Making body work sequences visible: an ethnographic study of acute orthopaedic hospital wards

Abstract

Within health and social care, academic attention is increasingly paid to understanding the nature and centrality of body work. Relatively little is known about how and where body work specifically fits into the wider work relations that produce it in healthcare settings. We draw on ethnographic observations of staff practice in three National Health Service acute hospital wards in the United Kingdom to make visible the microprocesses of patient care sequences including both body work and the work contextualising and supporting it. Our data, produced in 2015, show body work interactions in acute care to be critically embedded within a context of initiating, preparing, moving and restoring and proceeding. Shades of privacy and objectification of the body are present throughout these sequences. While accomplishing tasks away from the physical body, staff members must also maintain physical and cognitive work focussed on producing body work. Thus, patient care is necessarily complex, requiring much staff time and energy to deliver it. We argue that by making visible the microprocesses that hospital patient care depends on, including both body work and the work sequences supporting it, the complex physical and cognitive workload required to deliver care can be better recognised. (A virtual version of this abstract is available at: https://www.youtube.com/channel/UC_979cmCmR9rLrKuD7z0ycA )

From Preventing physical infection to managing affective contagion: An initial study of daily nursing practices in the early outbreak of the COVID-19 pandemic in Wuhan

“…In this paper, we adopt an approach that Backhouse et al (2020) call “institutional ethnography,” which offers a means for examining the complexities in enacting and delivering bodywork and associated actions in the acute hospital ward (p. 3). This method of inquiry is concerned with making visible “ordinary” work actions, which are less frequently given explicit attention as work practice.…”

“…This method of inquiry is concerned with making visible “ordinary” work actions, which are less frequently given explicit attention as work practice. This method can produce descriptions of what is relevant in practice, “mapping” actions undertaken, and so critically clarify the processes and forces in operation ( Backhouse et al, 2020 , p. 3). Empirical data for this study are based on five months of fieldwork in Shanghai from March to August 2021.…”

“…These time-linked actions led to tasks such as washing, dressing, and toileting also being routinized, to fit in with the other set actions. Due to the significant needs of patients on the acute wards, staff would regularly undertake “patient observations” of bodily functioning (including monitoring patients’ temperature, breathing, blood pressure), along with the regular turning of patients to prevent pressure ulcers ( Backhouse et al, 2020 , p. 6). One of our participants described the increased regimentation and enhanced sanitization procedures on the COVID-19 wards in the following way: The ECG monitoring data shall be recorded every hour, and the body temperature shall be measured every four hours.…”

Broken (Again) – Making Sense of Ankle Fracture, Hospitalisation, and Early Recovery: An Autoethnography

“…Perhaps this is because the majority of their experience is in caring for those older and more infirm – but it also could be another example of failing to think in a person-centred way. Backhouse et al (2020) conducted an ethnography of acute orthopaedic hospital wards, particularly focusing on ‘body work’ (Twigg et al, 2011). They note how this can lead to objectification and less personalised care, often carried out by the staff members with the least training, and little power.…”

Disjunctures in practice: ethnographic observations of orthopaedic ward practices in the care of older adults with hip fracture and presumed cognitive impairment

“…Participating PPI observers were given the contact number of the researcher who accompanied them on their observation so they had a point of contact to support them if they had witnessed any distressing scenes on the ward. In addition, PPI observers did not assist in data collection within the Emergency Department observational space due to the extremely sensitive nature of this care environment Site access was negotiated in advance, the details being reported previously (Backhouse et al, 2020). In brief, research nurses working on the PGfAR study provided staff with information sheets; once 75 per cent of ward or Emergency Department staff had consented, the site became a 'research ward'.…”