A linguistic perspective on “whole person” care: challenges for healthcare ideals and nursing identity

Abstract

Healthcare policy suggests that the quality of healthcare is dependent upon practitioners thinking about patients as “whole persons”, whilst a focus on the whole person is frequently argued to be particularly characteristic of nursing practice. This presentation highlights findings from an ethnographic study undertaken within one critical care unit in the United Kingdom which examined how critical care nurses do think about patients.

A purposive sampling strategy recruited 7 participants representing both experienced and inexperienced critical care nurses. Data were collected over a period of 8 months during 2006 to 2007, and primarily comprised the field notes from 92 hours of participant observation supplemented by 13 tape recorded interviews. Data analysis was influenced by Foucault and Goffman and adopted the perspective of linguistic ethnography.

Analysis revealed that all participants thought about patients in seven distinct ways: as ‘social beings’, as ‘valued individuals’, as ‘routine work’, as a ‘set of needs’, as a ‘body’, as ‘(un)stable’ or as a ‘medical case’. Drawing on the work of Polanyi, an interpretation of these findings makes clear that whilst practitioners may have a tacit understanding that these different ways of thinking relate to aspects of one coherent whole, they may not at any moment in time be described as thinking about this ‘whole person’.

This presentation particularly focusses upon a secondary set of findings from this study which related to the ways in which nurses talked about their practice. Analysis of interview data made clear that, in maintaining their identities as nurses, participants’ could only legitimately talk about themselves as giving care to persons. Participants characterised some of the ways in which they had to think about patients as impersonal, and this actively hindered these nurses from describing or reflecting upon elements of their practice. There is therefore conflict and dissonance between nurses’ expectation that they should think about patients as persons, and the fact that delivering nursing care requires them to think about patients in different ways.

These findings demonstrate that quality in healthcare practice may not be guided or explained by the idea that practitioners should think about patients as persons, but rather that expert practice is characterised by moving fluidly and appropriately between different ways of thinking about patients. There is therefore conflict and dissonance between the (nursing?) ideals of delivering care to persons, and the fact that practice requires practitioners to think about patients in different ways. This is of major significance given that dissonance between practitioners’ ideals and the realities of care delivery is a primary cause of burnout or moral distress.

It is concluded that there is a need for scholarship and healthcare policy which articulates a vision of person centred care clearly, and in ways which avoid constructing dissonance between professional ideals, and the ways in which practitioners do and must think about patients

More information

Identifiers

ORCID for C. McLean: orcid.org/0000-0002-9951-9894

Catalogue record

Export record

Altmetrics