Professionals’ involvement of relatives – only good intentions?

Abstract

Purpose The purpose of this paper is to explore how, and under what conditions, professionals involve relatives in clinical practice. Design/methodology/approach Two cases were constructed from two studies in Denmark, theoretically inspired by Bourdieu’s concepts of doxa and position and analyzed with focus on the involvement of relatives from the perspective of professionals. Findings Support to relatives in practice is rarely included in the way that treatment and care are organized in healthcare. Professionals’ views of the involvement of relatives were characterized by the values of neoliberal ideology and medical-professional rationality, in which relatives are not regarded as a subject of care and support in clinical practice. The involvement of relatives aimed to ensure patients’ participation in randomized clinical trial and to help professionals to care for patients when the professionals were not absolutely needed. Professionals were relatively higher positioned in the clinic than relatives were, which allowed professionals to in – and exclude relatives. Neoliberal ideology and medical-professional rationality go hand in hand when it comes to patient treatment, care and the involvement of relatives; it is all about efficiency, treatment optimization and increased social control of the diagnosed patient. These neoliberal, organizational values consolidate doxa of the medical field and the positions that govern the meeting with patients’ relatives – if it takes place at all. Originality/value The results put into perspective how the combination of neoliberalism and medical logic work as an organizing principle in contemporary healthcare systems, and challenge a normative, humanistic view on involving patients’ relatives in the medical clinic.

A gap between the philosophy and the practice of palliative healthcare: sociological perspectives on the practice of nurses in specialised palliative homecare

“…Nurses are socialised into the role of assistants to doctors, and the medical logic unconsciously rules their practical sense in specialised palliative homecare. It is important to be aware of how, historically, nursing is embedded in the medical field, which has significance for the context in which nursing is carried out in palliative homecare and the conditions under which nurses perform their jobs (Glasdam 2007;Carlhed 2007;Glasdam and Oute 2018). According to Bourdieu (1996b), an acquired habitus maintains an order that classifies people and knowledge.…”

“…In our study, we regarded specialised palliative homecare as a space in the field of medicine. Many studies showed how the logic of medicine, including palliative care, is based on an individualistic, bio-medical rationality, in which the diagnosis is foundational for making valid interpretations of the patient's somatic condition and accurate decisions about his/her treatment (Glasdam 2007;Mol 2008;Engström 2012;Højskov and Glasdam 2014;Glasdam and Oute 2018). It has also been shown that the logic of medicine formed an organising policy for clinical practice.…”

“…A latent content analysis, inspired by Bourdieu's theoretical framework, was made and inspired by other healthcare studies using Bourdieu as a theoretical lens (Engström 2012;Glasdam and Øye 2014;Glasdam and Oute 2018;Karidar and Glasdam 2018;Angus et al 2018). First, all interviews were transcribed verbatim by each interviewer.…”

Nurses' attitudes towards support for and communication about sexual health—A qualitative study from the perspectives of oncological nurses

“…The nurses' articulations, priorities and views on sexual health are governed by the medical logic that dominates the oncological clinic specifically (Glasdam, 2007;Karidar et al, 2016) and health care in general (Ellegaard & Dybbroe, 2015;Fox, Antony, Foley, O'Sullivan, & Timmons, 2018;Glasdam & Oute, 2018). Sabatino et al (2014) show how the dominance of medical logic reflects an environment where the medical discourse is at the top of the healthcare hierarchy.…”

“…This means that personal chemistry, as a guide for attention on sexual health and professional help, has an embedded risk of including patients living and thinking in the same way as nurses, the middle class and excluding patients from other social classes (Glasdam, 2007;Glasdam, Timm, & Vittrup, 2010). Many studies show how nurses have a gatekeeper function, for example, in relation to involving children in their parent's illness situation (Karidar et al, 2016), involving relatives in the medical clinic (Glasdam, 2007;Glasdam & Oute, 2018), shaping patients' experiences of health care, and producing opportunities to enable or constrain their choices (Collyer, Willis, & Lewis, 2017). By using personality and chemistry as indicators for professional attention and help regarding sexual health, nurses shape a patient as a picture of the potential self.…”