Working with older adults transitioning from living independently to living with support: healthcare professionals' roles, perspectives and lived experiences

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dc.check.chapterOfThesisAll Appendicesen
dc.check.date2035-09-30
dc.check.infoPartial Restriction
dc.contributor.advisorBalfe, Myles
dc.contributor.advisorKeohane, Kieran
dc.contributor.authorGleeson, Emmaen
dc.date.accessioned2025-05-19T10:16:20Z
dc.date.available2025-05-19T10:16:20Z
dc.date.issued2024en
dc.date.submitted2024
dc.descriptionPartial Restriction
dc.description.abstractHealthcare workers now have to navigate a complex work landscape, with several changes occurring in tandem. First, the population of older adults is increasing globally. This is likely to result in more people needing support from healthcare professionals as they age due to the increased likelihood of chronic disease, declining independence and frailty in this stratum of the population. Additionally, there has been a significant leaning in policy towards ageing in place, both nationally and internationally, a shift which aligns broadly with older peoples’ preference to remain in their familiar places of residence and the wider community. In Ireland, these dynamics are occurring during the active implementation of a new iteration of healthcare, namely Sláintecare, which intends to bring care closer to home or within the home for older adults, partly through the development of community healthcare networks. While this complements the policy and systems motivations for moving healthcare away from hospital-centric provision, little is known empirically about the experiences healthcare workers have when enacting their roles in home- and community-based care, and the impact this may have on them. Such dynamic changes prompted the current thesis which seeks to answer the following research questions: How do healthcare workers involved in supporting older adults who are transitioning from living independently to living with support (Turner, 1969; van Gennep, 1909/1960) experience the process of navigating the potential tensions existent between substantive-rational, communicative-action and lifeworld (Habermas, 1984) mediated practice, and the formal-rational, efficiency-mediated tenets of the healthcare system (Weber, 1922/2019)? For those with vocation to their work, what impact, if any, do these tensions manifest in their own professional and personal lifeworlds (Habermas, 1984), up to and including the possibility of moral injury (Shay, 2014)? This thesis employed a theoretically anchored qualitative methodology, semi-structured interviews and reflexive thematic analysis to develop insights into nursing, health and social care professionals’ and home care support assistants’ work with older adults. These interviews focused on gaining an appreciation of the professionals’ roles with older adults, the system in which they work and the professional as a person outside the bounds of work. Thematically, five overarching areas were generated during the reflexive thematic analysis (Braun & Clarke, 2006, 2022), as underpinned by theoretical concepts from Sociology and Anthropology including system and lifeworld (Jürgen Habermas), rationality of social action and vocation (Max Weber) rites of passage (Arnold van Gennep; Victor Turner) and moral injury (Jonathan Shay). The themes which were generated were “the colonization of the lifeworld by system logics”, as part of a general “rationalization of social action”; a rationalization and colonization that has negative and deleterious impacts on “healthcare workers’ vocations”; particularly on performing their roles in “navigating older adults in ‘rites of passage in the transition from independence to needing support”; the “moral injuries suffered by healthcare workers that threaten to damage their vocation”. Ideas and suggestions to support good care and to ameliorate the effects of the “colonisation of the lifeworld” are then explored. These thematic findings provide a springboard for the development of a discussion pertaining to the interaction between person, professional and system, and develops some propositions pertaining to ways in which moral injury is qualitatively different to what is commonly called burnout (Freudenberger, 1974; Maslach & Jackson, 1981). Finally, the themes provide a perspective from which to view the effects of formalising theoretical models such as rites of passage in the education and training of nursing, home care support assistants and health and social care professionals and I provide some suggestions for avenues for further research.en
dc.description.statusNot peer revieweden
dc.description.versionAccepted Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.citationGleeson, E. 2024. Working with older adults transitioning from living independently to living with support: healthcare professionals' roles, perspectives and lived experiences. PhD Thesis, University College Cork.
dc.identifier.endpage273
dc.identifier.urihttps://hdl.handle.net/10468/17519
dc.language.isoenen
dc.publisherUniversity College Corken
dc.rights© 2024, Emma Gleeson.
dc.rights.urihttps://creativecommons.org/licenses/by-nc-nd/4.0/
dc.subjectHome care
dc.subjectMoral injury
dc.subjectVocation
dc.subjectCommunicative action
dc.subjectHealthcare professionals
dc.subjectLifeworld
dc.subjectSystems
dc.titleWorking with older adults transitioning from living independently to living with support: healthcare professionals' roles, perspectives and lived experiences
dc.typeDoctoral thesisen
dc.type.qualificationlevelDoctoralen
dc.type.qualificationnamePhD - Doctor of Philosophyen
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