Abstract
BackgroundIn 2013–14, the evidence based care model Hospital-based Home Care for children newly diagnosed with diabetes was implemented at a large paediatric diabetes care facility in the south of Sweden. The first step of the implementation was to promote readiness for change among the professionals within the diabetes team through regular meetings. The aim was to analyse the implicit facilitators and barriers evident on a cultural micro level in discussions during the course of these meetings. What conceptions, ideals and identities might complicate, or facilitate, implementation?MethodsA case study was conducted during the implementation process. This article draw on ethnographic observations carried out at team meetings (n = 6) during the introductory element of implementation. From a discourse theoretical perspective, the verbal negotiations during these meetings were analysed.ResultsThree aspects were significant in order to understand the dislocation during this element of implementation: an epistemological disagreement that challenged the function of information within care practice; a paradoxical understanding of the time-knowledge intersection; and expressions of professional anxiety. More concretely, the professionals exhibited an unwillingness to give up the opportunity to provide structured, age-independent information; a resistance against allowing early discharge; and a professional identity formed both by altruistic concern and occupational guardiancy. The findings suggest the necessity of increased awareness of the conceptions and ideals that constitute the basis of a certain professional practice; a deeper understanding of the cultural meaning that influences care practice within a specific logic in order to predict in what way these ideals might be challenged by the implemented evidence.ConclusionsOur main contribution is the argument that the implemented evidence in itself needs to be examined and problematized from a cultural analytical perspective before initiation in order to be able to actively counter negative connotations and resistance.
Highlights
In 2013–14, the evidence based care model Hospital-based Home Care for children newly diagnosed with diabetes was implemented at a large paediatric diabetes care facility in the south of Sweden
During the hospital stay a team of paediatricians, paediatric diabetes nurses, dieticians and social workers initiate the process of educating the parents on how to balance the child’s treatment with daily life, giving them the necessary knowledge and skills [10]
Aim In 2013 the process of implementing hospital-based home care (HBHC) was initiated at a large paediatric diabetes care facility in Sweden
Summary
Aim In 2013 the process of implementing HBHC was initiated at a large paediatric diabetes care facility in Sweden. In this study the concept was employed to interpret the implementation process as such, since HBHC demands a reorganization of both care practices and to some extent the subjectively-based professional identity of the team members In this respect, dislocation can be regarded as something that both enforces and takes place during the implementation process, by 1) making contingency visible through the suggestion of an evidence-based alternative care practice, and 2) as it, through the presence and work of the facilitator, becomes part of an ongoing negotiation. It becomes central to identify why subjects invest in certain practices and reject others; why particular practices are experienced as possible and others impossible It will be shown through excerpts from the ethnographic data how different aspects of the HBHC model, that is the evidence in itself, grip the team members in different ways and effect the implementation process. In the analytical sections below we apply this model of hermeneutic interpretation
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