Mary Ellen Purkis | University of Victoria (original) (raw)
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Books by Mary Ellen Purkis
Demographic and epidemiological changes mean that frail older people have come to be seen as an e... more Demographic and epidemiological changes mean that frail older people have come to be seen as an expensive problem for health care systems. The challenge for professionals and policy-makers is to find ways to respond to the coming crisis by delivering high-quality care in the home. This collection offers a critical analysis of home care policy and practice. It focuses on how high-quality care is provided and the practices and policies that support this. It offers case studies (both policy- and practice-oriented empirical studies) from countries that share a basic orientation to social welfare: Canada, Denmark, Finland, Iceland, Sweden and the United Kingdom. The nine chapters set out a critical agenda for the development of "good" practices in challenging times. This book is essential reading for students, practitioners and researchers who wish to understand diverse problems in care provision for frail older persons and the complexities of policy responses in different health and social care contexts.
Papers by Mary Ellen Purkis
Nursing Inquiry, 1999
Contemporary societal factors influencing the delivery of healthcare in Canada include loud and p... more Contemporary societal factors influencing the delivery of healthcare in Canada include loud and persistent demands for accountability around the use of public funds. Interests in fiscal accountability are not only held by managers and politicians. Practitioners too hold interests in this domain, particularly where 'interest' means having a reserved seat at the table where discussions regarding resource allocation will take place. In this light, practitioners are also interested in enrolling forms of technology that enable them to make visible their 'unique contribution' to the care delivery enterprise. Latour's writings on 'technology' as durability offer methods for describing socio-technical processes that contribute to the appearance of domination. Challenging the prevailing view that order results from powerful domination, Latour argues that domination is an effect of contingent processes. A case study is presented where multiple interests in developing a form of nursing that is visibly 'autonomous' and 'cost-effective' are brought together with technological forms that promise such visibility. Costs associated with purchasing visibility are critically examined.
Sociology of Health & Illness, 2009
This paper examines, and problematises, a well-entrenched conceptualisation of how home care case... more This paper examines, and problematises, a well-entrenched conceptualisation of how home care case management practice works – that is, that case managers offer alternatives, and clients make choices. This understanding of practice is reinforced by organisational policy that states that clients have the right to live at risk if that is their choice. Analysis of data from a field study of home care practice in a western Canadian city, drawing predominantly on case managers’ accounts of actual practice situations, underscores the limitations of such a view, and suggests that conceptualising such practices as ongoing and fragile negotiations between freedom and security offers a more useful frame for thinking through the distance and difference between current home care policy and practice and what people might actually need.
Human Resources for Health, 2009
Vancouver Island lies just off the southwest coast of Canada. Separated from the large urban area... more Vancouver Island lies just off the southwest coast of Canada. Separated from the large urban area of Greater Vancouver (estimated population 2.17 million) by the Georgia Strait, this geographical location poses unique challenges in delivering health care to a mixed urban, rural and remote population of approximately 730 000 people living on the main island and the surrounding Gulf Islands. These challenges are offset by opportunities for the Vancouver Island Health Authority (VIHA) to collaborate with four publicly funded post-secondary institutions in planning and implementing responses to existing and emerging health care workforce needs.
BMC Medical Informatics and Decision Making, 2009
Background There are few studies that examine the processes that interdisciplinary teams engage i... more Background There are few studies that examine the processes that interdisciplinary teams engage in and how we can design health information systems (HIS) to support those team processes. This was an exploratory study with two purposes: (1) To develop a framework for interdisciplinary team communication based on structures, processes and outcomes that were identified as having occurred during weekly team meetings. (2) To use the framework to guide 'e-teams' HIS design to support interdisciplinary team meeting communication. Methods An ethnographic approach was used to collect data on two interdisciplinary teams. Qualitative content analysis was used to analyze the data according to structures, processes and outcomes. Results We present details for team meta-concepts of structures, processes and outcomes and the concepts and sub concepts within each meta-concept. We also provide an exploratory framework for interdisciplinary team communication and describe how the framework can guide HIS design to support 'e-teams'. Conclusion The structures, processes and outcomes that describe interdisciplinary teams are complex and often occur in a non-linear fashion. Electronic data support, process facilitation and team video conferencing are three HIS tools that can enhance team function.
Vancouver Island lies just off the southwest coast of Canada. Separated from the large urban area... more Vancouver Island lies just off the southwest coast of Canada. Separated from the large urban area of Greater Vancouver (estimated population 2.17 million) by the Georgia Strait, this geographical location poses unique challenges in delivering health care to a mixed urban, rural and remote population of approximately 730 000 people living on the main island and the surrounding Gulf Islands. These challenges are offset by opportunities for the Vancouver Island Health Authority
(VIHA) to collaborate with four publicly funded post-secondary institutions in planning and implementing responses to existing and emerging health care workforce needs.
