Published on April 3, 2014
The Patient’s Journey A Client Perspective Northern Adelaide Local Health Network Transition Care program: NALHN - TCP South Australian Community Health Research Unit: SACHRU
We acknowledge that the land we meet on today is the land of the Gadigal people of the Eora Nation. We pay our respect to Elders past and present, to their Ancestors and to other Aboriginal and Torres Strait Islander people present today.
PRESENTATION OVERVIEW > NALHN – TCP Model > What was the problem? > Engaging with SACHRU > The Project > What did we learn?
NALHN TCP - MODEL
NALHN TCP > A number of the agencies have their own feedback/ evaluation methods for their own services > Need to avoid ‘evaluation overload’ for clients > Clarification required about what we needed to know
WHAT DID WE WANT TO KNOW? > What was the experience of initial contact whilst a hospital patient – what was the expectation, and did our staff explain the program well? > What was the experience through the journey? > Was discharge supportive?
WHY SACHRU? > Situated within Flinders University > Well known for its commitment to community service evaluation > www.flinders.edu.au/medicine/sites/sachru
SACHRU research team > Lead Researcher > Dr Ruth Walker – Senior Research Fellow > Assistant > Julie Johns – Research Associate > TCP advisor > Dianne Halliday
THE PROJECT > The aim was to undertake a qualitative study of the ‘client journey’ from initial contact to discharge. The proposal was also to develop: > 1) a simple quantitative instrument which could be distributed to clients post discharge from hospital regarding their expectations of the program and; > 2) a tool that could be distributed to clients post TCP, regarding their experiences on the program.
The project methods > Stage 1 – development and distribution of pre TCP questionaire > Stage 2 – post TCP in depth interviews > Stage 3 – development and pilot testing of a post TCP questionaire > Stage 4 focus groups
Challenges encountered > Engaging clients • Frail and overwhelmed at the beginning > Ensuring follow up • Circumstances changed over course of the program
What did we learn? > Themes • Control • Loss/adaptation • Gains • Process issues/system literacy • Attending to the whole person • Role of personal outlook or attitude
What did we learn? -process issues: access > “It came about because I have… [if it were] just he and me it probably wouldn’t have happened... but I have two daughters, nurses. One’s in the public health and a son in law who’s very forceful and another daughter who’s very forceful and between them my one daughter in the public health thought of the Transitional because she knows all about aged care and I think the very nice lady who came and interviewed everybody thought there was a glimmer of hope there and he could be rehabbed you see and that was it. If it hadn’t have been for the family I don’t know what would have happened. I really don’t know. (carer interview; client 87 year old male; residential).
What did we learn? -process issues: access > “I think they just looked at him and they thought he's 86 and he's not very co-operative because he wasn't with the dementia and then the [effects of the] Aricept on top of that with a different personality and they looked at me and they thought she's an old woman too. The best thing for - we'll decide the best thing is that he goes into a nursing home, she can go and visit. That was the feeling. They didn't actually say that.” (carer interview; client 86 year old male; community)
What did we learn? -process issues: program design “I didn’t think that there was quite enough of it at [residential care setting]. It was about, I think the first couple of weeks I don’t think there was anybody, but then another bloke came along and he gave me a work over once a week and that was very good but weekly seemed to be a bit far apart” (85 year old male; residential).
What did we learn? -process issues: program design “Well, I just seemed to be plodding along and going to the physio everyday and generally having a very nice time, thank you. I am not making any progress and I have come to a dead halt and I have got to do something about this, so I spoke to the Care Coordinator and I said ‘I think it is time that I went home’ and she said ‘do you feel confident?’ I said ‘yes.’ She said ‘oh well, we will see but the occupational therapist will have to come out with you.’ I said, ‘fine.’ So she did that and then the next thing I know, a week later I am going home. I thought ‘whoopee, why did I wait so long.’ I think I could have done it two or three weeks earlier, but I was sort of waiting for them to tell me...They, I think, were waiting for me to tell them because your self confidence is a different thing, you can’t judge that if you are the other person. (80 year old female; community).
What did we learn? -process issues: discharge “Well [once I got home from residential care] I had what was left of my twelve weeks, so I had a girl for an hour and a half once a week and I had somebody taking me shopping for an hour on Fridays and that was terrific but then that finished a week past Wednesday, and of course, I knew it would happen. [The agency] tried to get rid of me back to [another agency] so I am now back with them and they are going to give me an hour and three quarters every two weeks... but if you look at the size of this place, you can’t clean this in an hour and a half or even an hour and three quarters but they don’t do shopping…(80 year old female; residential).
