Work in an intermediate unit: balancing between relational, practical and moral care

Johannessen, Anne‐Kari; Werner, Anne; Steihaug, Sissel

doi:10.1111/jocn.12213

Cited by 16 publications

(24 citation statements)

References 22 publications

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“…A recurring theme across the four contexts is the lack of appropriate collaboration: between patients and providers [1617] and between providers [1314151617181920]. The patients wanted better continuity and predictability in their services [17].…”

Section: Resultsmentioning

confidence: 99%

“…Several professionals in the municipalities reported that they are more in touch with their professional colleagues in specialist services than with other professional groups on the same level [13141820]. …”

Section: Resultsmentioning

confidence: 99%

“…Both in the intermediate unit [15] and the municipalities [181920] physicians, nurses and physiotherapists revealed different understandings of their own and others’ roles and tasks. Rehabilitation is clearly defined, but nurses, physiotherapists, and occupational therapists disagreed about what rehabilitation is and ought to be [131819]. In the intermediate unit the physician’s colleagues reported that she used to set the agenda in the inter-professional meetings and that medical issues often dominated at the expense of discussions concerning rehabilitation and recovery [15].…”

Section: Resultsmentioning

confidence: 99%

“…The findings indicate that unfavourable environmental and adverse organisational factors exerted pressure on effective working and impeded patient clinical pathways [13]. …”

Section: Background and Contextmentioning

confidence: 99%

See 3 more Smart Citations

Challenges in Achieving Collaboration in Clinical Practice: The Case of Norwegian Health Care

Steihaug¹,

Johannessen²,

Ådnanes³

et al. 2016

International Journal of Integrated Care

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Introduction:This article summarizes and synthesizes the findings of four separate but inter-linked empirical projects which explored challenges of collaboration in the Norwegian health system from the perspectives of providers and patients. The results of the four projects are summarised in eight articles.Methods:The eight articles constituted our empirical material. Meta-ethnography was used as a method to integrate, translate, and synthesize the themes and concepts contained in the articles in order to understand how challenges related to collaboration impact on clinical work.Results:Providers’ collaboration across all contexts was hampered by organizational and individual factors, including, differences in professional power, knowledge bases, and professional culture. The lack of appropriate collaboration between providers impeded clinical work. Mental health service users experienced fragmented services leading to insecurity and frustration. The lack of collaboration resulted in inadequate rehabilitation services and lengthened the institutional stay for older patients.Conclusion:Focusing on the different perspectives and the inequality in power between patients and healthcare providers and between different providers might contribute to a better environment for achieving appropriate collaboration. Organizational systems need to be redesigned to better nurture collaborative relationships and information sharing and support integrated working between providers, health care professionals and patients.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…The findings indicate that unfavourable environmental and adverse organisational factors exerted pressure on effective working and impeded patient clinical pathways [13]. …”

Section: Background and Contextmentioning

confidence: 99%

See 2 more Smart Citations

Challenges in Achieving Collaboration in Clinical Practice: The Case of Norwegian Health Care

Steihaug¹,

Johannessen²,

Ådnanes³

et al. 2016

International Journal of Integrated Care

Self Cite

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“…Successful patient participation within IC services is associated with satisfaction with health‐care services, a lower number of readmissions, better treatment outcome and has the potential to prevent the need for nursing home placement . Further, patient participation is shaped by organizational structures, the patients’ condition, resources, staff attitudes and support from relatives . Still, there is great variation in how patient participation is managed and experienced by patients and relatives .…”

Section: Introductionmentioning

confidence: 99%

Health‐care professionals’ experiences of patient participation among older patients in intermediate care—At the intersection between profession, market and bureaucracy

Kvæl

Bye

Bergland

2019

Health Expectations

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BackgroundPatient participation is a key concern in health care. Nevertheless, older patients often do not feel involved in their rehabilitation process. Research states that when organizational conditions exert pressure on the work situation, care as a mere technical activity seems to be prioritized by the health‐care staff, at the expense of patient involvement.ObjectiveThe aim of this article is to explore how health‐care professionals experience patient participation in IC services, and explain how they perform their clinical work balancing between the patient's needs, available resources and regulatory constraints.DesignUsing a framework of professional work and institutional logics, underpinned by critical realism, we conducted semi‐structured interviews with 18 health‐care professionals from three IC institutions.ResultsIC appears as an important service in the patient pathway for older people with a great potential for patient participation. However, health care staff may experience constraints that prohibit them from using professional discretion, which is perceived as a threat to patient participation. Further, they may adopt routines that simplify their interactions with patients. Our results call for more emphasis on an individualized rehabilitation process and a recognition that psychological and social aspects are critical for patient participation in IC.ConclusionPatients interact in the face of conflicting institutional priorities or protocols. The study adds important knowledge about the practice of patient participation in IC from a front‐line provider perspective. Underlying mechanisms are identified to understand and recommend how to facilitate patient participation at different levels in narrowing the gap between policy and clinical work in IC.

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A Concept Analysis of Patient Participation in Intermediate Care

Kvæl

Langaas

Bye

et al. 2018

Patient Education and Counseling

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Work in an intermediate unit: balancing between relational, practical and moral care

Abstract: To recruit, support and retain a multidisciplinary staff to the best interest of patients, it seems to be important to perform care work as a balance between relational, practical and moral activities.

Cited by 16 publications

References 22 publications

Challenges in Achieving Collaboration in Clinical Practice: The Case of Norwegian Health Care

Challenges in Achieving Collaboration in Clinical Practice: The Case of Norwegian Health Care

Health‐care professionals’ experiences of patient participation among older patients in intermediate care—At the intersection between profession, market and bureaucracy

A Concept Analysis of Patient Participation in Intermediate Care

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