Abstract
BackgroundPatient participation is a key concern in health care. Nevertheless, older patients often do not feel involved in their rehabilitation process. Research states that when organizational conditions exert pressure on the work situation, care as a mere technical activity seems to be prioritized by the health‐care staff, at the expense of patient involvement.ObjectiveThe aim of this article is to explore how health‐care professionals experience patient participation in IC services, and explain how they perform their clinical work balancing between the patient's needs, available resources and regulatory constraints.DesignUsing a framework of professional work and institutional logics, underpinned by critical realism, we conducted semi‐structured interviews with 18 health‐care professionals from three IC institutions.ResultsIC appears as an important service in the patient pathway for older people with a great potential for patient participation. However, health care staff may experience constraints that prohibit them from using professional discretion, which is perceived as a threat to patient participation. Further, they may adopt routines that simplify their interactions with patients. Our results call for more emphasis on an individualized rehabilitation process and a recognition that psychological and social aspects are critical for patient participation in IC.ConclusionPatients interact in the face of conflicting institutional priorities or protocols. The study adds important knowledge about the practice of patient participation in IC from a front‐line provider perspective. Underlying mechanisms are identified to understand and recommend how to facilitate patient participation at different levels in narrowing the gap between policy and clinical work in IC.
Highlights
Over recent decades, political changes have strengthened the pa‐ tient's position through laws and regulations that require the im‐ plementation of patient participation in health care.[1,2,3] Patient participation implies that the patient's capabilities, needs and goals should individualize the health care interventions.[3,4,5,6] This may be a concern in the care of frail older patients with multiple and chronic diseases, a group that is increasing globally.[7]
The aim of this study is to explore how health‐care profession‐ als in intermediate care (IC) services experience patient participation, and explain how they perform their clinical work balancing between the patient's needs, available resources and regulatory constraints
IC appears as an important service in the patient pathway for older people with a great potential for patient participation
Summary
Political changes have strengthened the pa‐ tient's position through laws and regulations that require the im‐ plementation of patient participation in health care.[1,2,3] Patient participation implies that the patient's capabilities, needs and goals should individualize the health care interventions.[3,4,5,6] This may be a concern in the care of frail older patients with multiple and chronic diseases, a group that is increasing globally.[7]. A concept analysis defines patient participation in IC as “a dy‐ namic process emphasizing the person as a whole, focusing on the establishment of multiple alliances that facilitate individualized in‐ formation and knowledge exchange, and ensuring a reciprocal en‐ gagement in activities within flexible and interactive organizational structures.” (p1343)[13] IC services are meant to be holistic, taking into consideration psychological, social and physical aspects of func‐ tion.[14] Yet, studies indicate that frail patients often do not feel in‐ volved in rehabilitation.[15,16] Identified challenges are organizational and professional collaboration, but there exists little information about how these challenges impact clinical work.[17,18,19]. Health care staff may experience con‐ straints that prohibit them from using professional discretion, which is perceived as a threat to patient participation. They may adopt routines that simplify their interactions with patients.
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