Feeling part of something bigger gives better home care

Disagreements can arise when different professions collaborate on municipal home care.

Researchers at Nord University have investigated which factors can contribute to building the best care services.

"Reablement" is a term used to describe a segment of home care provided in Norwegian municipalities, aimed at people who have experienced loss of function. 

A group of researchers at Nord University has investigated how different professional groups can cooperate within this area of health services, in order to provide the best care possible.

This is evident in their study,  "Facilitators and barriers for inter-professional collaboration of reablement".  The study also notes that reablement is time sensitive, intensive and goal-oriented. 

A range of specialists, nurses and municipal home care staff all participate in reablement. The service may be called "interprofessional", since many different professional groups collaborate in order to provide care.

- The idea is that collaboration between professional groups with different competencies should provide an overall better service for those who receive care, says Associate Professor Cathrine Moe from Nord University.

Facilitators and barriers

The study, which is based on data from Moe's doctoral thesis on the topic of reablement practice, identifies which factors facilitate reablement practice (facilitators), and which factors produce a subpar service (barriers).

Conditions that lead to subpar service are called barriers. However, the study also shows that even barriers can stimulate discussion that leads to improvement. 

Facilitating factors are:

  • A feeling of being part of something bigger
  • Close collaboration between professional groups
  • Professional autonomy and flexibility
  • Working towards a common goal

Associate Professor Moe explains that facilitators are necessary for ensuring that users benefit from each professional group's specialist knowledge.

- Are any of the factors more important?

- The study does not provide a basis for ranking different factors, but all factors contribute to positive collaborative conditions. These are parts of a collaboration that must work in order to deliver a good, complete service, says Associate Professor Moe.

Being part of something bigger

Researchers reablement: Associate Professor Cathrine Moe, Nord University. Photo: Svein-Arnt Eriksen. Top photo: Dominik Lange, Unsplash. 

Evident in the study is that reablement's profile as change-making and innovative within care services does contribute to a feeling of being part of something bigger for those working in the area.

Associate Professor Moe explains that participants in the study expressed a feeling of contributing to "turning the municipal tide".

- Those who express this feeling, have a sense that they are part of a bigger, modernising project within municipal healthcare. It can create enthusiasm and encourages a greater number of professionals to work towards a common, municipal vision, says Moe. 

Trust-based system

Within reablement, it is usually the user who determines the primary care objectives, and this can improve professionals ability to collaborate, the study shows.

Associate Professor Moe notes that the finding is supported by other studies, which demonstrate that professionals become equals in a system where the user determines his/her personal objectives.

- The objectives become external to the profession: In order to achieve the user's objectives, professional groups need to support one another. Working towards common goals produces a positive collaborative environment, says Moe.

The study describes reablement as a dynamic system in which there a few rules or restrictions. 

- This is a system in which professional discretion plays a big role in decision-making. The study refers to professional groups as having greater autonomy and flexibility. 

- We can call this trust on the balance of responsibility. This is in opposition to the manager-provider model, which emphasises standardisation of healthcare. 

Increased autonomy and flexibility enhance interprofessional collaboration in reablement practice, says Moe.

Barries that can affect reablement practice positively

The study states that both facilitators and barriers in professional practice can benefit the end user.

Barriers can work to sharpen professional practice, increasing the quality of healthcare. In order to address opposition and contrast, professional must think and have a conscious attitude to their own actions. 

The factors that contribute to counteraction are professional morale, care culture versus rehabilitation culture, difference in status among professions and expectations about profitability, says Moe.

According to the study, professional morale relates to tensions between the social mission, which might be increased economic efficiency, versus consideration for the user.

- Ambiguity surrounding professional morale related to fundamental professional values can create a barrier to good collaboration, says Moe

This is also the case when economic efficiency is one of the primary aims of healthcare, the study shows.

- Status can also play a part. There is a divide between those who work with planning and design, and those who work hands-on, in which designers and planners may experience greater status than those at the coalface, says Associate Professor Moe. 

Differences between care culture versus rehabilitation culture are also evident in reablement practice. These different ways of thinking can create tension, the study shows.

- To illustrate these tensions, we can think about an older person who has difficulty taking the stairs. 

- Rather than solve the problem by installing a chairlift, some might focus on balance training and strength so that the person becomes capable of taking the stairs, says Moe. 

She hopes the study can contribute to reflection about workplaces where different professions collaborate on home care.

Read more about the study:

"Facilitators and barriers for the interprofessional collaboration of reablement", by Cathrine Fredriksen Moe, Levi Gårseth-Nesbakk og Berit Støre Brinchmann

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