ABSTRACT
AIMS AND OBJECTIVES: This study will illustrate how stroke survivors, their relatives and different professionals communicated in care-planning meetings when planning care for patients after their discharge from hospital. We wanted to know what topics participants were talking about, to what extent they were involved in the discussion and how the communication was organized. BACKGROUND: Communication in health care is sometimes problematic because of the participants' asymmetrical positions when negotiating how to understand the patients' future care. METHODS: A qualitative and a quantitative design were adopted with a sample of 14 authentic audio-recorded care-planning meetings. The transcribed meetings were, together with observational notes, analysed from a data-driven approach. FINDINGS: Five topics emerged. The professionals tended to dominate the discourse space even if their involvement varied depending on the topic talked about. The most noteworthy finding was the patients' need of communicative alliances with other participants when negotiating their needs and desires of further care. When making decisions two approaches emerged. The 'aim-driven' approach was characterized by alliances between those participants who seemed to share a common goal for the patient's further care. When the participants used the 'open-minded' approach they merged information and discussed different solutions leading to a goal step by step. CONCLUSIONS: The importance of strengthening stroke survivors' participation in care-planning meetings is highlighted. Professionals have to increase their knowledge about how to involve the patients as well as their awareness of how to avoid power struggles between various professionals, patients and relatives. Relevance to clinical practice. This study shows the necessity for professionals to involve relatives when negotiating these patients' need of further care and to learn more about how to advocate stroke survivors.
Subject(s)
Communication , Needs Assessment , Patient Discharge , Social Support , Stroke/psychology , Survivors/psychology , Aftercare/organization & administration , Aftercare/psychology , Aged , Aged, 80 and over , Attitude of Health Personnel , Family/psychology , Female , Geriatric Assessment , Humans , Male , Middle Aged , Needs Assessment/organization & administration , Negotiating/methods , Negotiating/psychology , Nursing Methodology Research , Patient Care Planning , Patient Participation/methods , Patient Participation/psychology , Problem Solving , Professional-Patient Relations , Qualitative Research , Social Dominance , Stroke RehabilitationABSTRACT
BACKGROUND: Previous research has suggested technology may dehumanise patient care and also that technology may restrict nurses' freedom of action. This raises questions about the relationship between technology, care and medicine in units where the patient's need for treatment is often an emergency. AIM: The aim of the study was to explore how staff members in an intensive care unit (ICU) make sense of technology in their everyday practice. METHOD: Twelve staff members from one ICU were interviewed about their understanding of technology in their everyday practice. RESULT: Three main findings emerged from the analysis: Technology seems to be considered decisive as it directs and controls medical treatment and results in the patients' well being; technology is seen as facilitating everyday practice because it makes treatment more secure and decreases workload; however technology can complicate the staff members' everyday practice as it is not completely trustworthy, is not easy to handle and can cause ethical dilemmas. CONCLUSION: Contrary to previous findings this study shows that technology seems to be embedded in care and medical treatment. Furthermore, the meaning of technology appears to be dependent on the different staff members' accounting practices.
Subject(s)
Attitude of Health Personnel , Biomedical Technology/organization & administration , Critical Care/organization & administration , Nursing Staff, Hospital/psychology , Adaptation, Psychological , Anesthesiology/education , Anesthesiology/ethics , Anesthesiology/organization & administration , Biomedical Technology/education , Biomedical Technology/ethics , Communication , Conflict, Psychological , Cooperative Behavior , Critical Care/ethics , Ethnology , Health Knowledge, Attitudes, Practice , Humans , Intensive Care Units/ethics , Intensive Care Units/organization & administration , Interprofessional Relations , Medical Staff, Hospital/education , Medical Staff, Hospital/ethics , Medical Staff, Hospital/organization & administration , Medical Staff, Hospital/psychology , Nurse's Role , Nursing Methodology Research , Nursing Staff, Hospital/education , Nursing Staff, Hospital/ethics , Nursing Staff, Hospital/organization & administration , Nursing, Practical/education , Nursing, Practical/ethics , Nursing, Practical/organization & administration , Qualitative Research , Reproducibility of Results , Surveys and Questionnaires , Sweden , WorkloadABSTRACT
INTRODUCTION: Stroke survivors often have communicative disabilities. They should, however, be involved when decisions are made about their care treatment. AIM: To explore and describe how nurses act as moderators of the communication in cooperative care-planning meetings and what kind of participant status the patients achieve in this type of multi-party talk. METHOD: Thirteen care-planning meetings were audio-recorded and transcribed. Nurses, social workers and stroke survivors were the main participants for the meetings. A coding scheme was created and three main categories were used for the analysis: pure utterance types, expert comments (EC) and asymmetries. RESULTS: The nurses never invited the patients to tell their own versions without possible influence from them. Mostly the nurses gave ECs. The nurses acted as the patients' advocates by talking for or about them. They rarely supported the patients' utterances. CONCLUSION: There is an urgent need for nurses to learn how to involve the patients in the communicative process about their treatment. Assessment of the patients' communicative abilities before the care-planning meetings as well as knowledge about how to invite them can improve the patients' participant status.
