Gerontology & Geriatric Research

Abstract

The Rules in Institutional Care: An Ethnographic Style Study Introduction

Angela Kydd, Deidre Wild and Ann Fleming

Background: The purpose of this paper is to report on one area of findings that came from a larger doctoral study looking at what life was like for older people in receipt of long-term care in a hospital environment that was due for closure.

Method: Over the period of a year, the study's researcher regularly frequented a longterm care ward as a 'visitor'. Over time, she witnessed many day to day events experienced by frail older patients and recorded these as their stories in field notes as well as in her own related reflective notes. All data were transcribed and thematically analyzed.

Results: The researcher saw evidence of institutionalized rituals on the ward and underpinning these were one or other of four forms of thematically identified 'rules': procedural rules, hospital rules, unspoken rules and spontaneous rules. The imposition of these rules had a negative effect upon patients who were powerless in opposing them. In contrast for staff under stress, the 'rules' seemed to justify poor practice and served to excessively empower them over their patients. It was also clear that when staff displayed stress, emotional care for patients was poorer and the rules were exercised more frequently.

Conclusions: As the ward manager neither challenged poor practice nor prompted change towards person centered care, in the absence of management leadership, staff were left to their own devices as to their ways of working. Given staff shortages and the pressures that this placed upon workload resulted in an inappropriate economy of scale in terms of care-giving. This caused the older people to hold a inner sense of injustice and distress, that they felt unable articulate or to counter.