Everyday practices at the medical ward: a 16-month ethnographic field study (original) (raw)
Related papers
The interaction between doctors and nurses in the context of a hospital ward
Ciência e Saúde Coletiva, 2019
This article addresses a fundamental, albeit scarcely discussed, issue in health studies: the relationship between doctors and nurses. We rely on a ethnographic observation and in-depth interviews undertaken in a female ward of a public hospital in order to analyze certain aspects of these relationships, based on hermeneu-tics and science studies. The empiric observation showed that Doctors organized their practice and clinical decisions on certain abstractions and dialogued in a structured, highly specialized and restricted language. Nurses materialized medical decisions, guided by the prescriptions. They had no room to interfere in clinical decisions , being very busy with their tasks and not dominating the clinical discourse, which is crucial for discussing the decisions. In the context of this study, physicians and nurses maintained a distance established by the theory, technique and values shared by each professional group. Thus, we suggest that knowledge, practices and medical values and nurses were incommensurate with each other, and that this directly affected the health care actions performed in that setting.
American Anthropologist, 2002
Introduction: Nursing care takes place within nurse-patient relationships that can be demanding. In exceptional circumstances, the relationship may be destructive, and when this happens, significant onerous demands, appeals, or challenges can arise from patients and be placed upon nurses. Aim: The aim is to explore what can be termed boundaries of care responsibility when relationships with patients place significant destructive demands on nurses. Method: Based on a hermeneutical approach, this study introduces aspects of phenomenological philosophy as described by the Danish theologian and philosopher Knud E. Løgstrup and provides examples of nurses' experiences in everyday nursing practice drawn from a Norwegian empirical study focusing on remaining in everyday nursing practice. Data in that original study consisted of qualitative interviews and qualitative follow-up interviews with 13 nurses working in somatic and psychiatric health service. Discussion: The exploration of empirical examples demonstrates that nurses consider confronting demands from patients which manifest themselves as onerous and that they have to set limits to safeguard themselves. When the nurses had to manage acting out or actions from patients by opposing what was said and done, they experienced the situation as more than very unpleasant or connected to a perversion. Significant destructive caring relationships cannot be without boundaries, and explicating boundaries are of relevance to protect nurses from onerous demands. Protecting them implies reducing a hazard, that is, that nurses carry on even when this may be unhealthy for them. Conclusion: Consistently pinpointing boundaries between demands is assumed to be essential in caring relationships, as onerous or destructive demands are strongly connected to a content where boundlessness is involved. To protect both nurses and patients as valued human beings, thus raising and preserving the status of the nurse and the patient, the nature and possible detrimental effects of destructive caring relationships should be considered and examined.
International journal of qualitative studies on health and well-being, 2010
Registered nurses (RNs) have, according to the Swedish National Board of Health and Welfare, the overall responsibility for the medical care in the ambulance care setting. Bringing RNs into the ambulance service are judged, according to earlier studies, to lead to a degree of professionalism with a higher quality of medical care. Implicitly in earlier studies, the work in the ambulance service involves interpersonal skills. The aim of this study was to describe RNs' experiences of being responsible for the care of the patient in the Swedish ambulance service. A reflective lifeworld approach within the perspective of caring science was used. Five RNs with at least five years experience from care in the ambulance care setting were interviewed. The findings show that the essence of the phenomenon is to prepare and create conditions for care and to accomplish care close to the patient. Three meaning constituents emerged in the descriptions: prepare and create conditions for the nurs...
Gaming the system to care for patients: a focused ethnography in Norwegian public home care
BMC Health Services Research
Background: With its emphasis on cost-reduction and external management, New Public Management emerged as the dominant healthcare policy in many Western countries. The ability to provide comprehensive and customized patient-care is challenged by the formalized, task-oriented organization of home-care services. The aim of this study is to gain deeper understanding of how nurses and the patients they care for, relate to and deal with the organizational systems they are subjected to in Norwegian home care. Methods: The focused ethnographic design is based on Roper and Shapira's framework. Data collection consisted of participant observation with field notes and semi-structured interviews with ten nurses and eight patients from six home care areas located in two Norwegian municipalities. Results: Findings indicate cultural patterns regarding nurses' somewhat disobedient behaviors and manipulations of the organizational systems that they perceive to be based on economic as opposed to caring values. Rigid organization makes it difficult to deviate from predefined tasks and adapt nursing to patients changing needs, and manipulating the system creates some ability to tailor nursing care. The nurses' actions are founded on assumptions regarding what aspects of nursing are most important and essential to enhance patients' health and ensure wellbeingindividualized care, nurse-patient relationships and caringwhich they perceive to be devalued by New Public Management organization. Findings show that patients share nurses' perceptions of what constitute high quality nursing, and they adjust their behavior to ease nurses' work, and avoid placing demands on nurses. Findings were categorized into three main areas: "Rigid organizational systems complicating nursing care at the expense of caring for patients", "Having the patient's health and wellbeing at heart" and "Compensating for a flawed system". Conclusions: Our findings indicate that, in many ways, the organizational system hampers provision of high-quality nursing, and that comprehensive care is provided in spite of-not because of-the system. The observed practices of nurses and patients are interpreted as ways of "gaming the system" for caring purposes, in order to ensure the best possible care for patients.
