E to adapt to working around the program are weeded out and reassigned. Our findings suggest that within this program, the influence of shared cultural values (such as religious and familial orientation) may reinforce the hospice mission despite lack of formal hospice training or education for COs. Receipt of specialized training may be seen as changing the CO role in ways that alter the meaning of this identity within a correctional context. Following this, efforts to educate COs POR-8 site regarding hospice need to address this potential conflict; efforts should also be made to educate COs outside the program who have no opportunities to experience hospice first-hand. Cultural Elements: Shared Values, Teamwork Shared values and teamwork represent more informal, less programmatic but nonetheless central elements that support the daily management and long-term operation of prisonAuthor Manuscript Author Manuscript Author Manuscript Author ManuscriptAm J Hosp Palliat Care. Author manuscript; available in PMC 2016 May 01.Cloyes et al.Pagehospice. These elements represent cultural values that have emerged as COs, hospice staff and inmate volunteers have worked together to implement the hospice program over years. Formal IDT and the value of teamwork–The concept of teamwork emerged in our analysis as more of a shared cultural value than a formal Fruquintinib web structural element; it appears that teamwork as a value may exert a more powerful cultural influence than teamwork as a programmatic feature. We observed at least two scheduled IDT meetings involving the LSP hospice coordinator, social worker, chaplain, and medical director (inmate volunteers were not included in IDT meetings.) These meetings were brief, and largely focused on patient requests for medication changes, arrangements for family visits and pastoral care. Far more prominent and productive seemed to be the teamwork occurring in routine interactions between hospice medical staff, COs and volunteers “on the fly” as they worked together to deal with the everyday complications of managing various aspects of the program. The relationship between IDT as a structure and teamwork as a value seemed similar to the relationship between formal and experiential CO hospice training noted above–that is, there is a sense in which formalized or mandated policy may actually conflict with a sense of “doing” prison hospice because it is part of one’s job and (as so many participants said) “the right thing to do”–not something exceptional that redefines one’s fundamental role within the culture of the institution. This suggests that any additional training that COs and staff receive regarding hospice should not ignore extant concepts and values of cultural, ethical and moral responsibility which may already be working within a given system, as a way of naturalizing what may at first seem additional or exceptional. Of course our data does not inform either a casual or temporal interpretation of the relationship between having a formal IDT which includes COs, and the development of a shared cultural value of teamwork. It is conceivable that implementing an IDT model could eventually ingrain a team approach among stakeholders with differing perspectives and interests. On the other hand, if teamwork is already part of the culture, then implementation of an IDT model may be more easily accomplished and more likely to persist. Prison hospice recommendations could therefore be enhanced with a focus on team-building beyond th.E to adapt to working around the program are weeded out and reassigned. Our findings suggest that within this program, the influence of shared cultural values (such as religious and familial orientation) may reinforce the hospice mission despite lack of formal hospice training or education for COs. Receipt of specialized training may be seen as changing the CO role in ways that alter the meaning of this identity within a correctional context. Following this, efforts to educate COs regarding hospice need to address this potential conflict; efforts should also be made to educate COs outside the program who have no opportunities to experience hospice first-hand. Cultural Elements: Shared Values, Teamwork Shared values and teamwork represent more informal, less programmatic but nonetheless central elements that support the daily management and long-term operation of prisonAuthor Manuscript Author Manuscript Author Manuscript Author ManuscriptAm J Hosp Palliat Care. Author manuscript; available in PMC 2016 May 01.Cloyes et al.Pagehospice. These elements represent cultural values that have emerged as COs, hospice staff and inmate volunteers have worked together to implement the hospice program over years. Formal IDT and the value of teamwork–The concept of teamwork emerged in our analysis as more of a shared cultural value than a formal structural element; it appears that teamwork as a value may exert a more powerful cultural influence than teamwork as a programmatic feature. We observed at least two scheduled IDT meetings involving the LSP hospice coordinator, social worker, chaplain, and medical director (inmate volunteers were not included in IDT meetings.) These meetings were brief, and largely focused on patient requests for medication changes, arrangements for family visits and pastoral care. Far more prominent and productive seemed to be the teamwork occurring in routine interactions between hospice medical staff, COs and volunteers “on the fly” as they worked together to deal with the everyday complications of managing various aspects of the program. The relationship between IDT as a structure and teamwork as a value seemed similar to the relationship between formal and experiential CO hospice training noted above–that is, there is a sense in which formalized or mandated policy may actually conflict with a sense of “doing” prison hospice because it is part of one’s job and (as so many participants said) “the right thing to do”–not something exceptional that redefines one’s fundamental role within the culture of the institution. This suggests that any additional training that COs and staff receive regarding hospice should not ignore extant concepts and values of cultural, ethical and moral responsibility which may already be working within a given system, as a way of naturalizing what may at first seem additional or exceptional. Of course our data does not inform either a casual or temporal interpretation of the relationship between having a formal IDT which includes COs, and the development of a shared cultural value of teamwork. It is conceivable that implementing an IDT model could eventually ingrain a team approach among stakeholders with differing perspectives and interests. On the other hand, if teamwork is already part of the culture, then implementation of an IDT model may be more easily accomplished and more likely to persist. Prison hospice recommendations could therefore be enhanced with a focus on team-building beyond th.
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