| 1. |
- Britten, Nicky, et al.
(författare)
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Elaboration of the Gothenburg model of person-centred care
- 2017
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Ingår i: Health Expectations. - : Wiley. - 1369-6513 .- 1369-7625. ; 20:3, s. 407-418
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Tidskriftsartikel (refereegranskat)abstract
- Background Person-centred care (PCC) is increasingly advocated asa new way of delivering health care, but there is little evidence that itis widely practised. The University of Gothenburg Centre for Person-Centred Care (GPCC) was set up in 2010 to develop and implementperson-centred care in clinical practice on the basis of three routines.These routines are based on eliciting the patient’s narrative to initiatea partnership; working the partnership to achieve commonly agreedgoals; and using documentation to safeguard the partnership andrecord the person’s narrative and shared goals.Objective In this paper, we aimed to explore professionals’ under-standing of PCC routines as they implement the GPCC model in arange of different settings.Methods We conducted a qualitative study and interviewed 18 clini-cian-researchers from five health-care professions who were workingin seven diverse GPCC projects.Results Interviewees’ accounts of PCC emphasized the ways inwhich persons are seen as different from patients; the varia bleemphasis placed on the person’s goals; and the role of the person’sown resources in building partnerships.Conclusion This study illustrates what is needed for health-care pro-fessionals to implement PCC in everyday practice: the recognition ofthe person is as important as the specific practical routines. Intervie-wees described the need to change the clinical mindset and to developthe ways of integrating people’s narratives with clinical practice.
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| 2. |
- Britten, Nicky, et al.
(författare)
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Learning from Gothenburg model of person centred healthcare.
- 2020
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Ingår i: BMJ. - : BMJ. - 0959-8138 .- 1756-1833. ; 370
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Tidskriftsartikel (refereegranskat)abstract
- Systematik och en tydlig struktur – det är faktorer som är avgörande i omställningen till personcentrerad vård. I en studie från Göteborgs universitet, publicerad i tidskriften BMJ, speglas nu ett decennium av erfarenheter och forskning i fältet. Förväntningarna växer sig allt starkare på att hälso- och sjukvården ska vara personcentrerad, och därmed ta avstamp i ett partnerskap mellan personal, patient och anhöriga. Samtidigt är det på många håll trögt att införa och upprätthålla detta arbetssätt. Att personcentrerad vård kan minska antalet vårddagar på sjukhus och skapa ökad tilltro till vården är redan känt. Nu gäller det istället att fokusera på hur man går tillväga, menar författarna bakom den övergripande artikeln i BMJ. Studien ger tips och verktyg för fortsatt forskning och utveckling av personcentrering i hälso- och sjukvården. Korresponderande författare är Axel Wolf, docent i vårdvetenskap vid institutionen för vårdvetenskap och hälsa på Sahlgrenska akademin, Göteborgs universitet, och verksam vid Centrum för personcentrerad vård, GPCC. Hela organisationen ska med – Ett av de viktigaste råden är att personcentrerad etik måste praktiseras på ett systematiskt sätt i vardagen. Det innebär att skapa organisatoriska och individuella förutsättningar för utvecklingen av ett partnerskap mellan patient, anhöriga om det är aktuellt, och personal vid varje möte, inte bara när det passar i schemat, säger han, och fortsätter: – För att få bästa kliniska effekt är det viktigt att frågan om personcentrering inte enbart blir något mellan patienten och den enskilde yrkesföreträdaren, utan återfinns i hela organisationen. Det ligger också en stor utmaning i att öka förståelsen för hur personcentrerad vård skiljer sig från nuvarande vårdpraktik. Grundläggande är att representanter från hälso- och sjukvården tar sig tid att lyssna in patientens