The introduction sets out two central ideas around which this collection of articles on hospital ethnography has been organised. The first is that hospitals are not identical clones of a global biomedical model. Hospitals take on different forms in different cultures and societies. Medical views and technical facilities may vary considerably leading to different diagnostic and therapeutic traditions. The second idea, related to the first, is that biomedicine and the hospital as its foremost institution is a domain where the core values and beliefs of a culture come into view. Hospitals both reflect and reinforce dominant social and cultural processes of their societies. The authors further discuss some methodological and ethical complexities of doing feildwork in a hospital setting and present brief summaries of the contributions, which deal with hospitals in Ghana, South Africa, Bangladesh, Mexico, Italy, The Netherlands, Papua New Guinea, Egypt and Lebanon. r
Care ethics and corporeal inquiry in patient relations
International Journal of Feminist Approaches To Bioethics, 2012
JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms of scholarship. For more information about JSTOR, please contact support@jstor.org.
Nursing Inquiry, 2004
Nursing on the medical ward This paper considers some issues confronting contemporary medical nursing and draws upon psychoanalytic theories to investigate some seemingly straightforward and taken-for-granted areas of medical nursing work. I am arguing that the everyday work of medical nurses in caring for patients is concerned with bringing order to and placing boundaries around inherently unsettled and destabilized circumstances. I am also arguing that how nurses manage and organize their work in this regard stems from traditional practices that tend to be taken for granted and not explicitly thought about. It is therefore difficult for nurses to consider changing these practices that often have negative consequences for the nurses. I want to examine the impact upon nurses of the consequences of three taken-for-granted nursing practices: (i) the tendency of nurses to confine their reactions to what is going on so as to present a caring self; (ii) the tendency of nurses in their everyday talk to patients to confine, limit and minimize meaning; and (iii) the tensions and ambiguities that emerge for nurses in the policing function they perform in confining patients to the bed or the ward. Negative consequences on nurses of these practices potentially include stress and confusion regarding their ability to care for patients; an undervaluing of nursing skills; and a deterioration in the nurse-patient relationship. Clinical supervision for medical nurses is proposed as a means of facilitating greater understanding of the nature of nurses' relationships with patients and the complex dimensions of their medical nursing role.
The effectiveness of the treatments carried out in the intensive care unit (ICU) is guaranteed by a socio-technical ensemble where material resources, scientific knowledge, technological artefacts, social norms, spatial dispositions, and professional practices coexist and constantly interact. On the basis of data collected in 12 months of participant observation in an Italian ICU, this paper intends to penetrate such an ensemble for analysing the moral order produced and maintained in everyday medical practice. I will illustrate how ward organisation and professional practices of medical and nurse staff create and reproduce two models of body centred on the staff’s perception of the therapeutic appropriateness of patients. On one side, there are the bodies that staff expect to get better, and these bodies are exposed through a series of organisational devices and activities in order to make them immediately accessible and available for every type of treatment; on the other side, the bodies of chronic and terminal patients tend to become invisibles in the working practice of the unit. This process does not follow any guideline or protocol but is embodied in informal routine and communicative interactions. The actions of invisibility surrounding certain patients can be seen as strategies for the management of professional conflict and bioethical issues that stem from different interpretations of the degree of severity of the patients' conditions.
Nursing in Critical Care, 2014
Background: The environment of an intensive care unit (ICU) is, in general, stressful and has an impact on quality of care in terms of patient outcomes and safety. Little is known about nurses' experiences, however, from a phenomenological perspective with regard to the critical care settings as a place for the provision of care for the most critically ill patients and their families. Aim: The aim of this study was to explore nurses' lived experiences of ICU bed spaces as a place of care for the critically ill. Design and methods: A combination of qualitative lifeworld interviews and photos -photovoice methodology -was used when collecting data. Fourteen nurses from three different ICUs participated. Data were analysed using a phenomenological reflective lifeworld approach. Findings: An outer spatial dimension and an inner existential dimension constitute ICU bed spaces. Caring here means being uncompromisingly on call and a commitment to promoting recovery and well-being. The meanings of ICU bed spaces as a place of care comprise observing and being observed, a broken promise, cherishing life, ethical predicament and creating a caring atmosphere. Conclusions and relevance to clinical practice: The architectural design of the ICU has a great impact on nurses' well-being, work satisfaction and the provision of humanistic care. Nurses need to be involved in the process of planning and building new ICU settings. There is a need for further research to highlight the quality of physical environment and its impact on caring practice.
The introduction sets out two central ideas around which this collection of articles on hospital ethnography has been organised. The first is that hospitals are not identical clones of a global biomedical model. Hospitals take on different forms in different cultures and societies. Medical views and technical facilities may vary considerably leading to different diagnostic and therapeutic traditions. The second idea, related to the first, is that biomedicine and the hospital as its foremost institution is a domain where the core values and beliefs of a culture come into view. Hospitals both reflect and reinforce dominant social and cultural processes of their societies. The authors further discuss some methodological and ethical complexities of doing feildwork in a hospital setting and present brief summaries of the contributions, which deal with hospitals in Ghana, South Africa, Bangladesh, Mexico, Italy, The Netherlands, Papua New Guinea, Egypt and Lebanon. r