Introduction
Methods
Design
Recruitment
Research team
Data collection
We’ve been running a project over the last couple of years about diversity and diversity in its broader sense. That is, not just cultural diversity, but any type of unique characteristic that someone might have and how that might impact their healthcare in some way. Perhaps you can begin by just telling me a bit about yourself and why you use [home nursing] services. Prompt topics if not covered in the discussion raised above – these were raised more in a conversation way, wended into discussion as the opening presented itself: • Is there anything that you would like to do but you feel like you can’t do at the moment? • Do you feel that the staff know what activities you would like to get back to? • Do you feel that you can talk to the doctors and nurses about what you want? • Do you feel that staff listen to you, and provide services in a way that suits you and your needs? • What positive characteristics do you think you’ve got to help you with your health? • Is there any characteristics about you that make it harder to get well? • Do you ever find it difficult to access health services? Physically getting there? • With services do you find that they are affordable for you? • Do you find you get enough information about your health care services and can read and understand it? • Have you ever felt that a service or a health professional has been unacceptable to you? • Have you experienced bias or prejudice during any health care encounters? • Do you feel that health professionals understand you as a person? • How would you like to be treated as a person in health encounters? |
Data analysis
Reliability and validity
Ethics
Results
Participants
Thematic mapping to diversity principles
Intersectionality
‘My university degree was in [majored in] applied mathematics, so that was really helpful, in helping with clear thinking and expression. All those things were set up in my early days’ (P04).
‘I was a professional cook, the cooking … My daughter has got six children and they used to come here - well, they still come but I used to cook. I used to love it. Bake and do all that sort of thing for them’ (P08).
‘ … I am from Europe … I learned a lot. I was studying for 18 years only at schools’ (P14).
‘I took part in an experimental treatment of quadriplegics with music therapy, by a young woman who is a music therapist at the Austin. That was brilliant. The aim was to see what the effects of singing were on the respiratory capacity of a quadriplegic but also on the emotional state.
It was very uplifting. It was the best therapy of any kind that I’ve ever had. It was better than drugs. Of course, that came to an end. The young woman got her PhD but she got some special award too for the innovation of her treatment. So it was from that I joined the choir.
So I’d like to be able to join a choir. I’d like to take up singing and I’ve looked around for choirs but there’s nothing that I can find that suits. Usually they’re fairly late at night and in fairly inaccessible places’ (P10).
Building trust and rapport
‘You’ll more likely share with people, and feel more comfortable, if you get to know them as a person’ (P04).
‘Yeah, they just treat you as a patient, they’re not [knowing] about your private life that much, I don’t think … Patient is a patient and that’s it - I mean, start to get involved in personal matters you might as well forget that, that’s silly’ (P02).
‘Well I would think that just some informal questioning of a new client, new to them. Some of your staff may be pretty good at sitting down, making people feel comfortable. Have a cup of tea with them, and talk to them, just to start to understand them as a client’ (P04).
‘The people that get up my nose are the people that don’t show any interest’ (P07).
‘I was sort of angry because she didn’t listen to me. She was quite nice to talk to but she just wouldn’t listen. I said can you stop, please, I said it’s hurting a lot, she said I’m nearly finished. My god, it’s taken me three months to get my leg better’ (P06).
‘ … she is very competent at her job. But I like to have something more with the carers than just their care function’ (P10).
‘You have two types of people … You’ve got the class of people that are extremely good and they care about what they’re doing, and you’ve got another class down here who don’t give a shit’ (P07).
‘I’ve always gone by that. If you don’t understand anything, ask and see what it’s all about. It’s not going to hurt you. If they can’t answer you, well, they don’t know what they’re talking about’ (P02).
‘We have the right … to say no [to treatments]’ (P14).
‘I gave [smoking] away voluntarily myself, before the doctors got to tell me to give it away. Yeah, I woke up myself that it was doing me no good’ (P05).
‘I used to teach people to drive cars … I would make sure, before I pulled up or picked anyone up, that I knew what their first name was, what their surname was, their date of birth and a little bit about them, before I’d even met them … No matter what you do, if you’re trying to create a bond or a - yeah, a bond will do - they’re the things you need to start with. Following on from that, you need to know the person’s needs … and their wants’ (P07).
‘Respect is something - people bandy it around as a word, but respect is something that’s earned, something is shown insomuch as how you approach people, how you interact with people in a respectful way and showing them the value of who they are and what sort of life they’ve lived in a lot of cases’ (P07).
‘How would I like to be treated? Just as a normal person. I’d like people to treat me as I treat them’ (P07).
‘Well, I’m very independent, I tell you. I prefer to walk myself. Even though I’m like a tortoise but I get there’ (P06).
‘I’m a bit of a smart alec. Don’t boss me around and tell me what to do... I’ve been my own person for too long [laughs]’ (P08).
‘I still think and work things out for myself. I don’t want to be just treated like somebody who is stupid. Do we give that impression when we’re old? Perhaps we do’ (P12).
Awareness of unconscious bias and prejudice
‘Well I think sometimes when you’re older, that people think they’re doing you a favour. Well, I would think that that is irritating to people because you’re being treated as if you’ve lost your mind or - no, that’s not the right word. That you’re not aware of things. Well lots of old people, they are aware of things’ (P12).
‘When new [staff] come, I say ‘if you need help I’ll help you’ … Because I see how my leg’s done every day and I know what they put on’ (P06).
‘I dare say [consumer directed care is] a case of arranging services that are available that provide that service within the cost. I think we’ll be able to work our way through it’ (P11).
Promotion of inclusion through use of language
‘people can tell you what to do in a nice way and people will tell us what to do in a - trying to get the word - peremptory way. I can’t - as if what they believe themselves always to be right. That annoys me’ (P09).
‘Oh, well that they listen and take note of what you’re saying. I take great objection to be treated as if I don’t know what day it is …. I hate having my word - or my comments questioned, as if I don’t know what I’m talking about’ (P08).
Access and equity
‘To an able bodied person it would be nothing, but to me it was a hell of a long way [to the clinic]. I’m not capable of doing that’ (P03).‘I don’t think there’s enough services available to transport people who need it. We have these - what do they call them - taxis of multipurpose I think - who are solely there for transport people in wheelchairs and people who’ve got disabilities. You try and get one’ (P07).
‘They should have less work where they can … , spend more time getting to know the person that they’re dealing with. They haven’t got time for it’ (P07).
‘They’re always on the go these girls. To see what they do, how quickly they’ve got to do it and where they’ve got to go next - how they keep sane sometimes. They’ve just got too much work, in my opinion’ (P07).
‘The case manager, … they sent out an [Occupational Therapist] and under the [federal funding] arrangements, … organised an electric wheelchair. Yeah, … she organised that and I’ve used it ever since’ (P11).
‘I think it’s got to be in partnership. I think it’s got to be in partnership with the management, with the staff, and with the client. If you can develop that respect, and a bit of networking, and team work, I think is really important’ (P04).
‘Well yes because I liked to have a massage but a massage is $80. The - what was it - gym is $75. I had a personal trainer for half hour sessions a week. So that’s - what’s that? That’s $155 a week. But I have a pension and I have about $430 a week. So $150 out of that [laughs] becomes pretty impossible’ (P10).