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Vårdplaneringsmötet.: En studie av det institutionella samtalet mellan äldre kvinnor, närstående och vårdare
Umeå University, Faculty of Medicine, Nursing.
2005 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis is to describe how elderly women’s encounters with an institutionalised world of health care manifest itself in a discharge planning conference (DPC). The thesis is based on eight video recorded DPCs and follow-up interviews with the women who took part in the conferences.

The result of study I, a case study, showed that the woman’s experience of taking part in the DPC was characterised as a feeling of powerlessness. The women’s possibility to have influence on the care planning was small (Study II). Study III revealed that the participants adopted or were assigned to different roles during the DPC. As these roles collided dilemmatic situations occurred. Simultaneously the women and family members struggled to manage the institutional frame that surrounded the meeting by trying to find room within it or by challenging it. Study IV revealed that the women found themselves to be in a vulnerable situation. Their body had failed them, their future was insecure and they felt unprepared as they took part in the DPC. They felt as if they were being affiliated with the other participants in a joint project, as if they were standing outside the event or as if they were in focus for the conversation which. The last was a double edged experience: getting confirmative attention but also being exposed as dependent. Four themes characterise the care that was jointly constructed by all participants during the DPC. These themes are “Care as spirit of community and confirmation”, ”Care as alienation”, ”The incomprehensible care” and “The inflexible and betraitful care”.The result gives rise to questions about the relevance of DPCs in their present shape. Further research and developmental projects requested to achieve dicharge planning conferences that are corresponding better to official caring ideals and the patients needs.

Place, publisher, year, edition, pages
Umeå: Omvårdnad , 2005. , 89 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 967
Keyword [en]
Nursing, Discharge planning
Keyword [sv]
Omvårdnad
National Category
Nursing
Research subject
Caring Sciences
Identifiers
URN: urn:nbn:se:umu:diva-590ISBN: 91-7305-883-1 (print)OAI: oai:DiVA.org:umu-590DiVA: diva2:143886
Public defence
2005-09-30, Aulan, Vårdvetarhuset, Institutionen för omvårdnad, 901 87Umeå, 13:00 (English)
Opponent
Supervisors
Available from: 2005-09-19 Created: 2005-09-19 Last updated: 2009-11-11Bibliographically approved
List of papers
1. Expressions of power and powerlessness in discharge planning: a case study of an older woman on her way home
Open this publication in new window or tab >>Expressions of power and powerlessness in discharge planning: a case study of an older woman on her way home
2003 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 12, no 5, 717-716 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this case study was to illuminate and describe the phenomenon of power as it appeared in a discharge planning conference. The patient was an older woman who needed long-term care as a result of stroke and heart failure. Data comprised transcriptions of a video-recorded discharge planning conference and two audio-recorded interviews focusing on the patient's experience of the discharge planning conference. The findings reveal that the content of the discharge planning conference focused on the patient's medical state and routine administrative protocols. Analysis of the participants' activities, strategies and attitudes during the conference indicate that the professional carers dominated the conversation. Analysis further reveals that the patient experienced a feeling of powerlessness and of being treated as an object. The findings are interpreted and discussed based on the concepts of 'institutional frame' and 'client's frame', derived from Agar's theory of institutional discourse.

Keyword
discharge planning, older women, power, powerlessness
Identifiers
urn:nbn:se:umu:diva-4677 (URN)10.1046/j.1365-2702.2003.00718.x (DOI)12919217 (PubMedID)
Available from: 2005-09-19 Created: 2005-09-19 Last updated: 2017-12-14Bibliographically approved
2. Discharge planning: "fooling ourselves?"--patient participation in conferences.
Open this publication in new window or tab >>Discharge planning: "fooling ourselves?"--patient participation in conferences.
2004 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 13, no 5, 562-570 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The aim of discharge planning conferences (DPCs) is to co-ordinate resources and to enhance patient involvement in care in connection with relocation from hospital. DPCs can be characterized as institutional conversations, and are often executed as standard procedures, but the scientific basis for the activity is weak. AIMS AND OBJECTIVES: The aim of this study was to illuminate and describe the communication at DPCs. DESIGN: A purposeful and consecutive sample of eight DPCs was collected in which the future care of eight women, aged 70 years or more, was discussed. METHODS: Transcribed video recordings were analysed in two steps. "The initial analysis" aimed at describing the structure and content of the communication. This description constituted the basis for an interpretation, leading to "the focused analysis" aiming at finding evidence for the assumptions made in the interpretation. RESULTS: The result revealed that the participation of patients was very less the DPCs. The decisions had often already been made, and the women were expected to be pleased with the decision; institutional representatives (IRs) frequently justified their actions by referring to bureaucratic praxis. CONCLUSIONS: The women were both encouraged and excluded from participation by the IRs. This dichotomy occurred because the IRs, as professionals, struggled to simultaneously realize their caring mission and their obligation to enforce the values and rules of the institution, i.e. efficiency and rationality. Thus, IRs and patients were equally imprisoned within the institutional system. RELEVANCE TO CLINICAL RESEARCH: This result illustrates how conflicting paradigms are imbedded and reproduced by healthcare professionals in their communicative praxis. Awareness of this is a prerequisite for improvements in working procedures congruent with a caring paradigm that support patient participation.

