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Open Access Research article

Multidisciplinary teams, and parents, negotiating common ground in shared-care of children with long-term conditions: A mixed methods study

Veronica M Swallow1*, Ruth Nightingale6, Julian Williams5, Heather Lambert3, Nicholas JA Webb2, Trish Smith2, Lucy Wirz3, Leila Qizalbash3, Laura Crowther2 and Davina Allen4

Author affiliations

1 School of Nursing, Midwifery and Social Work, Faculty of Medical and Human Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Oxford Road, Manchester, M13 9PT, UK

2 Royal Manchester Children’s Hospital, Central Manchester University Hospitals NHS Foundation Trust, Oxford Road, Manchester, M13 9WL, UK

3 The Great North Children’s Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK

4 Cardiff School of Nursing and Midwifery Studies, Cardiff University, Newport Road, Cardiff, CF24 0AB, UK

5 School of Education, University of Manchester, Oxford Road, Manchester, M13 9PL, UK

6 Medicines for Children Research Network, c/o Somers Clinical Research Facility, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK

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Citation and License

BMC Health Services Research 2013, 13:264  doi:10.1186/1472-6963-13-264

Published: 8 July 2013

Abstract

Background

Limited negotiation around care decisions is believed to undermine collaborative working between parents of children with long-term conditions and professionals, but there is little evidence of how they actually negotiate their respective roles. Using chronic kidney disease as an exemplar this paper reports on a multi-method study of social interaction between multidisciplinary teams and parents as they shared clinical care.

Methods

Phases 1 and 2: a telephone survey mapping multidisciplinary teams’ parent-educative activities, and qualitative interviews with 112 professionals (Clinical-psychologists, Dietitians, Doctors, Nurses, Play-specialists, Pharmacists, Therapists and Social-workers) exploring their accounts of parent-teaching in the 12 British children’s kidney units. Phase 3: six ethnographic case studies in two units involving observations of professional/parent interactions during shared-care, and individual interviews. We used an analytical framework based on concepts drawn from Communities of Practice and Activity Theory.

Results

Professionals spoke of the challenge of explaining to each other how they are aware of parents’ understanding of clinical knowledge, and described three patterns of parent-educative activity that were common across MDTs: Engaging parents in shared practice; Knowledge exchange and role negotiation, and Promoting common ground. Over time, professionals had developed a shared repertoire of tools to support their negotiations with parents that helped them accomplish common ground during the practice of shared-care. We observed mutual engagement between professionals and parents where a common understanding of the joint enterprise of clinical caring was negotiated.

Conclusions

For professionals, making implicit knowledge explicit is important as it can provide them with a language through which to articulate more clearly to each other what is the basis of their intuition-based hunches about parents’ support needs, and may help them to negotiate with parents and accelerate parents’ learning about shared caring. Our methodology and results are potentially transferrable to shared management of other conditions.

Keywords:
Activity theory; Chronic kidney disease; Common ground; Communities of practice; Ethnography; Long-term; Multi-disciplinary teams; Negotiation; Parents; Professionals