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Capturing the concealed: Interprofessional practice and older patients' participation in decision-making about discharge after acute hospitalization
- Authors:
- HUBY Guro, et al
- Journal article citation:
- Journal of Interprofessional Care, 21(1), January 2007, pp.55-67.
- Publisher:
- Taylor and Francis
The aim of this paper is to investigate ways in which the dynamics of interprofessional work shaped older patients' “participation” in decision-making about discharge from acute hospital care in a medical directorate of a District General Hospital in Scotland. Twenty-two purposively selected older patients and their key professional hospital carers in three different ward environments participated in the study. An ethnographic approach was adopted, involving semi-structured interviews with patients and staff combined with rigorous observation of the practical context for staff and patient interactions during the discharge planning process over a 5-month period. Patients' and staff's understanding of “decision-making” and their priorities for discharge were different, but patients' perspectives fragmented and became invisible. Care routines, which centred around assessments and the decisions that flowed from these tended to exclude both staff and patients from active decision-making. Research and practice on patient involvement in discharge decision-making needs to focus on the organizational context, which shapes patients', unpaid carers' and staff's interactions and the dynamics by which some views are privileged and others excluded. Procedurally driven care routines and their impact on patients', carers' and staff's opportunity to actively engage in decision-making should be re-considered from an empowerment perspective.
Preparation to care for confused older patients in general hospitals: a study of UK health professionals
- Author:
- GRIFFITHS Amanda
- Journal article citation:
- Age and Ageing, 43(4), 2014, pp.521-527.
- Publisher:
- Oxford University Press
Background and Objective: In the UK, two-thirds of patients in general hospitals are older than 70, of whom half have dementia or delirium or both. The authors' objective was to explore doctors, nurses and allied health professionals' perceptions of their preparation to care for confused older patients on general hospital wards. Methods: Using a quota sampling strategy across 11 medical, geriatric and orthopaedic wards in a British teaching hospital, we conducted 60 semi-structured interviews with doctors, nurses and allied healthcare professionals and analysed the data using the Consensual Qualitative Research approach. Results: There was consensus among participants that education, induction and in-service training left them inadequately prepared and under-confident to care for confused older patients. Many doctors reported initial assessments of confused older patients as difficult. They admitted inadequate knowledge of mental health disorders, including the diagnostic features of delirium and dementia. Handling agitation and aggression were considered top priorities for training, particularly for nurses. Multidisciplinary team meetings were highly valued but were reported as too infrequent. Participants valued specialist input but reported difficulties gaining such support. Communication with confused patients was regarded as particularly challenging, both in terms of patients making their needs known, and staff conveying information to patients. Participants reported emotional and behavioural responses including frustration, stress, empathy, avoidance and low job satisfaction. Conclusion: Findings indicate that a revision of training across healthcare professions in the UK is required, and that increased specialist support should be provided, so that the workforce is properly prepared to care for older patients with cognitive problems. (Edited publisher abstract)
Notes on the end of life: the social interactions between patients, carers and professionals
- Author:
- BRIGGS Daniel
- Journal article citation:
- Quality in Ageing and Older Adults, 11(2), June 2010, pp.35-46.
- Publisher:
- Emerald
Using data from the findings of an NHS primary care trust funded consultation examining the quality of end of life care services in a London borough, this paper reports on social interactions between patients, carers and professionals during end of life care. The project used ethnographic methods (open-ended qualitative interviews and observations) with 50 residents, of whom 30 were patients and 20 were carers, examining their knowledge of services, experiences of services with which they had contact, the efficiency of those services, and suggestions for improvements. The author discusses the findings on patients' and carers' views of end of life care services, how emotions and social relations develop between patients, carers and professionals, and the resulting complex social relationships between patients, carers and professionals as a result of their experiences of those services and as a consequence of the emotional suffering that they endure through the process, concluding that the consultation found some good aspects to end of life care but that there was still room for improvement, and setting out some implications for practice.
Physician attitudes toward treatment of depression in older medical inpatients
- Author:
- KOENIG Harold G.
- Journal article citation:
- Aging and Mental Health, 11(2), March 2007, pp.197-204.
- Publisher:
- Taylor and Francis
In this American study physicians caring for a consecutive series of 1000 depressed older patients during medical hospitalization and/or after discharge were asked about their general attitudes and behaviours related to the treatment of depression in older patients. Of 422 physicians responding to questionnaires, less than half (48%) usually started more than two patients a month on antidepressants. Even fewer (14%) referred more than two patients a month for counselling; 37% usually referred none. Only 11% referred more than two patients a month to psychiatrists; nearly 40% usually referred none. Antidepressants, counselling, and psychiatric referral were seldom thought very effective. Physicians out of their training and those in primary care specialties (especially family practice) were more likely to treat patients. Common reasons for not treating these patients were perceived resistance to treatment (62.3%), lack of time (61.1%), uncertainty of depression diagnosis (56.2%), belief that patients couldn't afford treatment (50.5%), and concern about medication/disease interactions (58.8%). One-third (33.5%) emphasized that they were unsure about treatment effectiveness and one-third (34.4%) that they were poorly prepared to treat depression in older patients. Non-white physicians were more likely to refer to psychiatrists. Many older depressed patients in medical settings are not treated or referred.
