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A MISMATCH OF EXPECTATIONS? POWER, HIERARCHY AND THE INTERACTION BETWEEN CLINICAL STAFF AND THE OLDER PERSON APPROACHING END-OF-LIFE AND THEIR OLDER LOVED ONES

C Dobbs, S. Carnes Chichlowska, Christine Dobbs

BMJ Supportive & Palliative Care, Volume: 3, Issue: 1

Swansea University Author: Christine Dobbs

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DOI (Published version): 10.1136/bmjspcare-2013-000453b.9

Abstract

This paper presents findings from a part of a larger qualitative study involving 1) older people, 2) clinical staff, 3) multi-faith spiritual mentors and 4) policy-makers/-influencers in Wales (N=56). Taking a whole-systems approach throughout, a major aim was to identify and rank the expectations t...

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Published in: BMJ Supportive & Palliative Care
ISSN: 2045-435X 2045-4368
Published: 2013
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URI: https://cronfa.swan.ac.uk/Record/cronfa14868
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first_indexed 2013-07-23T12:13:01Z
last_indexed 2018-02-09T04:46:30Z
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spelling 2016-10-19T07:42:35.3573334 v2 14868 2013-05-23 A MISMATCH OF EXPECTATIONS? POWER, HIERARCHY AND THE INTERACTION BETWEEN CLINICAL STAFF AND THE OLDER PERSON APPROACHING END-OF-LIFE AND THEIR OLDER LOVED ONES 937b7a89ff111abd197e192a6a850f22 Christine Dobbs Christine Dobbs true false 2013-05-23 FGMHL This paper presents findings from a part of a larger qualitative study involving 1) older people, 2) clinical staff, 3) multi-faith spiritual mentors and 4) policy-makers/-influencers in Wales (N=56). Taking a whole-systems approach throughout, a major aim was to identify and rank the expectations that older people in Wales have of high-quality end-of-life care in the hospital setting. Phase 1 comprised in-depth interviews with participant groups 1-3. Phase 2 involved consultation workshops with older people (Nominal Group Technique). Phase 3 saw policy-makers/influencers in Summative Consultation Workshops develop road-maps for change. Demonstrating a bias in the health-care system, health policies and/or procedures are not always culturally sensitive, particularly where the actual needs and preferences are culturally/faith defined. Further – and surprisingly to us – the hospital hierarchy plays an immense role for the older patient and the older carer. A minority experienced excessive frustration through disempowerment when striving to obtain optimal care. Many would not seek to have their needs met due to fear of repercussions. Importantly, for the majority, there appeared to be a conflict in wanting to comply to the system as best they could, but were unsure of what the modern NHS expects from the patient. We question the way in which the NHS understanding of ‘patient-centred care’ and ‘patient choice’ is put into practice. Whilst hierarchy and (mis-)use of power between and within clinical staff groups is a deep-rooted cultural issue, we conclude that the older person approaching end-of-life and their loved ones have, in many cases, different expectations to clinical staff. The patient is tasked with meeting NHS needs, rather than the NHS meeting the patient’s needs. Journal Article BMJ Supportive & Palliative Care 3 1 127 2045-435X 2045-4368 31 12 2013 2013-12-31 10.1136/bmjspcare-2013-000453b.9 COLLEGE NANME Medicine, Health and Life Science - Faculty COLLEGE CODE FGMHL Swansea University 2016-10-19T07:42:35.3573334 2013-05-23T10:01:19.2026293 Faculty of Medicine, Health and Life Sciences The Centre for Innovative Ageing C Dobbs 1 S. Carnes Chichlowska 2 Christine Dobbs 3
title A MISMATCH OF EXPECTATIONS? POWER, HIERARCHY AND THE INTERACTION BETWEEN CLINICAL STAFF AND THE OLDER PERSON APPROACHING END-OF-LIFE AND THEIR OLDER LOVED ONES
spellingShingle A MISMATCH OF EXPECTATIONS? POWER, HIERARCHY AND THE INTERACTION BETWEEN CLINICAL STAFF AND THE OLDER PERSON APPROACHING END-OF-LIFE AND THEIR OLDER LOVED ONES
Christine Dobbs
title_short A MISMATCH OF EXPECTATIONS? POWER, HIERARCHY AND THE INTERACTION BETWEEN CLINICAL STAFF AND THE OLDER PERSON APPROACHING END-OF-LIFE AND THEIR OLDER LOVED ONES
title_full A MISMATCH OF EXPECTATIONS? POWER, HIERARCHY AND THE INTERACTION BETWEEN CLINICAL STAFF AND THE OLDER PERSON APPROACHING END-OF-LIFE AND THEIR OLDER LOVED ONES
title_fullStr A MISMATCH OF EXPECTATIONS? POWER, HIERARCHY AND THE INTERACTION BETWEEN CLINICAL STAFF AND THE OLDER PERSON APPROACHING END-OF-LIFE AND THEIR OLDER LOVED ONES
title_full_unstemmed A MISMATCH OF EXPECTATIONS? POWER, HIERARCHY AND THE INTERACTION BETWEEN CLINICAL STAFF AND THE OLDER PERSON APPROACHING END-OF-LIFE AND THEIR OLDER LOVED ONES
title_sort A MISMATCH OF EXPECTATIONS? POWER, HIERARCHY AND THE INTERACTION BETWEEN CLINICAL STAFF AND THE OLDER PERSON APPROACHING END-OF-LIFE AND THEIR OLDER LOVED ONES
author_id_str_mv 937b7a89ff111abd197e192a6a850f22
author_id_fullname_str_mv 937b7a89ff111abd197e192a6a850f22_***_Christine Dobbs
author Christine Dobbs
author2 C Dobbs
S. Carnes Chichlowska
Christine Dobbs
format Journal article
container_title BMJ Supportive & Palliative Care
container_volume 3
container_issue 1
publishDate 2013
institution Swansea University
issn 2045-435X
2045-4368
doi_str_mv 10.1136/bmjspcare-2013-000453b.9
college_str Faculty of Medicine, Health and Life Sciences
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hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str The Centre for Innovative Ageing{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}The Centre for Innovative Ageing
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description This paper presents findings from a part of a larger qualitative study involving 1) older people, 2) clinical staff, 3) multi-faith spiritual mentors and 4) policy-makers/-influencers in Wales (N=56). Taking a whole-systems approach throughout, a major aim was to identify and rank the expectations that older people in Wales have of high-quality end-of-life care in the hospital setting. Phase 1 comprised in-depth interviews with participant groups 1-3. Phase 2 involved consultation workshops with older people (Nominal Group Technique). Phase 3 saw policy-makers/influencers in Summative Consultation Workshops develop road-maps for change. Demonstrating a bias in the health-care system, health policies and/or procedures are not always culturally sensitive, particularly where the actual needs and preferences are culturally/faith defined. Further – and surprisingly to us – the hospital hierarchy plays an immense role for the older patient and the older carer. A minority experienced excessive frustration through disempowerment when striving to obtain optimal care. Many would not seek to have their needs met due to fear of repercussions. Importantly, for the majority, there appeared to be a conflict in wanting to comply to the system as best they could, but were unsure of what the modern NHS expects from the patient. We question the way in which the NHS understanding of ‘patient-centred care’ and ‘patient choice’ is put into practice. Whilst hierarchy and (mis-)use of power between and within clinical staff groups is a deep-rooted cultural issue, we conclude that the older person approaching end-of-life and their loved ones have, in many cases, different expectations to clinical staff. The patient is tasked with meeting NHS needs, rather than the NHS meeting the patient’s needs.
published_date 2013-12-31T03:17:00Z
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score 10.997956

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