Conflicting rationales: leader's experienced ethical challenges in community health care for older people

2017 ◽  
Vol 32 (2) ◽  
pp. 645-653 ◽  
Author(s):  
Åshild Slettebø ◽  
Ragnhild Skaar ◽  
Kari Brodtkorb ◽  
Anne Skisland
Keyword(s):  
Health Care ◽  
Older People ◽  
Community Health ◽  
Community Health Care ◽  
Ethical Challenges ◽  
Care For Older People

scholarly journals The difference an end-of-life diagnosis makes: qualitative interviews with providers of community health care for frail older people

2020 ◽  
Vol 70 (699) ◽  
pp. e757-e764
Author(s):  
Louisa Polak ◽  
Sarah Hopkins ◽  
Stephen Barclay ◽  
Sarah Hoare
Keyword(s):  
Health Care ◽  
Older People ◽  
Community Health ◽  
End Of Life ◽  
Community Care ◽  
Qualitative Interviews ◽  
Community Health Care ◽  
Care Provision ◽  
Care Providers ◽  
Frail Older People

BackgroundIncreasing numbers of people die of the frailty and multimorbidity associated with old age, often without receiving an end-of-life diagnosis. Compared to those with a single life-limiting condition such as cancer, frail older people are less likely to access adequate community care. To address this inequality, guidance for professional providers of community health care encourages them to make end-of-life diagnoses more often in such people. These diagnoses centre on prognosis, making them difficult to establish given the inherent unpredictability of age-related decline. This difficulty makes it important to ask how care provision is affected by not having an end-of-life diagnosis.AimTo explore the role of an end-of-life diagnosis in shaping the provision of health care outside acute hospitals.Design and settingQualitative interviews with 19 healthcare providers from community-based settings, including nursing homes and out-of-hours services.MethodSemi-structured interviews (nine individual, three small group) were conducted. Data were analysed thematically and using constant comparison.ResultsIn the participants’ accounts, it was unusual and problematic to consider frail older people as candidates for end-of-life diagnosis. Participants talked of this diagnosis as being useful to them as care providers, helping them prioritise caring for people diagnosed as ‘end-of-life’ and enabling them to offer additional services. This prioritisation and additional help was identified as excluding people who die without an end-of-life diagnosis.ConclusionEnd-of-life diagnosis is a first-class ticket to community care; people who die without such a diagnosis are potentially disadvantaged as regards care provision. Recognising this inequity should help policymakers and practitioners to mitigate it.

Patient Flow or the Patient’s Journey? Exploring Health Care Providers’ Experiences and Understandings of Implementing a Care Pathway to Improve the Quality of Transitional Care for Older People

2021 ◽  
pp. 104973232110038
Author(s):  
Cecilie Fromholt Olsen ◽  
Astrid Bergland ◽  
Jonas Debesay ◽  
Asta Bye ◽  
Anne Gudrun Langaas
Keyword(s):  
Health Care ◽  
Older People ◽  
Health Care Providers ◽  
Transitional Care ◽  
Care Pathway ◽  
Patient Flow ◽  
Care Pathways ◽  
Care Providers ◽  
Patient Centered ◽  
Care For Older People

Internationally, the implementation of care pathways is a common strategy for making transitional care for older people more effective and patient-centered. Previous research highlights inherent tensions in care pathways, particularly in relation to their patient-centered aspects, which may cause dilemmas for health care providers. Health care providers’ understandings and experiences of this, however, remain unclear. Our aim was to explore health care providers’ experiences and understandings of implementing a care pathway to improve transitional care for older people. We conducted semistructured interviews with 20 health care providers and three key persons, along with participant observations of 22 meetings, in a Norwegian quality improvement collaborative. Through a thematic analysis, we identified an understanding of the care pathway as both patient flow and the patient’s journey and a dilemma between the two, and we discuss how the negotiation of conflicting institutional logics is a central part of care pathway implementation.

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