Managing socio-institutional enclosure: A grounded theory of caregivers' attentiveness in hospital care
Introduction
Attentiveness in care is often dismissed as a bonus, something extra, or as something that one can be good at besides one's real work. Care ethicists however have shown that attention is part of the core business of medicine (Klaver and Baart, 2011). Attentiveness, or attention, has been defined as the quality of individuals to open themselves for the needs of others. Attentiveness meaning the noting of the existence of a need by assuming the position of another person, is seen as the first step to care, which should be followed by a responsibility to respond to this need (Tronto, 1993). Ethics of care researchers such as Conradi (2001), Baart (2005), and Klaver and Baart (2011) emphasize the recognizing meaning of attentiveness. Being attentive does not only have an instrumental function in care (to find out what is needed), but it can also have a good effect on itself. Research has shown (Evans, 2012, Cole-King and Gilbert, 2014) that in order to provide good care - that is good care in the experience of the patient - open attentiveness is of crucial importance. The attention of the caregiver should not always be focused on something functional (i.e. on the diagnosis). At times, care benefits from attentiveness just for the sake of attentiveness because it can create a relationship in which the patient may express himself. It is clear that being attentive is not a matter of individual caregivers but rather depends on several different factors in health care (Iles, 2014), and that it has important implications for the care patients receive. However, as attentiveness is often done tacitly or pre-reflexively, it is not easily accessible, and caregivers do not always refer to it as attentiveness (Klaver and Baart, 2011). To date there has been no published literature on empirical studies of this conceptualization of attentiveness in health care practices. This qualitative study was conducted to address this gap.
Section snippets
Methods
The aim of this study is to formulate a theory that describes attentiveness and its categories and properties as these unfold from the empirical data. This paper presents a grounded theory (Glaser and Straus, 1967) drawing on participant observation on an Oncology Department of a general hospital in The Netherlands. In grounded theory, theoretical concepts are developed during the research process, and there are no pre-formulated hypotheses. However, many scholars have questioned whether
Findings
Caregivers are not free to focus their attention. It is clear that being attentive is not a matter of individual caregivers but rather depends on several different factors in health care (Iles, 2014). Why does a caregiver practice one type of attention in a certain situation, and not another type?
Managing socio-institutional enclosure was the central process identified during analysis of the qualitative data. This concerns the space a caregiver may or may not experience to come loose from the
Discussion
Attentiveness has often been reported as an important factor in health care but there is a lack of adequate and rich concepts and theories for thinking about and supporting it. In this qualitative study we turned to actual care practices in a hospital and examined how attentiveness appears. The analysis of the data showed that attentiveness occurs in different types, which are characterized by a certain goal and a strategy to achieve that goal. Some of these types may contribute to good care
References (27)
Aandacht. Etudes in presentie
(2005)- et al.
The Communicative Relationship between Dialogue and Care
(2009) Care in Everyday Life: an Ethic of Care in Practice
(2012)Research Methods in Anthropology: Qualitative and Quantitative Approaches
(1994)Grounded theory and sensitizing concepts
Int. J. Qual. Methods
(2006)Constructing Grounded Theory. A Practical Guide through Qualitative Analysis
(2006)- et al.
Compassionate care: the theory and the reality
Take care. Grundlagen einer Ethik der Achtsamkeit
(2001)- et al.
Participant Observation: a Guide for Fieldworkers
(2002) Implicit Meanings: Essays in Anthropology
(1975)
Introduction to grid/group analysis
Wonder and the clinical encounter
Theor. Med. Bioeth.
The Constitution of Society. Outline of the Theory of Structuration
Cited by (2)
Effects on staff outcomes and process evaluation of the educating nursing staff effectively (TENSE) program for managing challenging behavior in nursing home residents with dementia: A cluster-randomized controlled trial
2021, International Journal of Nursing StudiesCitation Excerpt :These results may indicate that the training contributed to the skills of nursing staff that are required for managing challenging behavior. Being able to attune to the resident and their needs, skills and wishes is important for managing challenging behavior (Klaver and Baart, 2011, 2016; Mallon et al., 2019) and nursing staff's job-related wellbeing (Willemse et al., 2015). This requires self-awareness, reflective abilities and sharing thoughts and uncertainties (Berg et al., 1998; Younas et al., 2020).
Scheduled care—As a way of caring: A phenomenological study of being cared for when suffering from alcohol use disorders
2019, Journal of Clinical Nursing