Relatives’ negotiation power in relation to older people’s acute hospital admission: A qualitative interview study

Hoffmann, Eva; Andersen, Pernille Tanggaard; Mogensen, Christian Backer; Prinds, Christina; Primdahl, Jette

doi:10.1111/scs.13012

Cited by 7 publications

(7 citation statements)

References 38 publications

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“…Our study indicates that family and friends had a vital role in older adults' acute disease trajectory and ED readmission. This aligns with other studies reporting that relatives are essential advocates in supporting older adults during admission and discharge [34,[36][37][38]. Therefore, they are considered important collaborators when older adults are affected by acute illness.…”

Section: Discussionsupporting

confidence: 89%

Readmission is experienced as inevitable among older adults receiving homecare: A qualitative interview study

Elkjær

Gram

Mogensen

et al. 2023

Scandinavian Caring Sciences

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BackgroundOlder adults receiving homecare have an increased risk of readmission. The transition from hospital to home can be experienced as unsafe, and older adults describe themselves as vulnerable during the post‐discharge period. Thus, the objective was to explore the experiences of unplanned readmissions among older adults who receive homecare.MethodsWe conducted qualitative individual semi‐structured interviews with older adults, 65 years or above, receiving homecare and being readmitted to an emergency department (ED) between August and October 2020. Data were analysed by systematic text condensation as described by Malterud.FindingsWe included 12 adults aged 67–95 years, seven were male, and eight lived alone. The analysis derived three themes: (1) Responsibility and security at home, (2) the role of family, friends and homecare and (3) the importance of trust. The older adults felt that the hospital strived for too‐early discharge, as they still did not feel well. They worried about how to manage their daily life. Active involvement of their family increased their sense of security, but those living alone described feeling anxious being at home by themselves after discharge. Although older adults did not wish to go to the hospital, inadequate treatment at home and the feeling of responsibility for their illness made them feel insecure. They expressed that earlier negative experiences affected their trust in the system and their inclination to ask for help.ConclusionsThe older adults were discharged from the hospital despite feeling ill. They described inadequate competencies from healthcare professionals in the home as a contributing factor to their readmission. The readmission increased a sense of security. Support from the family in the process was essential and provided a sense of security, whereas older adults living alone experienced feelings of insecurity in the home environment.

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Section: Discussionsupporting

confidence: 89%

Readmission is experienced as inevitable among older adults receiving homecare: A qualitative interview study

Elkjær

Gram

Mogensen

et al. 2023

Scandinavian Caring Sciences

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“…Relatives with an active attitude to action often appeared to challenge the undescribed rules (doxa) by, for instance, trying to change an HCP's perspective on the older person into a more holistic perspective and individualise the older person's care and treatment. This description of relatives as passive or active is also reported in other qualitative studies describing the different strategies relatives use when interacting with healthcare professionals (Allen, 2000; Guldager et al, 2019; Hoffmann et al, 2022).…”

Section: Discussionsupporting

confidence: 64%

Section: Backg Rou N Dmentioning

confidence: 99%

“…The literature recognises relatives as important for older patients' care and treatment, quality and continuity of care (Bendix Andersen, 2018; de Vries et al, 2019; Mackie et al, 2019; Stie et al, 2020). The relative's approach to interaction with HCPs can be described as a continuum ranging from being reactive to proactive (Allen, 2000; Guldager et al, 2019; Hoffmann et al, 2022). Studies conceptualise relatives as ‘advocates’, ‘case managers’ and ‘conductors’, who protect and ensure the patient's wellbeing and sometimes argue and negotiate with HCPs to secure the best care and treatment for the patient (Mackie et al, 2019; Sivertsen et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

