NANCARROW, S. (2004). Dynamic role boundaries in intermediate care services. Journal of interprofessional care, 18 (2), 141-151. [Article]
Abstract
This paper examines the impact of intermediate care service delivery on the role
boundaries of service providers. Two intermediate care teams were selected as case studies to explore the
roles of workers in the context of an admission avoidance and assisted discharge service. Data were
collected through semi-structured interviews with 26 intermediate care staff, including physiotherapists,
occupational therapists, nurses, a social worker and support workers. The study found that therapists’
roles were most closely aligned with each other, whilst nurses perceived their roles as being distinct from
therapists, with a more medical emphasis. Therapists and nurses delegate a range of tasks to support
workers, although the nature of task delegation differed across the two teams. A number of factors were
associated with the role flexibility of staff including the setting, duration and nature of care, access to
alternative care providers and the ability of staff to undertake joint visits. Contrary to previous
research, the practitioners were not threatened by overlapping roles, and recognised that confidence in
their own roles and an understanding of the roles of other workers was necessary to avoid feeling
threatened. The study concludes that intermediate care can promote role overlap across a range of
workers. Role overlap can enhance clinician confidence in their own area of expertise whilst optimising
patient care. Role overlap has the potential to optimise limited staff resources in an interprofessional
working environment. Interprofessional working can be enhanced in the workplace through joint visits
and shared working practices.
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