CFN Funded ProjectsProducts
| Title |
Category |
Date |
Authors |
| Understanding performativity: An inquiry into interprofessional teams supporting frail elderly to age-in-placeBackground
Patient complexity and multiple comorbidities call for well-designed and carefully implemented community programs to improve outcomes for clients and families living within communities. An innovative program initiative called Senior’s First was developed within an existing community home care system to provide frail elderly persons access and mechanisms to address complex health needs while remaining in their own home. An interprofessional team comprised of homecare nurses, physicians, nurse practitioners, physical therapists, occupational therapists, and a social worker worked together to form Senior’s First in an urban health region in western Canada.
Aim
The purpose of the Senior’s First program was to intensify the contact between a specialized community health team and complex, frail patients presenting at the emergency room in an effort to facilitate management of their health at home. The aim of our study was to make innovative and new inferences between processes and outcomes within a ‘real world’ or natural context. As part of a larger case study, the objective of our current analysis is to explore performativity within the team and the specific socio-material forces shaping its work.
Methods
In-depth interviews (n=17) with patients, caregivers and involved care providers, direct observations and two healthcare team focus groups generated data. Healthcare team observations included team interactions and select daily team huddles where the team planned the day’s activities and visits. Themes were determined through transcripts being reviewed and coded by the research team. Further analysis revealed indicators of perfomative behavior and socio-material structures that both supported and disrupted the work of the team.
Discussion/Conclusion
While overall thematic analysis findings of the study are reported elsewhere, this presentation explores insights that emerged in the theme of power and control. Further analysis of this theme demonstrated the effects of performative behaviours and attitudes that reinforced hierarchies and questioned role overlapping. The socio-material aspects of imposed change within the organizational structures disrupted the organic team workings and was characterized by the participants as oppressive. Examining data through a performative lens reveals threats to teamness in participants, which includes compliance, diminished voice, powerlessness and silencing. SHRF2015-Compton University of Alberta, University of Saskatchewan | Publication | 2018-06-22 | | | Patient Engagement within an Interprofessional Health Care Team: A Case StudyBackground
Senior's First is a quick response interprofessional healthcare team that aims to improve access to community supports that allow older adults to age in a place of choice. The interprofessional healthcare team attends not only to complex care needs, but also to patients and their caregivers’ increased need for or maintenance of autonomy and control, attitudes, physical environments, and social pressures. Senior's First has demonstrated success through significant reductions in hospital re-admissions, emergency room visits, and delayed progression to long-term care placements.
Aim
In this presentation, we report findings from a larger case study analysis, which aimed to explore the intersections of leadership, interdisciplinary teams, and patient engagement in an established health care team. The specific focus of this presentation is on the patients’ and caregivers' perceptions of their role and engagement within an interprofessional care team.
Method
Over the 8 months of data collection, we observed participants (patients, team, and interactions), conducted 17 in-depth interviews with patients, family caregivers, and health professionals and held two focus group discussions with the health care team. The data from this case study were analyzed thematically to understand how patients and family caregivers engaged in care.
Findings
The analysis revealed several primary themes and sub-themes. Shared decision making was a key indicator of patient engagement, as was the patient driven activation of services. Team communication and team support, as well as evolving leadership were essential. Noteworthy is the importance of advocacy, a sense of achievement and a shared philosophy of care.
Discussion/Conclusion
The Canadian Interprofessional Health Collaborative (2010) sees the participation of patients and their families in care decisions as an integral part of its competency framework. Yet, it remains a challenge for healthcare providers to relinquish power, as well as healthcare providers are slow to fundamentally rethink the role patients and family members can play. In this presentation we will focus on the context of care, as well as the deliberate decisions and ways in which patients and their families became key team members of Senior’s First. SHRF2015-Compton University of Saskatchewan, University of Alberta | Publication | 2018-06-22 | |
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