Exploring the effects of social network dynamics on patients receiving ‘hospital at home’ care in a rural environment.

Abstract

Global aging places pressure on traditional models of healthcare such as inpatient wards. Part of UK government’s resilience plans involves an emphasis on community services such as HaH but this risks transforming pressure onto community based services. HaH is a contemporary service which treats people with acute illness in the context of their own home. Doing so requires patients to undertake substantial self-management with Social Network (SN) involvement. This thesis uses mixed methodology to explore how this works in practice from varying perspectives, in the context of people’s everyday lives, and how it is affected by wider factors such as rurality. Three papers make up the nucleus of this thesis. The first is a metasynthesis which used district nursing services to illuminate how external influences (specifically rurality) affect the way service providers utilise SNs for patients in the community. The paper identified that in rural areas nurses work beyond professional boundaries to provide emotional support, help with daily tasks, and link to others. There was also evidence that nurses embedded within rural localities developed friend-like relationships with patients and negotiated with existing SN to find more support for patients. The second paper used interviews with HaH nurses to illuminate the roles of healthcare professionals and how they perceive the work of patients to be completed with the help of SN support. Findings demonstrate tensions between nurse discourse of patient-centeredness and the reality that HaH is a health-focussed service. However, there is recognition (albeit limited) of the positive role of SNs. By developing a deeper understanding of the SNs of HaH patients then nurses can identify gaps in support that could limit the experiences of patients and respond accordingly, especially for people who are vulnerable, with complex needs, living alone, and with limited access to resources. Finally, a quantitative study from patient perspectives explored correlations between health, demographic, psychosocial, SN data and quality of life for the purpose of mapping patients’ SNs and establishing which factors affect the outcomes of patients using HaH. Findings indicate that HaH treats a diverse patient group with equally diverse SN structures. This was largely influenced by having a partner. Where there was not a partner, there was a degree of substitutability, but replacing the partners’ roles appears difficult. Weak ties function differently and are less important compared to chronic illness because they are unable to be mobilised quickly enough for HaH use. Regression analysis shows that self-reported health status and self-efficacy were key predictors of quality of life. This thesis makes a novel contribution to the research literature through illuminating the contribution of HaH patients’ SN members of HaH patients and understanding some of the processes and limitations through which they are mobilised. The thesis also identifies the limitations of HaH services, the gaps in care provided to patients and how SN dynamics differ from in chronic illness. HaH nurses should be given the tools and resources to formalise their process of SN exploration in order to understand how best to support patients and therefore provide they patient-centred care they aspire for.

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Identifiers

ORCID for Jack Hardy Gillham: orcid.org/0000-0001-8938-7720

ORCID for Ivaylo Vassilev: orcid.org/0000-0002-2206-8247

ORCID for Becky Band: orcid.org/0000-0001-5403-1708

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