The modern hospice movement emerged in the 1960s as a grassroots social movement that attempted to restore an holistic and contextualised approach to the care of people at the end of life. This approach embraced the lived experience of the dying person at the centre of care across physical, emotional, social and spiritual domains of life. To achieve this, the care of dying people was largely removed from mainstream health care systems to promote more holistic and socially contextualised dying. In recent decades, the evolution of palliative care demonstrates the gradual return of palliative care services to the mainstream. It has been asserted that, in this process, palliative care services have progressively abandoned the social context of dying people, increasing instead an emphasis on "physical care [while] simultaneously de-emphasizing psychological, social and spiritual care" (Kellehear, 1999a, p.76). Kellehear and others have proposed that the repositioning of palliative care within mainstream health care systems has increased a focus upon illness and disease at the expense of health and wellbeing. Subsequently, conventional palliative care services have been criticised for not adequately locating end of life care within the social contexts in which death and dying take place. In an attempt to address this problem, Australian sociologist Allan Kellehear proposed an approach to end of life care that brought together the core concerns of palliative care with the principles and practices of health promotion (Kellehear, 1999b). Whilst their congruence is not immediately apparent, these two fields have been increasingly examined for their potential benefits in the provision of end of life care. In the current policy climate in Australia, there is an imperative to consider how end of life support services might be improved through adopting a health promoting palliative care approach. The aim of this study has been to investigate the integration of health promotion principles and practice by a selected palliative care service by examining the qualitative impact of this change on the organisation. Specifically, it endeavoured to identify the factors that advanced or impeded this integration by examining how the structures and processes of, and outcomes for, the organisation reflected a health promoting approach. To meet these aims, this study undertook an in-depth examination of the implementation of a health promoting palliative care model by a community based palliative care organisation. Based in a constructionist-interpretivist paradigm, a mixed-method (QUAL+quant), instrumental case study research design was utilised to capture multiple perspectives of the implementation process. Data collection comprised examination of 127 organisational documents, 32 in-depth interviews with staff, volunteers and consumers, 5 focus groups with staff and volunteers, and 25 carer questionnaires. Qualitative data were subject to thematic analysis, with supplementary quantitative data analysed to generate descriptive statistics. The findings demonstrated a large number of complex and interrelated enabling and impeding factors to the implementation in the case study site. These factors have been grouped into four key themes which have been examined in light of the aims of this study and the issues identified in a comprehensive review of the literature. This study found that: ◦ Conceptual congruence between health promotion and palliative care was a fundamental starting point in the implementation of a health promoting palliative care model. ◦ Where conceptual congruence was clear, activities associated with the model that were regarded as beyond conventional approaches to palliative care core business were viewed favourably by stakeholders and were less likely to encounter resistance within the organisation. ◦ When systematic approaches to organisational change, such as quality improvement systems, were rigorously applied, the impact of the transition upon stakeholders was qualitatively less. ◦ Where this transition had been effectively made, consumers, staff, volunteers and members of the wider community were seen to benefit. This study adds to the current discourse regarding the intersection between end of life support and health promotion, and provides insight into how palliative care organisations might undertake the transition from conventional models to a health promoting palliative care approach.
| Identifer | oai:union.ndltd.org:ADTP/265578 |
| Date | January 2007 |
| Creators | Rosenberg, John Patrick |
| Publisher | Queensland University of Technology |
| Source Sets | Australiasian Digital Theses Program |
| Detected Language | English |
| Rights | Copyright John Patrick Rosenberg |
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