In this commentary, we outline strategies we have found successful in aligning health education and training with local health needs in ways that demonstrate socially accountable outcomes. Challenges encountered through this process (i.e. regulatory reform, post-secondary policy reform, impacts of an ageing population, impact of private, for-profit educational institutions) have placed demands on us to establish and build on open and collaborative working relationships. Some
of our successes can be attributed to evidence-informed decision-making. Other successes result from less tangible but no less important factors. We argue that both rational and "accidental" factors are significant – and that strategic use of "accidental" features may prove most significant in our efforts to ensure the delivery of high-quality health care to our communities.
The study findings substantiated many of the team practice concepts outlined in Elizabeth Latimer... more The study findings substantiated many of the team practice concepts outlined in Elizabeth Latimer’s model. Palliative care teams engage in a number of processes that address patient
symptoms, suffering, hopes, and plans. However, several new findings also emerged from the data that were not explicit in Latimer’s original model. Teams employed five additional emergent team processes when addressing patient symptoms and suffering while attempting to fulfill patient hopes and plans. Those five team processes included explicating practice norms,
leadership, provider assumptions, interdisciplinary teaching, and patient safety. Although many team processes have been identified by practice models in the literature, there is a need to study the applicability of these models empirically to validate their representation of aspects of team practice.
Nursing Philosophy, 2001
Abstract While health promotion is widely acknowledged as a practice field where multidisciplinar... more Abstract While health promotion is widely acknowledged as a practice field where multidisciplinary teamwork is important, within nursing's discipline-specific literature, a strong argument can be discerned regarding the profession's belief that it has a clear and unique role to play in that field. Yet rarely is this unique role, how it arises, and specifically how its effects are to be demarcated, attended to within the discipline-specific literature. Two philosophical perspectives on science are presented and we demonstrate the extent to which these two perspectives influence nursing scholarship, including nursing practice within the field of health promotion. We then go on to argue that, for nurses to sustain their claim to a unique and important contribution within health promotion, clear articulation of the philosophical premises underpinning practice methodologies is warranted. Specifically we argue the importance of such clarity within the context of an analysis of the discourse of multidisciplinary practice as a strategy for avoiding confronting the ways in which bio-medical authority has already significantly demarcated how health promotion practice can proceed.
Demographic and epidemiological changes mean that frail older people have come to be seen as an e... more Demographic and epidemiological changes mean that frail older people have come to be seen as an expensive problem for health care systems. The challenge for professionals and policy-makers is to find ways to respond to the coming crisis by delivering high-quality care in the home. This collection offers a critical analysis of home care policy and practice. It focuses on how high-quality care is provided and the practices and policies that support this. It offers case studies (both policy- and practice-oriented empirical studies) from countries that share a basic orientation to social welfare: Canada, Denmark, Finland, Iceland, Sweden and the United Kingdom. The nine chapters set out a critical agenda for the development of "good" practices in challenging times. This book is essential reading for students, practitioners and researchers who wish to understand diverse problems in care provision for frail older persons and the complexities of policy responses in different health and social care contexts.
Nursing Inquiry, 1999
Contemporary societal factors influencing the delivery of healthcare in Canada include loud and p... more Contemporary societal factors influencing the delivery of healthcare in Canada include loud and persistent demands for accountability around the use of public funds. Interests in fiscal accountability are not only held by managers and politicians. Practitioners too hold interests in this domain, particularly where 'interest' means having a reserved seat at the table where discussions regarding resource allocation will take place. In this light, practitioners are also interested in enrolling forms of technology that enable them to make visible their 'unique contribution' to the care delivery enterprise. Latour's writings on 'technology' as durability offer methods for describing socio-technical processes that contribute to the appearance of domination. Challenging the prevailing view that order results from powerful domination, Latour argues that domination is an effect of contingent processes. A case study is presented where multiple interests in developing a form of nursing that is visibly 'autonomous' and 'cost-effective' are brought together with technological forms that promise such visibility. Costs associated with purchasing visibility are critically examined.
Sociology of Health & Illness, 2009
This paper examines, and problematises, a well-entrenched conceptualisation of how home care case... more This paper examines, and problematises, a well-entrenched conceptualisation of how home care case management practice works – that is, that case managers offer alternatives, and clients make choices. This understanding of practice is reinforced by organisational policy that states that clients have the right to live at risk if that is their choice. Analysis of data from a field study of home care practice in a western Canadian city, drawing predominantly on case managers’ accounts of actual practice situations, underscores the limitations of such a view, and suggests that conceptualising such practices as ongoing and fragile negotiations between freedom and security offers a more useful frame for thinking through the distance and difference between current home care policy and practice and what people might actually need.
