Striking a balance: Health care providers’ experiences with home-based, patient-centered care for older people—A meta-synthesis of qualitative studies

Olsen, Cecilie Fromholt; Bergland, Astrid; Bye, Asta; Langaas, Anne Gudrun

doi:10.1016/j.pec.2019.05.017

Cited by 35 publications

(32 citation statements)

References 46 publications

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“…Our findings thus suggest that the influence of conflicting goals and constraints could have led the participants to approach WMTY in a task-oriented manner. These findings align with previous research claiming that constraints at the system level may reinforce a paternalistic and taskoriented care approach [8,25,45,[63][64][65]. This implies that without appropriate changes at the macro-and meso level, there is a risk that WMTY may become just another catchy phrase, reinforcing an already existing practice, thus operating as "the emperor's new clothes.…”

Section: What Matters To You or What Matters To The System?supporting

confidence: 87%

“…There seemed to be a fine line between negotiating goals with the patient and persuading the patient to accept professional goals. The uncertainty regarding the limits of the HCPs' new responsibility in relation to asking WMTY was thus an important finding and is in line with previous research [45,57]. A central critique of the patient-centered approach is that it represent a blurring of responsibility, not only for professionals, but also in relation to the increased responsibility given to the patients themselves [57].…”

Section: What Matters To the Patient Or What Matters To The Professiosupporting

confidence: 69%

“…Consistent with this, Berntsen et al [14] maintain that, in a patient-centered goal setting process, HCPs need the competence to elicit goals sensitively and to be able to translate personal goals into realistic and manageable professional goals. Dilemmas and tensions in practice often occur pertaining to having to fulfill professional tasks while maintaining the relationship and respecting the patient's needs, preferences and goals [14,41,43,45]. At the system level, organizational factors play an important role.…”

Section: Conceptual Frameworkmentioning

confidence: 99%

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What matters when asking, “what matters to you?” — perceptions and experiences of health care providers on involving older people in transitional care

Olsen

Bergland

Bye

et al. 2020

BMC Health Serv Res

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Background: Transitional care for older chronically ill people is an important area for healthcare quality improvement. A central goal is to involve older people more in transitional care and make care more patient-centered. Recently, asking, "What matters to you?" (WMTY) has become a popular way of approaching the implementation of patientcentered care. The aim of this study was to explore health care providers' perceptions and experiences regarding the question of WMTY in the context of improving transitional care for older, chronically ill persons. Methods: The data comprise semi-structured individual interviews with 20 health care providers (HCPs) who took part in a Norwegian quality improvement collaborative, three key informant interviews, and observations of meetings in the quality improvement collaborative. We used a thematic analysis approach. Results: Three interrelated themes emerged from the analysis: WMTY is a complex process that needs to be framed competently; framing WMTY as a functional approach; and framing WMTY as a relational approach. There was a tension between the functional and the relational approach. This tension seemed to be based in different understandings of the purpose of asking the WMTY question and the responsibility that comes with asking it. Conclusions: WMTY may appear as a simple question, but using it in everyday practice is a complex process, which requires professional competence. When seen in terms of a patient-centered goal process, the challenge of competently eliciting older people's personal goals and transferring these goals into professional action becomes evident. An important factor seems to be how HCPs regard the limits of their responsibility in relation to giving care within the larger frame of the patient's life project. Factors in the organizational and political context also seem to influence substantially how HCPs approach older patients with the WMTY question.

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Section: What Matters To You or What Matters To The System?supporting

confidence: 87%

Section: What Matters To the Patient Or What Matters To The Professiosupporting

confidence: 69%

Section: Conceptual Frameworkmentioning

confidence: 99%

See 1 more Smart Citation

What matters when asking, “what matters to you?” — perceptions and experiences of health care providers on involving older people in transitional care

Olsen

Bergland

Bye

et al. 2020

BMC Health Serv Res

Self Cite

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“…Home health care service (HHCS) is recognized by health systems as a resource for assisting patients with di culties in accessing health care service environments. Prevention, rehabilitation and health care are increasingly provided by in-home professionals due to the aging population, the increase in chronic degenerative diseases and the number of people in need of continuous care (Olsen et al 2019;Ritchie and Leff 2018). HHCS reduces the congestion of hospitals, promotes greater turnover of occupied beds and improves patients' quality of life (Di Mascolo et al 2017).…”

Section: Main Textmentioning

confidence: 99%

SWOT-TOWS analysis to improve home health waste management during the COVID-19 pandemic

Silva¹,

Maciel²,

Florêncio³

et al. 2020

Preprint

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Home health services are of great concern, as infectious diseases can be transmitted not only to residents but also to home health care workers. Worldwide, there are few studies related to home health waste management. Before the COVID-19 pandemic, a survey on waste management from home health care services was carried out between October and December 2019. In the survey, all 67 stakeholders (health teams and caregivers/patients) involved in home health care services in the municipality of Caruaru (Brazil) were interviewed. The collected data showed that the home health care and waste management practices identified during field visits would be severely impacted by the pandemic. In this context, a SWOT analysis and TOWS matrix were employed in the analysis of home health care practices; in this work, those practices include care provided by health teams and patient caregivers, encompassing the handling of waste resulting from health care. The results show the need to promote strategies to improve home health care services to preserve the health of professionals and patients in the pandemic and post-pandemic periods. In this context, care related to the transmission of COVID-19 has been ratified, generating additional actions for the proper management of health waste.

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“…In line with our ndings and Pearson et al (2015), service users sometimes want health professionals or their next of kin to make choices for them. This indicates that service users have trust in health professionals, but it could also be because many elderly service users are accustomed to the traditional, paternalistic and task-oriented care approach (35,54,57,58).…”

Section: Conditions and Challenges For Involvement And Decision Makingmentioning

confidence: 99%

‘They Just Came with the Medication Dispenser’ – A Qualitative Study of Service User Involvement and Welfare Technology in Public Home Care Services

Glomsås

Knutsen

Fossum

et al. 2020

Preprint

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BackgroundPublic home care for the elderly is a key area in relation to improving health care quality. It is an important political goal to increase elderly people’s involvement in their care and in the use of welfare technology. The aim of this study was to explore elderly service users’ experience of user involvement in the implementation and everyday use of welfare technology in public home care services.MethodThis qualitative study has an explorative and descriptive design. Sixteen interviews of service users were conducted in five different municipalities over a period of six months. The data were analysed using reflexive thematic analysis. Results Service users receiving public home care service are not a homogenous group, and the participants had different wishes and needs as regards user involvement and the use of welfare technology. The analysis led to four main themes: 1) diverse preferences as regards user involvement, 2) individual differences as regards information, knowledge and training, 3) feeling safe and getting help, and 4) a wish to stay at home for as long as possible.ConclusionThe results indicated that user involvement was only to a limited extent an integral part of public home care services. Participants had varying insight into and interest in welfare technology, which was a challenge for user involvement. User involvement must be facilitated and implemented in a gentle way, highlighting autonomy and collaboration, and with the focus on respect, reciprocity and dialogue.

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Striking a balance: Health care providers’ experiences with home-based, patient-centered care for older people—A meta-synthesis of qualitative studies

Cited by 35 publications

References 46 publications

What matters when asking, “what matters to you?” — perceptions and experiences of health care providers on involving older people in transitional care

What matters when asking, “what matters to you?” — perceptions and experiences of health care providers on involving older people in transitional care

SWOT-TOWS analysis to improve home health waste management during the COVID-19 pandemic

‘They Just Came with the Medication Dispenser’ – A Qualitative Study of Service User Involvement and Welfare Technology in Public Home Care Services

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