Understanding Practices of Patient and Family Centred Care in Hospitals

• Author / Creator

  Judge, Harkeert

• In Canada, the adoption of Patient and Family Centred Care (PFCC) initiatives for adult patient populations across hospital care settings are thought to improve quality of care, safety, and cost effectiveness. However, PFCC strategies have been reported to be difficult to implement and sustain at the direct level of acute patient care due to a variety of issues including competing organizational priorities, paradoxical ethical implications, and insufficient conceptual knowledge about PFCC in practice. These persistent difficulties suggest that care in general may actually be more complex than often assumed. As such, this study investigates everyday care practices to explore how patient and family centredness is enacted in acute care. The main research objective of this study is to think about the possibilities of improving care for patients and families in hospital settings by paying attention to the complex and entangled relations, actors, technologies, and politics involved in organizing care. A practice view of work and organization is used to explore how care of families and patients is enacted in hospitals. Ethnographic methods, including participant observation, document analysis, and interviews with patients, families and members of patient care teams were conducted over one year. The study took place in a teaching hospital located within Alberta and included two surgical wards that specialized in the delivery of orthopaedic care to adult patient populations. Five patients and their family members were recruited as case study participants. Nurses and unit managers were also shadowed, interviewed, and observed while organizing everyday care. Findings in this study are organized around three observations. First, hospitals are not neutral settings of care in which PFCC can simply be implemented. Second, there were multiple values entangled in nursing practices and these were not always aligned with the values, desires, or preferences of patients. Third, despite, or perhaps because of, significant material and bodily precarity, patients and families in this study worked actively to ‘centre’ themselves in day-to-day orthopaedic care practices. These findings are relevant for nurses and researchers interested in reinventing ideas about good care practices for patients and families experiencing hospitalization.

• Subjects / Keywords

  • Nursing
  • Patient and Family Centred Care
  • Ethnography
  • Practice-based research

• Graduation date

  Fall 2023

• Type of Item

  Thesis

• Degree

  Doctor of Philosophy

• DOI

  https://doi.org/10.7939/r3-k32q-ee04

• License

  This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.