Human Resources for Health, 2009
Vancouver Island lies just off the southwest coast of Canada. Separated from the large urban area... more Vancouver Island lies just off the southwest coast of Canada. Separated from the large urban area of Greater Vancouver (estimated population 2.17 million) by the Georgia Strait, this geographical location poses unique challenges in delivering health care to a mixed urban, rural and remote population of approximately 730 000 people living on the main island and the surrounding Gulf Islands. These challenges are offset by opportunities for the Vancouver Island Health Authority (VIHA) to collaborate with four publicly funded post-secondary institutions in planning and implementing responses to existing and emerging health care workforce needs.
BMC Medical Informatics and Decision Making, 2009
Background There are few studies that examine the processes that interdisciplinary teams engage i... more Background There are few studies that examine the processes that interdisciplinary teams engage in and how we can design health information systems (HIS) to support those team processes. This was an exploratory study with two purposes: (1) To develop a framework for interdisciplinary team communication based on structures, processes and outcomes that were identified as having occurred during weekly team meetings. (2) To use the framework to guide 'e-teams' HIS design to support interdisciplinary team meeting communication. Methods An ethnographic approach was used to collect data on two interdisciplinary teams. Qualitative content analysis was used to analyze the data according to structures, processes and outcomes. Results We present details for team meta-concepts of structures, processes and outcomes and the concepts and sub concepts within each meta-concept. We also provide an exploratory framework for interdisciplinary team communication and describe how the framework can guide HIS design to support 'e-teams'. Conclusion The structures, processes and outcomes that describe interdisciplinary teams are complex and often occur in a non-linear fashion. Electronic data support, process facilitation and team video conferencing are three HIS tools that can enhance team function.
Vancouver Island lies just off the southwest coast of Canada. Separated from the large urban area... more Vancouver Island lies just off the southwest coast of Canada. Separated from the large urban area of Greater Vancouver (estimated population 2.17 million) by the Georgia Strait, this geographical location poses unique challenges in delivering health care to a mixed urban, rural and remote population of approximately 730 000 people living on the main island and the surrounding Gulf Islands. These challenges are offset by opportunities for the Vancouver Island Health Authority
(VIHA) to collaborate with four publicly funded post-secondary institutions in planning and implementing responses to existing and emerging health care workforce needs.
In this commentary, we outline strategies we have found successful in aligning health education and training with local health needs in ways that demonstrate socially accountable outcomes. Challenges encountered through this process (i.e. regulatory reform, post-secondary policy reform, impacts of an ageing population, impact of private, for-profit educational institutions) have placed demands on us to establish and build on open and collaborative working relationships. Some
of our successes can be attributed to evidence-informed decision-making. Other successes result from less tangible but no less important factors. We argue that both rational and "accidental" factors are significant – and that strategic use of "accidental" features may prove most significant in our efforts to ensure the delivery of high-quality health care to our communities.
The study findings substantiated many of the team practice concepts outlined in Elizabeth Latimer... more The study findings substantiated many of the team practice concepts outlined in Elizabeth Latimer’s model. Palliative care teams engage in a number of processes that address patient
symptoms, suffering, hopes, and plans. However, several new findings also emerged from the data that were not explicit in Latimer’s original model. Teams employed five additional emergent team processes when addressing patient symptoms and suffering while attempting to fulfill patient hopes and plans. Those five team processes included explicating practice norms,
leadership, provider assumptions, interdisciplinary teaching, and patient safety. Although many team processes have been identified by practice models in the literature, there is a need to study the applicability of these models empirically to validate their representation of aspects of team practice.
Nursing Philosophy, 2001
Abstract While health promotion is widely acknowledged as a practice field where multidisciplinar... more Abstract While health promotion is widely acknowledged as a practice field where multidisciplinary teamwork is important, within nursing's discipline-specific literature, a strong argument can be discerned regarding the profession's belief that it has a clear and unique role to play in that field. Yet rarely is this unique role, how it arises, and specifically how its effects are to be demarcated, attended to within the discipline-specific literature. Two philosophical perspectives on science are presented and we demonstrate the extent to which these two perspectives influence nursing scholarship, including nursing practice within the field of health promotion. We then go on to argue that, for nurses to sustain their claim to a unique and important contribution within health promotion, clear articulation of the philosophical premises underpinning practice methodologies is warranted. Specifically we argue the importance of such clarity within the context of an analysis of the discourse of multidisciplinary practice as a strategy for avoiding confronting the ways in which bio-medical authority has already significantly demarcated how health promotion practice can proceed.