‘I'll put up with things for a long time before I need to call anybody’: Face work, the Total Institution and the perpetuation of care inequalities

Hope, Joanna; Schoonhoven, Lisette; Griffiths, Peter; Gould, Lisa; Bridges, Jackie

doi:10.1111/1467-9566.13435

Cited by 7 publications

(4 citation statements)

References 42 publications

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“…Across both the quantitative and qualitative data, the gap in knowledge regarding cannabis and the need for continuing education for HCPs working in LTC were readily apparent. When HCPs are unfamiliar about the various forms of medical cannabis, appropriate dosing and titration schedules, and routes of administration, they are hindered in their ability to engage in shared decision making with LTC residents as well as provide high-quality care [ 51 – 54 ]. Education is particularly needed that is tailored to the unique risks and benefits of medical cannabis use among LTC populations, including those living with physical and cognitive impairment.…”

Section: Discussionmentioning

confidence: 99%

Cannabis use in a Canadian long-term care facility: a case study

Balneaves,

Alraja,

Thompson

et al. 2024

BMC Geriatr

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Background Following the legalization of cannabis in Canada in 2018, people aged 65 + years reported a significant increase in cannabis consumption. Despite limited research with older adults regarding the therapeutic benefits of cannabis, there is increasing interest and use among this population, particularly for those who have chronic illnesses or are at end of life. Long-term Care (LTC) facilities are required to reflect on their care and policies related to the use of cannabis, and how to address residents’ cannabis use within what they consider to be their home. Methods Using an exploratory case study design, this study aimed to understand how one LTC facility in western Canada addressed the major policy shift related to medical and non-medical cannabis. The case study, conducted November 2021 to August 2022, included an environmental scan of existing policies and procedures related to cannabis use at the LTC facility, a quantitative survey of Healthcare Providers’ (HCP) knowledge, attitudes, and practices related to cannabis, and qualitative interviews with HCPs and administrators. Quantitative survey data were analyzed using descriptive statistics and content analysis was used to analyze the qualitative data. Results A total of 71 HCPs completed the survey and 12 HCPs, including those who functioned as administrators, participated in the interview. The largest knowledge gaps were related to dosing and creating effective treatment plans for residents using cannabis. About half of HCPs reported providing care in the past month to a resident who was taking medical cannabis (54.9%) and a quarter (25.4%) to a resident that was taking non-medical cannabis. The majority of respondents (81.7%) reported that lack of knowledge, education or information about medical cannabis were barriers to medical cannabis use in LTC. From the qualitative data, we identified four key findings regarding HCPs’ attitudes, cannabis access and use, barriers to cannabis use, and non-medical cannabis use. Conclusions With the legalization of medical and non-medical cannabis in jurisdictions around the world, LTC facilities will be obligated to develop policies, procedures and healthcare services that are able to accommodate residents’ use of cannabis in a respectful and evidence-informed manner.

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Section: Discussionmentioning

confidence: 99%

Cannabis use in a Canadian long-term care facility: a case study

Balneaves,

Alraja,

Thompson

et al. 2024

BMC Geriatr

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“…These patients were often looking for someone to support them emotionally as well as physically through their experience. Medical care is often prioritised over emotional support when patient need outstrips resources ( Hope et al, 2022 ). Time pressures, lack of resources and a focus on task-based work practices all conspire against establishing rich communicative relationships in today’s healthcare practice ( Kidd & Carel, 2017 ).…”

Section: Discussionmentioning

confidence: 99%

Am I safe? An Interpretative Phenomenological Analysis of Vulnerability as Experienced by Patients With Complications Following Surgery

