Norwegian version

Public Defense: Ingvild Lilleheie

Ingvild Lilleheie will defend her thesis “Older geriatric patients’ and family caregivers’ perceptions on the quality of healthcare services at discharge and during the 30 days course after hospitalization. A qualitative study for the PhD in Health Sciences."

Zoom link

Zoom link trial lecture and public defense (oslomet.zoom.us).

Meeting ID: 686 9097 2088

Password: 065426

Trial Lecture

The trial lecture starts at 10:00 in Zoom.
We ask the audience to enter Zoom 15 minutes prior to commencement of the trial lecture.

Title: Bærekraftig samarbeid mellom pårørende (informal caregivers) til skrøpelige gamle og helsetjenesten med særskilt fokus på helserelaterte overganger - teoretiske perspektiver og kliniske implikasjoner.

Public defense

The candidate will defend her thesis at 12:15 in Zoom.

Ordinary opponents

Leader of the public defense

Leader of the public defense: Associate Professor Slawomir Wojniusz, Faculty of Health Sciences, OsloMet

Supervisors

  • Abstract

    Background

    Previous research has reported lack of attention on how quality of healthcare is perceived by older patients themselves and by their informal caregivers, based on their reported experiences of the discharge process and how older patients and their informal caregivers experience the return to everyday life. Thus, the overall aim of this study is to produce evidence-based knowledge that can inform policy, clinical practice, and research on how to provide high-quality healthcare services to geriatric patients in hospital, during the discharge process, and during the 30-day period after discharge. 

    Method

    The thesis consists of two qualitative approaches; 1) a metasummary and 2) data from semi-structured interviews. The metasummary is based on Sandelowski and Barroso’s method. In addition, semi-structured interviews with 18 older patients (aged ≥80) and 12 informal caregivers were performed.  Thematic analysis was used to analyse the data. 

    Results

    The analysis in the metasummary (paper I), based on 18 studies, portraying older patients’ experiences regarding participation in hospital discharge, revealed five main themes: 1) the complexity of the patients’ state of health, 2) management and hospital routines, 3) the norm and preference of returning home, 4) challenges of mutual communication and asymmetric relationships, and 5) the significance of networks. The patients experience of participation was related to factors as personal health status, hospital routines, mutual communication, family networks, and the asymmetric relationship between healthcare professionals and patients. Most patients indicated that they were given few opportunities to participate in shared decision-making regarding their own discharge.

    The older patients’ experiences of the quality of the healthcare in hospital and the first 30 days after discharge (paper II), revealed five themes: 1) hospital stay and the person behind the diagnosis, 2) poor communication and coordination, 3) life after discharge, 4) relationship with their next of kin, and 5) organizational and systemic determinants. The older patients reported few invitations to participate in decisions regarding their own care, to share their concerns, or to tell the staff what was important to them. They reported insecurity and distress due to a lack of information and coordination. The caregivers helped patients when the health service was unable to assist. The patients experienced healthcare services focused on diagnosis rather than listening to their concerns or addressing their needs.

    In paper III the informal caregivers’ experiences of the healthcare quality provided to older patients in hospital and the 30 days after hospitalisation were related to four themes: 1) fast in, fast out – the tension between appropriate and efficient healthcare, 2) scant information – the tension between short-term versus long-term goals and openness versus closeness, 3) disclaimer of responsibility – the gap between the hospital, the city district and the intra-city district, and 4) a struggle to secure professional care – the tension between competence and incompetence. The participants reported that the healthcare system payed little attention to the mutual understanding of those involved in patient care. They experienced the healthcare as focused on the patients’ diseases rather view patients holistically. They indicated that hospital stays were short owing to financial considerations. After discharge, they reported receiving insufficient information. They questioned who was responsible for the follow-up of the patients and stated that they felt left alone with responsibility for practical tasks and securing sufficient care. 

    Regarding how older patients and their informal caregivers perceived the informal care, (paper IV) our analysis revealed four main themes: 1) bridging the gap, 2) family is family, 3) never enough, and 4) stress and distress. Our findings suggest that informal caregivers and care recipients experienced an imbalance between their care needs and available resources from the health services. Formal resources were not balanced against the participants’ available time, social roles, physical and emotional states. Although the patients desired to maintain independence and equity in relation to their informal caregivers, their needs for assistance and care seemed to have a negative impact on the informal caregivers’ ability to balance care tasks against other life commitments. This influenced the relationship between them. 

    Conclusion

    The metasummary showed that collaboration between different levels in the health systems and information between staff, patient and families which is adapted to the user's needs and preferences are crucial for the involvement of older patients in the hospital discharge process. Organisational structure may need to be restructured to ensure older patients participation. With respect to quality of the health services, the patients disclosed that healthcare focused on measurable values and biomedical inquiries. Few opportunities for participation, scant information and suboptimal care coordination left the patients with a feeling of being in limbo, struggling to manage everyday life.  

    The older patient’s informal caregivers suggested that health services must consider each person’s preferences and strengthen and support the involvement of caregivers. Both old patients and informal caregivers faced strains within their roles and the care situation has potential to be burdensome. 

  • Digital defense information

    The OsloMet campus is closed as a consequence of the corona virus pandemic

    Due to restrictions and limitations on physical participation, the public defense will be conducted on the zoom digital platform.

    Attend the public defense live in Zoom

    The link to the digital defense in Zoom is on the top of this page. OsloMet students and employees use OsloMet accounts. Others can download Zoom or use a browser.

    How to oppose ex auditorio

    Please send your question to the host during the break, before the second opponent begins. Raise your digital hand by clicking on "Participants" at the bottom of the zoom window and choose "Raise Hand" if you would like to voice the question yourself after both opponents have finished their questions. The technical administrator will ask to activate your microphone. Click Yes.

    Attend the trial lecture live in Zoom

    The link to the trial lecture in Zoom is the same as the public defense. We ask the audience to enter 15 minutes early by clicking the yellow button at the top of this page. You can leave the Webinar and come back or stay in Zoom during the break (30-45 minutes).

    Need help to get into Zoom?

    About Zoom (ansatt.oslomet.no)

  • Publication of the approved PhD thesis

    Request a copy of the PhD thesis by e-mail. Include the name of the PhD candidate.

  • Questions?

    Who can answer questions prior to trial lecture and public defense? phd-hv@oslomet.no