Developing Practice in Healthcare: The Contribution of Bildung to Negotiating the Tensions among Practical, Professional and Organisational Knowing

"Action research provides a framework for developing practice in healthcare. While developing practice typically implies a combination of patient centeredness, quality improvement and change, conflicts arise in how concepts such as patient centredness are defined. Developing practice invites attention to positionality and engagement with policy directives, trends in clinical care, and other disciplines each with their own language stratification reflecting particular sets of values and beliefs. Our process of engagement is value-based, requiring attention to different and often conflicting languages or worldviews. We understand practice development as responding to different calls from the system, our individual disciplines, patients and changing discourses in healthcare, each exerting different pressures at different times. This paper describes an action research project aimed at developing nursing practice through engaging with two conflicting philosophies of care. We illustrate the contribution made by a particular understanding of Bildung to engaging with positionality, different voices in healthcare and the context of care in a complex environment. Bildung, as self-cultivation, invites engagement with other as an underpinning for developing practice beginning with first person inquiry. The idea of Bildung drew attention to the local moral world of nursing and the experience of dual citizenship. Dual citizenship reflected engagement with conflicting care philosophies and notions of evidence." (author's abstract

Exploring Vulnerability and Risk in an Action Research Writing Group: A Cooperative Inquiry

This article describes how, the authors, as members of an action research writing group, responded to a comment about feeling vulnerable in risking bringing their work-in-progress to the group and in giving feedback to colleagues by adopting a cooperative inquiry approach to explore vulnerability and risk in the group. In cooperative inquiry group members act as both co-researcher and co-subject in the inquiry and action. The article describes the evolution of the group and how the topic of exploring risk and vulnerability emerged. The group’s exploration is grounded in the theory and practice of cooperative inquiry that gives voice to the group members questioning and reflecting. The article concludes by offering three propositions to enhance the work of writing groups

Evaluation: Programme to Support Palliative and Hospice Care in the Republic of Ireland, Final Report

Investment in end-of-life care has made Ireland a world leader in advancing palliative and hospice care but regional inequities persist, according to an evaluation by Professor Mary McCarron and colleagues at Trinity College Dublin.This evaluation examined The Atlantic Philanthropies' End of Life programme -- which aimed to improve the care and quality of life for patients dying from an incurable illness and to ensure they and their families received excellent end-of-life care and services. From its first grant in 2004 through its final grant in 2010, Atlantic invested 25 million in the programme

Dying to breathe : a conversation at the crossroads of respiratory and palliative nursing care -an action report project

THESIS 945

Policy analysis: Palliative care in Ireland

Palliative care for patients with advanced illness is a subject of growing importance in health services, policy and research. In 2001 Ireland became one of the first nations to publish a dedicated national palliative care policy. This paper uses the ?policy analysis triangle? as a framework to examine what the policy entailed, where the key ideas originated, why the policy process was activated, who were the key actors, and what were the main consequences. Although palliative care provision expanded following publication, priorities that were unaddressed or not fully embraced on the national policy agenda are identified. The factors underlying areas of non-fulfilment of policy are then discussed. In particular, the analysis highlights that policy initiatives in a relatively new field of healthcare face a trade-off between ambition and feasibility. Key policy goals could not be realised given the large resource commitments required; the competition for resources from other, better-established healthcare sectors; and challenges in expanding workforce and capacity. Additionally, the inherently cross-sectoral nature of palliative care complicated the co-ordination of support for the policy. Policy initiatives in emerging fields such as palliative care should address carefully feasibility and support in their conception and implementation

Voices that matter: end-of-life care in two acute hospitals from the perspective of bereaved relatives

