ABSTRACT
This paper explores telephone counsellors' experiences of the spatial dimensions of their work. Henri Lefebvre's spatial triad is applied to explore how counsellors conceive, perceive, and experience the spaces and places of this work. Three key findings are outlined: 1) the purpose built telephone counselling space is experienced as noisy and distracting; 2) counsellors engage in spatial practices to manage their depth of caller interaction; and 3) counsellors construct a mental place to foster intimacy with callers. These findings contribute to a novel conceptualisation of telephone counselling, raising implications for how it is performed and understood.
Subject(s)
Attitude of Health Personnel , Counseling , Telephone , Adolescent , Child , Child, Preschool , Female , Humans , Interviews as Topic , Male , New Zealand , Qualitative ResearchABSTRACT
BACKGROUND: Long-stay patients in acute hospitals commonly present with complex psychosocial needs and use high levels of hospital resources. OBJECTIVE: To determine whether a specialist social worker-led model of care was associated with a reduction in length of stay for medically stable patients with complex psychosocial needs who were at risk of long stay, and to determine the economic value of this model relative to the decision makers' willingness to pay for bed days released. DESIGN: A prospective, matched cohort study with historical controls. SETTING: A large, tertiary teaching and referral hospital in metropolitan Southeast Queensland, Australia. METHODS: Length of hospital stay for a cohort of patients seen under the specialist social worker-led model of care was compared with a matched control group of patients admitted to the hospital prior to the introduction of the new model of care using a multistate model with the social worker model of care as an intermediate event. Costs associated with the model of care were calculated and an estimate of the 'cost per bed day' was produced. RESULTS: The model of care reduced mean length of stay by 33 days. This translated to 9999 bed days released over 12 months. The cost to achieve this was estimated to be $A229 000 over 12 months. The cost per bed day released was $23, which is below estimates of hospital decision makers' willingness to pay for a bed day to be released for an alternate use. CONCLUSIONS: The specialist social worker-led model of care was associated with a reduced length of stay at a relatively low cost. This is likely to represent a cost-effective use of hospital resources. The limitations of our historic control cohort selection mean that results should be interpreted with caution. Further research is needed to confirm these findings.
