The rhetoric of patient and family centred care: an institutional ethnography into what actually happens

Rankin, Janet

doi:10.1111/jan.12575

Cited by 27 publications

(35 citation statements)

References 17 publications

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“…However, only a few articles have reported explicitly on NMMs and PCC. These emphasized their failure to implement PCC (Rankin, ; Rozenblum et al., ) or illustrate their perceptions of patient‐centeredness (Gillespie, Florin, & Gillam, ; Taylor & Groene, ). Insight into the contributions of NMMs to PCC is lacking and asks for further exploration.…”

Section: Introductionmentioning

confidence: 99%

Nurse middle managers contributions to patient‐centred care: A ‘managerial work’ analysis

et al. 2017

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Nurse middle managers are in an ideal position to facilitate patient-centred care. However, their contribution is underexposed in literature due to difficulties to articulate this in practice. This paper explores how nurse middle managers contribute to patient-centred care in hospitals. A combination of time-use analysis and ethnographic work was used to disclose their contribution to patient-centred care at a micro level. Sixteen nurse managers were shadowed for over 560 hours in four hospitals. Some nurse middle managers seldom contribute to patient-centred care. Others are involved in direct patient care, but this does not result in patient-centred practices. At one hospital, the nurse middle managers did contribute to patient-centred care. Here balancing between "organizing work" and "caring work" is seen as a precondition for their patient-centeredness. Other important themes are feedback mechanisms; place matters; with whom to talk and how to frame the issues at stake; and behavioral style. Both "hands-on" and "heads-on" caring work of nurse middle managers enhances their patient-centeredness. This study is the first of its kind to obtain insight in the often difficult to articulate "doings" of nurse middle managers with regard to patient-centred care through combining time-use analysis with ethnographic work.

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Section: Introductionmentioning

confidence: 99%

Nurse middle managers contributions to patient‐centred care: A ‘managerial work’ analysis

et al. 2017

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“…Patient-centered care has been called an "idealized abstraction" because of the challenges in implementing and evaluating PCC interventions in a clinical setting (p. 533). 53 Nurses need information about how to provide PCC while maintaining efficiency. Without explicit direction on how to integrate the two concepts on the unit, nurses are left in an unsettling environment where the identified priorities seem to be at odds.…”

Section: Tension Between Efficiency and Patient-centered Carementioning

confidence: 99%

Factors influencing orthopedic nurses’ pain management: A focused ethnography

Denness

Carr

Seneviratne

et al. 2017

Canadian Journal of Pain

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Aim: The aim of this study was to explore the factors influencing orthopedic surgery nurses' decisions to administer pro re nata (PRN) opioid analgesia for postoperative pain. Background: Fast-track surgery programs reduce length of stay by identifying and addressing factors causing patients to remain in hospital, including pain (H. Kehlet, Lancet. 2013;381:9878 (9878)). The management of acute pain is an important component of quality care for patients after total knee arthroplasty. Methods: The study used a qualitative design of focused ethnography. Ten nurses working on an orthopedic surgery unit at a large urban hospital in western Canada participated in semistructured interviews that used a patient vignette to examine factors that influenced participants' pain management in the context of fast-track surgery. Interviews were transcribed and analyzed using thematic analysis and constant comparison. Findings: Nurses described a complex clinical environment where the interplay of several factors informed decisions to administer PRN opioid analgesia. The unit's culture and physical space influenced nurses' assessments of pain and their decisions whether to treat pain with PRN opioids. Each nurse's self-concept affected pain management decisions because of perceived importance of pain control and perceived duty to provide analgesics. The subjectivity of pain added another layer of complexity as nurses responded to the patient's expression of pain from within the milieu of the unit culture and their unique self-concept. Conclusion: Understanding the complexity of factors that influence nurses' postoperative pain management provides clinical nurses and nursing leaders with directions for future education and research, guided by the goal of continued improvement in pain management in the challenging setting of fast-track surgeries. RÉSUMÉBut: Étudier les facteurs qui influencent la décision des infirmières en chirurgie orthopédique d'administrer des analgésiques opiacés pro re nata pour la douleur postopératoire. Contexte: Les programmes de chirurgie accélérée réduisent la durée du séjour en cernant les facteurs qui font en sorte que les patients restent à l'hôpital, dont la douleur, et en y apportant des réponses (Kehlet, 2013). La gestion de la douleur aigue est une composante importante de la qualité des soins pour les patients après une arthroplastie totale du genou. Méthodes: L'étude a eu recours à un devis qualitatif d'ethnographie focalisée. Dix infirmières travaillant dans l'unité de chirurgie orthopédique d'un grand hôpital urbain de l'Ouest du Canada ont participé à des entrevues semi-structurées qui avaient recours à une vignette de patient pour examiner les facteurs influençant la gestion de la douleur dans le contexte d'une chirurgie accélérée. Les entrevues ont été transcrites et analysées au moyen d'une analyse thématique et de la méthode de comparaison constante. Résultats: Les infirmières ont décrit un environnement clinique complexe où l'interaction de plusieurs facteurs était à l'origine ...