Keyword
Activities of Daily Living, Aged/*psychology, Aged; 80 and over, Attitude of Health Personnel, Communication, Decision Making; Organizational, Family/psychology, Female, Geriatric Assessment, Humans, Inpatients/*psychology, Negotiating, Nursing Methodology Research, Nursing Staff; Hospital/organization & administration/psychology, Patient Advocacy, Patient Care Planning/*organization & administration, Patient Discharge, Patient Participation/methods/*psychology, Power (Psychology), Professional-Patient Relations, Social Work/organization & administration, Sweden, Videotape Recording, Women/*psychology
Identifiers
urn:nbn:se:umu:diva-6594 (URN)10.1111/j.1365-2702.2004.00900.x (DOI)15189409 (PubMedID)
Available from: 2007-12-14 Created: 2007-12-14 Last updated: 2017-12-14Bibliographically approved
3. How to get one's voice heard: the problems of the discharge planning conference.
Open this publication in new window or tab >>How to get one's voice heard: the problems of the discharge planning conference.
2006 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 53, no 6, 646-655 p.Article in journal (Refereed) Published
Abstract [en]

AIMS: This paper reports a study describing how patients, relatives and healthcare professionals dealt with the variety of problems and responsibilities that occur in discharge planning conferences and especially how they managed to do this given the institutional frame that surrounded the meeting. BACKGROUND: In Sweden, the aim of a discharge planning conference is to co-ordinate social and healthcare resources as patients are discharged from hospitals. Patients, relatives and hospital staff, along with healthcare professionals responsible for outpatient care, assemble to achieve an individual care plan. One of the explicit principles informing the discharge planning conference is to increase patients' influence on decision-making. However, research points at shortcomings in this respect. METHOD: A discourse analysis was conducted using transcriptions of eight video-recorded discharge planning conferences. The selected patients were eight older women expected to be discharged from hospital. Other participants were staff nurses, social workers and occasionally relatives, an occupational therapist, district nurse or home care aide. FINDINGS: Participants adopted different roles as persons/patients, relative/next of kin and healthcare professionals/institutional representatives during the discharge planning conference, which they simultaneously struggled to act upon. The findings are presented under the categories 'Clashing roles and perspectives' and 'Facing the institutional frame'. CONCLUSIONS: The performance of the discharge planning conference in its present form interferes with a caring perspective that protects patients' integrity and gives prominence to their life worlds. Moreover, it does not satisfy patients' and relatives' right to expect proceedings that enhance their possibility to express their personal wishes in a dignified manner.

Keyword
Aftercare, Aged, Communication, Decision Making, Family, Female, Humans, Patient Care Team, Patient Discharge, Patient Participation, Power (Psychology), Sweden
Identifiers
urn:nbn:se:umu:diva-6764 (URN)10.1111/j.1365-2648.2006.03771.x (DOI)16553673 (PubMedID)
Available from: 2007-12-17 Created: 2007-12-17 Last updated: 2017-12-14Bibliographically approved
4. "They were talking about me"--elderly women's experiences of taking part in a discharge planning conference.
Open this publication in new window or tab >>"They were talking about me"--elderly women's experiences of taking part in a discharge planning conference.
2006 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 20, no 1, 68-78 p.Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Discharge planning procedures needs improving to make transition to care settings in the community smooth, safe and secure. Research about discharge planning that involves a patient perspective is limited. The intention of this study was to focus on the patients' (elderly women) experiences of taking part in discharge planning conferences (DPCs) to deepen our understanding of the meaning of facing "the world of the institution" from a life-world perspective. AIM: This study aims at describing elderly women's experience of taking part in a DPC as they are about to be discharged from hospital. METHODOLOGICAL DESIGN: To illuminate the phenomenon from a life-world perspective, an interview study was chosen. Eight follow-up interviews with seven elderly women were carried out. The interviews were analysed using a qualitative content analysis methodology. FINDINGS: The interpretation of data was that the women's future was as in suspense as they got ill or were hit by accidents. The analysis revealed four themes that reflected the women's experiences of taking part in the DPCs: Being affiliated; Being in focus, Standing outside; and finally Being unprepared. STUDY LIMITATIONS AND CONCLUSION: The limitations of the study are related to: selection of participants; participation in the interview was connected to a video recording study; gap in time between participation in the DPC and the interview. The findings are still seen as trustworthy as the experiences expressed by the participating women in data are to be seen as a contribution to an emerging understanding of the meaning of the phenomenon from a life world perspective. The findings make clear that the institutional world easily and without much resistance from the patients transgresses the border of their life worlds. This awakes a need to reconsider how a caring perspective can be established in practice.

Keyword
Adaptation; Psychological, Aged/*psychology, Aged; 80 and over, Attitude to Health, Communication, Empathy, Family/psychology, Female, Follow-Up Studies, Health Knowledge; Attitudes; Practice, Health Services Needs and Demand, Humans, Narration, Nursing Methodology Research, Patient Discharge, Patient Education as Topic, Patient Participation/methods/*psychology, Power (Psychology), Qualitative Research, Questionnaires, Social Support, Sweden, Uncertainty, Women/*psychology
Identifiers
urn:nbn:se:umu:diva-6595 (URN)10.1111/j.1471-6712.2006.00382.x (DOI)16489962 (PubMedID)
Available from: 2007-12-14 Created: 2007-12-14 Last updated: 2017-12-14Bibliographically approved

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