Balancing organisational frameworks and the human experience when working with patients in prolonged disorder of consciousness in Switzerland: a reflexive thematic analysis

Abstract

Purpose: Patients in prolonged disorder of consciousness (PDOC) require complex care from a multi-disciplinary team. Delivering this holistic care can be demanding for healthcare professionals (HCP), and yet little is known of their experiences. This qualitative study was aiming to explore the experiences HCP have when working with patients with PDOC in a specialised rehabilitation unit in Switzerland, and potential support mechanisms used by staff.

Materials and methods: A qualitative study, adopting a contextualist approach. Eight participants from four different professions, based in a specialised PDOC unit in Switzerland, undertook semi-structured online interviews. Verbatim transcripts were analysed using reflexive thematic analysis.

Findings: Three overarching themes, including ten sub-themes, were developed: (1) Impacts and dynamics of PDOC care; (2) Flexible structural framework as the base in PDOC care; and (3) Human interactions are at the centre of care. These led to the understanding that to acquire patient-centred care, a fragile balance between flexible organisational frameworks and human interactions, with a flow of communication, is needed.

Conclusion: The findings highlight that the balance between a flexible framework and human interactions form the basis for patient-centred care of HCP when providing care to patients with PDOC on a specialised rehabilitation unit in Switzerland.

IMPLICATION FOR REHABILITATION • Patients in prolonged disorder of consciousness (PDOC) require complex physical care from a multi-disciplinary team, in addition to decision making and care of relatives.

• Delivering care to PDOC patients impacts healthcare professionals in different ways, requiring support mechanisms in place.

• A balance between a flexible organisational framework and human interactions is needed to optimise the delivery of person-centred care provided by healthcare professionals caring for patients with PDOC in a rehabilitation setting.