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- Jobe, Ingela
(author)
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“A chain is only as strong as its weakest link” : collaborative care planning as a person-centred practice
- 2020
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Doctoral thesis (other academic/artistic)abstract
- In recent years, person-centred care has become one of the major goals of health and social care policies. A method used, to facilitate collaboration and integrate the person’s perspective in the decision-making process, is the collaborative care planning process. The collaborative care planning process, taking place within primary health care with actors from different welfare services, is a relative new phenomenon. There is a need for more research to understand the process and outcomes.The overall aim of the thesis was to explore and describe the collaborative care planning process as a person-centred practice. This was achieved by conducting four studies describing the collaborative care planning conference (I), exploring how the person-centred practice framework can be applied to professionals participating in collaborative care planning (II), exploring which attributes contribute to making the collaborative care planning process work for all participants (III) and exploring documented collaborative care plans (IV). The design of the studies were a single – instrumental qualitative case study (I), explorative deductive approach (II), qualitative explorative with a grounded theory approach (III) and explorative descriptive approach (IV). Using different methodologies, data were collected through interviews with older adults, their care partners and health and social care professionals, focus group discussion with health and social care managers, observations of collaborative care planning conferences and documented collaborative care plans. Data were analysed with qualitative case study, qualitative content analysis, constructivist grounded theory and content analysis.Older adults wanted to be actively engaged in decision-making processes regarding their care and services. However, the professionals had challenges in carrying out the collaborative care planning process (I). Collaborative care planning and person-centred practice was a complex process that needed to take into account system factors both on macro- and micro level (II). A joint philosophy, an ethic, could facilitate and guide professionals in everyday practice (III). The collaborative care plans had poor quality, insufficient content and lack of personcentredness (IV). Further research is needed to understand the role of the documented collaborative plan and the best way of working to make the collaborative care planning process and collaborative care plan person-centred. To gain a deeper understanding of the studies (I – IV) results an interpreted synthesis were conducted resulting in two common threads, personhood and power asymmetry. The two common threads were discussed using philosophy and Paul Ricoeur’s (1994) “little ethics”. The collaborative care planning process has to be seen in a larger context for it to be person-centred. All levels, the older adult and their care partners, the professionals and the organizations, need to be permeated of ethics and human values, and these have to be visible in every action and practice. Health and social care are relational practices and organizations. During the collaborative care planning the professionals, the older adults, and their care partners become interwoven. By using reciprocity and balancing the different dimensions and perspectives, the plan, their relationships and the organizations can improve. In conclusion, the thesis highlight the importance of ethics, relationships and reciprocity during the collaborative care planning process. The philosophical texts by Ricoeur expand the perspectives and contribute to a greater understanding of the collaborative care planning process as a person-centred practice.
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- Jobe, Ingela, et al.
(author)
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Exploration of how to make the collaborative planning process work - a grounded theory study
- 2021
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In: Cogent Medicine. - : Taylor & Francis. - 2331-205X. ; 8:1
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Journal article (peer-reviewed)abstract
- The integration of healthcare and social services has made collaborative care plans an important tool for health and social care professionals and the person involved. The collaborative planning process is challenging, and studies have revealed that its implementation and outcomes are not satisfactory for all participants. The study aimed to explore the collaborative planning process and attributes contributing to making the process work for all participants. The study focused on older adults in need of a collaborative care plan and adopted a grounded theory approach. Several sources were used to collect data from participants. The findings revealed an overarching process and two sub-processes. The overarching process “holding the links together” described the identified core attributes, joint philosophy, everyday practice and planning through partnership. The two sub-processes, “the missing link” and “connecting the links”, described the participants’ perspectives. The conceptual model explained the identified attributes and the connections between the overarching process and the two sub-processes. The study confirmed the complexity of collaboration between actors, professionals, older adults and informal caregivers. When one or more attribute did not function optimally or was missing, it affected the collaborative care planning process and participants involved, with consequences for the older adult. A joint philosophy, an ethic, could facilitate and guide professionals in everyday practice through all steps of the collaborative care planning process and contribute in making the process successful.
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- Jobe, Ingela, et al.
(author)
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Health and social care professionals’ experiences of collaborative planning : Applying the person‐centred practice framework
- 2020
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In: Nursing Open. - : John Wiley & Sons. - 2054-1058. ; 7:6, s. 2019-2028
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Journal article (peer-reviewed)abstract
- AimTo explore how person‐centred practice framework can be applied to professionals participating in collaborative planning.DesignAn explorative, deductive approach.MethodEleven professionals from health care and social care participated in the study. A deductive content analysis was performed using a framework for person‐centred practice for the analysis.ResultsPracticing person‐centred care and collaborative planning is a complex process that needs to take into account system factors on both the macro‐ and the microlevel. Everyone working within the system needs to apply the same approach. Using a framework analysis offered new insights into how person‐centred care is expressed in practice during collaborative planning between the patient, and healthcare and social care professionals.
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- Jobe, Ingela, et al.
(author)
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Knowledge and views about coordinated individual planning from the perspective of active older adults
- 2019
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In: Clinical Journal of Nursing Care and Practice. - : Heighten Science Publications Corporation. - 2639-9911. ; 3, s. 17-26
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Journal article (peer-reviewed)abstract
- Background Today’s older adults are often well informed and want to participate in decision-making processes. The coordinated individual planning process offers them active involvement in deciding and owning how their care will be managed.AimThe aim of the study was to explore active older adults’ knowledge and views regarding coordinated individual planning.MethodsThe study has an exploratory inductive approach. Five focus-group discussions were conducted with 40 participants from different organizations and associations. A qualitative interpretive description framework was used, and the analysis resulted in four unique themes.ResultsThe four themes resulting from the analysis are collaboration and continuity, participation and involvement in decision, individual need for support, and access to information and service. Collaboration between different levels of the healthcare system and between professionals is crucial. Older adults wanted to be participating actors in their healthcare. They worried about the lack of continuity and thought that services were not responsive or did not meet individuals’ needs.ConclusionsOlder adults want their views and preferences to be taken into consideration, and they want to be actively engaged in the decision-making process regarding their care.