Social work involvement in end of life planning
- Authors:
- HEYMAN Janna C., GUTHEIL Irene A.
- Journal article citation:
- Journal of Gerontological Social Work, 47(3/4), 2006, pp.47-61.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
This cross sectional study examined the factors associated with social workers' involvement in end-of-life (EOL) planning using a random sample of NASW members in health and aging in the United States. Of the 390 social workers who worked in EOL planning, the majority were involved in health care proxy discussions and counselling with patients. Respondents tended to see barriers to proxy completion as client-related. However, some system barriers were correlated with overall involvement. Factors that predicted social workers' involvement with the health care proxy included age, attitudes, perceptions of barriers, and perceived physician support. Social workers need to attend to the systems in which they operate as well as to client concerns. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580).
Hard truths: the journey to putting patients first: Volume one of the Government response to the Mid Staffordshire NHS Foundation Trust Public Inquiry; presented to Parliament by the Secretary of State for Health
- Author:
- GREAT BRITAIN. Department of Health
- Publisher:
- TSO
- Publication year:
- 2013
- Pagination:
- 137
- Place of publication:
- London
The Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry chaired by Robert Francis QC (February 2013) called for a ‘fundamental culture change’ across the health and social care system to put patients first at all times. This is one of four documents which build on the Government’s initial response, ‘Patients first and foremost’ (published March 2013). This response begins with a statement of common purpose signed by the Chairs or Chief Executives of key health and care organisations, in which they renew and reaffirm their personal commitment and their organisations’ commitment to the values of the NHS and its Constitution. It sets out how the whole health and care system will prioritise and build on recommendations made in six further reports (including the 'Cavendish review: an independent review into healthcare assistants and support workers in the NHS and social care settings) commissioned by the Government that considered key issues identified by the Inquiry (findings and recommendations summarised in Annexes A-F). These include “major new action on the following vital areas”: transparent reporting on ward-by-ward staffing levels; how patients and their families can raise concerns or complain; a statutory duty of candour; legislation on wilful neglect; a fit and proper person’s test which will act as a barring scheme; and a new Care Certificate for Healthcare Assistants and Social Care Support Workers. The Care Bill will introduce a new criminal offence applicable to care providers who supply or publish certain types of information which is false or misleading, where that information is required to comply with a statutory or other legal obligation. Chapters cover: preventing problems; detecting problems quickly; taking action promptly; ensuring robust accountability; and ensuring staff are trained and motivated. Each chapter sets out themes and issues raised in the Inquiry report. Case studies illustrate instances of failings in patient care, examples of hospitals which have adopted procedures that are patient focused, and innovations of benefit to service users. (Original abstract)
Hard truths: the journey to putting patients first: Volume two of the Government response to the Mid Staffordshire NHS Foundation Trust Public Inquiry: response to the Inquiry’s recommendations: presented to Parliament by the Secretary of State for Health
- Author:
- GREAT BRITAIN. Department of Health
- Publisher:
- TSO
- Publication year:
- 2013
- Pagination:
- 248
- Place of publication:
- London
The Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry chaired by Robert Francis QC (February 2013) called for a ‘fundamental culture change’ across the health and social care system to put patients first at all times. This document provides responses to each of the 290 recommendations made by the Public Inquiry, in respect of accountability, roles and responsibilities in patient care. It also addresses the recommendations made in six related independent reviews, including 'Cavendish review: an independent review into healthcare assistants and support workers in the NHS and social care settings'. (Original abstract)
Waiting for change: how the NHS is responding to the needs of older people
- Authors:
- AGE CONCERN, HELP THE AGED
- Publisher:
- Age Concern; Help the Aged
- Publication year:
- 2009
- Pagination:
- 13p.
- Place of publication:
- London
This report by Age UK (formerly Age Concern) describes how the NHS, politicians and health professionals are failing to prioritise issues which older patients most value. The report focuses on the needs of the over 80s, and concluded that this group have a clear idea of what they want from health services, but all too often this is not delivered. Current NHS targets and performance indicators fail to adequately address the issues that matter most to older people. Findings indicate that face to face and flexible appointments with health professionals they know and trust and better coordination of care are among those things older people want from community-based healthcare. The study also highlighted the importance placed on social aspects of healthcare, particularly for those older people who are isolated in their own homes. The study also identified privacy, good relationships with staff and retaining choice and control over daily routines to be vital for positive patient experience, within hospital settings. The report stresses how these needs are not always met. Recent Government figures show that 47 percent of inpatients said that they were not, or only partially, involved as much as they wanted to be in decisions about their care and treatment in hospital.
The attitudes of carers and old age psychiatrists towards the treatment of potentially fatal events in end-stage dementia
- Authors:
- COETZEE S. J., LEASK S. J., JONES R.G.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 18(2), February 2003, pp.169-173.
- Publisher:
- Wiley
Deciding how to treat patients with end-stage dementia developing potentially fatal events has long been contentious. Under expected new legislation the role of carers is likely to increase. Old age psychiatrists frequently have to decide between active or palliative approaches to such patients. Little is known concerning the comparative attitudes of carers and old age psychiatrists. This research examined how their attitudes differed. Clinicians favoured active treatment of potentially fatal events in end-stage dementia less than carers who more significantly valued patient-centred issues such as dying with dignity, the patient's best interests and the patient's wishes.