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‘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
‘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
0141-9889
469-487
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
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), 469-487. (doi:10.1111/1467-9566.13435).

Record type: Article

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.

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I'll put up with things for a long time before I need to call anybody - Accepted Manuscript
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More information

Accepted/In Press date: 5 January 2022
e-pub ahead of print date: 25 January 2022
Published date: 25 January 2022
Additional Information: Research funding National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Wessex
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
ORCID for Jo Hope: ORCID iD orcid.org/0000-0002-8939-7045
ORCID for Lisette Schoonhoven: ORCID iD orcid.org/0000-0002-7129-3766
ORCID for Peter Griffiths: ORCID iD orcid.org/0000-0003-2439-2857
ORCID for Jackie Bridges: ORCID iD orcid.org/0000-0001-6776-736X

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Date deposited: 09 Feb 2022 17:38
Last modified: 23 Jul 2022 02:12

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