Abstract Background End-of-life care (EoLC) is an experience that touches the lives of everyone. Dying in an acute hospital is a common occurrence in developed countries across the world. Previous studies have shown that there is wide variation in EoLC and at times is experienced as being of poor quality. Assessing and measuring the quality of care provided is a key component of all healthcare systems. This paper reports on the qualitative analysis of open-ended free text questions that were asked as part of a post-bereavement survey conducted in two adult acute hospitals in Ireland. Methods This was a quantitative descriptive post-bereavement postal survey, gathering data retrospectively from relatives or friends of patients who died, utilising an adapted version of the VOICES (Views of Informal Carers - Evaluation of Services) questionnaire. VOICES MaJam has 29 core questions, seven questions requesting personal demographic information and four open-ended questions gathering descriptive data about the care experience during the patient’s last admission to hospital. A total of 356 valid questionnaires were returned. Qualitative data were managed, coded and analysed with NVivo 10, using a template analysis framework approach. Results Three quarters (75%: n = 268) responded to at least one of the open-ended questions. Several key themes emerged, indicating areas that require particular attention in EoLC. Two themes relate to how care needs are met and how the hospital environment has a critical influence on EoLC experiences. The remaining three themes relate more to the interpersonal context including whether patients are treated with dignity and respect, the psychological, emotional and spiritual needs of patients and their family members and communication. Conclusions Acute hospitals need to ensure that patients and their relatives receive high quality EoLC. Seeking the views of bereaved relatives should be considered by all hospitals and healthcare settings to ascertain the quality of care at end of life. This study contributes to our understanding and knowledge of what good EoLC looks like and where care can be improved, thus enabling hospitals to direct and inform quality improvement

28th Alzheimer Europe Conference: Making dementia a European priority .

Background: The use of assistive technology (AT) to support people with dementia to live well at home has gained increasing attention. During two pilot projects, AT packages were provided as part of enhanced community supports for people living with dementia. The authors were commissioned to evaluate the pilot projects. Aim: The aim of this presentation is to discuss the findings in relation to key stakeholders perceptions of the use of assistive technology for people with dementia living at home. Methods: The findings are drawn from the qualitative arm of the evaluation. Interviews were conducted with people with dementia and family carers, and individual interviews and focus groups were held with service providers. Seventeen people with dementia and their family carers (n=17), and fifty-eight (n=58) service providers took part across the two project sites. Findings: The assistive technology included fall detectors, smoke detectors, carbon monoxide detectors, bed occupancy sensors, pillow alerts, personal alarms, and property exit sensors.There was a mixed reaction to the AT. In one project site, uptake was less than anticipated, as it was not perceived as useful given the person with dementia?s individual needs at that particular time. There were also reports of confusion as to the role of the AT and a lack of knowledge about how to use it by people with dementia. There were some positive reports with family carers suggesting that the technology provided some peace of mind. Service providers noted that applications for AT involved excessive paperwork and were sometimes unsuccessful. Conclusion: Under-utilisation of AT may have occurred because the technology provided was inconsistent with the wants, needs or abilities of those it was provided to. The range of AT provided emphasised safety. More appropriate options may have been considered in light of individual needs given their stage in the dementia journey

Developing agreed and accepted understandings of spirituality and spiritual care concepts among members of an innovative spirituality interest group in the Republic of Ireland

A Spirituality Interest Group (SIG) was set up in in the School of Nursing and Midwifery, Trinity College Dublin, Republic of Ireland (ROI), in March 2013. This paper reports on some of the journey and requirements involved in developing the group. It highlights the essential work of establishing agreed understandings in an objective way in order for the group to move forward with action. These agreed understandings have contributed to the group?s success. Outlining the group?s journey in arriving at agreements may be of use to others considering creating similar groups. One key action taken to determine the suitability of the group?s aims and terms of reference was the distribution of a Survey Monkey to group members (n = 28) in 2014. One early meeting of the group discussed future goals and direction using the responses of this anonymous survey. This paper reports on the results of the survey regarding the establishment of the SIG and the development of a shared understanding of spiritual care among the members. There is consensus in the group that the spiritual care required by clients receiving healthcare ought to be an integrated effort across the healthcare team. However, there is an acceptance that spirituality and spiritual care are not always clearly understood concepts in practice. By developing shared or at least accepted understandings of spirituality and spiritual care, SIG hopes to be able to underpin both research and practice with solid foundational conceptual understanding, and in the process also to meet essential prerequisites for achieving the group?s aims