Conducting an Organizational Ethnography: This case study is an example of organizational qualitative research in action. InI began the methodological journey for my PhD to study the link between how violence in particular bullying is constructed on an everyday basis by organizational members and organizational practices developed and implemented to counter and respond to forms of violen The use of visual methods in social science research has become popular, and creative techniques are widely recognised as having the potential to evoke more nuanced understanding of the ways in which other people experience their worlds.
Over the last decade, there has been a significant reorientation of health care delivery from institutional-based settings, like hospitals and long-term care LTC homes, toward more home and community-based settings see Figure 1 for Conceptual Framework for Home and Community Care in Canada.
Statistics Canada recently estimated that while 2. Furthermore, it has been demonstrated that there are still many older Canadians who are prematurely institutionalized in LTC homes due to challenges in accessing even basic home and community care supports or other more general appropriate support services.
One of the latest promising approaches to address access to care issues are community paramedicine models, especially in more rural and remote communities See Case Study 16,7. Innovative Approaches Case studies a research strategy appropriate for palliative care Home and Community Care with Community Paramedicine While waiting for placement in a long-term care home, older adults make frequent contact with the health care system and have high rates of emergency department use.
As a result, in the rural town of Deep River, Ontario, the County of Renfrew Paramedic Service launched a unique community paramedicine program with funding from the Champlain Local Health Integration Network LHIN to support older adults who are eligible for or awaiting a long-term home placement to stay in their own homes longer.
Through this cost-effective program, paramedics in association with other community partners, developed a system to provide hour flexible and proactive supportive and enhanced home-based primary and community care services to these older adults — with impressive results. The program reduced overall ED and hospital utilization, and improved the health status of individuals such that it delayed or even completely avoided admissions to the local long-term care home.
That the proportion of older Canadians is growing, and many of them are living far longer with more complex and often inter-related health, social and functional issues than previous generations, means that our ability to meet the rapidly growing needs for home and community care services is becoming increasingly challenging.
Additionally, understanding the growing need for more robust home and community care services must be understood in the context of what legitimate needs do and will exist for institutional-based care such as assisted living, acute and LTC services.
Only by understanding the evolving care needs of Canadians across all aspects of system will we be able to avoid the provision of inappropriate and often more costly care for older Canadians.
Avoiding inappropriate LTC admissions and inappropriate stays in acute care settings amongst older Canadians has become a significant policy and health services research focus for health care systems across Canada.
At the same time, demand for LTC declined 6. We would expect to see that as the proportion of public spending for home and community care increased, rates of LTC placement may be curtailed. That some provinces e. Newfoundland and Labrador spend a higher proportion on home and community care yet also have higher than average rates of LTC placement, while provinces such as Prince Edward Island spend a very low proportion on home and community care yet also have the highest rates of LTC placement, demonstrates the importance of understanding contextual complexities in health system capacity planning.
While many capacity challenges exist throughout the health care continuum, the unmet palliative and end of life care needs of Canadians run across the continuum of care with respect to home, community, and institutional-based services. Future research must be directed toward understanding resource allocation and the systemic implications of providing this service.
Currently, no consensus on cost-benefit of physician assisted death exists at the system level. Exploring how to leverage knowledge and evidence from other jurisdictions where physician assisted death has been part of the continuum of care e. The Netherlands, various U.
States, and Belgium may also go some way to inform capacity planning. Across all levels of health care service delivery, we must recognize that access to appropriate and high quality care for older Canadians not only directly impacts the quality of life of individuals but can also deliver significantly improved patient and system outcomes and costs.
What are the Issues? While health care specific services are extremely important, evidence suggests that older adults who have inadequate access to the necessary home and community care supports for activities of daily living ADLs — such as personal care, cooking, cleaning and transportation — ultimately end up using more health care resources.
Much of this care is what family members, friends, caregivers and lower paid and less regulated healthcare professionals like personal support workers or care aides provide. For families and friends of older Canadians, meeting needs that are under-supported by home and community care can lead to increased caregiver burden, stress and anxiety.
Furthermore, unmet needs can present significant out of pocket costs to friends and family.
Most immediately, individuals with unmet home care needs are more likely to experience injuries specifically increased risk of fallsdepression, reduced morale, lower self-reposted health status, feelings of decreased control, smaller social networks and an inability to prepare food.
Furthermore, understanding the need to support families and caregivers in order to alleviate caregiver burden whenever possible, will enable the chances that a person will be able to continue ageing in place.
Certain Older Canadians are More Likely to Have Unmet Needs We know that certain groups of older Canadians are more likely to have unmet home and community care needs due to a variety of social and economic determinants that limit their access to these services.
According to the evidence, groups more likely to have unmet needs include the following: Low Income Older Canadians — Older Canadians cited their ability to pay as the biggest factor contributing to their access to the home and community care support they need.
Our oldest Canadians — The likelihood of having unmet needs doubles between ages and 85 years and better. Enabling individuals to age in the place of their choice will often save the health and social care systems more money than the associated costs of having them pre-maturely placed in institutional care settings.
There is Currently No Clear Capacity Plan to Address Home and Community Care and Palliative Care Needs of Older Canadians Despite the fact that we know that the number of Canadians 65 and older will double over the next twenty years — and those 85 and older will quadruple — there is no province or territory that has a clear capacity plan to meet the evolving home and community care and palliative care needs of our ageing population.
Work must be undertaken to set minimum national standards for home and community care, long-term care and palliative care services. Though challenging at a national level, such work will enable provincial and territorial efforts toward the development of more unifying health human resources strategies and the development, expansion and evolution of services that better enable the provision of care closer to home.
Evidence-Based Policy Options to Consider 1. Federal Leadership in Sharing Best Practices and Supporting the Establishment of Common Standards, Targets and Benchmarks for the Provision of Home and Community, Palliative and Long-Term Care Services Given that this area of health services provision is becoming of growing importance for Canadians and health system sustainability, the federal government should help play an important leadership role as a jurisdictional convener to explore and support the development of common policies and practices and programs of research in these areas.
Supporting the spread of innovative solutions and best practices that better enable the provision of care closer to home will not only allow more Canadians to age and die in the place of their choosing, but will also enable broader system savings for its overall sustainability.
Working with all provincial and territorial partners could foreseeably result in common basic standards, targets and benchmarks which allow jurisdictions to more easily plan health system capacity and compare or benchmark their performance.Case studies developed by the APS Task Force on Ethics Education range of factors, including prior experience, an understanding of appropriate procedures, and an understanding • Responsible Conduct of Research and Participation Case Study: Conflict of Interest (p 60) Conflict of Interest.
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Abstract. Selecting an appropriate research strategy is key to ensuring that research questions are addressed in a way which has value and is congruent with the overall topic, questions and purpose of the research.
Palliative care doctors, palliative care nurses, endocrinologists, and diabetes nurse educators participated in this study. A two-phase project was undertaken: 1) two focus groups, and 2) a cross-sectional survey using a self-completed questionnaire.
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To analyze a case study, therefore, you must examine closely the issues with which the company is confronted. the company is currently strong and currently weak.
Some companies might be weak in marketing; some might be strong in research and development. debate the merits of this strategy. Is it appropriate, given the environment the.