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Rituals of Medicalisation – Everyday Practice at a Medical Ward. A 16-Month Ethnographic Field Study


Background

Modern hospital care should allegedly be multi- professional and person-centred, still it seems foremost to be driven by a hegemonic positivistic biomedical agenda.

Purpose

This study aims at describing professionals’ and the patients’ everyday practices at a Coronary Care Unit, analysing how the particular care environment with its routines, structures and physical environment influences both patients’ and healthcare professionals’ agency and relationships. 

Method

Ethnographic fieldwork was conducted in parallel by two researchers at a Swedish CCU over a 16-month period (between 2009 and 2011), using participant observation, informal talks as well as formal interviews. The formal interviews were conducted with six registered nurses (RN) including the chief nurse manager (five female, one male), three Assistant nurses (AN)(all female), two Cardiologists and three patients (one female, two male). 

Results

Based on data interpretation, a care environment with ritualistic structures that either promoted or counteracted the patients’ and healthcare professionals’ different agencies and relationships was described. The care environment, with its minimalistic design, strong focus on routines and modest capacity for dialog, controlled the choices available to the patient and healthcare professionals, inducing feelings of guilt and moral stress, predominantly for the RNs. 

Conclusions

Ritualistic structures, minimalistic architecture and modest capacity for dialog suppressed person-centred care by creating demarcated routines rather than holistic care. The care environment exercised control over the choices available, effectively reducing the possibilities for health professionals and patients to create a common careplan. In particular the registered nurses reacted to the restriction of choice with feelings of guilt, inadequacy and moral stress.

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