Browsing by Author "Stajduhar, Kelli"

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    Caring for People on the Margins: An Institutional Ethnographic Exploration of Community Palliative Care Work for People who are Precariously Housed
    (2023-09-15) Petruik, Courtney Rae; Ducey, Ariel; McCoy, Liza ( Associate Professor Emerita); Milaney, Katrina; Tezli, Annette; Marshall, Zachary; Stajduhar, Kelli
    People experiencing homelessness have more barriers accessing healthcare than the general population. Challenges are worsened when people become ill and require end-of-life care (EOLC). Some barriers to EOLC for this population include discrimination, service providers who lack knowledge about homelessness, and fewer opportunities to voice care preferences. As part of a developing palliative equity movement, small teams have been created to provide better EOLC for people experiencing homelessness. While much research explores homelessness and healthcare, to date, none investigates the social organization of these teams amidst the mainstream system. This research addresses this gap by exploring how one of these small teams, the Community Allied Mobile Palliative Partnership (CAMPP), interacts with clients, structures their work, hooks into the mainstream healthcare system, and is institutionally accountable to a broader philanthropic funding structure in Calgary, Canada. This project uses institutional ethnography (IE) as its guiding mode of inquiry. From the standpoint of CAMPP clients, IE promotes understanding of how this team’s work is put together, produced, legitimized, and challenged while operating in the interstices of the mainstream healthcare system. With over 100 hours of observations, document reviews, and 21 client and service provider interviews, this research recasts the reader’s view from taken for granted medical models of palliative care toward the social realities of people at society’s margins and how the CAMPP team embeds these needs into their care model. Grounded in client accounts, this project illustrates how the mainstream system is structured to create challenges for people facing economic marginalization warranting a service like the CAMPP team. Paying close attention to language, this study shows how CAMPP is shaped by and reshapes the palliative care discourse to include social factors, mobilizing the widely recognized model of “harm reduction”. Lastly, this project describes how the CAMPP team is funded and their perceptions of the sustainability of their program. This study has implications for policymakers, community programs, researchers, and people experiencing homelessness by making visible how teams like CAMPP provide care “at the margins” of dissolution while caring for people “at the margins” of society.
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    Design and introduction of a quality of life assessment and practice support system: perspectives from palliative care settings
    (2018-08-22) Sawatzky, Richard; Laforest, Esther; Schick-Makaroff, Kara; Stajduhar, Kelli; Reimer-Kirkham, Sheryl; Krawczyk, Marian; Öhlén, Joakim; McLeod, Barbara; Hilliard, Neil; Tayler, Carolyn; Robin Cohen, S.
    Abstract Background Quality of life (QOL) assessment instruments, including patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs), are increasingly promoted as a means of enabling clinicians to enhance person-centered care. However, integration of these instruments into palliative care clinical practice has been inconsistent. This study focused on the design of an electronic Quality of Life and Practice Support System (QPSS) prototype and its initial use in palliative inpatient and home care settings. Our objectives were to ascertain desired features of a QPSS prototype and the experiences of clinicians, patients, and family caregivers in regard to the initial introduction of a QPSS in palliative care, interpreting them in context. Methods We applied an integrated knowledge translation approach in two stages by engaging a total of 71 clinicians, 18 patients, and 17 family caregivers in palliative inpatient and home care settings. Data for Stage I were collected via 12 focus groups with clinicians to ascertain desirable features of a QPSS. Stage II involved 5 focus groups and 24 interviews with clinicians and 35 interviews with patients or family caregivers during initial implementation of a QPSS. The focus groups and interviews were recorded, transcribed, and analyzed using the qualitative methodology of interpretive description. Results Desirable features focused on hardware (lightweight, durable, and easy to disinfect), software (simple, user-friendly interface, multi-linguistic, integration with e-health systems), and choice of assessment instruments that would facilitate a holistic assessment. Although patient and family caregiver participants were predominantly enthusiastic, clinicians expressed a mixture of enthusiasm, receptivity, and concern regarding the use of a QPSS. The analyses revealed important contextual considerations, including: (a) logistical, technical, and aesthetic considerations regarding the QPSS as a technology, (b) diversity in knowledge, skills, and attitudes of clinicians, patients, and family caregivers regarding the integration of electronic QOL assessments in care, and (c) the need to understand organizational context and priorities in using QOL assessment data. Conclusion The process of designing and integrating a QPSS in palliative care for patients with life-limiting conditions and their family caregivers is complex and requires extensive consultation with clinicians, administrators, patients, and family caregivers to inform successful implementation.
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    What are healthcare providers' understandings and experiences of compassion? The healthcare compassion model: a grounded theory study of healthcare providers in Canada
    (British Medical Journal, 2018-03-14) Sinclair, Shane; Hack, Thomas F; Raffin-Bouchal, Shelley; McClement, Susan; Stajduhar, Kelli; Singh, Pavneet; Hagen, Neil A; Sinnarajah, Aynharan; Chochinov, Harvey Max
    Background Healthcare providers are considered the primary conduit of compassion in healthcare. Although most healthcare providers desire to provide compassion, and patients and families expect to receive it, an evidence-based understanding of the construct and its associated dimensions from the perspective of healthcare providers is needed. Objectives The aim of this study was to investigate healthcare providers’ perspectives and experiences of compassion in order to generate an empirically derived, clinically informed model. Design Data were collected via focus groups with frontline healthcare providers and interviews with peer-nominated exemplary compassionate healthcare providers. Data were independently and collectively analysed by the research team in accordance with Straussian grounded theory. Setting and participants 57 healthcare providers were recruited from urban and rural palliative care services spanning hospice, home care, hospital-based consult teams, and a dedicated inpatient unit within Alberta, Canada. Results Five categories and 13 associated themes were identified, illustrated in the Healthcare Provider Compassion Model depicting the dimensions of compassion and their relationship to one another. Compassion was conceptualised as—a virtuous and intentional response to know a person, to discern their needs and ameliorate their suffering through relational understanding and action. Conclusions An empirical foundation of healthcare providers’ perspectives on providing compassionate care was generated. While the dimensions of the Healthcare Provider Compassion Model were congruent with the previously developed Patient Model, further insight into compassion is now evident. The Healthcare Provider Compassion Model provides a model to guide clinical practice and research focused on developing interventions, measures and resources to improve it.