Caring at the edge: a synthesis of new paradigm insights and a case study of care for older people

Taylor, Sarah (2017) Caring at the edge: a synthesis of new paradigm insights and a case study of care for older people. PhD thesis, University of Glasgow.

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Modernity has brought many benefits (e.g. technological advances, material comfort, longer life expectancy and improved health). However, it is argued that we are now experiencing 'diminishing returns‘ from and 'adverse effects‘ of a Modernist worldview (Hanlon et al 2011; 2012a; 2012b). Evolutionary theories and models of paradigm change (e.g. Beck and Cowan 2006; Senge et al 2005; Scharmer 2009; Wilber 2001) offer a way of thinking about how our worldviews emerge and shift in response to existential challenges and so called 'wicked problems‘ (Rittel and Webber 1973). This study aimed to explore people‘s experiences of co-production and wicked problems in the context of care for older people in light of theoretical perspectives of evolutionary paradigm change.

Method: This study adopted a parallel process of a) an instrumental case study to explore the substantive topics of co-production and wicked problems in the context of care for older people and b) the development of an analytical lens informed by concepts associated with evolutionary theories of paradigm change, through which empirical case study findings were re-interpreted. The case was an older people‘s residential care service within a Scottish Local Authority. This encompassed 11 care homes for older people. 30 in-depth qualitative semi-structured interviews were undertaken with frontline Care Workers, Care Home Unit Managers, Senior Managers and Key Theoretical informants. A constructivist-grounded theory approach was taken to data analysis to produce narratives around care, change and problems. These narratives were then re-interpreted through an evolutionary paradigm change lens.

Findings: Using an evolutionary paradigm lens enabled an exploration of the underpinning worldview that is giving rise to patterns of activity and way of organising care observed in the case study. It also led to a reframing of care for older people as an existential issue rather than a conventional wicked problem. Co-production was reinterpreted as a yearning for connection, humanity and aliveness within our health and social care services in response to the dehumanising tendencies and effects of the Modernist paradigm. However, it was found that the organisational response to this yearning was rooted in a dominant Modernist way of thinking, being and doing. Instances of so-called 'horizon capture‘ (Sharpe 2013) were witnessed, suggesting that the spirit of co-production could become thwarted and subsumed within mechanistic approaches.

Conclusion: An evolutionary paradigm change lens yields ideas and novel perspectives which may be of use to those in the public sector who are seeking to navigate the uncharted territories inherent to being at the edge of an emerging paradigm.

Item Type: Thesis (PhD)
Qualification Level: Doctoral
Keywords: paradigm change, wicked problems, co-production, care, older people.
Subjects: H Social Sciences > H Social Sciences (General)
H Social Sciences > HN Social history and conditions. Social problems. Social reform
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Colleges/Schools: College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Public Health
Supervisor's Name: Sara, Dr. MacDonald
Date of Award: 2017
Depositing User: Dr Sarah Taylor
Unique ID: glathesis:2017-8309
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 25 Jul 2017 09:12
Last Modified: 02 Aug 2017 08:22

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