'it was that … specialist … that finally listened to us … that's probably a weird answer to what you were expecting': Clinician and carer perspectives on brilliant feeding care

Brilliant care: a conceptual argument for scholarship of the extraordinary

Critiques of healthcare often focus on negative experiences to address gaps, issues, and problems. While important, this often obscures care that exceeds expectation - that is, brilliant care. This article centres brilliant care by considering the questions that might be asked to surface it, and what might happen when brilliant care is centred. Specifically, a conceptual understanding of brilliant care is extended within health sociology. In doing so, the article draws on Mol's research on the logic of care, Fredrickson's broaden-and-build theory, and Hochschild's notion of emotion work. Through an application of this conceptual framework to secondary data - namely, reported stories of healthcare experiences from the series 'What's right in health care' - the article demonstrates how the framework surfaces and illuminates aspects of brilliance and its emergence. The article concludes by considering the implications this has on how we make sense of healthcare and the positive, social, and relational aspects that might be surfaced in current and future practices.

Who really decides? Feeding decisions 'made' by caregivers of children with cerebral palsy

BACKGROUND

 There are no definitive guidelines for clinical decisions for children with cerebral palsy (CP) requiring enteral feeds. Traditionally, medical doctors made enteral feeding decisions, while patients were essentially treated passively within a paternalistic 'doctor knows best' approach. Although a more collaborative approach to decision-making has been promoted globally as the favoured model among healthcare professionals, little is known about how these decisions are currently made practically.

OBJECTIVES

 This study aimed to identify the significant individuals, factors and views involved in the enteral feeding decision-making process for caregivers of children with CP within the South African public healthcare sector.

METHOD

 A single-case research design was used in this qualitative explorative study. Data were collected using semi-structured interviews and analysed using reflexive thematic analysis.

RESULTS

 Four primary individuals were identified by the caregivers in the decision-making process: doctors, speech therapists, caregivers' families and God. Four factors were identified as extrinsically motivating: (1) physiological factors, (2) nutritional factors, (3) financial factors and (4) environmental factors. Two views were identified as intrinsically motivating: personal beliefs regarding enteral feeding tubes, and feelings of fear and isolation.

CONCLUSION

 Enteral feeding decision-making within the South African public healthcare sector is currently still dominated by a paternalistic approach, endorsed by a lack of caregiver knowledge, distinct patient-healthcare provider power imbalances and prescriptive multidisciplinary healthcare dialogues.Contribution: This study has implications for clinical practice, curriculum development at higher education training facilities, and institutional policy changes and development, thereby contributing to the current knowledge and clinical gap(s) in the area.