University Of Tasmania
Spinaze_whole_thesis.pdf (3.27 MB)

Swimming in the stream : being a health professional and doing chronic conditions healthcare

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posted on 2023-05-27, 09:55 authored by Spinaze, AC
This thesis is about chronic conditions healthcare. In a world of increasing chronic conditions prevalence, chronic conditions healthcare exists in experimental as well as more formalised forms. Drawing on observations, interviews and video-triggered interviews; this thesis documents present-day chronic conditions healthcare in regional Australia. It provides thick description of the experience of chronic conditions healthcare in response to the question: what is the lived experience of doing healthcare work with people with chronic conditions? The key finding is that chronic conditions healthcare is a distinct but largely implicit part of healthcare work. Participants are beginning to formulate their own definitions of chronic conditions healthcare, and creative ways of engaging with the tasks of such work. Findings explore clinicians' definitions (individualistic, sometimes multiple, and generally indirect); tactics and techniques used; and external factors which shape chronic conditions healthcare. At present, healthcare workers are 'swimming in the stream' of chronic conditions healthcare, staying afloat though immersed in a constant flow of clinical need. Incremental healthcare change is presently created through bottom-up appropriating, resisting, and hybridising‚ÄövÑvp of existing professional care-giving practices (Dombroski 2012, p. v), more than through top-down reorienting of healthcare systems away from acute and towards chronic conditions as the dominant priority. Characteristic dimensions construct health professionals' experience of chronic conditions healthcare: temporality, ambiguity, complexity, and contingency. Such dimensions constitute chronic conditions healthcare as qualitatively and pragmatically different to other kinds of healthcare work. This research highlights three aspects of chronic conditions healthcare. First, not all healthcare change comes from above, through institutionalised change management. Considerable change comes from below, from the grassroots of the actual people doing healthcare. Second, the acute care focus of the healthcare system presents considerable challenges for chronic conditions healthcare. Third, chronic conditions healthcare remains marginalised in culture of healthcare. I argue that naming and explicitly describing chronic conditions healthcare is an important first step in improving chronic conditions healthcare. Chronic conditions healthcare is an entity which warrants exploration and establishment as a healthcare sub-discipline in its own right.


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