Background
Methods
Design
Setting
Participants
Data collection
Care home | Interview type | Profession | Gender | Informants |
---|---|---|---|---|
A | Group interview | Nurse | Female | N1 |
Social and health care assistant | Female | HA1 | ||
Single interview | Designated GP | Female | GP1 | |
B | Group interview | Nurse | Female | N2 |
Nurse | Female | N3 | ||
Single interview | Designated GP | Male | GP2 | |
C | Group interview | Nurse | Female | N4 |
Nurse | Female | N5 | ||
Single interview | Designated GP | Female | GP3 | |
D | Single interview | Nurse | Female | N6 |
Single interview | Designated GP | Female | GP4 |
Data analysis
Results
Acknowledging competencies and roles
Mutual trust, understanding, and knowledge about professions
“I certainly have the feeling that they [GPs] think that our professional competency is OK and that they can rely on what we say. And I trust what they say. So, it is a collaboration. It is like at the hospital; the doctor cannot do his or her job if a nurse or an assistant has not done their part. Well, you depend on one another in that way. So I actually feel that they trust us.” (N2)
“And it’s also because she [the nurse] is good at finding out […] where there is a need for a medical specialist or rather a need for a nursing specialist, or nursing care, right. And if there is something that she finds that she needs my help for, then she is really good at writing a good correspondence that makes it possible for us to move on with it.” (GP3)
“I believe that it really makes a difference when we [GPs] sit and talk with the nurses about treatment, and we wonder about different problematic issues. And we tell them how to treat different things”. (GP2)
Acknowledgement of the different roles
“I find that the doctors [GPs] express that they feel that some kind of ‘gatekeeper’ has now been introduced. Like, we are a kind of intermediate station, where we filter out the minor things – that then are dealt with in-house – and that the need for care is first assessed; Is it something that can wait, or is it something that must be dealt with now? Is it something that should be written down in a correspondence [to the GP]?” (N1)
“In the beginning, assistants and social and health care assistants used to participate in the ward rounds, and that did not work. They also made a lot of irrelevant enquiries; things that they should first have cleared with a nurse.” (GP1)
“That [the rejection] affected us in the way that some – a lot – of the assistants took it personally, as a shortcoming in their professional competence. And it isn’t – but it was [perceived that way] regardless of how you communicated it. So they took it badly. Even if you tried to explain ‘this is not a bad thing, it is just about developing you and your skills and knowledge in terms of how you should do things, so that you can do it.’. But there just wasn’t anyone who heard that.” (N2)
“Well, we encourage them to go mainly through their nurses if there is something. But it is not always that it … well, you could say, that it has not always proven successful. ... Because there may be a carer or an assistant, who is really accomplished, and who manages the residents well, and all that. And then it will be perfectly fine that she does the writing. So, therefore, it can be difficult to, like say – well, all that matters is education” (GP3)
Interprofessional communication
Appropriate and ongoing interprofessional communication
“So, you may say that [before introducing the designated GP model] I used to have a lot of residents at different care homes, but I did not see them very often because it was a difficult process to go and see them – so then you do really a lot through correspondence and written communication. And we don’t do that quite as much now.” (GP2)
“And we get more knowledge because we [the care home staff and the designated GPs] have this distinct contact, which allows us to get more knowledge about the residents … ‘why, now I see the same thing as what happened the last time I had a resident presenting like this, and it was that and that and that.” (N1)
Compromises in professional competencies
“If they [the designated GPs] make an order for a resuscitation, well, then they will get it. I may disagree in it. But that’s how it is – you don’t have to agree on everything.” (N3)
“Well, the last [patient] I saw, she gets both a morphine patch and Lyrica for pain in her bones – that is, vertebral collapse in her back. And I also tell her that she might easily do without it because it was a long time ago that it happened, the collapse. But she doesn’t want out of it, and she is a little confused. And the staff says, ‘we don’t think so’, and then we don’t go anywhere with it.” (GP4)