Sutton

Booth²,

Ibrahim

et al. 2022

Qual Health Res

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Abdominal surgery carries with it risks of complications. Little is known about patients’ experiences of post-surgical deterioration. There is a real need to understand the psychosocial as well as the biological aspects of deterioration in order to improve care and outcomes for patients. Drawing on in-depth interviews with seven abdominal surgery survivors, we present an idiographic account of participants’ experiences, situating their contribution to safety within their personal lived experiences and meaning-making of these episodes of deterioration. Our analysis reveals an overarching group experiential theme of vulnerability in relation to participants’ experiences of complications after abdominal surgery. This encapsulates the uncertainty of the situation all the participants found themselves in, and the nature and seriousness of their health conditions. The extent of participants’ vulnerability is revealed by detailing how they made sense of their experience, how they negotiated feelings of (un)safety drawing on their relationships with family and staff and the legacy of feelings they were left with when their expectations of care (care as imagined) did not meet the reality of their experiences (care as received). The participants’ experiences highlight the power imbalance between patients and professionals in terms of whose knowledge counts within the hospital context. The study reveals the potential for epistemic injustice to arise when patients’ concerns are ignored or dismissed. Our data has implications for designing strategies to enable escalation of care, both in terms of supporting staff to deliver compassionate care, and in strengthening patient and family involvement in rescue processes.

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“…Wider workforce and external challenges, such as excessive workloads and inadequate staffing, can have a significant impact on leadership styles. For patients, their families and/or carers, witnessing these pressures can deter them from raising worries due to fears of being a ‘burden’ or ‘imposing on already busy staff 4,11–13 . Despite national policies and procedures directly aimed at speaking up about concerns, 14 the outcome of the trial of Lucy Letby in the United Kingdom demonstrated patients’ families and staff did not feel safe to raise concerns or confident that they would be followed by a prompt response 15…”

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confidence: 99%

“…For patients, their families and/or carers, witnessing these pressures can deter them from raising worries due to fears of being a 'burden' or 'imposing on already busy staff. 4,[11][12][13] Despite national policies and procedures directly aimed at speaking up about concerns, 14 the outcome of the trial of Lucy Letby in the United Kingdom demonstrated patients' families and staff did not feel safe to raise concerns or confident that they would be followed by a prompt response. 15 Evidence suggests collaborative leadership, compared to commandand-control, can facilitate better communication and collaboration among stakeholders, increase staff confidence in responding to care concerns, and allow patients to take a more active role in their care.…”

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confidence: 99%

Influences of Leadership, Organizational Culture, and Hierarchy on Raising Concerns About Patient Deterioration: A Qualitative Study

Vehvilainen,

Charles,

Sainsbury

et al. 2024

J Patient Saf

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Background Raising concerns is essential for the early detection and appropriate response to patient deterioration. However, factors such as hierarchy, leadership, and organizational culture can impact negatively on the willingness to raise concerns. Objectives This study aims to delve into how leadership, organizational cultures, and professional hierarchies in healthcare settings influence healthcare workers, patients, and caregivers in raising concerns about patient deterioration and their willingness to do so. Methods The study used a qualitative approach, conducting focus group discussions (N = 27), utilizing authentic audio-visual vignettes to prompt discussions about raising concerns. Deductive thematic analysis was employed to explore themes related to hierarchy, leadership, and organizational culture. Results Positive leadership that challenged traditional professional hierarchies by embracing multidisciplinary teamwork, valuing the input of all stakeholders, and championing person-centered practice fostered a positive working culture. This culture has the potential to empower clinical staff, patients, caregivers, and family members to confidently raise concerns. Staff development, clinical supervision, and access to feedback, all underpinned by psychological safety, were viewed as facilitating the escalation of concerns and, subsequently, have the potential to improve patient safety. Conclusions This study offers crucial insights into the intricate dynamics of leadership, hierarchy, and organizational culture, and their profound impact on the willingness of staff and patients to voice concerns in healthcare settings. Prioritizing the recommendations of this study can contribute to reducing avoidable deaths and elevating the quality of care in healthcare settings.

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‘I'll put up with things for a long time before I need to call anybody’: Face work, the Total Institution and the perpetuation of care inequalities

Cited by 7 publications

References 42 publications

Cannabis use in a Canadian long-term care facility: a case study

Cannabis use in a Canadian long-term care facility: a case study

Am I safe? An Interpretative Phenomenological Analysis of Vulnerability as Experienced by Patients With Complications Following Surgery

Influences of Leadership, Organizational Culture, and Hierarchy on Raising Concerns About Patient Deterioration: A Qualitative Study

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