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Pause time: a multi-perspective exploration of person-centred care in an acute hospital: an interpretative phenomenological analysis study with older people, families and staff.

Whittingham, Katrina Anne

Authors

Katrina Anne Whittingham



Contributors

Fiona Work
Supervisor

Lisa Kidd
Supervisor

Karen Strickland
Supervisor

Sally Lawton
Supervisor

Abstract

Since the turn of the 21st century, the term 'Person Centred Care' (PCC) has become integral to healthcare language in policy, education, research and practice. In several healthcare arenas, PCC has become synonymous with the delivery of high-quality care along with multiple drivers - politically motivated, research driven and from the health-related voluntary sector - to incorporate a variety of models of PCC in healthcare. Additionally, a growing body of evidence supports embedding PCC-focused approaches, particularly for older people with cognitive impairment. Evidence supporting PCC approaches for older people without cognitive impairment is less evident, especially in the context of acute hospital care, as is the exploration of simultaneous PCC experiences from the multiple perspectives of older people, their families and MDT members. The study in this thesis explores, interprets and illuminates the experiences of PCC from the perspectives of older people (without cognitive impairment), their families and members of the MDT in an acute medicine for the elderly unit. A hermeneutic phenomenological approach was taken, combining collective case studies with Interpretative Phenomenological Analysis (IPA). The methodological decisions and approach are underpinned by a pluralistic philosophical approach. The methods employed involved purposive sampling to recruit four collectives, each comprising of an older person, a family member, at least one nurse from the MDT team and (ideally) one other member of the MDT team. The research setting consisted of four wards (acute medicine for the elderly wards) within one acute hospital site, providing care for both males and females. All participants were requested to keep a diary of their experiences of giving or receiving care for at least 3 days. Each participant was then interviewed, using a face-to-face semi-structured approach. Older people were offered the choice of being interviewed alone or with their family present. All diaries and interviews were transcribed and the qualitative data was subsequently analysed using an IPA approach. Four collective case studies, with between 2 and 4 participants in each, participated in the study (n=11). Data analysis resulted in four superordinate themes: the impact of personhood on PCC experiences; the PCC experience of accessing acute hospital; the PCC experience in acute hospital and the PCC experience of leaving acute hospital. Subthemes were evident in all the superordinate themes. This study adds to the PCC knowledgebase most notably in relation to the personhood of participants. Personhood shaped participants' definition and expectation of PCC in ways which are not consistently aligned to current theoretical models of PCC, such as being actively involved in the care experience. Within the context of accessing acute care, participants shared assorted experiences of PCC and non-PCC approaches. Diverse perceptions of positive and negative experiences were also evident in the very rich superordinate theme of PCC experiences in acute care. An expectation of PCC being based on the relational aspects of care was uncovered, where staff pause time, connect and establish what PCC means to individuals. In some instances, PCC experiences were attributed to certain healthcare staff - in others, the experiences were assigned to governing systems and processes. Similarly, PCC experiences of discharge from acute care revealed powerful positive PCC approaches, yet both older people and staff shared frustration around health and social care systems not meeting their PCC expectations. Furthermore, a flexible model of PCC where staff, older people and families can be cared about, for and with, is suggested. The findings present a platform from which to celebrate and learn from positive PCC experiences, and to plan strategies for improvements in which the experiences of PCC approaches were lacking. Combining collective case studies with IPA contributes uniquely to the PCC knowledgebase by illuminating simultaneous perceptions of PCC experiences from older people, families and MDT staff. There is a need to base PCC on the relationship-building aspects of care, moulding PCC to the personhood and the priorities of the older person. In order to deliver PCC, there was an evident need for the MDT to 'pause time' with older people and to get to know them, regardless of the busy environment around them. The collected data demonstrated that, from the perspective of older people and their families, staff did indeed 'pause time', to a greater extent than the staff themselves realised. Findings established that staff participants could be encouraged by their ability to meet expectations of PCC, whilst remaining open to adapting their PCC approach around the personhood of the older people for whom they care. Finally, if integrated health and social care policy continues to promote PCC as an integral component to high quality care, then the findings suggest that more flexible and achievable PCC approaches are required in the long term in order to generate and embed enduring change. The PCC experiences and perspectives unveiled by this study support aspects of the current PCC evidence-base, but illuminate the need to flexibly adapt PCC approaches, such as older people's active involvement and enablement. The findings illustrate how authentic PCC consistently requires idiographic framing to the uniqueness of individuals.

Citation

WHITTINGHAM, K.A. 2021. Pause time: a multi-perspective exploration of person-centred care in an acute hospital: an interpretative phenomenological analysis study with older people, families and staff. Robert Gordon University, DPP thesis. Hosted on OpenAIR [online]. Available from: https://doi.org/10.48526/rgu-wt-1358171

Thesis Type Thesis
Deposit Date Jun 8, 2021
Publicly Available Date Jun 8, 2021
Keywords Person-centred care; Elderly patients; Health services
Public URL https://rgu-repository.worktribe.com/output/1358171
Publisher URL https://doi.org/10.48526/rgu-wt-1358171

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