‘I'll put up with things for a long time before I need to call anybody’: face work, the Total Institution and the perpetuation of care inequalities
‘I'll put up with things for a long time before I need to call anybody’: face work, the Total Institution and the perpetuation of care inequalities
Failures in fundamental care (e.g. nutrition or pain-relief) for hospitalised patients can have serious consequences, including avoidable deaths. Policy rhetoric of ‘shared decision-making’ fails to consider how structural constraints and power dynamics limit patient agency in nursing staff-patient interactions. Goffman's concepts of face work, the presentation of self and the Total Institution shaped our analysis of interview and focus group data from hospital patients. Patients avoided threatening ‘good’ patient and staff face by only requesting missed care when staff face was convincing as ‘caring’ and ‘available’ (‘engaged’). Patients did not request care from ‘distracted’ staff (‘caring’ but not ‘available’), whilst patient requests were ignored in Total Institution-like ‘dismissive’ interactions. This meant patients experienced missed care with both ‘distracted’ and ‘dismissive’ staff. Patients with higher support needs were less able to carry out their own missed care to protect staff face, so experienced more serious care omissions. These findings show that many elements of the Total Institution survive in modern healthcare settings despite attempts to support individualised care. Unless nursing staff can maintain face as ‘engaged’ (despite organisational constraints that can reduce their capacity to do so) patient participation in care decisions will remain at the level of rhetoric.
Goffman, fundamental care, hospitals, missed care, nursing, patient experience, personalisation
469-487
Hope, Jo
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Schoonhoven, Lisette
46a2705b-c657-409b-b9da-329d5b1b02de
Griffiths, Peter
ac7afec1-7d72-4b83-b016-3a43e245265b
Gould, Lisa
363cc1b3-078d-48eb-a164-feee7dcd9246
Bridges, Jackie
57e80ebe-ee5f-4219-9bbc-43215e8363cd
February 2022
Hope, Jo
5d49099e-13bc-49d2-88d8-48e1ec6d25fc
Schoonhoven, Lisette
46a2705b-c657-409b-b9da-329d5b1b02de
Griffiths, Peter
ac7afec1-7d72-4b83-b016-3a43e245265b
Gould, Lisa
363cc1b3-078d-48eb-a164-feee7dcd9246
Bridges, Jackie
57e80ebe-ee5f-4219-9bbc-43215e8363cd
Hope, Jo, Schoonhoven, Lisette, Griffiths, Peter, Gould, Lisa and Bridges, Jackie
(2022)
‘I'll put up with things for a long time before I need to call anybody’: face work, the Total Institution and the perpetuation of care inequalities.
Sociology of Health & Illness, 44 (2), .
(doi:10.1111/1467-9566.13435).
Abstract
Failures in fundamental care (e.g. nutrition or pain-relief) for hospitalised patients can have serious consequences, including avoidable deaths. Policy rhetoric of ‘shared decision-making’ fails to consider how structural constraints and power dynamics limit patient agency in nursing staff-patient interactions. Goffman's concepts of face work, the presentation of self and the Total Institution shaped our analysis of interview and focus group data from hospital patients. Patients avoided threatening ‘good’ patient and staff face by only requesting missed care when staff face was convincing as ‘caring’ and ‘available’ (‘engaged’). Patients did not request care from ‘distracted’ staff (‘caring’ but not ‘available’), whilst patient requests were ignored in Total Institution-like ‘dismissive’ interactions. This meant patients experienced missed care with both ‘distracted’ and ‘dismissive’ staff. Patients with higher support needs were less able to carry out their own missed care to protect staff face, so experienced more serious care omissions. These findings show that many elements of the Total Institution survive in modern healthcare settings despite attempts to support individualised care. Unless nursing staff can maintain face as ‘engaged’ (despite organisational constraints that can reduce their capacity to do so) patient participation in care decisions will remain at the level of rhetoric.
Text
I'll put up with things for a long time before I need to call anybody
- Accepted Manuscript
More information
Accepted/In Press date: 5 January 2022
e-pub ahead of print date: 25 January 2022
Published date: February 2022
Additional Information:
Funding Information:
Thank you to the patients and staff who took part in our wider project. We’d also like to thank Jess Atkinson, our Patient and Public Involvement representative, for her advice during the project and feedback on early drafts and findings, and the members of Different Strokes Southampton, who gave us encouraging feedback on our initial findings. Finally thank you to the editors and anonymous reviewers who gave constructive and detailed feedback on this paper. This study was funded by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Wessex. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.
Funding Information:
Thank you to the patients and staff who took part in our wider project. We?d also like to thank Jess Atkinson, our Patient and Public Involvement representative, for her advice during the project and feedback on early drafts and findings, and the members of Different Strokes Southampton, who gave us encouraging feedback on our initial findings. Finally thank you to the editors and anonymous reviewers who gave constructive and detailed feedback on this paper. This study was funded by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Wessex. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.
Publisher Copyright:
© 2022 The Authors. Sociology of Health & Illness published by John Wiley & Sons Ltd on behalf of Foundation for SHIL (SHIL).
Keywords:
Goffman, fundamental care, hospitals, missed care, nursing, patient experience, personalisation
Identifiers
Local EPrints ID: 454433
URI: http://eprints.soton.ac.uk/id/eprint/454433
ISSN: 0141-9889
PURE UUID: a16ddebb-7366-4063-9dc4-ed42b8c5b7cf
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Date deposited: 09 Feb 2022 17:38
Last modified: 17 Mar 2024 03:40
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