What did we learn? -process issues: discharge “This is not very much different from what it was before he had the fall because we're very self- sufficient and I know a lot of people will say, oh you have to look after yourself and have all these social engagements. Well I didn't have them before because I didn't need them and I don't need them now. So, but I know that there are people who do feel totally limited if they have to be at home helping with somebody. I was doing it before we had the fall. That's just part of growing old together” (carer interview; client 86 year old male; community).
What did we learn? - control: relinquishing “It was marvellous really. Because I said I didn’t think I would need much at all, but they said oh no, you need to… yeah they wrote down what I really needed”. (78 year old female; community) “Well I presume [the purpose] was principally [to] ease the transition from a very caring and persistent outfit like the hospital, to the situation here, I’m on my own” (85 year old male; residential).
What did we learn? - control: maintaining “When we came home and the next day, oh no, that very afternoon, the TCP people were [there], the co-ordinator, the physio and the OT, [it was] like Piccadilly circus. Once it was sorted what was going to happen, it fitted around. It just meant that virtually four days a week your mornings were not our own, given that you spent the early part of the morning making sure that you could get him up out of bed in time and get his breakfast and tidy everything up before the carer came. And for four mornings, it was pretty well a write-off for him and occasionally there'd be someone who would come in the afternoon, maybe just to do a review of something or other, but they weren't intrusive and they were always very courteous and helpful”. (carer interview; client 86 year old male; community).
What did we learn? – loss/adaptation “Well I think we're probably a bit more day to day here. It's...who knows what the future will bring. I mean he's got vascular dementia and hypertension. He's had it for 40 years. So I just have to go with the flow with that, see where it takes us. And he might go on for years with it, who knows? He's managed it, we've all managed really well all his life with exercise and diet but nothing lasts forever. While we have the carer coming in twice a week and the equipment service there if we need it, I think we're okay. We've got Access cabs if we have to have an appointment in town”. (Carer interview; client 86 year old male; community).
What did we learn? - Gains “Once they [the TCP program] stepped in, into the situation things changed… Well they were positive. I mean their part of their mission I guess is to help people to get back home and they've achieved that to my satisfaction because I said all the way along the line at the hospital, he has a mobility problem and he's had a fall so it's not going to be short term getting him back onto his feet again, but he just needs to get back to where he was. Like he doesn't need to be able to run the London marathon...” (carer interview; client 86 year old male; community).
What did we learn? - attending to the whole person “Oh yeah we went through all of that. Well they wanted to know when he passed away, like how long ago type of thing, was I coping and I said, “Oh well he’d been sick so I knew he was going to die”, if you know what I mean and I didn’t expect this then to happen straight away. So I thought I was going to get on with my sewing and fill in my time that way, and that wasn’t to be as such but they did as me all those sort of things and they asked me what I was eating, what I was – was I drinking enough, or all those sort of things yeah” (67 year old female community)
What did we learn? - role of self-perception “I’m not a look backer, I’m an optimist and look ahead, I don’t think in the past… Because I do believe the less you do, the less you want to do, and so therefore I did need to help myself… So really in a lot of ways it’s really just common sense. If you can’t do something one way, well you find another way to do it”. (66 year old female; community) “I’ve been making hot drinks for people who come to see me for a long time, and they’ll say, “We’ll do it for you”, and I say, “Let me do it”, they think they’re being helpful but I’ve got to do things for myself. I can’t just sit here like a big lump in a chair and not do anything”. (78 year old female; community)
Our response - through the journey > Strengthen our presence in hospital > Enable the client voice to be heard > Lobby for better discharge opportunities
Our response - improving our service quality > Attend to whole person > Goals designed by the client > Not allow losses to dominate/ highlight and emphasize gains > Work across whole sector to identify best discharge options for individual circumstances > Keep listening
Summing Up “And we were just saying, do we bring him home with us? Do we bring him back here and try and get someone to come in? And we thought that we should come and stay with him and then of course when we had that meeting [with the TCP], they explained what services they can have and we thought, yes, please. Because we didn’t want to take independence away from him because I mean he’s so used to having his own home and everything and we have had him once before when he had a lot of problems with his lungs and everything. We had him for nearly two weeks, him and mum. And you could see by the end of it, he was just like, I want to go home, sort of thing” (carer interview; client 84 year old male; community). www.flinders.edu.au/medicine/sites/sachru
Mitos y realidades de las sustancias psicoactivas
Mitos y realidades de las sustancias psicoactivas.