Patient-centred care--what is it and how is it practised in the dental surgery?

OBJECTIVES

This paper explores the understanding and practice of patient-centred care (PCC) within dentistry. The aim of the research was to explore the nature of PCC, how PCC is taught and how it is practiced within a dental setting.

METHODS

The results of a qualitative, interview-based study of dental professionals working across clinical and teaching positions within a dental school are presented.

RESULTS

Results suggest that a shared understanding of PCC revolves round a basic sense of humanity ('being nice to patients'), giving information that is judged, by the clinician, to be in the patient's best interest and 'allowing' patient choice from a set of choices made available to patients by the clinicians themselves.

CONCLUSIONS

This research suggests that significant work is needed if dentists are going to conform to the General Dental Council guidelines on patient-centred practice and a series of recommendations are made to this end.

The context of empowerment and self-care within the field of diabetes

There is a growing emphasis within the diabetes literature on the importance of empowerment as a way of encouraging people to take control of and responsibility for the successful management of their disease. Patients are actively encouraged to become active participants in their care, and there is an expectation that health-care professionals will facilitate this process. This article uses Bourdieu’s concept of field, as a bounded social space in which actors conduct their lives day-to-day, to explore the context within which issues of empowerment are addressed and negotiated. The practice of empowerment within the biologically defined and biomedically ‘policed’ field of diabetes is explored using empirical data from a study of diabetes health-care professionals’ understanding and practices around empowerment. It is concluded that rather than promoting active self-management and empowerment, the nature of the field of diabetes, and in particular its privileging of the biomedical, can mitigate against people with diabetes negotiating the field effectively and taking control of the disease and its management.

Barriers and opportunities of empowerment as applied in diabetes settings: a focus on health care professionals' experiences

This exploratory study examines the opportunities and barriers health care professionals (HCPs) working with diabetes patients face when they try to implement the rhetoric of patient empowerment in practice. A small sample of diabetes HCPs (N=13), from National Health Service (NHS) hospital, walk-in and general practitioner (GP) clinics in South-East England, was interviewed through in-depth semi-structured interviews. Interviews were recorded, transcribed verbatim and analysed thematically. The analysis showed that empowerment was seen as beneficial for patients and HCPs. Time and resources could be moved from successfully empowered patients and focussed on more complex patients, this was termed 'selective empowerment'. The main barriers to empowerment were identified as a lack of resources, time and HCPs trained in empowerment techniques. Empowerment is a popular concept in theory, and presents HCPs with several opportunities but also important barriers in its practical, clinical implementation day-to-day.

Health care professionals' understanding and day-to-day practice of patient empowerment in diabetes; time to pause for thought?

This exploratory study examines what Health Care Professionals (HCPs) working with diabetes patients, understand by the term 'empowerment', their attitudes towards it and whether they believe they practise in ways consistent with empowerment principles. A small sample of diabetes HCPs (N=13), from National Health Service (NHS) hospital, walk-in and General Practitioner (GP) clinics in South-East England, was interviewed. In-depth semi-structured interviews established attitudes towards and use of empowerment in day-to-day practice. Interviews were recorded, transcribed verbatim and analysed thematically. There was no clear specific understanding of what empowerment is and what it involves, although there was broad reporting of factors around education and informed choices. Disagreement was evident about the level of freedom patients should have in making choices - from leading them to the 'right' choice to an acceptance that they may have the right to choose not to be empowered. No consensus emerged on what is successful empowerment and how it is measured. The resistance of some patients to the process of empowerment in its original definition of active partnership in care, was seen as problematic by HCPs. Although empowerment is a popular concept in theory, its practical, clinical implementation day to day, can be problematic.

Marrying contradictions: healthcare professionals perceptions of empowerment in the care of people with Type 2 Diabetes

OBJECTIVE

The aim of the study was to establish how healthcare professionals (HCPs) involved in Type 2 Diabetes (T2D) perceive patient-empowerment. We aimed to identify their understanding of empowerment, and how these inform their day-to-day practice.

METHODS

Employing a qualitative approach, ten interviews with diabetes HCPs in two local Health Trusts were conducted. Data were transcribed verbatim and analysed using framework analysis.

RESULTS

HCPs viewed empowerment as a rejection of the paternalistic approach. Emphasis was given to ways of balancing clinical aims against patients' concerns. Some saw the approach as improving service quality, whereas others saw empowerment as a process of social justice. These were related variably to the expedient use of resources.

CONCLUSION

Models of empowerment, which promote that HCPs bring clinical expertise and patients 'lay' expertise of illness to the medical encounter, are inadequately descriptive of how empowerment approaches are actually engaged with, by HCPs.

PRACTICE IMPLICATIONS

The empowerment approach is construed and utilised in different ways. Clarification of what empowerment entails in practice for HCPs, as well as what HCPs perceive are its multiple aims, is required.