Conflicted Health Care

Charles S. Varano, Ester Carolina Apesoa-Varano

Description

Anyone who has spent time in a hospital as a patient or family member of a patient hopes that those who attend to us or our loved ones are at their professional best and that they care for us in ways that console us and preserve our dignity. This book takes an intimate look at how health care practitioners struggle to live up to their professional and caring ideals through (or during?) twelve-hour shifts on the hospital floor.

From 3,200 hours of participant-observation and 500 hours of follow-up interviews with twenty-one doctors, thirty registered nurses, twenty-one respiratory therapists, twenty medical social workers, and eighteen occupational, physical, and speech therapists, the authors create a complex picture of the workplace conflicts that different types of health care practitioners face. Though all these groups espouse caring ideals, professional interests and a curative orientation dominate in patient care and interoccupational relations. Because emotive caring is not supported by the organization of health care in the hospital, it becomes an individual virtue that overworked staff find hard to perform, and it takes on an ideological form that obscures the status hierarchy among practitioners. Conflicts between practitioners rest upon the ranking of each group's knowledge base. They manifest in efforts to work as a team or set limits on practitioner responsibilities and in differing views on unionization.

Sujets

• Health Care Delivery
• Medical
• Médecine
• Sociology
• Industrial relations
• Index of urban studies articles
• Ethnography
• Health

Informations

• Publié par: Vanderbilt University Press
• Date de parution: 19 septembre 2014
• Nombre de lectures: 0
• EAN13: 9780826520104
• Langue: English

