From the crisis in acute care to postdischarge resilience – The communication experience of Geriatric patients: A qualitative study

Gabay, Gillie

doi:10.1111/scs.12826

Cited by 11 publications

(15 citation statements)

References 59 publications

(87 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…PCC fosters healing relationships; responds to patients' emotions; engages patients in informed and collaborative decision making; and seeks to provide each patient with care she values (8,9). PCC leads to improved health outcomes through improved patient safety, higher patient trust in physicians, higher adherence, better recuperation, fewer readmissions, and higher quality of life (7,8,(10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

From a View of the Hospital as a System to a View of the Suffering Patient

Gabay

Asher

2022

Front. Public Health

Self Cite

View full text Add to dashboard Cite

Purpose: Hospitals aspire to provide patient-centered care but are far from achieving it. This qualitative mixed methods study explored the capacity of hospital directors to shift from a hospital systemic-view to a suffering patient-view applying the Salutogenic theory.Methods: Following IRB, we conducted in-depth narrative interviews with six directors of the six Israeli academic tertiary public hospitals, focusing on their managerial role. In a second meeting we conducted vignette interviews in which we presented each director with a narrative of a suffering young patient who died at 33 due to medical misconduct, allowing self-introspection. Provisional coding was performed for data analysis to identify categories and themes by the three dimensions of the sense-of-coherence, an anchor of Salutogenics: comprehensibility, manageability, and meaningfulness.Results: While at the system level, directors reported high comprehensibility and manageability in coping with complexity, at the patient level, when confronted with the vignette, directors acknowledged their poor comprehensibility of patients' needs and patient's experience during hospitalizations. They acknowledged their poor capacity to provide patient-centered care. Meaningfulness in the narrative interview focused on the system while meaningfulness in the vignette interview focused on providing patient care.Conclusions: The evident gaps between the system level and the patient level create lack of coherence, hindering the ability to cope with complexity, and are barriers to providing patient-centered care. To improve the delivery of patient-centered care, we suggest ways to consolidate the views, enabling the shift from a systemic-view to a patient-view.

show abstract

Section: Introductionmentioning

confidence: 99%

From a View of the Hospital as a System to a View of the Suffering Patient

Gabay

Asher

2022

Front. Public Health

Self Cite

View full text Add to dashboard Cite

show abstract

“…This argues for ongoing communication between patients and healthcare professionals, such as physicians, nurses and physiotherapists about expectations and satisfaction. Giving patients information on what to expect, and reflecting on the emotions of the experience, enables patients to perceive control [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

Outcomes as experienced by older patients after hospitalisation: satisfaction, acceptance, frustration and hope—a grounded theory study

Kluit

2022

Age and Ageing

View full text Add to dashboard Cite

Background outcomes of hospitalisation are often described in quantitative terms. It is unknown how older frail patients describe their own outcomes. Objective to discover how older frail persons describe their own hospitalisation outcomes and the meaning of these outcomes for their daily lives. Design Constructivist Grounded Theory approach. Participants frail older people discharged from hospital. Methods Open interviews in the participant’s home. Transcripts were coded inductively according to the Constructivist Grounded Theory approach. Results Twenty-four interviews were conducted involving 20 unique participants. Although for some participants hospitalisation was just a ripple, for others, it was a turning point. It could have positive or negative impacts on outcomes, including remaining alive, disease, fatigue/condition, complaints, daily functioning, social activities and intimate relationships, hobbies, living situation and mental well-being. Few participants were completely satisfied, but for many, a discrepancy between expectation and reality existed. Some participants could accept this, others remained hopeful and some were frustrated. Factors associated with these categories were research and treatment options, (un)clarity about the situation, setting the bar too high or pushing boundaries, confidence in physicians, character traits and social factors. Conclusions of the persons whose outcomes did not meet their expectations, some were frustrated, others hopeful and others accepted the situation. The following interventions can help patients to accept: clear communication about options and expectations before, during and after hospitalisation; giving room for emotions; help finding social support, encouragement to engage in pleasant activities and find meaning in small things. For some patients, psychological treatment may be needed.

show abstract

“…The provider may instill hope for improving the patients' health condition. In the patient-relationships, the provider's emotional presence is of great significance (20). Applying Bion's theory (19) to address the uniqueness of each patient, the provider, as a container, must be free to absorb the patient's unique experience.…”

Section: Bion's Container-contained Theorymentioning

confidence: 99%

“…When patients' expectations are unmet by providers, there is no containing. If the patient can contain the frustration, it may facilitate growth (4,12,20). The current study, examining the provider-patient interaction, aims at identifying the container-contained modes that providers use and their relation to attaining PCC.…”

Section: Bion's Container-contained Theorymentioning

confidence: 99%

An Inverted Container in Containing and Not Containing Hospitalized Patients—A Multidisciplinary Narrative Inquiry

Gabay

Ben-Asher

2022

Front. Public Health

Self Cite

View full text Add to dashboard Cite

ObjectivePatient-centered care calls to contain patients in their time of crisis. This study extends the knowledge of provider patient interactions in the hectic environment of acute care applying Bion's container-contained framework from psychoanalysis.MethodsFollowing ethical approval, we performed a narrative inquiry of the experiences of ten patients upon discharge from lengthy hospitalizations in acute care. Interviews were conducted upon discharge and about one-month post-discharge.FindingsData analysis suggests four modes of containing of patients by providers. In nurturing interactions, typical of an active container-contained mode, patients experienced humanized care, symptom control, hope, and internal locus of control. This mode yielded patient gratitude toward providers, wellbeing, and post-discharge self-management of diseases. In rigid and wall-free modes of containing, patients experienced a sense of powerlessness and discomfort. A new mode of container-contained was identified, the “Inverted Container”, which extends Bion's theory and contradicts patient-centered care. In inverted containers, patients contained the providers yet reported feeling gratitude toward providers. The gratitude constitutes a defense mechanism and reflects a traumatic experience during hospitalization, which led to post-discharge distrust in providers and hospitals and poor self-management of illness.ConclusionsTo effectively provide patient-centered care, provider-patient interaction in lengthy hospitalizations must move along a clinical axis and a relationship axis. This shifting may facilitate containing patients in their time of crisis so essential processes of reflection, projection, and transference are facilitated in-hospital care.

show abstract

From the crisis in acute care to postdischarge resilience – The communication experience of Geriatric patients: A qualitative study

Cited by 11 publications

References 59 publications

From a View of the Hospital as a System to a View of the Suffering Patient

From a View of the Hospital as a System to a View of the Suffering Patient

Outcomes as experienced by older patients after hospitalisation: satisfaction, acceptance, frustration and hope—a grounded theory study

An Inverted Container in Containing and Not Containing Hospitalized Patients—A Multidisciplinary Narrative Inquiry

Contact Info

Product

Resources

About