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- Jobe, Ingela, et al.
(author)
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Perceptions of healthcare services and preference of factors related to care planning among active older persons
- 2019
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Conference paper (peer-reviewed)abstract
- IntroductionThe care-planning process offers people active involvement in deciding, agreeing and owning how their care will be managed. It is intended to be a process of collaboration supported by the principles of person-centredness, partnership and empowerment. According to Swedish legislation, coordinated individual planning must occur for patients transferring to another level of care or when an individual, living in their own home, has the need of efforts from different welfare actors. Awareness of older peoples’ preferences regarding different factors related to the care-planning process may generate knowledge that can facilitate bridging the gaps between care recipients’ preferences and caregivers’ decisions during the care-planning process. The aim of the study was to explore active older persons’ perceptions of healthcare services and preferences of factors related to care planning.MethodsA qualitative interpretive description framework was chosen for the study. Five focus-group were conducted with 40 members, aged between 70 to 88 years, from six different organizations and associations. Participants represent the growing older population in society that remains active for many years after retirement. The general principles of interpretative descriptions were used in the analysis.ResultsThe results showed that the participants thought that many organizational changes that had been made had not improved healthcare services. The participants wanted more flexibility regarding decisions and the possibility to change them. Personal freedom and making choices independently were momentous. They worried about the lack of continuity and perceived that no one assumed overall responsibility. Overall, participants cared more about the quality of the interactions with personnel than about how services were organized. The majority of participants were not aware of the development of a coordinated individual plan. A new service of being able to access the coordinated individual plan on the Internet is offered. A majority of the participants did not have Internet access; they saw themselves as the generation between the old and new systems. They did not resist the new technology but stressed the importance of not excluding anyone.DiscussionsOlder persons want their views and preferences to be taken into consideration, and they want to be actively engaged in the decision-making process and make decisions themselves. Older people’s lives have become more individualized with the rest of society, and this requires healthcare service solutions that are more tailored and include different options.Conclusions Older persons’ want to be active partners in healthcare and social services and they value a personal relation with the professional actor, easy access and well-coordinated and more personalized and flexible services. They value their independency and want to stay active as long as possible.Lessons learned Older persons value their independency and want to remain active and maintain functioning. Views of older people must be considered on different levels, from planning healthcare and social services to individualized care-planning processes.Limitations It is important to remember that older people are not a homogeneous group. The participants in this study are active in society and chose to participate. Majority of the participants had no previous experiences of the coordinated individual planning however, they can still have other experiences of healthcare and social services that influence their preferences, and made them participate in the study. Their views do not necessarily correspond with older persons’ views in general.Suggestions for future researchMore knowledge is needed about how individuals and their relatives experiences the Coordinated individual planning process.
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- Jobe, Ingela
(author)
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Reflections of the collaborative care planning as a person‐centred practice
- 2022
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In: Nursing Philosophy. - : John Wiley & Sons. - 1466-7681 .- 1466-769X. ; 23:3
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Journal article (peer-reviewed)abstract
- The ageing population is increasing worldwide with an increase in chronic disorders. At the same time, person-centred care has become a policy within both health and social care. To facilitate coordination and collaboration and integrate the older adult's perspective in the decision-making process the collaborative care planning process with the development of a written care plan can be used. In this study, the result of an interpreted analysis of four empirical studies of the collaborative care planning as a person-centred practice will be discussed and reflected on. A framework based on the French philosopher Paul Ricoeur's little ethics was used in the synthesis of the studies. The findings revealed two common threads: personhood and power asymmetry. Both challenges in achieving a person-centred collaborative care planning. Ricoeur's dialogical thinking and description of a person served as an underpinning in discussing and reflecting upon the findings of the interpreted synthesis. Collaborative care planning is a complex process. However, Ricoeur's philosophy contributed to a greater understanding of the collaborative care planning as a person-centred practice and accentuated that ethics, human values, and the older adults and care partners perspectives need to be given the same importance and considerations as the medical and social sciences perspectives for the collaborative care planning process to truly become person-centred.
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- Jobe, Ingela, et al.
(author)
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The care‐planning conference : Exploring aspects of person-centered interactions
- 2018
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In: Nursing Open. - : John Wiley & Sons. - 2054-1058. ; 5:2, s. 120-130
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Journal article (peer-reviewed)abstract
- AimThe aim of this study was to describe the care-planning conference from the participants' and researchers' perspectives, focusing on exploring aspects of person-centred interactions.DesignA single-instrumental, qualitative case study design was used describing a care-planning conference taking place in the home of an older woman and her daughter.MethodsData collection consisted of observation and digital recording of the care-planning conference and individual interviews with all the participants before and after the conference. Data were analysed in several phases: first, a narrative description followed by a general description and, thereafter, qualitative content analysis.ResultsThe findings revealed that the care-planning conference conducted had no clear purpose and did not fulfil all parts of the planning process. Three themes emerged related to aspects of person-centred interactions. The theme “expectations meet reality” showed different expectations, and participants could not really connect during the conference. The theme “navigate without a map” revealed health professionals' lack of knowledge about the care-planning process. The theme “lose the forest for the trees” described that the conference was conducted only as part of the health professionals' duties. Management and healthcare professionals cannot automatically assume that they are delivering person-centred care. Healthcare professionals need to be sensitive to the context, use the knowledge and tools available and continuously evaluate and reassess the work carried out.
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