erfarenheter och mål, som kan handla om att till exempel återgå i arbete eller kunna ta en promenad, och låter dessa mål vara vägledande i den gemensamt överenskomna hälsoplanen. Patientens prioriteringar ska speglas i planen som också ska utvärderas kontinuerligt. Dokumentationen ska sedan följa patienten, även vid övergång från exempelvis sjukhusvård till primärvård eller kommunal omsorg. Hierarkier och låsta roller Sedan starten för tio år sedan har den nationella centrumbildningen GPCC varit ledande aktör i att utveckla, testa, utvärdera och implementera personcentrerad vård i många olika hälso- och sjukvårdssammanhang, nationellt och internationellt. Tillsammans med kollegan Nicky Britten, professor vid University of Exeter, England, har Axel Wolf lett en internationell forskargrupp som har undersökt förutsättningar och hinder som forskare, kliniker och patienter upplevt under kliniska studier inom ramen för GPCC, och vid implementering av forskningsresultat i vardagen. Bland de hinder som beskrivs i den aktuella studien finns hierarkiska vårdstrukturer, låsta yrkesroller och övertygelsen om att man redan jobbar personcentrerat. – I och med omställningen till nära vård, som genomsyras av ett personcentrerat arbetssätt, måste den personcentrerade etiken praktiseras konstant för att få optimala förutsättningar. Det kräver en systematik gällande utbildning, livslångt lärande och verktyg som underlättar partnerskapet, avslutar Axel Wolf.
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| 3. |
- Ekman, Inger, 1952, et al.
(författare)
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The person-centred approach to an ageing society
- 2013
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Ingår i: European Journal for Person Centered Healthcare. - : University of Buckingham Press. - 2052-5656 .- 2052-5648. ; 1:1, s. 132-137
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Tidskriftsartikel (refereegranskat)abstract
- Modern care is often based on investigations such as laboratory markers and imaging - for example, x-ray or ultrasound. The results contribute to a diagnosis and, if judged necessary, treatment is initiated. This diseased-oriented approach is the prevailing mode of management in modern medicine. In contrast, person-centered care (PCC) takes the point of departure from each person´s subjective experience of illness and its impact on daily life. A patient is considered as a person with emotions and feelings. PCC is considered present within clinical care according to a definition articulated by the Centre for Person Centred Care at the University of Gothenburg (GPCC) when three core components are present: elicitation of a detailed patient narrative; formulated partnership between caregiver and patient and documentation of the partnership in the patient record. Accordingly, when there is an illness requiring care and the person is attended using these components, PCC is being applied. In most situations today, PCC is not applied as the narrative is not fully elicited or the partnership and/or the documentation are not included. It is proposed that the challenge to Society arising from changing demographics can be addressed by implementing PCC and creating an alternative to existing healthcare. The importance and benefits of such an approach on a wider scale is not yet clear as research has been limited to date. Studies in selected patient populations (heart failure and hip fractures), however, have shown promising results. As the population ages, there will be a dramatic increase in healthcare consumption. Even with technological developments, there will be a need for tremendous resources to be dedicated to care. A new organization and attitude from healthcare policymakers and providers above and beyond the present model appears required in order to respond to this demand. As part of such change, person-centred care, with the interaction between healthcare providers and the person of the patient, can facilitate, compensate and develop more effective healthcare services for the future.
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| 6. |
- Lydahl, Doris, 1986, et al.
