Palliative care teams and individual behaviours

The nature and importance of quality of therapeutic relationships in the delivery of palliative care to people with intellectual disabilities

BACKGROUND

The importance of the therapeutic relationship in the delivery of palliative care is well recognised. Little has been published on the nature or quality of relationships formed between staff and patients with intellectual disabilities despite case reports suggesting that difficulties exist in providing palliative care to this group.

AIMS

This study was part of a project that aimed to describe the delivery of palliative care to people with intellectual disabilities in a region of Ireland and to conduct a corporate assessment of palliative care need. We detail findings that explore the nature and importance of the quality of relationship in the delivery of care.

METHODS

91 staff from palliative care and intellectual disability services participated in 16 focus groups.

FINDINGS

Staff valued their relationships with service users, and felt that the quality of their relationship affected its therapeutic potential. Participants described factors fundamental to the development of quality relationships. Palliative care and intellectual disability staff commented on the importance of trust, of continuity of relationship and of knowing the individual. However, palliative care staff admitted to difficulties in these areas when providing care to people with intellectual disabilities. It appeared that quality of care was affected in situations where staff failed to form authentic relationships.

CONCLUSIONS

This study adds to our knowledge of the processes of delivery of care to people with intellectual disabilities. The description of difficulties experienced by palliative care staff gives us an opportunity to develop strategies to improve the quality of services provided.

Organisational culture and change: implementing person-centred care

PURPOSE

The purpose of this paper is to explore the connection between organisational cultures and the employee's resistance to change at five hospital wards in Western Sweden. Staff had experienced extensive change during a research project implementing person-centred care (PCC) for patients with chronic heart failure.

DESIGN/METHODOLOGY/APPROACH

Surveys were sent out to 170 nurses. The survey included two instruments--the Organisational Values Questionnaire (OVQ) and the Resistance to Change Scale (RTC).

FINDINGS

The results indicate that a culture with a dominating focus on social competence decreases "routine seeking behaviour", i.e. tendencies to uphold stable routines and a reluctance to give up old habits. The results indicate that a culture of flexibility, cohesion and trust negatively covariate with the overall need for a stable and well-defined framework.

PRACTICAL IMPLICATIONS

An instrument that pinpoints the conditions of a particular healthcare setting can improve the results of a change project. Managers can use instruments such as the ones used in this study to investigate and plan for change processes.

ORIGINALITY/VALUE

Earlier studies of organisational culture and its impact on the performance of healthcare organisations have often investigated culture at the highest level of the organisation. In this study, the culture of the production units--i.e. the health workers in different hospital wards--was described. Hospital wards develop their own culture and the cultures of different wards are mirrored in the hospital.

Relating configuration and learning in Brazil and Australia

PURPOSE

This paper aims to investigate whether an organisation's configuration, with regard to its operating environment, could have a bearing on the learning that occurs within the organisation because the configuration can be considered an artefact capable of enabling learning and capable of facilitating the storage and utilisation of the results of learning. This raises an interesting question about the ability of organisations to shape the configuration that enables and facilitates them, which in turn would shape the learning itself.

DESIGN/METHODOLOGY/APPROACH

Reported in this paper is research in healthcare organisations in Brazil and Australia that use a multidisciplinary model of care delivery which test these relationships.

FINDINGS

The paper's findings indicate that in the Brazilian case learning has to do with the formal acquisition of knowledge for use within professions, by professionals who are in practice and teaching. In the Australian case learning has to do with the flexible acquisition of knowledge across professions, within and between teams. ORIGINALITY/APPROACH: This paper is useful to those wishing to facilitate learning in an organisation.