Ethical dilemmas: balancing choice and risk with a duty of care in extending personalisation into the care home

Miller, Emma; Barrie, Karen

doi:10.1017/s0144686x20001737

Cited by 5 publications

(4 citation statements)

References 36 publications

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“…Narratives are more prone to show the tensions that may arise between different quality aspects in practice, as opposed to normative outcomes from surveys. For instance, the preferences of residents may not always be in line with predetermined indicators such as health and safety, which poses dilemmas to professionals when providing person-centered care ( Miller & Barrie, 2022 ). An example of such a dilemma could be that residents prefer a nonpureed diet, although professionals fear a choking incident.…”

Section: The Added Value Of Using Narrative Methods In Nursing Homesmentioning

confidence: 99%

How Stories Can Contribute Toward Quality Improvement in Long-Term Care

et al. 2023

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It is important to evaluate how residents, their significant others and professional caregivers experience life in a nursing home in order to improve quality of care based on their needs and wishes. Narratives are a promising method to assess this experienced quality of care as they enable a rich understanding, reflection and learning. In the Netherlands, narratives are becoming a more substantial element within the quality improvement cycle of nursing homes. The added value of using narrative methods is that they provide space to share experiences, identify dilemmas in care provision, and provide rich information for quality improvements. The use of narratives in practice, however, can also be challenging as this requires effective guidance on how to learn from this data, incorporation of the narrative method in the organizational structure, and national recognition that narrative data can also be used for accountability. In this article, five Dutch research institutes reflect on the importance, value and challenges of using narratives in nursing homes.

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Section: The Added Value Of Using Narrative Methods In Nursing Homesmentioning

confidence: 99%

How Stories Can Contribute Toward Quality Improvement in Long-Term Care

et al. 2023

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“…Ontario offers a fitting case study with applications to other contexts (see Miller and Barrie 2022;Leontowitsch et al, 2021). Tensions in LTRC are also evident internationally, with studies linking tensions or even scandals to the dangers of privatisation or inadequate public-sector supports (Lloyd, 2014;Lopes, 2016;Armstrong and Armstrong, 2019) or to ageism and other forms and relations of oppression (Jönson, 2016;Faghanipour et al, 2020).…”

Section: Locating Ltrcmentioning

confidence: 99%

More than a visitor? Rethinking metaphors for family care in long-term care homes

Klostermann

Funk²

2022

Ageing and Society

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Recent public and policy interventions aim to recognise formally the contributions of family care-givers to long-term residential care in Canada, with some arguing family carers are more than visitors and should be recognised as essential care-givers. These developments call for reconsidering how family care roles are understood and operationalised. Drawing on ethnographic research conducted in three care homes in Ontario, Canada, we present an in-depth feminist rhetorical analysis of the narrated lives and work practices of 12 unpaid family carers. Specifically, we explore how unpaid family carers themselves draw on broader discursive ‘ruling metaphors’ to interpret their roles and activities (e.g. as essential care-givers, visitors, team members), and how these metaphors invoke, organise and/or give rise to particular practices, responsibilities and relations. We contrast the stories of a family member who positioned herself as an essential care-giver and expressed a more onerous sense of individual responsibility with the stories of people who enjoyed the pleasures of visiting, who contributed as team members in ways that went beyond caring for their own relatives' care needs, and who embraced the possibilities that came with volunteering and with being able to influence change. Our analysis situates and contextualises participants' stories of their involvement and unpaid work in relation to their everyday material conditions and circumstances. We elaborate how different ways of understanding caring roles shape the nature of carers' unpaid work, as well as their options to share responsibility or set limits on that work. We also raise questions about the organisational conditions needed to help enact care as a shared collective responsibility.

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“…In NHS policy, personalisation is a means of giving people the ‘choice and control’ that they have come to expect in other aspects of their lives (NHS England, 2019 , p. 25). Translating a personalisation agenda that promotes choice into front‐line care can reveal tensions between its individualist assumptions (Needham & Glasby, 2014 ) and the complicated local contexts that can make choice appear no more than an illusion (Dalmer, 2019 ; Henwood et al., 2011 ; Miller & Barrie, 2020 ). In other settings, it has been suggested that a focus on choice can devalue care (Barnes, 2011 ) and obscure the need for wider investment (Needham, 2014 ).…”

Section: Introductionmentioning

confidence: 99%

“…Care attends to uncertainty whilst ‘disentangle[ing] the practicalities’ (Mol, 2008 , p. 60). Through a logic of care, personalisation becomes about relational understandings, negotiating and agreeing targets with close attention to individual context (Miller & Barrie, 2020 ; Mol, 2008 ). Individual experiences foreground the way in which ‘what matters’ is understood (Barnes, 2011 ).…”

Section: Introductionmentioning

confidence: 99%

Constituting link working through choice and care: An ethnographic account of front‐line social prescribing

Griffith

Pollard

Gibson

et al. 2022

Sociology Health & Illness

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Link worker social prescribing has become a prominent part of NHS England's personalisation agenda. However, approaches to social prescribing vary, with multiple discourses emerging about the potential of social prescribing and different interpretations of personalisation. The transformational promise of social prescribing is the subject of ongoing debate, whilst the factors that shape the nature of front-line link working practices remain unclear. Based on 11 months of in-depth ethnographic research with link workers delivering social prescribing, we show how link workers' practices were shaped by the context of the intervention and how individual link workers navigated varied understandings of social prescribing. Following the work of Mol, we showhow link workers drew differentially on the interacting logics of choice and care and trace a multiplicity in front-line link working practices within a single intervention. However, over time, it appeared that a logic of choice was becoming increasingly dominant, making it harder to deliver practices that aligned with a logic of care. We conclude that interpreting personalisation through a logic of choice could potentially undermine

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Ethical dilemmas: balancing choice and risk with a duty of care in extending personalisation into the care home

Cited by 5 publications

References 36 publications

How Stories Can Contribute Toward Quality Improvement in Long-Term Care

How Stories Can Contribute Toward Quality Improvement in Long-Term Care

More than a visitor? Rethinking metaphors for family care in long-term care homes

Constituting link working through choice and care: An ethnographic account of front‐line social prescribing

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