title: Shared care requires a shared vision: communities of clinical practice in a primary care setting.
abstract: OBJECTIVE
  To understand how a vision of care is formed and shared by patients and the primary care professionals involved in their care.
  
  
  BACKGROUND
  To achieve the best health outcomes, it is important for patients and those who care for them to have a mutual understanding about what is important to the patient in their everyday life and why, and what care is necessary to realise this vision. Shared or team care does not necessarily translate to a consistent and integrated approach to a patient's care. An individual patient's care network of clinical and lay participants can be conceptualised as the patient's own 'Community of Clinical Practice' of which they are the central member.
  
  
  METHODS
  Working alongside a long-term conditions nursing team, we conducted a focused ethnography of nine 'Communities of Clinical Practice' in one general practice setting.
  
  
  METHODS
  Participant observation, in-depth qualitative interviews with 24 participants including nine patients, and the patients' medical records. Data were analysed using a template organising style.
  
  
  RESULTS
  Primary care professionals' insight into a patient's vision of care evolves through a deep knowing of the patient over time; this is shared between 'Community of Clinical Practice' members, frequently through informal communication and realised through respectful dialogue. These common values - respect, authenticity, autonomy, compassion, trust, care ethics, holism - underpin the development of a shared vision of care.
  
  
  CONCLUSIONS
  A patient's vision of care, if shared, provides a focus around which 'Community of Clinical Practice' members cohere. Nurses play an important role in sharing the patient's vision of care with other participants.
  
  
  CONCLUSIONS
  A shared vision of care is an aspirational concept which is difficult to articulate but with attentiveness, sustained authentic engagement and being driven by values, it should evolve amongst the core participants of a 'Community of Clinical Practice'.
authors.affiliation: Department of General Practice and Rural Health, University of Otago, Dunedin, New Zealand.
authors.forename: Jessica
authors.identifier: http://orcid.org/0000-0002-8173-0552
authors.initials: J
authors.lastname: Young
authors.affiliation: Department of General Practice and Rural Health, University of Otago, Dunedin, New Zealand.
authors.forename: Tony
authors.initials: T
authors.lastname: Egan
authors.affiliation: Department of General Practice and Rural Health, University of Otago, Dunedin, New Zealand.
authors.forename: Chrystal
authors.initials: C
authors.lastname: Jaye
authors.affiliation: Department of General Practice and Rural Health, University of Otago, Dunedin, New Zealand.
authors.forename: Martyn
authors.initials: M
authors.lastname: Williamson
authors.affiliation: Otago Polytechnic, Dunedin, New Zealand.
authors.forename: Anna
authors.initials: A
authors.lastname: Askerud
authors.affiliation: Department of General Practice and Rural Health, University of Otago, Dunedin, New Zealand.|Mornington Health Centre, Dunedin, New Zealand.
authors.forename: Peter
authors.initials: P
authors.lastname: Radue
authors.affiliation: Mornington Health Centre, Dunedin, New Zealand.
authors.forename: Maree
authors.initials: M
authors.lastname: Penese
mesh_terms: D001291:Attitude of Health Personnel; D003695:Delivery of Health Care; D004645:Empathy; D006801:Humans; D009723:Nurse-Patient Relations; D009732:Nursing Care / Q000379:methods*; D017060:Patient Satisfaction; D059017:Primary Care Nursing / Q000379:methods*; D036301:Qualitative Research
keywords: care networks; communication; communities of clinical practice; interprofessional care; patient-centred care; shared care; shared decision-making shared vision of care, teamwork