Abstract
BackgroundModern hospital care should ostensibly be multi-professional and person-centred, yet it still seems to be driven primarily by a hegemonic, positivistic, biomedical agenda. This study aimed to describe the everyday practices of professionals and patients in a coronary care unit, and analyse how the routines, structures and physical design of the care environment influenced their actions and relationships.MethodsEthnographic fieldwork was conducted over a 16-month period (between 2009 and 2011) by two researchers working in parallel in a Swedish coronary care unit. Observations, informal talks and formal interviews took place with registered nurses, assistant nurses, physicians and patients in the coronary care unit. The formal interviews were conducted with six registered nurses (five female, one male) including the chief nurse manager, three assistant nurses (all female), two cardiologists and three patients (one female, two male).ResultsWe identified the structures that either promoted or counteracted the various actions and relationships of patients and healthcare professionals. The care environment, with its minimalistic design, strong focus on routines and modest capacity for dialogue, restricted the choices available to both patients and healthcare professionals. This resulted in feelings of guilt, predominantly on the part of the registered nurses.ConclusionsThe care environment restricted the choices available to both patients and healthcare professionals. This may result in increased moral stress among those in multi-professional teams who work in the grey area between biomedical and person-centred care.
Highlights
Modern hospital care should ostensibly be multi-professional and person-centred, yet it still seems to be driven primarily by a hegemonic, positivistic, biomedical agenda
Michel Foucault argues that modern healthcare and its organisation are based on the historical ideal of the medical discourse as a positivistic tradition built around objectivity [5]
Patients are seen as generalizable, pathological processes rather than individual people in a particular context [7,8,9], and little scope is available for more subjective interpretations, e.g. a hermeneutical approach [10] or person-centred care (PCC)
Summary
Modern hospital care should ostensibly be multi-professional and person-centred, yet it still seems to be driven primarily by a hegemonic, positivistic, biomedical agenda. Ethnographic studies suggest that biomedical knowledge takes precedence in multi-professional dialogue, and that even when physicians are not present, other professionals such as nurses act as ‘deputies for medicine’ [2]. It appears that the shift from traditional, disease-centred care towards more person-centred, multi-professional care is Michel Foucault argues that modern healthcare and its organisation are based on the historical ideal of the medical discourse as a positivistic tradition built around objectivity [5]. Patients are seen as generalizable, pathological processes rather than individual people in a particular context [7,8,9], and little scope is available for more subjective interpretations, e.g. a hermeneutical approach [10] or person-centred care (PCC)
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