• Six mechanisms behind carer wellbeing effects: A qualitative study of healthcare delivery

      Al-Janabi, H.; McLoughlin, C.; Oyebode, Jan R.; Efstathiou, N.; Calvert, M. (2019-08)
      Health and care services for patients may improve or harm the wellbeing of their family carers. Formal consideration of these effects (also known as spillovers) in decision-making is advocated, but, to date, little is known about how they occur. This paper presents the first empirical study to determine the mechanisms by which health and care services affect family carers' wellbeing. The study focused on three major health conditions: dementia, stroke, and mental health. Focus groups and interviews were conducted with 49 purposefully sampled care professionals and family carers in the UK between December 2016 and September 2017. Transcripts were coded and analysed thematically, using descriptive accounts and an explanatory account. The analysis generated six over-arching mechanisms by which health and care services affect family carers' wellbeing, through: (i) information (degree to which service delivery informs and trains family carers); (ii) management of care (shifts of responsibility for care between formal and family sectors); (iii) patient outcomes (services changing patient outcomes); (iv) alienation (feelings of alienation or inclusion created by service delivery); (v) compliance (barriers to patients complying and engaging with services); and (vi) timing or location (changes in the timing or location of services). Each mechanism was associated with sub-themes relating to both positive and negative spillovers on the family carers. The six mechanisms can be summarised with the mnemonic ‘IMPACT’. The IMPACT mechanisms may be useful in designing and evaluating services to optimise the wellbeing of carers as well as patients.
    • Using ethnography (or qualitative methods) to investigate medication errors: a critique of a published study.

      Armitage, Gerry R.; Hodgson, Ian J. (2009-11-18)
      The effects of drug errors and any consequent adverse events frequently impact on patients, their relatives and professional carers. Furthermore, the financial cost to the National Health Service is considerable (DoH, 2000; DoH, 2001; DoH, 2004). In a study of two London teaching hospitals, Vincent et al. (2001) found that 10% of patients are exposed to an adverse event, which adds a mean 8.5 days to their hospital stay. Drug errors are recurrently reported to account for between 10 and 20% of all adverse events (DoH, 2004). In response to Department of Health policy, NHS trusts are changing their approach to the management of error to encourage more reporting. The emphasis is on openness and support, and individual and organisational learning rather than blame. Research designed to increase a knowledge of the aetiology and context of drug errors should be carefully constructed and include qualitative methods which, if implemented according to established convention, can reflect the approaches described above. This paper will critique a recently published study that focused on nursing practice and was, in our view, inappropriately described as ethnographic. The study undoubtedly adds to the body of existing knowledge about drug errors and, crucially, if the study contributes to improved patient safety, it must, fundamentally, be valued. Nevertheless, some qualitative research conventions were broken and, as such, it is suggested, some opportunities for a broader understanding and for learning may have been lost. The critique will lead to a range of recommendations about future qualitative studies in this research domain which, it is argued, could produce a fuller picture of the context, culture and, perhaps, even the cause of error.