Nurse-led interventions in the concept of randomized controlled trials – critical perspectives on how to handle social contexts

Oute

2019

JOE

Self Cite

Purpose The purpose of this paper is to explore how, and under what conditions, professionals involve relatives in clinical practice. Design/methodology/approach Two cases were constructed from two studies in Denmark, theoretically inspired by Bourdieu’s concepts of doxa and position and analyzed with focus on the involvement of relatives from the perspective of professionals. Findings Support to relatives in practice is rarely included in the way that treatment and care are organized in healthcare. Professionals’ views of the involvement of relatives were characterized by the values of neoliberal ideology and medical-professional rationality, in which relatives are not regarded as a subject of care and support in clinical practice. The involvement of relatives aimed to ensure patients’ participation in randomized clinical trial and to help professionals to care for patients when the professionals were not absolutely needed. Professionals were relatively higher positioned in the clinic than relatives were, which allowed professionals to in – and exclude relatives. Neoliberal ideology and medical-professional rationality go hand in hand when it comes to patient treatment, care and the involvement of relatives; it is all about efficiency, treatment optimization and increased social control of the diagnosed patient. These neoliberal, organizational values consolidate doxa of the medical field and the positions that govern the meeting with patients’ relatives – if it takes place at all. Originality/value The results put into perspective how the combination of neoliberalism and medical logic work as an organizing principle in contemporary healthcare systems, and challenge a normative, humanistic view on involving patients’ relatives in the medical clinic.

Section: Resultsmentioning

confidence: 99%

Professionals’ involvement of relatives – only good intentions?

Oute

2019

JOE

Self Cite

“…Moreover, the results point to this frame in relation to how specialised palliative homecare prioritised earning possibilities where point-in-action tasks were weighted at the expense of the palliative patients in the institution. Today, there is focus on cost-effectiveness and utility of public services, where the efforts also must be evidencebased (Glasdam et al 2015). Rationalisation, quality management and control are key concepts in evidence-based practice (Olesen 2007).…”

Section: Discussionmentioning

confidence: 99%

“…A selective view on the results of an assessment might lead to a (non-holistic) reduction of human beings to a generic phenomenon void of culture, religion, gender, age, social class etc. (Glasdam et al 2015;Martinsen 2009).…”

Section: Discussionmentioning

confidence: 99%

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A gap between the philosophy and the practice of palliative healthcare: sociological perspectives on the practice of nurses in specialised palliative homecare

Med Health Care and Philos

Ekstrand²,

Rosberg³

et al. 2019

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Palliative care philosophy is based on a holistic approach to patients, but research shows that possibilities for living up to this philosophy seem limited by historical and administrative structures. From the nurse perspective, this article aims to explore nursing practice in specialised palliative homecare, and how it is influenced by organisational and cultural structures. Qualitative, semi-structured interviews with nine nurses were conducted, inspired by Bourdieu. The findings showed that nurses consolidate the doxa of medicine, including medical-professional values that configure a control-oriented, positivistic approach, supported by the organising policy for clinical practice. Hierarchically, nurses were positioned under doctors: medical rounds functioned as a structuring structure for their working day. They acted as medical assistants, and the prevailing medical logic seemed to make it difficult for nurses to meet their own humanistic ideals. Only short time slots allowed nurses to prioritise psychosocial needs of patients and relatives. Point-of-actions had high priority, added financial resources and ensured that budgets were allocated. Weekly visits made it possible for nurses to measure, control and govern patients' drugs and symptoms which was a necessity for their function as medical assistants. The findings challenge nurses to take on an ethical point of view, partly to ensure that patients and their families receive good palliative care focusing on more than medical issues and logic, and partly to strengthen the nurses' profession in the palliative field and help them implement palliative care philosophy in practice.

“…It is per se a transition of a constructed, controlled context to 'the real reality' in all its complexity. In a systematic literature review on interventions, it is shown that RCTs often operate as if no contextual impacts exist and, at the same time, the studies consider that the addressed health activity has as its core element the encounter between humans (Glasdam et al, 2015). Not only does the context affect the results that can be achieved but also the people involved will affect what and how things can be done.…”

Section: Introductionmentioning

confidence: 99%

Critical perspectives on implementation of evidence-based practice in occupational therapy – Exemplified by Lifestyle Redesign® in a Danish context

British Journal of Occupational Therapy

Oute²,

Stjernswärd

2021

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Introduction Evidence-based practice is an increasing demand in occupational therapy (OT), although multiple barriers can hinder the translation of research knowledge into practice. The article illuminates the transformation of results from a randomised controlled trial into a practice development project with future practice implementation in mind. Method A case study was carried out, consisting of a comparison of the US randomised controlled trials (RCTs) Lifestyle Redesign® and the derived Danish practice development project. Results The study showed how results from RCTs of Lifestyle Redesign® were transformed into a practice development project with intentions to implement the programme in a Danish context. The modifications of the US RCT into a practice development project in Denmark compromised the study’s scientific execution. The practice development project was used to legitimise the intervention within OT locally by testing an evidence-based intervention, without using associated scientific tools and without considering barriers and facilitators for implementing the project in clinical practice. Conclusion Research design compromises in practice development projects may have implications for the internal and external dynamics of professionalisation processes regarding OT and the recognition of OT as a scientific discipline and an autonomous profession, nationally and internationally.