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Seeking exemptions from nursing home routines: Residents' everyday influence attempts and institutional order
Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
2010 (English)In: Journal of Aging Studies, ISSN 0890-4065, E-ISSN 1879-193X, Vol. 24, no 4, p. 292-301Article in journal (Refereed) Published
Abstract [en]

Using ethnographic data collected from a Swedish nursing home, this article analyzes residents’ everyday or subtle influence attempts relative to the maintenance of institutional routines. Residents’ efforts to carve out some autonomy or fulfill personal preferences in everyday matters could be categorized as (1) disruptions, (2) disturbances, or (3) “good matches” relative to ongoing and up-coming nursing home routines. Striking disruptions were often fruitless, while attempts rendered as disturbances were typically postponed or modified. In general, the outcomes of residents’ maneuvers were shaped by brief and situational negotiations of whether (and how) temporary exemptions from the institutional order were deemed accountable or not by the staff. Although staff sometimes arranged situations in which residents were given some defined or symbolic decision-making authority, the findings of this study show how an inflexible local routine culture can constitute a constraining and only occasionally porous framework for residents’ self constructions and everyday life.

Place, publisher, year, edition, pages
2010. Vol. 24, no 4, p. 292-301
Keywords [en]
nursing home, institution, everyday influence, negotiation, routines
National Category
Sociology
Identifiers
URN: urn:nbn:se:hj:diva-11626DOI: 10.1016/j.jaging.2010.08.001OAI: oai:DiVA.org:hj-11626DiVA, id: diva2:294162
Available from: 2010-02-16 Created: 2010-02-16 Last updated: 2017-12-12Bibliographically approved
In thesis
1. The Trivial Matters: Everyday power in Swedish elder care
Open this publication in new window or tab >>The Trivial Matters: Everyday power in Swedish elder care
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This is a study about fairly ordinary situations in elder care: how staff deal with older people’s influence, how staff talk about older people’s complaints, how family members talk about elder mistreatment, and how older people act in order to exert influence in a nursing home. However ordinary, these are situations where relational power is accentuated, accomplished and able to be empirically explored. The aim here is to analyze power and influence as social phenomena in elder care. More specifically, the aims are 1) to analyze the political and bureaucratic frame in which older people have formal “voice” options; 2) to analyze staff members’ “folk logic” as they respond to residents’ complaints in Swedish nursing homes; 3) to analyze how family members of care recipients define and sustain claims of elder mistreatment; and 4) to ethnographically depict how older people’s attempts at influence unfold in everyday interactions in a nursing home and how these attempts can be understood in the context of a “local routine culture.”

Several kinds of empirical material have been used: 100 structured telephone interviews with local municipal officials, 13 qualitative interviews with nursing home staff, 21 interviews with family members of care recipients, and ethnographic data comprised of field notes and field-based interviews from five months of observation in a nursing home.

The findings demonstrate the difficulties of turning policies about older people’s influence into practice. Yet, the main finding is not the “policy–practice gap” per se, but rather an understanding of how this gap is situationally shaped and maintained. The dissertation shows how the subtleties of actions and talk have powerful implications, and can constitute barriers to older people’s influence. Two examples are the “rhetoric of trivialization” and a “local routine culture”; both can easily and quite inconspicuously restrict older people’s autonomy and influence. A routine culture is a locally and situationally generated action repertoire and as such provides an understanding of how routines shape power relations in a nursing home. The findings also show how a rhetoric of trivialization can function as a power resource, through which older people’s and family members’ views are “made trivial” by the ways they are described and rhetorically treated by staff and local officials. Through the use of trivializing accounts, staff members legitimized their neglect of complaints and restrictions of older people’s influence. The study argues that by recognizing how older people’s influence is “made trivial,” we gain an understanding of how to accomplish just the opposite. Local routines and accountability practices have a strong inertia, but the findings indicate that if actors reframe influence and complaints, they may substantially affect power relations in elder care.

Place, publisher, year, edition, pages
Jönköping: Intellecta infolog, 2010
Series
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 9
National Category
Other Social Sciences not elsewhere specified
Identifiers
urn:nbn:se:hj:diva-11674 (URN)978-91-85835-08-9 (ISBN)
Public defence
2010-03-26, Forum Humanum, Hälsohögskolan, Box 1026, 551 11, Jönköping, 13:00 (English)
Opponent
Supervisors
Available from: 2010-03-02 Created: 2010-03-01 Last updated: 2013-01-14Bibliographically approved

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