Apr 8, 2018 - thingsâ¦it pleased my eye as well as the .... scan it and get me out of there, quick ... Radiography http://dx.doi.org/10.1016/j.radi.2013.10.009.
Patient Centred CareMyth or Reality? Dr Pauline J Reeves Sheffield Hallam University
Challenge 1- Language Endemic use of reductionist language to refer to patients
REDUCTIONISM Reducing patients to their constituent parts, signs or symptoms
The concept of reductionism derives from the biomedical model of disease which assumes that; • The body acts like a machine, with parts & processes that malfunction • Illness is generated by assault from pathogens (bacteria, viruses etc) • Treatment uses chemicals to rectify physiology or eliminates parts by surgery or radiation
How radiographers refer to patients; • “ There‟s a chest in the cubicle”
• “ There‟s a lumbar spine on a trolley” • “Can I do the next pelvis?” • “We‟ve got 3 left and 4 right breasts on the list”
• We have a system of clinical assessment that perpetuates this
Protective mechanisms • In a key paper about nursing practice, Menzies (1960) argues that task orientation and depersonalisation of the patient protects the practitioner from the totality of the patient‟s illness
How radiographers often refer to each other; • It has been noted that there is an increasing tendency to refer to other colleagues by their banding • „there are only 2 band 5‟s on the rota today‟
Whiting (2010 ) argued that; • Students‟ awareness of the holistic nature of professionalism and its long term responsibilities were not brought to the fore
HOLISM
“ You know, sometimes you get so bugged up with technology, you forget there is a patient there, that it is a whole person that we‟re dealing with” (Reeves & Decker 2012)
Challenge 2- focus Technological aspects of our role(s) shift the focus away from the patient
The Patient-Centred Model of Radiography (Reeves 1999) Assessment/planning
Patient communication
Patient care
Patient
Sequencing/adaptation
Evaluation of images
Speed/efficiency
Bolderston et al (2010) • Qualitative study of radiation therapists using 4 focus groups • Sub-themes included: The patient at the centre of care
From the beginning of diagnostic radiography our focus has always been the image NOT the patient
Bolderston et al (2010) • “There‟s no result just from being kind to someone, or listening to them. How do you evaluate what that really did for someone? • Whereas the technical part of it, like if you take a good image or match the cone beam, it‟s much easier to evaluate those things”
Image focussed • “And I still like to see an aesthetically beautiful film. I actually think …there is beauty in the way you can set it out and things…it pleased my eye as well as the other senses” (Reeves & Decker 2012)
Radiotherapy treatment- Settings focussed? • Personal experience of radiotherapy revealed a tendency to focus on the set-up • The fact that there must always be 2 people tended to mean that they related to each other, rather than the patient
Challenge 3- Distance Distancing as a tool to cope with emotional aspects of the role
(Reeves & Decker 2012) • Distancing oneself from the patient is a tool for dealing with the emotional demands of the job • Emotion work is the process of handling our daily, personal emotions; • Emotional labour involves invoking, performing, and managing emotions that are a required aspect of a job or occupation” (ie. Professional).
@BigRad Tom
• We put our game face on and portray the demeanour of a Jekyll character in order to promote professionalism and integrity in a national health service where our true „identity‟ lay hidden with Hyde. • Only behind closed doors or out of work hours this trait is allowed to surface. • With morale levels at an all-time low …..there is very little focus on the staff themselves who are fighting to keep the NHS going. Often branded as heroes, it is important to remember we are not. Jekyll and Hyde in the NHS April 8, 2018 https://medradresearch.wordpress.com/
Distancing in Radiotherapy • Distancing is enforced by the need to vacate the treatment area • This is further reinforced when the use of masks is required
Challenge 4- Time Short episodes of care
Defining the role of the radiographer It is a caring role, but tends to be characterised by less time or close involvement with patients, when compared to other professions. (Reeves 1999)
The Patient-Centred Model of Radiography (Reeves 1999) Assessment/planning
Patient communication
Patient care
Patient
Sequencing/adaptation
Evaluation of images
Speed/efficiency
Speed & • Diagnostic radiographersefficiency the „hit and run‟ carers • ‘blip culture’ (Murphy 2006; Hayre et al 2016))
• “You‟re not holding on to them long enough for them to realise who you are, what you do…” (Reeves & Decker 2012)
Speed & efficiency
• Not only short episodes of care, but, unlike radiotherapy treatment, they are not (or very rarely) repeated • Bolderston et al (2010) contrasted single appointments for planning with treatment cycles • As radiotherapy treatment periods get shorter, this will also be an issue
Challenge 5- Volume Challenges and responses to increasing workloads
Whiting (2010) • Professionalism was defined in terms of the capacity to get through a large volume of patients and produce high quality images in the shortest possible time.
Hayre, Blackman & Eyden (2016) • „Right. Let‟s knock these out-get them in, get them out, get them done‟ • „If it‟s busy, it‟s literally one in; one out….it‟s like a bit of a conveyer belt.‟ • (Referring to DDR rooms);
• „They‟re now more like sausage factories‟.
Bjorkman et al (2017)
• Swedish study using focus groups identified this as one of 4 possible future scenarios • “…you count the minutes and how long an examination will take – chop-chop.”
Hayre et al (2016)
• There is also a suggestion now that patients themselves may value the speed of digital examinations • „So they‟re like „Wow!‟. Every time they come in they say that.‟
Bolderston et al (2010) • The rapport built during weeks of treatment was also discussed when comparing radiation therapy to diagnostic imaging. • It was perceived that: • “Caring is different because when you‟re going in for a one time X-ray or something like that, you don‟t expect that much care. I want you to scan it and get me out of there, quick and easy”
Media attention • If patients‟ attention is constantly being drawn by media focus on NHS waiting times, it may encourage patients to value speed and efficiency even more
Whiting (2009):
• A study of radiography students found a disparity between patient care skills and technical competence. • Students felt that they were being socialised into a profession where technical competence was being prioritised over patient care.
Bjorkman et al (2017)
• In Sweden, the future availability of radiographers is uncertain, due to increased retirement among radiographers and a smaller number of young people entering higher education. • This implies a reduced number of radiographers in the future.
References • • •
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Bjorkman B, Fridell K & Tavakol Olufsson P (2017)Plausible scenarios for the radiography profession in Sweden in 2025 Radiography 23(4) 314-320 Bolderston A, Lewis D & Chai MJ (2010) The concept of caring: Perceptions of radiation therapists Radiography 16(3) 198-208 Hayre CM, Blackman S & Eyden A (2016)Do general radiographic examinations resemble a person-centred environment? Radiography 22 (4) e245-e251 Reeves P (2013) Chapter 2- Communication with specific patient groups in Ramlaul A & Vosper M Patient Centred Care in Medical Imaging and Radiotherapy Elsevier Reeves P & Decker S. (2012) Diagnostic radiography; A study in distancing Radiography 18 (2) 78-83 Strudwick R (2013) The Radiographic Image: A Cultural Artefact? Radiography http://dx.doi.org/10.1016/j.radi.2013.10.009 Whiting C (2009) Promoting professionalism. Synergy, September, p4-7. Whiting C (2010) Developing Professionalism: how effective are we? Synergy June p16-20