Extrait

Conflicted Health Care
Conflicted Health Care
Professionalism and Caring in an Urban Hospital
Ester Carolina Apesoa-Varano and Charles S. Varano
VANDERBILT UNIVERSITY PRESS
Nashville
© 2014 by Vanderbilt University Press
Nashville, Tennessee 37235
All rights reserved
First printing 2014
Chapter 6 , “Crossing the Line,” was previously published in a different form: Apesoa-Varano, Ester Carolina. “Interprofessional Conflict and Repair: A Study of Boundary Work in the Hospital.” Sociological Perspectives 56, no. 3 (2013): 327–49.
This book is printed on acid-free paper.
Manufactured in the United States of America
Library of Congress Cataloging-in-Publication Data on file
LC control number 2014007694
LC classification number RA972
Dewey class number 362.11068'3—dc23
ISBN 978-0-8265-2008-1 (cloth)
ISBN 978-0-8265-2009-8 (paperback)
ISBN 978-0-8265-2010-4 (ebook)
For Sofia, Ellah, Magali, and Liam
Contents
Acknowledgments
Introduction
1. The Professional Self
2. Teamwork in the Hospital
3. The Dilemma of Caring
4. Caring Reconsidered
5. When the Day Is Done, It’s Still Work
6. Crossing the Line
7. Unions: “The Elephant in the Room”
Conclusion
Notes
Bibliography
Index
Acknowledgments
This book culminates years of our ongoing collaboration and shared interests as ethnographers and sociologists. It builds on and reexamines extensive qualitative research that Carolina Apesoa-Varano conducted: she was responsible for the project’s conception, design, data collection, and analysis, while Charles Varano provided constant feedback in the form of theoretical and analytical suggestions. We decided to coauthor this book because it reflects how much our personal and professional lives intersect, but because we are at different stages in our academic careers, we each took charge of the manuscript at different stages. Carolina produced its early drafts, with editing from Charles, and Charles handled the final rewrite, with editing and further revisions from Carolina. Both of us actively engaged in refining the analysis and developing the interpretations and theoretical understanding we present in this book.
Given the nature of our collaboration, we struggled with how to achieve an appropriate authorial voice throughout the text. Although the first-person plural pronoun “we” best reflects our collective engagement in the analytical process and our shared interpretation of the data’s meaning and theoretical relevance, we have decided to use the first-person singular pronoun “I” throughout the text because Carolina was the only participant observer in the field and this best reflects the ethnographer’s voice.
We would like to thank all the hospital practitioners who graciously donated their time outside of work to participate in the research interviews. We also appreciate the practitioners who allowed Carolina to follow them day in and day out, through thick and thin, so that we could learn firsthand what they do for a living. They welcomed Carolina into their world, shared their experiences, and showed her what work and life is in a hospital. In the same light, we want to extend our appreciation to all the administrative staff, managers, and supervisors who helped Carolina maneuver through the bureaucracy of the hospital, introduced her to important contacts, and provided necessary information. Last but not least, we would like to thank the many patients who allowed Carolina into their rooms during the most intimate of moments. Some of them, recovering quickly from their illnesses or injuries, were on good terms with life when they left the hospital; others were confined to hospital care for long, long periods of time. Many of them passed away with family by their side; others were not so lucky, and the practitioners who cared for them were the closest they had to friends or family.
This book would not have been possible without the faculty and institutional support Carolina received from the Department of Sociology at the University of California, Davis, especially from 2004 to 2008. The Office of Graduate Studies, the Department of Sociology, and the Labor and Employment Research Fund of the University of California Office of the President provided generous financial support to Carolina during the initial writing of the manuscript. Our deepest gratitude goes to Vicki Smith, who meticulously read numerous early drafts of the manuscript, offered detailed comments, and closely edited what must have seemed like mind-numbing prose. We also wish to thank Carole Joffe, Ming-Cheng Lo, Beth Bechky, and Drew Halfmann, who all offered invaluable feedback and saw “the forest for the trees” during this phase of manuscript preparation. At the University of Colorado, Boulder, thanks to Martha Gimenez for her intellectual guidance and close friendship and Jane Menken and Tom Mayer for their expertise and encouragement. Bob Kloss and Dean Dorn at California State University, Sacramento, also deserve special thanks: Bob started Carolina down the road of researching nursing for her master’s thesis, while Dean read through a late draft of the book and offered useful comments on every chapter. Other colleagues also lent their support through the latter stages of this project, including Heather Young, Judith Barker, Ladson Hinton, Sergio Aguilar-Gaxiola, Stuart Henderson, Jud Landis, and especially Anita Kando, who, with admirable patience and diligence, transcribed countless hours of interviews.
We could not have been more fortunate than to have Michael Ames, of Vanderbilt University Press, as our editor for this book. Michael saw some promise in an early draft of this work and steered us critically yet patiently through the revision process. We greatly appreciate copyeditor Peg Duthie for her careful work clarifying our muddled prose and catching numerous mistakes throughout the manuscript. We also want to thank the Vanderbilt University Press editorial board, as well as the outside reviewers whose extensive comments alerted us to relevant literature, helped us avoid errors at various points, and guided us in writing a more coherent book.
Finally, we would like to thank Nidia and David Apesoa, Carolina’s parents. Nidia served as a pediatrician among the urban poor of Argentina for many years, and we have always been inspired by her personal selflessness and professional commitment to health—something we also found among the practitioners in this hospital. Both she and David offered countless hours of their time to help with childcare, as our children were all born during the research and writing of this book. Sofia Leonor and Ellah Rose both arrived as Carolina worked on the initial drafts, while our twins, Magali Grace and Liam Joseph, joined us during the final year of manuscript revisions.
Introduction
CODE BLUE, code blue, unit 3, code blue, code blue, unit 3,” the speaker system blared, as Mike rushed into a patient’s room in disbelief. “Mike,” a clerk yelled, “your guy in 34, he’s coding!”
Mike was a competent and pleasant nurse who had worked on the floor for over ten years. Today he was looking after five patients, and among them was a seventy-year-old man who had been admitted through the emergency room in the early morning hours with cardiac symptoms. The patient had seemed stable throughout the morning and was “hooked up” so that his heart rate could be constantly monitored at the nurse’s station in case of emergency. We had an emergency.
The patient appeared to be asleep as Mike loudly called out his name. After moving his face near the man’s mouth to feel if he was breathing, Mike began rubbing the patient’s chest around the heart area. A group of doctors, another nurse, a respiratory therapist, and a pharmacist stormed into the room. Mike placed his finger on the man’s neck—“no breathing, no pulse.” With everyone hovering over the patient, there was loud yelling, with some people calling for medications and others giving instructions (“get the pads!”). People were moving fast and someone ran out to the supply room.
“Everybody calm down,” a physician ordered. “Everyone out of this room except you, you, and you!” The junior residents and interns huddled outside by the door, listening and peering in. Four people remained in the room, disagreeing about one thing or another as they worked on the patient.
After what seemed like a few minutes had passed, Mike sighed, “He’s back. He’s back, okay, okay,” and things started to settle down. At the door, people whispered anxiously to one another. A resident physician, visibly distraught, said to one of the nurses, “I was working on him—that’s wrong to kick us out—I’m part of the team.” Nodding, the nurse patted her on the back as the patient was wheeled from the room.
Mike kept a close eye on the patient as this took place, and then said to a nurse standing nearby, “Teresa, I’m going up to the OR. Can you watch my other guys?” A little later, as he quietly walked back to the unit, Mike seemed exhausted. Upon entering the room the patient had been in, he saw a social worker gently speaking to a crying woman, with her hand on the woman’s shoulder—the woman was the daughter of Mike’s patient, and she had just been informed of the incident. Mike tried to comfort the worried daughter, who kept asking if her father would be okay.
It was a strange feeling on the floor: everyone seemed a little tense, yet everything seemed like business as usual. Later that afternoon in the break room, the nurse manager debriefed some junior residents, a social worker, and the nurses who were present. “What happened today was traumatic and that’s why I think it is important to talk about it,” the nurse manage