Theory

2018 ◽  
Author(s):  
J. Donald Boudreau ◽  
Eric J. Cassell ◽  
Abraham Fuks
Keyword(s):  
Medical Education ◽  
Role Model ◽  
Clinical Care ◽  
Significant Feature ◽  
Student Centered ◽  
Functional Relationships ◽  
Person Centered Care ◽  
Centered Care ◽  
Clinician Teacher ◽  
Medical Judgment

The conceptual framework for the Physicianship Curriculum is described in this chapter. The crucial participants are depicted in an “educational triangle,” a diagrammatic representation illustrating the roles and functional relationships of these participants. The chapter introduces the concept of the attending teacher, who is at once a clinician, teacher, and role model. We draw an explicit parallel between clinical care and medical education; it leads us to consider student-centered education as the pedagogical analogue to person-centered care. The text addresses the nature of medical judgment and the significant feature of uncertainty that is part of the experiences of all the relevant actors. The second half of the chapter explicates the constructs of epistēme, techné, and phronēsis, originating from Aristotle, whose framework underpins the philosophic armature of the Physicianship Curriculum.

scholarly journals Healthcare professionals’ practice and interactions in older peoples’ cross-sectoral clinical care trajectories when acutely hospitalized - a qualitative observation study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Maiken Hjuler Persson ◽  
Christian Backer Mogensen ◽  
Jens Søndergaard ◽  
Helene Skjøt-Arkil ◽  
Pernille Tanggaard Andersen
Keyword(s):  
Decision Making ◽  
Older People ◽  
New Public Management ◽  
Healthcare Professionals ◽  
Clinical Care ◽  
Research Integrity ◽  
Care Practice ◽  
Observation Study ◽  
Person Centered Care ◽  
Centered Care

Abstract Background Healthcare services have become more complex, globally and nationally. Denmark is renowned for an advanced and robust healthcare system, aiming at a less fragmented structure. However, challenges within the coordination of care remain. Comprehensive restructures based on marketization and efficiency, e.g. New Public Management (NPM) strategies has gained momentum in Denmark including. Simultaneously, changes to healthcare professionals’ identities have affected the relationship between patients and healthcare professionals, and patient involvement in decision-making was acknowledged as a quality- and safety measure. An understanding of a less linear patient pathway can give rise to conflict in the care practice. Social scientists, including Jürgen Habermas, have highlighted the importance of communication, particularly when shared decision-making models were introduced. Healthcare professionals must simultaneously deliver highly effective services and practice person-centered care. Co-morbidities of older people further complicate healthcare professionals’ practice. Aim This study aimed to explore and analyse how healthcare professionals’ interactions and practice influence older peoples’ clinical care trajectory when admitted to an emergency department (ED) and the challenges that emerged. Methods This qualitative study arises from a hermeneutical stand within the interpretative paradigm. Focusing on the healthcare professionals’ interactions and practice we followed the clinical care trajectories of seven older people (aged > 65, receiving daily homecare) acutely hospitalized to the ED. Participant observations were combined with interviews with healthcare professionals involved in the clinical care trajectory. We followed-up with the older person by phone call until four weeks after discharge. The study followed the code of conduct for research integrity and is reported in accordance with the Standards for Reporting Qualitative Research (SRQR) guidelines. Results The analysis revealed four themes: 1)“The end justifies the means – ‘I know what is best for you’”, 2)“Basic needs of care overruled by system effectiveness”, 3)“Treatment as a bargain”, and 4)“Healthcare professionals as solo detectives”. Conclusion Dissonance between system logics and the goal of person-centered care disturb the healthcare practice and service culture negatively affecting the clinical care trajectory. A practice culture embracing better communication and more person-centered care should be enhanced to improve the quality of care in cross-sectoral trajectories.

scholarly journals A Dialogic Approach to Teaching Person-Centered Care in Graduate Medical Education

2019 ◽  
Vol 11 (4) ◽  
pp. 460-467
Author(s):  
Ayelet Kuper ◽  
Victoria A. Boyd ◽  
Paula Veinot ◽  
Tarek Abdelhalim ◽  
Mary Jane Bell ◽  
...  
Keyword(s):  
Medical Education ◽  
Faculty Development ◽  
Graduate Medical Education ◽  
Development Program ◽  
Faculty Development Program ◽  
Dialogic Teaching ◽  
Graduate Medical ◽  
Person Centered Care ◽  
Centered Care ◽  
Education Model

ABSTRACT Background Training future physicians to provide compassionate, equitable, person-centered care remains a challenge for medical educators. Dialogues offer an opportunity to extend person-centered education into clinical care. In contrast to discussions, dialogues encourage the sharing of authority, expertise, and perspectives to promote new ways of understanding oneself and the world. The best methods for implementing dialogic teaching in graduate medical education have not been identified. Objective We developed and implemented a co-constructed faculty development program to promote dialogic teaching and learning in graduate medical education. Methods Beginning in April 2017, we co-constructed, with a pilot working group (PWG) of physician teachers, ways to prepare for and implement dialogic teaching in clinical settings. We kept detailed implementation notes and interviewed PWG members. Data were iteratively co-analyzed using a qualitative description approach within a constructivist paradigm. Ongoing analysis informed iterative changes to the faculty development program and dialogic education model. Patient and learner advisers provided practical guidance. Results The concepts and practice of dialogic teaching resonated with PWG members. However, they indicated that dialogic teaching was easier to learn about than to implement, citing insufficient time, lack of space, and other structural issues as barriers. Patient and learner advisers provided insights that deepened design, implementation, and eventual evaluation of the education model by sharing experiences related to person-centered care. Conclusions While PWG members found that the faculty development program supported the implementation of dialogic teaching, successfully enabling this approach requires expertise, willingness, and support to teach knowledge and skills not traditionally included in medical curricula.

