with dementia in extra care housing (ECH). This is a model of housing with care and support aiming to support older people, including those with dementia, to live independently. Previous research identifies benefits but is predominantly derived from third-party accounts, with the voices of those living with dementia in ECH significantly absent.
Design/methodology/approach
This study adopted a qualitative approach conducting 100 interviews across 8 ECH schemes in England. Over half of the interviews were conducted with people living with dementia and their families with the remainder involving staff and commissioners.
Findings
Findings suggest there are a range of benefits including owning your own home, having a safe, age friendly location with flexible support, social interaction and continuing to live as a couple. Challenges included availability of staff, flexible resourcing, loneliness and the advancing symptoms of dementia.
Research limitations/implications
Despite efforts to create an inclusive, diverse sample, the participants were all White British. Participants involved were identified by gatekeepers, which may present some bias in the selection.
Practical implications
Whilst ECH offers benefits to people living with dementia, addressing the challenges is essential for effective dementia care. Improving staff training, promoting person-centred care and fostering an inclusive community are critical for enhancing residents’ well-being and quality of life.
Originality/value
This paper explored the lived experiences of residents and family members, providing new insight into the advantages and disadvantages of ECH for people living with dementia.
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Inger James, Annica Kihlgren, Margaretha Norell Pejner and Sofia Tavemark
The purpose of this paper is to describe how first-line managers (FLMs) in home care (HC) reason about the opportunities and obstacles to lead the work according to the…
Abstract
Purpose
The purpose of this paper is to describe how first-line managers (FLMs) in home care (HC) reason about the opportunities and obstacles to lead the work according to the individual’s needs and goals.
Design/methodology/approach
In this participatory appreciative action reflection project, eight managers within one Swedish municipality were interviewed. The data were analysed using a thematic analysis.
Findings
The results showed a polarization between two different systems that FLMs struggle to balance when attempting to lead HC that adapts to the needs and goals of individuals. One system was represented by the possibilities of a humane system, with human capital in the form of the individual, older persons and the co-workers in HC. The second system was represented by obstacles in the form of the economic needs of the organization in which the individual receiving HC often felt forgotten. In this system, the organization’s needs and goals governed, with FLMs needing to adapt to the cost-effectiveness principle and keep a balanced budget. The managers had to balance an ethical conflict of values between the human value and needs-solidarity principles, with that of the cost-effectiveness principle.
Originality/value
The FLMs lack the opportunity to lead HC according to the needs and goals of the individuals receiving HC. There is a need for consensus and a value-based leadership model based on ethical principles such as the principles of human value and needs-solidarity to lead the HC according to the individual’s needs and goals.
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Tiffany Cheng Han Leung, Robin Stanley Snell and Daisy Lee
We identify lessons from a project sponsored by a large charitable trust, which sought to build capability for end-of-life (EOL) care in Hong Kong through interdisciplinary and…
Abstract
Purpose
We identify lessons from a project sponsored by a large charitable trust, which sought to build capability for end-of-life (EOL) care in Hong Kong through interdisciplinary and multi-agency collaboration.
Design/methodology/approach
An in-depth case study drawing on 21 in-depth interviews with diverse stakeholders was conducted. Lyman et al.’s (2018) model of organisational learning (OL) in healthcare settings was applied to analyse the relative emphasis on particular contextual factors and mechanisms, and to identify outcomes perceived to have been achieved.
Findings
Infrastructure such as materials for assessment and education received the most emphasis among the contextual factors and deliberate learning such as training sessions received the greatest attention among the mechanisms. While perceptions indicated that desired outcomes were being achieved in terms of social impact, there were relatively few mentions of “soft” factors such as enhanced motivation, leadership or OL skills among staff.
Originality/value
This study extends the literature on how to create valuable social impact through OL. While prior studies have examined social impact in terms of solutions for social and environmental problems, ours is one of the few that examines how improvements are made to organisations’ capability to deliver such impacts in the context of healthcare.
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Valeria Pulignano, Mê-Linh Riemann, Carol Stephenson and Markieta Domecka
This study applies Garfinkel’s (1967) concept of ‘breaching experiment’ to explore the impact of COVID-19-induced disruptions on the ‘emotion management’ practices of residential…
Abstract
This study applies Garfinkel’s (1967) concept of ‘breaching experiment’ to explore the impact of COVID-19-induced disruptions on the ‘emotion management’ practices of residential care workers in the United Kingdom and Germany. It examines the influence of professional feeling rules on workers, emphasizing the prescribed importance of displaying affective, empathetic concern for residents’ health and well-being. Findings demonstrate that authenticity and adherence to professional feeling rules in relation to emotional management are not mutually exclusive. The authors underscore how adherence to professional feeling rules upholds authentic care by reinforcing a professional ethos, which acts as a cornerstone motivating residential care workers. Ultimately, the study showcases how a professional ethos substantiates altruistic motivations, guiding proficient emotion management practices among care workers. It highlights how these workers drew upon their personal understanding and experiences to determine the appropriate emotions to express while providing care for residents amid the unprecedented challenges of the pandemic.
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Luke Sheeran-Purcell, Geoff McCombe, John Broughan, Emils Sietins, Ronan Fawsitt, Martina Queally, Timothy Lynch and Walter Cullen
Readmissions to the hospital are expensive and can have negative health consequences for patients. Older adults are at greater risk of readmission. Patient perspectives are…
Abstract
Purpose
Readmissions to the hospital are expensive and can have negative health consequences for patients. Older adults are at greater risk of readmission. Patient perspectives are valuable in identifying areas for improvement in the transition of care. The purpose of this qualitative study is to increase our understanding of patients’ perspectives on the transition of care from hospital to primary care.
Design/methodology/approach
This study employs a qualitative methodology to conduct semi-structured interviews with patients who have been discharged from hospitals in the Ireland East Hospital Group region. Remote interviews were conducted with 18 participants from eight general practices. Transcripts were analysed using thematic analysis as described by Braun and Clarke.
Findings
The three main themes identified were communication, outpatient supports and patient education. Gaps in communication do occur, but patients are often too external to comment. Patients benefit from a wide variety of outpatient supports including general practice, family, carers, allied health professionals and voluntary organisations. Access and cost are barriers to these supports. Participants were generally positive towards proposed primary care-based interventions such as follow-up appointments with general practitioners (GPs) and education sessions.
Originality/value
This study highlights a number of areas for improvement in the transition of care in current practice including communication between services and access to outpatient care. It also suggests directions for further research, such as explorations of healthcare provider perspectives and pilot studies of readmission reduction interventions.
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