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The Trivial Matters: Everyday power in Swedish elder care
Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
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: urn:nbn:se:hj:diva-11674ISBN: 978-91-85835-08-9 (print)OAI: oai:DiVA.org:hj-11674DiVA, id: diva2:300847
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
List of papers
1. Older people's "voices" - On paper: Obstacles to influence in welfare states - A Case Study of Sweden
Open this publication in new window or tab >>Older people's "voices" - On paper: Obstacles to influence in welfare states - A Case Study of Sweden
2009 (English)In: Journal of Aging & Social Policy, ISSN 0895-9420, E-ISSN 1545-0821, Vol. 21, no 1, p. 94-111Article in journal (Refereed) Published
Abstract [en]

The official rhetoric of welfare states unconditionally pays tribute to older people’s right to express dissatisfaction. In practice, users of ‘older service’ in welfare states may be deprived of their ‘exit’ option and face considerable constraints when it comes to raising their ‘voices’. For example, when older people in nursing homes would like to lodge a complaint, they may well be referred to the very staff members they depend upon in their everyday life. This article analyses a national case in which these contradictory tendencies are especially explicit: formal influence channels for older people in Sweden. Using data from structured interviews with 100 representatives of Swedish municipalities, and drawing on Hirschman’s (1970) theory on exit and voice, the article analyses obstacles for older service users’ influence in Sweden and develops explanations for these obstacles in terms of social contexts.

Keywords
influence, exit, voice, older people, welfare state, Sweden
National Category
Other Social Sciences not elsewhere specified
Identifiers
urn:nbn:se:hj:diva-5372 (URN)
Available from: 2008-02-28 Created: 2008-02-28 Last updated: 2017-12-12Bibliographically approved
2. Such Trivial Matters: How staff account for restrictions of residents' influence in nursing homes
Open this publication in new window or tab >>Such Trivial Matters: How staff account for restrictions of residents' influence in nursing homes
2009 (English)In: Journal of Aging Studies, ISSN 0890-4065, E-ISSN 1879-193X, Vol. 23, no 1, p. 1-11Article in journal (Refereed) Published
Abstract [en]

National policies emphasize older people’s right to autonomy, yet nursing home residents often have restricted opportunities to make decisions about everyday matters. We use qualitative interview data to analyze staff members’ explanations of actions that conflict with both social norms and national policies. Two types of problematic actions are discussed: restrictions of elderly residents’ influence in decision making and neglect of residents' complaints. While staff members describe residents’ influence as desirable, they simultaneously formulate accounts that justify their inability to live up to this ideal. Further, we demonstrate how certain complaints are “made trivial” when they are described and treated in particular ways by the staff. We argue that the accounts offered by staff members draw on an implicit folk logic, a logic in which residents are allowed to exercise influence only as long as it does not conflict with the efficient running of the institution as a whole.

National Category
Other Social Sciences not elsewhere specified
Identifiers
urn:nbn:se:hj:diva-4000 (URN)
Available from: 2008-07-04 Created: 2008-07-04 Last updated: 2017-12-12Bibliographically approved
3. That’s not my Robert!: Identity maintenance and other warrants in family members’ claims about mistreatment in old age care
Open this publication in new window or tab >>That’s not my Robert!: Identity maintenance and other warrants in family members’ claims about mistreatment in old age care
2010 (English)In: Ageing & Society, ISSN 0144-686X, E-ISSN 1469-1779, Vol. 30, no 4, p. 627-647Article in journal (Refereed) Published
Abstract [en]

This study has explored how family members of care recipients define and sustain claims of mistreatment in old-age care. Twenty-one informants were recruited from an association of relatives of care recipients in Sweden. Using argumentation analysis, four warrants about mistreatment were identified from the qualitative interview data: they referred to physical harm, psychological harm, social-care deficiencies and identity subversion. The first three categories are similar to those recognised in previous research on elder mistreatment, but the fourth, which is described in detail in the article, is less familiar : eldermistreatment as the violation of an older person’s identity. The family members backed their claims about staff members’ violation of a care recipient’s persona or identity by using arguments that drew on their unique knowledge of the care recipient’s appearance, daily routines and preferred activities. They also described their attempts to protect the dignity and identity of a care recipient, their fears of abuse, and actual cases of conflict and retribution by care staff. They consistently positioned themselves as guardians of identity through their claims of mistreatment. The study provides important knowledge about family members’ moral view of elder mistreatment, which may enhance the understanding of conflicts between formal care providers and family members.

Place, publisher, year, edition, pages
Cambridge: Cambridge University Press, 2010
Keywords
claims-making, elder abuse, elder care, family members
National Category
Social Work
Identifiers
urn:nbn:se:hj:diva-11625 (URN)10.1017/S0144686X09990584 (DOI)000277653200005 ()
Available from: 2010-02-22 Created: 2010-02-16 Last updated: 2021-04-04Bibliographically approved
4. Seeking exemptions from nursing home routines: Residents' everyday influence attempts and institutional order
Open this publication in new window or tab >>Seeking exemptions from nursing home routines: Residents' everyday influence attempts and institutional order
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.

Keywords
nursing home, institution, everyday influence, negotiation, routines
National Category
Sociology
Identifiers
urn:nbn:se:hj:diva-11626 (URN)10.1016/j.jaging.2010.08.001 (DOI)000283970900009 ()
Available from: 2010-02-16 Created: 2010-02-16 Last updated: 2021-04-04Bibliographically approved

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