Standing secure amidst a falling world? Practitioner understandings of old age in responses to a case vignette

Internationally, system-wide changes to the structures and systems governing health care aim to improve outcomes for patients, quality of care and access to services. The introduction of top-down centrally driven solutions to governance of health care, at the same time as increasing policy emphasis on greater 'bottom up' patient and public involvement in all aspects of health care, has set up complex tensions for policy implementation and health care practice. This paper explores the interplay of these agendas in the context of changes in primary health care services provided by the National Health Service (NHS) in England.Specifically, it looks at an example of service user involvement in a study (the PEGI study) of professional response to changes in the governance and incentives in the care of people with long-term conditions. This qualitative study was conducted in three Primary Care Trust sites in England. Service users influenced and guided the study throughout. In-depth interviews with 56 health and social care professionals engaged in the development of local policies and the delivery of care for people with complex long-term illness drew on vignettes developed by 32 members from three Service User Reference Groups (SURG).Themes generated by the cross case analysis were validated through these SURG groups. The findings presented here focus on four themes about risk and comparison of professionals'/service users' perspectives of the issues: managing 2 risks/consistent support, the risks of letting go/feeling in control, professionalism/helping people to help themselves, and managing expectations/professionals losing out. Service user involvement added value by:validating understandings of governance, framing debates to focus on what matters at the point of care, and enabling perspective sharing and interaction. We suggest that more collaborative forms of governance in health care, that take account of service user perspectives and enable interaction with professional groups, could help to validate processes of quality assurance and provide motivation for continuous quality improvement. We offer a model for 'opening up' collaborative projects to evaluation and appraisal and a process for critical reflection of the interrelationships between the PEGI study context, researcher issues, methods/approach and outcomes/impact of service user involvement.Key words: Governance, incentives, long-term conditions, risk, service user involvement, patient participation, collaboration 3 What is known about this topic? Health care systems internationally have undergone major and rapid changes in governance structures with the aim of improving accountability, transparency and outcomes of care. At the same time there is growing policy emphasis on service user (patient, carer and public) involvement in all aspects of health care and research. These simultaneous policy agendas have led to complex tensions for policy implementation and health care practice, including how involvement can be successful and authentic i...

show abstract

“…, Richards et al . ) and increasing insight into complex issues surrounding caring relationships (Rahman ).…”

Section: Introductionmentioning

confidence: 99%

Learning from people with long-term conditions: new insights for governance in primary healthcare

Ross

Smith

Byng

et al. 2014

Health Soc Care Community

Self Cite

View full text Add to dashboard Cite

show abstract

“…A survey among 200 clinical psychologists in training programs found that many reported having "less to offer" to older patients compared to patients from other age groups (Lee et al 2003). Another study in Britain (Richards et al 2007) conducted 30 interviews with health and social care practitioners currently working with older people. This study found that the practitioners lacked essential theoretical and research-based knowledge in the field of ageing and old age; rather, they primarily made use of common organizational policies and personal experience with ageing family members to analyze a clinical vignette presented to them.…”

Section: Training In Geriatric Mental Health and Exposure To Older Pamentioning

confidence: 99%

Ageism in Mental Health Assessment and Treatment of Older Adults

Bodner

Palgi

Wyman

2018

International Perspectives on Aging

View full text Add to dashboard Cite

“…(7) and Richard et al. (26), or to individual risk values, as identified by Clemson et al. (35) and Zinn (10).…”

Section: Discussionmentioning

confidence: 99%

“…These were based on questions devised by Richard et al. (26), who used vignettes to explore professionals’ perceptions of old age (Table 4). These questions provided a template to interrogate the data.…”

Section: Methodsmentioning

confidence: 99%

Risks with older adults in acute care settings: UK occupational therapists’ and physiotherapists’ perceptions of risks associated with discharge and professional practice

Atwal¹,

McIntyre

Wiggett

2011

Scandinavian Journal of Caring Sciences

View full text Add to dashboard Cite

Internationally, there is evidence that hospital discharge to home for older adults is a complex and challenging process that is dependent upon multidisciplinary team working. At the centre of the discharge process is the management of risk, which involves occupational therapists and other healthcare professionals managing perceived dangers and determining why some dangers are seen as presenting risks while others are not. This study did not aim to explore interprofessional differences but to ascertain a greater understanding of professionals' perceptions of risk in acute care settings. This qualitative study utilised 12 semi-structured interviews with seven occupational therapists and five physiotherapists in the United Kingdom (UK). During the interview, therapists were asked to read and answer questions on a validated vignette. The interview data were subjected to thematic content analysis and the vignettes to template analysis. Our research is one of the first studies to explore therapists' perceptions of risk with older adults in acute care settings. Our study has highlighted that perception of risk does have an impact on discharge decision-making and location. Therapists used negative terminology to refer to patients who wanted to take risks, which could be a reflection of the therapists' anxiety. Mental capacity, and patients' functioning and safety were key factors in risk decision-making with older adults. Our research has highlighted the potential value of multidisciplinary working to manage risk situations and the need for reflection and discussion regarding how persons who do not have capacity wishes are managed within acute care settings. There is a need to develop an interprofessional care pathway to guide clinicians through the risk decision-making process which needs to ensure that the client's opinions and wishes are taken into account throughout.

show abstract

Standing secure amidst a falling world? Practitioner understandings of old age in responses to a case vignette

Cited by 9 publications

References 33 publications

Learning from people with long-term conditions: new insights for governance in primary healthcare

Learning from people with long-term conditions: new insights for governance in primary healthcare

Ageism in Mental Health Assessment and Treatment of Older Adults

Risks with older adults in acute care settings: UK occupational therapists’ and physiotherapists’ perceptions of risks associated with discharge and professional practice

Contact Info

Product

Resources

About