Investigating patient centered care in an acute older adult ward - a qualitative study

Ball, J 2011, Investigating patient centered care in an acute older adult ward - a qualitative study , MPhil thesis, University of Salford.

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This project investigates patient centred care on an acute older persons' unit in a NHS Trust in the UK. It uses a method based on grounded theory, integrated with an ethnographic approach to examine the knowledge, beliefs and behaviour of staff working on an acute older persons' unit regarding patient centred care. The data was gathered over a period of one year using interviews and participant observation. The National Service Framework for Older People produced by the Department of Health (DOH) is the first ever, comprehensive strategy to ensure fair, high quality, integrated health and social care services for older people. It is a 10 year programme of action linking services to support independence and promote good health, specialised services for key conditions, and culture change so that all older people and their carers are always treated with respect, dignity and fairness (DOH 2001). Patient-centred care is central to this strategy, however Nolan & Davies (2002) suggest that patient-centred care may not be the panacea that it is held up to be and may perpetuate, rather than eliminate poor standards of care for older people. Nolan et al (2002) stated that although 'patient-centred care' has challenged many negative stereotypes and lies at the heart of the NSF for older people, it presents a rather limited vision. They instead promote 'relationship-centred care' initially proposed by the Tresolini and Pew-Fetzer Task Force (1994), this focuses on the relationships that form the context of care. McCormack in his 2004 review observes that patient-centred practice is a recurring theme in the gerontological nursing literature, there are many descriptive accounts of attempts at developing patient-centred practice but in reality there are few studies that identify the benefits of this way of working. He raises the question that perhaps good quality care for older people and patient-centred care may indeed be the same thing, suggesting that we shouldn't chase after an ideal of patient-centredness, but instead strive for a constant state of 'becoming more patient-centred' in our practice. Dewing (2004) looked at five frameworks that appear to promote patient-centredness in nursing which for the for the most part, are all conceptual and all advocate the values of patient-centred care. Dewing questions the collective belief that person-centred care is now being achieved when the degree to which practitioners know the older person is actually very limited, claiming that this is exacerbated by the limited vision of patient-centred care set out in the National Service Framework for Older People. Dewing recommends further work into translating the complex conceptual frameworks into ones that are meaningful to older people and the nurses working with them. In her conclusion Dewing suggests that when frameworks are used in a technical way, the older person and/or oneself is made to 'fit' into the framework. The challenge of nursing older people in a patient or relationship-centred way is often aggravated by trying to consciously and intentionally use frameworks. As patient-centred care is the central philosophy around which services for older people are being developed and how they are likely to develop in the future, it is prudent to look at whether this way of caring translates from theory into practice and how it affects the patient experience. Semi-structured interviews were conducted with staff nurses and healthcare assistants on the three wards on the older persons unit. 60 'personal memos' and field notes were recorded in over 100 hours spent on the wards as a participant observer. The interviews and field notes were analysed. Quotes and pertinent material that related to each other were sorted by hand into eight initial categories. These categories were analysed further and sorted into four final themes. The themes identified from the data were used to form a descriptive analysis. The results of the study generated insights into the nature of patient centred care in the acute care of older people. The four major categories which emerged from the findings, are discussed and analysed in this thesis. These were 'it's about the individual', 'if only we had time', 'it's 98% relationships' and 'too posh to wash'. The conclusions describe the factors affecting patient centred care and how these are related to practice and policy. Evidence of patient centred care was observed on the ward and also relationship centred care was recorded. While many nursing activities were consistent with patient centred care the study results also highlighted factors influencing these activities and suggests opportunities to perhaps help improve nursing practice. To ensure patient centred care remains at the core of nursing practice on the OPU nurses should carry out ongoing assessment of patients needs in relation to their care and try to encourage patients to participate actively in their care. From these findings it is apparent that a patient centred approach would have to involve practitioners having appropriate space and support to enable them to work in this manner. This may require the provision of clinical supervision and training and space for reflection on their work with older people. They themselves would need to feel valued and recognised both by their colleagues and the organisation that they work for.

Item Type: Thesis (MPhil)
Contributors: Johnson, M (Supervisor)
Schools: Schools > School of Health and Society
Depositing User: Institutional Repository
Date Deposited: 16 Aug 2021 12:50
Last Modified: 04 Aug 2022 11:28

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