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Relatives' negotiations with healthcare professionals during older people's admission in an emergency department: An ethnographic study

et al. 2023

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BackgroundRelatives are recognised as important for older patients' care and treatment. Variations in relatives' opportunities to negotiate the quality and continuity of older people's care and treatment can potentially lead to inequality in older people's access to care and treatment.AimThis study aimed to examine relatives' opportunities and strategies for negotiation with health care professionals (HCPs) during the admission of older people to emergency departments in Denmark.Materials and MethodsWe planned a qualitative ethnographical study employing a hermeneutic approach. Observations focused on social situations and interactions between relatives and HCPs. The analysis was guided by qualitative content analysis.ResultsThe analysis derived one main theme, attitude to action, containing three subthemes: frustration obtaining access, presenting the case and a powerful relationship. Being active appeared to be essential to achieving possibilities for negotiation with HCPs.DiscussionInspired by Bourdieu, habitus, doxical values and institutional logics of relatives seem to affect their opportunities to negotiate with HCPs during older people's admission to an emergency department.ConclusionActive and proactive relatives seem to have better opportunities to negotiate with HCPs during older people's acute hospital admission than reactive, passive and hesitant relatives. The logic of public management and the medical profession seem to dominate and influence doxa in the EDs and put special demands on the relatives. This imbalance constitutes a risk of inequality in older people's access to health.

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“…The study is an individual part of an overall, umbrella project, addressing different but individual perspectives. Other perspectives addressed in the overall umbrella project include among others the perspectives of relatives [38], and older persons' perspectives to care coordination [25,39]. Thus, the direct focus on the older persons' perspectives is not an objective in the present paper.…”

Section: Methodsmentioning

confidence: 99%

Healthcare professionals’ practice and interactions in older peoples’ cross-sectoral clinical care trajectories when acutely hospitalized - a qualitative observation study

Persson

Mogensen

Søndergaard

et al. 2021

BMC Health Serv Res

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Background Healthcare services have become more complex, globally and nationally. Denmark is renowned for an advanced and robust healthcare system, aiming at a less fragmented structure. However, challenges within the coordination of care remain. Comprehensive restructures based on marketization and efficiency, e.g. New Public Management (NPM) strategies has gained momentum in Denmark including. Simultaneously, changes to healthcare professionals’ identities have affected the relationship between patients and healthcare professionals, and patient involvement in decision-making was acknowledged as a quality- and safety measure. An understanding of a less linear patient pathway can give rise to conflict in the care practice. Social scientists, including Jürgen Habermas, have highlighted the importance of communication, particularly when shared decision-making models were introduced. Healthcare professionals must simultaneously deliver highly effective services and practice person-centered care. Co-morbidities of older people further complicate healthcare professionals’ practice. Aim This study aimed to explore and analyse how healthcare professionals’ interactions and practice influence older peoples’ clinical care trajectory when admitted to an emergency department (ED) and the challenges that emerged. Methods This qualitative study arises from a hermeneutical stand within the interpretative paradigm. Focusing on the healthcare professionals’ interactions and practice we followed the clinical care trajectories of seven older people (aged > 65, receiving daily homecare) acutely hospitalized to the ED. Participant observations were combined with interviews with healthcare professionals involved in the clinical care trajectory. We followed-up with the older person by phone call until four weeks after discharge. The study followed the code of conduct for research integrity and is reported in accordance with the Standards for Reporting Qualitative Research (SRQR) guidelines. Results The analysis revealed four themes: 1)“The end justifies the means – ‘I know what is best for you’”, 2)“Basic needs of care overruled by system effectiveness”, 3)“Treatment as a bargain”, and 4)“Healthcare professionals as solo detectives”. Conclusion Dissonance between system logics and the goal of person-centered care disturb the healthcare practice and service culture negatively affecting the clinical care trajectory. A practice culture embracing better communication and more person-centered care should be enhanced to improve the quality of care in cross-sectoral trajectories.

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Relatives’ negotiation power in relation to older people’s acute hospital admission: A qualitative interview study

Cited by 7 publications

References 38 publications

Readmission is experienced as inevitable among older adults receiving homecare: A qualitative interview study

Readmission is experienced as inevitable among older adults receiving homecare: A qualitative interview study

Relatives' negotiations with healthcare professionals during older people's admission in an emergency department: An ethnographic study

Healthcare professionals’ practice and interactions in older peoples’ cross-sectoral clinical care trajectories when acutely hospitalized - a qualitative observation study

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