End-of-life Care and Interprofessional Communication: Not Simply a Matter of More

INTRODUCTION A well-functioning interprofessional team has been identified as a central requirement for high quality palliative care. In particular, interprofessional communication and teamwork have been directly linked to patient and family health outcomes. However, evidence suggests that substandard communication and team collaboration between healthcare providers is a persistent challenge that is heightened during palliative care in in-patient settings. This research examined the mechanisms of communication that shaped and impeded interprofessional team practice and coordinated palliative care on acute medical and long-term care units. METHODS This participatory action research project was informed by planned-action and educative-research strategies. The research team worked with healthcare practitioners who cared for dying people in acute and long-term care settings to develop and change practices and institutional arrangements through concurrent phases of ongoing analysis, dialogue, action, and reflection. Data-gathering methods included audio-recorded baseline interviews, observations and on site interactions with field notes, focused group discussions, and meetings. All data was coded using NVivo 9 and a subsequent second level analysis was conducted using Critical Discourse Analysis and Relational Inquiry as an analytical framework. FINDINGS Two main findings included (a) the way in which participants drew upon socio-cultural knowledge to structure and enact communication processes and to describe and interpret their communication experiences within the team, and (b) four recurring relational disjunctures in which conflicting and/or competing messages, goals, or processes hindered the flow and processes of communication and interprofessional team practice. CONCLUSION Given the way in which ideologies and normative practices shape and contribute to ineffective communicative patterns, the findings suggest that the issue is not only how much communication is happening, but the nature of that communication. Thus, addressing the conflicting and/or competing messages, goals, or processes shaping the flow and processes of communication within the interprofessional team is necessary. In particular, explicitly addressing the complex interplay between autonomous professional practice and interprofessional team collaboration is a crucial step in supporting more effective communication and team cohesion

Examining the social construction of surveillance: a critical issue for health visitors and public health nurses working with mothers and children

Aims and objectives In this paper we will critically examine surveillance practices of health visitors (HV) in the UK and public health nurses (PHNs) in Canada. Background The practice and meaning of surveillance shifts and changes depending on the context and intent of relationships between mothers and HVs or PHNs. Design We present the context and practice of HVs in the UK and PHNs in Canada and provide a comprehensive literature review regarding surveillance of mothers within public health systems. We then present our critique of the meaning and practice of surveillance across different settings. Methods Concepts from Foucault and discourse analysis are used to critically examine and discuss the meaning of surveillance Results Surveillance is a complex concept that shifts meaning and is socially and institutionally constructed through relations of power Conclusions Health care providers need to understand the different meanings and practices associated with surveillance to effectively inform practice. Relevance to clinical practice Health care providers should be aware of how their positions of expert and privilege within health care systems affect relationships with mothers. A more comprehensive understanding of personal social and institutional aspects of surveillance will provide opportunities to reflect upon and change practices that are supportive of mothers and their families