(författare)
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Exploring documentation in Person-centred care : A content analysis of care plans
- 2022
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Ingår i: International Journal of Older People Nursing. - : John Wiley & Sons. - 1748-3735 .- 1748-3743. ; 17:5
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Tidskriftsartikel (refereegranskat)abstract
- Background: Person-centred care is a growing imperative in healthcare, but the documentation of person-centred care is challenging. According to the Gothenburg Framework of Person-centred Care, care should be documented in continuously revised care plans and based on patients’ personally formulated goals and resources to secure a continuous partnership.Objectives: This study aimed to examine care plans produced within a randomised controlled trial that tested a person-centred care intervention in older people with acute coronary syndrome. Nurses with training in the theory and practice of person-centred care had written the care plans.Methods: We conducted a secondary analysis of care plans developed in a randomised controlled trial for assessing person-centred care in patients with acute coronary syndrome (Myocardial Infarct [MI] or unstable angina pectoris). The study sample included 84 patients, with three care plans for each patient from inpatient (T1), outpatient (T2) and primary care (T3), that is, a total of 252 care plans. We conducted a descriptive quantitative content analysis of the care plans to examine the reported patients' life-world and medical/health resources and goals.Results: The analysis illustrates the differences and overlaps between life-world and medical/health goals and resources. The documented goals and resources change over time: life-world goals and resources decreased with time as medical/health goals and resources documentation increased.Conclusions: This paper illustrates that in the setting of a randomised controlled trial, nurses with training in person-centred care recorded fewer life-world and more medical/health goals over time. Placing life-world goals at the top of the goal hierarchy enables alignment with medical/health goals. Further research should explore whether the goals and resources documented in care plans accurately reflect patients' wishes as they transition along the care chain.Trial registration: Swedish registry, Researchweb.org, ID NR 65 791.
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| 7. |
- Moore, Lucy, et al.
(författare)
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Barriers and facilitators to the implementation of person‐centred care in different healthcare contexts
- 2017
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318. ; 31:4, s. 662-673
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Tidskriftsartikel (refereegranskat)abstract
- To empower patients and improve the quality of care, policy-makers increasingly adopt systems to enhance person-centred care. Although models of person-centredness and patient-centredness vary, respecting the needs and preferences of individuals receiving care is paramount. In Sweden, as in other countries, healthcare providers seek to improve person-centred principles and address gaps in practice. Consequently, researchers at the University of Gothenburg Centre for Person-Centred Care are currently delivering person-centred interventions employing a framework that incorporates three routines. These include eliciting the patient's narrative, agreeing a partnership with shared goals between patient and professional, and safeguarding this through documentation. Aim To explore the barriers and facilitators to the delivery of person-centred care interventions, in different contexts. Method Qualitative interviews were conducted with a purposeful sample of 18 researchers from seven research studies across contrasting healthcare settings. Interviews were transcribed, translated and thematically analysed, adopting some basic features of grounded theory. Ethical issues The ethical code of conduct was followed and conformed to the ethical guidelines adopted by the Swedish Research Council. Results Barriers to the implementation of person-centred care covered three themes: traditional practices and structures; sceptical, stereotypical attitudes from professionals; and factors related to the development of person-centred interventions. Facilitators included organisational factors, leadership and training and an enabling attitude and approach by professionals. Trained project managers, patients taking an active role in research and adaptive strategies by researchers all helped person-centred care delivery. Conclusion At the University of Gothenburg, a model of person-centred care is being initiated and integrated into practice through research. Knowledgeable, well-trained professionals facilitate the routines of narrative elicitation and partnership. Strong leadership and adaptive strategies are important for overcoming existing practices, routines and methods of documentation. This study provides guidance for practitioners when delivering and adapting person-centred care in different contexts.
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| 8. |
- Naldemirci, Öncel, 1983, et al.