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“…Institutional ethnography helps magnify discrimination that may be hidden in institutional relations (Rankin, 2015). As I explored in my introduction, the way a topic is spoken of during nursing reports, contributed to my discovery of how these gestures could be implicating…”

Section: Institutional Ethnography and Reflective Field Notesmentioning

confidence: 99%

“…IE has been used in health care settings, and there is in fact a growing body of literature that illustrates the application of IE in exploring how authoritative knowledge is integrated into institutional processes to ultimately control the work of nurses in clinical settings (Adams et al, 2015;Hamilton & Campbell, 2011;McGibbon et al, 2010;Rankin, 2015).…”

Section: Institutional Ethnography and Reflective Field Notesmentioning

confidence: 99%

“…I think that IE complements the theoretical frameworks on which I draw, i.e. postcolonial feminist theory, intersectionality, and social constructions of motherhood in a way that allows for potential illumination of daily oppressive processes and depersonalized interactions.Institutional ethnography helps magnify discrimination that may be hidden in institutional relations (Rankin, 2015). As I explored in my introduction, the way a topic is spoken of during nursing reports, contributed to my discovery of how these gestures could be implicating…”

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confidence: 99%

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Examining the climate for Aboriginal mothers in neonatal intensive care units (NICUs): an exploratory qualitative study about views of health care professionals

Marcotte¹

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This thesis presents a qualitative exploratory ethnographic study that examines views of a small number of health care professionals towards Aboriginal mothers at risk for child apprehension within two neonatal intensive care units (NICUs) The premise of this study is that various kinds of discrimination and stigma toward Aboriginal mothers in the NICU may 1) contribute to potentially harmful health care experiences for these mothers and 2) manifest in their children being at greater risk for apprehension. The methods of investigation included in-depth qualitative interviews with health care professionals, personal reflective field notes and institutional ethnographic enquiry. These latter two methods stem from my role as an active health care professional within both NICUs. The research was informed by post-colonial theory, feminist theory, intersectionality, and social constructionism of motherhood. Thematic analysis of qualitative data resulted in six main themes. These themes were 1) barriers, 2) policy confusion, 3) judgement, 4) support/empowerment, 5) oppression, and 6) racism. The potential benefits of this study include: fostering dialogues among health care professionals; illuminating views of health care professionals towards Aboriginal mothers; increasing awareness about the vulnerability that exists among Aboriginal mothers, and; providing insight into invisible neo-colonial practices that may adversely impact Aboriginal mothers in NICUs. think of as various 'discourses and social constructions' of motherhood that I believe might be affecting decision making processes about child apprehensions from Aboriginal mothers. By various 'discourse and social constructions,' I mean ways that topics are spoken about, the languages used to converse about Aboriginal mothers and their children, and the institutional norms that have developed (Barker & Conrad, 2010;. Accessing a part of these discourses of motherhood occurred through observing conversations between health care professionals in NICUs. Many of the Aboriginal mothers I have encountered in the NICU were women dealing with low socio-economic status, suffering from addiction: many had also experienced violence at least once in their lives. It has been challenging at times to listen to conversations between health care professionals who do not always demonstrate empathy or understanding for vulnerable mothers in challenging situations affected by broader social determinants of health and systemic injustices. By 'social determinants of health', I mean that historical, cultural, environmental, and political factors have an impact on the health of especially Aboriginal people Priest et al., 2012). Examples of CLIMATE OF NICUs FOR ABORIGINAL MOTHERS 2 social determinants of health include income, housing, nutrition, education, peace, equity, and importantly, colonialism . This means that someone from a lower socio-economic status may have poorer health than someone from a higher socioeconomic status . It also means that Aboriginal peoples' wel...

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The rhetoric of patient and family centred care: an institutional ethnography into what actually happens

Abstract: Nurses' work is overwhelmed with the imperative to discharge patients. This happens with an ideological construction of patient centred care that obscures what is actually happening.

Cited by 27 publications

References 17 publications

Nurse middle managers contributions to patient‐centred care: A ‘managerial work’ analysis

Nurse middle managers contributions to patient‐centred care: A ‘managerial work’ analysis

Factors influencing orthopedic nurses’ pain management: A focused ethnography

Examining the climate for Aboriginal mothers in neonatal intensive care units (NICUs): an exploratory qualitative study about views of health care professionals

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