Healthcare Decisions

2019 ◽  
pp. 118-136
Author(s):  
Ulrik Kihlbom ◽  
Christian Munthe
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Healthcare Professionals ◽  
Clinical Care ◽  
Decision Making Process ◽  
Shared Decision ◽  
The Core ◽  
Person Centered Care ◽  
Centered Care ◽  
Core Idea

The aim of this chapter is to outline how different relational aspects of families may ground obligations on the part of healthcare professionals toward patients and their families in the decision-making process. The exploration starts from the core idea within person-centered care of having patients’ general life situation, experiences, wants, and values to be a substantial topic of concern in a process of shared decision making. If relational decision-making paradigms are to be minimally functional, healthcare professionals’ stances need to involve complex schemes of including people closely related to patients, who will have to be recognized as legitimate stakeholders and partners in, as well as resources for, clinical care.

Servicing the Senior Swallow: A Family-Centered Private Practice Model of Service Delivery

2020 ◽  
pp. 1-4 ◽  
Author(s):  
Yvette M. McCoy
Keyword(s):  
Older Adults ◽  
Medical Model ◽  
Recovery Process ◽  
Swallowing Disorders ◽  
Current Evidence ◽  
Care Needs ◽  
Skilled Nursing ◽  
Person Centered Care ◽  
Centered Care ◽  
Traditional Medical Model

Purpose Person-centered care shifts the focus of treatment away from the traditional medical model and moves toward personal choice and autonomy for people receiving health services. Older adults remain a priority for person-centered care because they are more likely to have complex care needs than younger individuals. Even more specifically, the assessment and treatment of swallowing disorders are often thought of in terms of setting-specific (i.e., acute care, skilled nursing, home health, etc.), but the management of dysphagia in older adults should be considered as a continuum of care from the intensive care unit to the outpatient multidisciplinary clinic. In order to establish a framework for the management of swallowing in older adults, clinicians must work collaboratively with a multidisciplinary team using current evidence to guide clinical practice. Private practitioners must think critically not only about the interplay between the components of the evidence-based practice treatment triad but also about the broader impact of dysphagia on caregivers and families. The physical health and quality of life of both the caregiver and the person receiving care are interdependent. Conclusion Effective treatment includes consideration of not only the patient but also others, as caregivers play an important role in the recovery process of the patient with swallowing disorders.

PRELIMINARY ASSESSMENT OF GPS' KNOWLEDGE AND ATTITUDE ABOUT PERSON CENTRED CARE

2018 ◽  
Vol 28 (2) ◽  
pp. 567-570
Author(s):  
Radost Assenova ◽  
Levena Kireva ◽  
Gergana Foreva
Keyword(s):  
General Practice ◽  
Patient Empowerment ◽  
Patient Relationship ◽  
Preliminary Assessment ◽  
Doctor Patient Relationship ◽  
Patient Centered ◽  
Term Care ◽  
Family Doctors ◽  
Person Centered Care ◽  
Centered Care

Introduction: The European definition of WONCA of general practice introduces the determinant elements of person-centered care regarding four important, interrelated characteristics: continuity of care, patient "empowerment", patient-centred approach, and doctor-patient relationship. The application of person-centred care in general practice refers to the GP's ability to master the patient-centered approach when working with patients and their problems in the respective context; use the general practice consultation to develop an effective doctor–patient relationship, with respect to patient’s autonomy; communicate, set priorities and establish a partnership when solving health problems; provide long-lasting care tailored to the needs of the patient and coordinate overall patient care. This means that GPs are expected to develop their knowledge and skills to use this key competence. Aim: The aim of this study is to make a preliminary assessment of the knowledge and attitudes of general practitioners regarding person-centered care. Material and methods: The opinion of 54 GPs was investigated through an original questionnaire, including closed questions, with more than one answer. The study involved each GP who has agreed to take part in organised training in person-centered care. The results were processed through the SPSS 17.0 version using descriptive statistics. Results: The distribution of respondents according to their sex is predominantly female - 34 (62.9%). It was found that GPs investigated by us highly appreciate the patient's ability to take responsibility, noting that it is important for them to communicate and establish a partnership with the patient - 37 (68.5%). One third of the respondents 34 (62.9%) stated the need to use the GP consultation to establish an effective doctor-patient relationship. The adoption of the patient-centered approach at work is important to 24 (44.4%) GPs. Provision of long-term care has been considered by 19 (35,2%). From the possible benefits of implementing person-centered care, GPs have indicated achieving more effective health outcomes in the first place - 46 (85.2%). Conclusion: Family doctors are aware of the elements of person-centered care, but in order to validate and fully implement this competence model, targeted GP training is required.

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