(författare)
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Deliberate and emergent strategies for implementing person-centred care: a qualitative interview study with researchers, professionals and patients
- 2017
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Ingår i: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 17:527
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Background The introduction of innovative models of healthcare does not necessarily mean that they become embedded in everyday clinical practice. This study has two aims: first, to analyse deliberate and emergent strategies adopted by healthcare professionals to overcome barriers to normalization of a specific framework of person-centred care (PCC); and secondly, to explore how the recipients of PCC understand these strategies. Methods This paper is based on a qualitative study of the implementation of PCC in a Swedish context. It draws on semi-structured interviews with 18 researchers and 17 practitioners who adopted a model of PCC on four different wards and 20 patients who were cared for in one of these wards. Data from these interviews were first coded inductively and emerging themes are analysed in relation to normalization process theory (NPT). Results In addition to deliberate strategies, we identify emergent strategies to normalize PCC by (i) creating and sustaining coherence in small but continuously communicating groups (ii) interpreting PCC flexibly when it meets specific local situations and (iii) enforcing teamwork between professional groups. These strategies resulted in patients perceiving PCC as bringing about (i) a sense of ease (ii) appreciation of inter-professional congruity (ii) non-hierarchical communication. Conclusion NPT is useful to identify and analyse deliberate and emergent strategies relating to mechanisms of normalization. Emergent strategies should be interpreted not as trivial solutions to problems in implementation, but as a possible repertoire of tools, practices and skills developed in situ. As professionals and patients may have different understandings of implementation, it is also crucial to include patients’ perceptions to evaluate outcomes.
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| 9. |
- Naldemirci, Öncel, et al.
(författare)
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Epistemic injustices in clinical communication: the example of narrative elicitation in person-centred care
- 2021
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Ingår i: Sociology of Health & Illness. - : Wiley. - 0141-9889 .- 1467-9566. ; 43:1, s. 186-200
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Tidskriftsartikel (refereegranskat)abstract
- The increasing popularity of the term 'person-centred' in the healthcare literature and a wide range of ideals and practices it implies point to the need for a more inclusive and holistic healthcare provision. A framework developed in a Swedish context suggested narrative elicitation as a key practice in transition to person-centred care. Initiating clinical communication by inviting people to tell their stories makes persistent yet often subtle problems in clinical communication visible. By drawing upon an observational study on narrative elicitation and vignette-based focus group interviews with nurses, our aim is to trace 'credibility deficits' (Fricker 2007. Epistemic Injustice. Power and the Ethics of Knowing. Oxford: Oxford University Press) and 'credibility excesses' (Medina 2011, Social Epistemology, 25, 1, 15-35, 2013, The Epistemology of Resistance: Gender and Racial Oppression, Epistemic Injustice, and the Social Imagination. Oxford: Oxford University Press) in narrative elicitation. We argue that narrative elicitation may be one way to tackle epistemic injustices by giving voice to previously silenced groups, yet it is not enough to erase the effects of 'credibility deficits' in clinical communication. Rather than judging individual professionals' success or failure in eliciting narratives, we underline some extrinsic problems of narrative elicitation, namely structural and positional inequalities reflecting on narrative elicitation and the credibility of patients. 'Credibility excesses' can be useful and indicative to better understand where they are missing.
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| 10. |
- Naldemirci, Öncel, 1983, et al.
(författare)
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Tenacious assumptions of person-centred care
- 2015
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Ingår i: ESA 12th Conference Abstract Book, ESA Conference, August 26, Prag. - 9788073302726
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Person-centred care (PCC) seeks to treat and care for patients as persons. Within this approach, persons who seek expertise or professional care are expected and encouraged to share their stories, provide an account of their symptoms and goals, and participate in decisionmaking processes and care plans. This approach envisions a shift from the paternalistic biomedical tradition where the healthcare experts are omniscient, competent and ultimate decision-makers to a more humanistic, dialogic and collaborative relationship with lay people seeking expertise and care for particular medical conditions but also having resources and capabilities. However, even though PCC challenges the tenacious assumptions of the biomedical approach, it also requires questioning of how the person is defined and seen by healthcare experts. Drawing upon in-depth interviews with researchers in three research projects within the University of Gothenburg Centre of Person-centred Care (GPCC), one strong lead in developing PCC research, we will shed light on how the person is conceived as unique and capable differs from one medical and/or care setting to another. Based on these projects where persons are not able and/or willing to participate in PCC, we will argue that even though PCC targets the problems and inequalities in the provision of care, a monolithic and standardized definition of the person glosses over the complexity of situations where both caregivers and persons engage differently in creating narrative, partnership and documentation.
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