Cott CA, Falter LB, Gignac M, Badley E. Helping networks in
community home care for the elderly: types of team. Can J Nurs
Res. 2008 Mar;40(1):19-37. [Pub
Med ID 18459270]
Changes in the delivery of health care have led to a shift in the location of care from the institution to the community. This has resulted in a need to re-examine current models of health-care practice in terms of their applicability and relevance to the community setting. The purpose of this study was to determine the relevance of traditional models of multidisciplinary teams by examining interrelationships amongst community-dwelling seniors with arthritis, their families, and health and community service providers (HCSPs). In-depth interviews or focus groups were conducted with clients, family members, and HCSPs. Participants described 4 different types of interaction within the helping network, with no interaction whatsoever being the most common except for with the seniors themselves. Three types of team emerged: client-centred, case manager-centred, and discipline-specific. No evidence of formal collaborative interdisciplinary teams was found, with HCSPs most valuing the discipline-specific model.p>
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This study reveals the emergence of a new team leader in the healthcare field: the case manager with a background in nursing or social work. Case managers have the authority to make decisions regarding services to be provided in the community. According to the HCSPs who participated in the study, including physicians and clients, case managers have the final say in treatment decisions, mainly because they control the purse strings.
Overall, this study reveals a lack of collaboration, a hallmark of effective teamwork, in the community. Participants, particularly HCSPs, believed the word team applied mostly to discipline-specific teams and felt most emotionally engaged with these teams. These teams, although an important source of support for health-care workers, were self-isolating. The lack of opportunity for interdisciplinary exchange, with powerful socialization into the discipline-specific view of the world, can be a barrier to the development of effective interprofessional teamwork. The two other types of team are also problematic. For example, the client-centred team is plagued by a lack of communication among members and inconsistency of membership. The case manager-centred team is rigidly hierarchical, with decision-making revolving around financial rather than patient-care concerns. This lack of collaboration in community care for the elderly with arthritis raises concerns about the quality of care available to this population, as collaborative goal-setting and decision-making are considered essential for the management of chronic conditions.
List of Tables and Figures (in the publication)
- Table 1. HCPS Focus Groups and Individual Interviews.
- No figures for this paper.
Selected Tables from the Publication (with interpretation)
Table 1 summarizes the composition of the focus groups and the HCSP interviews according to profession.
Supplementary Tables (with interpretation)
No supplementary information is available for this paper.
