英国老年人临终前从社区医院出院时的选择和自主权的修辞与现实:建构主义基础理论研究

IF 2 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Emily Mckean, Claire Butler, Patricia Wilson
{"title":"英国老年人临终前从社区医院出院时的选择和自主权的修辞与现实:建构主义基础理论研究","authors":"Emily Mckean,&nbsp;Claire Butler,&nbsp;Patricia Wilson","doi":"10.1155/2024/3808095","DOIUrl":null,"url":null,"abstract":"<p>There has been an increasing acknowledgement in the UK of the importance of recognising frailty as a condition that leaves older people vulnerable to dramatic, sudden changes in health triggered by seemingly small events. In policy, the approach to managing frailty is often an emphasis on staying well with limited consideration to frailty as an end-of-life phase. Meanwhile, discharge from hospital continues to be complex. Overstretched acute hospitals are juxtaposed with community and social services that struggle to keep up with the demand of those being discharged and the labelling of older people as “bed blockers” at the centre of delayed discharges. This paper reports a study underpinned by constructivist grounded theory methodology, with the aim of exploring the experiences and perceptions of stakeholders. Semistructured interviews were conducted with 57 participants including patients, their informal carer(s), community hospital staff, community health professionals, and care home managers. The core category of “the drive to discharge conveyor belt” was derived from data analysis. A significant finding of this study was that of the carer, their burden, and their intrinsic role in facilitating discharge, filling in gaps in services, coordinating services, and enabling the patient to stay at home, with little consideration of their choices or autonomy. The “drive to discharge” impacts older people, their informal carers, and health professional. This study suggests how they may be supported, through an ethical lens.</p>","PeriodicalId":48195,"journal":{"name":"Health & Social Care in the Community","volume":null,"pages":null},"PeriodicalIF":2.0000,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The Rhetoric and Reality of Choice and Autonomy When Older People Are Discharged from Community Hospital at the End-of-Life in England: A Constructivist Grounded Theory Study\",\"authors\":\"Emily Mckean,&nbsp;Claire Butler,&nbsp;Patricia Wilson\",\"doi\":\"10.1155/2024/3808095\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p>There has been an increasing acknowledgement in the UK of the importance of recognising frailty as a condition that leaves older people vulnerable to dramatic, sudden changes in health triggered by seemingly small events. In policy, the approach to managing frailty is often an emphasis on staying well with limited consideration to frailty as an end-of-life phase. Meanwhile, discharge from hospital continues to be complex. Overstretched acute hospitals are juxtaposed with community and social services that struggle to keep up with the demand of those being discharged and the labelling of older people as “bed blockers” at the centre of delayed discharges. This paper reports a study underpinned by constructivist grounded theory methodology, with the aim of exploring the experiences and perceptions of stakeholders. Semistructured interviews were conducted with 57 participants including patients, their informal carer(s), community hospital staff, community health professionals, and care home managers. The core category of “the drive to discharge conveyor belt” was derived from data analysis. A significant finding of this study was that of the carer, their burden, and their intrinsic role in facilitating discharge, filling in gaps in services, coordinating services, and enabling the patient to stay at home, with little consideration of their choices or autonomy. The “drive to discharge” impacts older people, their informal carers, and health professional. This study suggests how they may be supported, through an ethical lens.</p>\",\"PeriodicalId\":48195,\"journal\":{\"name\":\"Health & Social Care in the Community\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.0000,\"publicationDate\":\"2024-03-26\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Health & Social Care in the Community\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1155/2024/3808095\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Health & Social Care in the Community","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1155/2024/3808095","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH","Score":null,"Total":0}
引用次数: 0

摘要

在英国,越来越多的人认识到体弱的重要性,因为体弱会使老年人的健康状况很容易因一些看似微小的事件而突然发生急剧变化。在政策上,管理虚弱的方法往往是强调保持健康,而对作为生命末期阶段的虚弱考虑有限。与此同时,出院问题依然十分复杂。急症医院捉襟见肘,而社区和社会服务机构却难以满足出院者的需求,老年人被称为 "床位阻碍者",是出院延迟的核心问题。本文报告了一项以建构主义基础理论方法为基础的研究,旨在探索利益相关者的经验和看法。研究人员对 57 名参与者进行了半结构化访谈,其中包括患者、患者的非正式照护者、社区医院工作人员、社区卫生专业人员和护理之家经理。通过数据分析,得出了 "出院传送带 "这一核心类别。这项研究的一个重要发现是护理人员、他们的负担以及他们在促进出院、填补服务空白、协调服务和使病人留在家中方面的内在作用,而很少考虑他们的选择或自主权。出院的动力 "影响着老年人、他们的非正式照顾者和医疗专业人员。本研究从伦理角度提出了如何为他们提供支持的建议。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The Rhetoric and Reality of Choice and Autonomy When Older People Are Discharged from Community Hospital at the End-of-Life in England: A Constructivist Grounded Theory Study

There has been an increasing acknowledgement in the UK of the importance of recognising frailty as a condition that leaves older people vulnerable to dramatic, sudden changes in health triggered by seemingly small events. In policy, the approach to managing frailty is often an emphasis on staying well with limited consideration to frailty as an end-of-life phase. Meanwhile, discharge from hospital continues to be complex. Overstretched acute hospitals are juxtaposed with community and social services that struggle to keep up with the demand of those being discharged and the labelling of older people as “bed blockers” at the centre of delayed discharges. This paper reports a study underpinned by constructivist grounded theory methodology, with the aim of exploring the experiences and perceptions of stakeholders. Semistructured interviews were conducted with 57 participants including patients, their informal carer(s), community hospital staff, community health professionals, and care home managers. The core category of “the drive to discharge conveyor belt” was derived from data analysis. A significant finding of this study was that of the carer, their burden, and their intrinsic role in facilitating discharge, filling in gaps in services, coordinating services, and enabling the patient to stay at home, with little consideration of their choices or autonomy. The “drive to discharge” impacts older people, their informal carers, and health professional. This study suggests how they may be supported, through an ethical lens.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
CiteScore
4.50
自引率
8.30%
发文量
423
期刊介绍: Health and Social Care in the community is an essential journal for anyone involved in nursing, social work, physiotherapy, occupational therapy, general practice, health psychology, health economy, primary health care and the promotion of health. It is an international peer-reviewed journal supporting interdisciplinary collaboration on policy and practice within health and social care in the community. The journal publishes: - Original research papers in all areas of health and social care - Topical health and social care review articles - Policy and practice evaluations - Book reviews - Special issues
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信