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Discharge planning: "fooling ourselves?"--patient participation in conferences.
Umeå University, Faculty of Medicine, Nursing.
Umeå University, Faculty of Medicine, Nursing.
Umeå University, Faculty of Medicine, Nursing.
2004 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, 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.

Place, publisher, year, edition, pages
2004. Vol. 13, no 5, 562-570 p.
Keyword [en]
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
URN: urn:nbn:se:umu:diva-6594DOI: 10.1111/j.1365-2702.2004.00900.xPubMedID: 15189409OAI: diva2:146263
Available from: 2007-12-14 Created: 2007-12-14 Last updated: 2009-11-11Bibliographically approved
In thesis
1. Vårdplaneringsmötet.: En studie av det institutionella samtalet mellan äldre kvinnor, närstående och vårdare
Open this publication in new window or tab >>Vårdplaneringsmötet.: En studie av det institutionella samtalet mellan äldre kvinnor, närstående och vårdare
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.
Umeå University medical dissertations, ISSN 0346-6612 ; 967
Nursing, Discharge planning, Omvårdnad
National Category
Research subject
Caring Sciences
urn:nbn:se:umu:diva-590 (URN)91-7305-883-1 (ISBN)
Public defence
2005-09-30, Aulan, Vårdvetarhuset, Institutionen för omvårdnad, 901 87Umeå, 13:00 (English)
Available from: 2005-09-19 Created: 2005-09-19 Last updated: 2009-11-11Bibliographically approved

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