This book offers a long-overdue exploration of care at a pivotal moment in the history of health care.

This article examines field studies of nursing work published in the English language between 1993 and 2003 as the first step towards an empirically based reformulation of the nursing mandate. A decade of ethnographic research reveals that, contrary to contemporary theories which promote an image of nursing work centred on individualised unmediated caring relationships, in real‐life practice the core nursing contribution is that of the healthcare mediator. Eight bundles of activity that comprise this intermediary role are described utilising evidence from (...) the literature. The mismatch between nursing's culture and ideals and the structure and constraints of the work setting is a chronic source of practitioner dissatisfaction. It is argued that the profession has little to gain by pursuing an agenda of holistic patient care centred on emotional intimacy and that an alternative occupational mandate focused on the healthcare mediator function might make for more humane health services and a more viable professional future. (shrink)

This article explains the attempts of nurses to practice humanistic, holistic care in line with their professionalizing strategy. Ideally, the intention of nurses is to broaden their concerns beyond the physiological needs of patients, thereby circumventing biomedical control over their work. However, the author argues that resource constraints, and the coalescing of biomedical and managerial definitions of patients, suggest that holistic notions of care are subjected to a new form of calculus and normalizing technology. Critically, nurses are more preoccupied with (...) the day-to-day struggle to free up resources for healthcare, in particular bed spaces, and to pre-empt the problem of bed blocking. Such work suggests that the ‘emptying of beds’ is not just a symbol of accomplishment for nursing work. From the governmentality theory of Foucault, the administration of ‘beds’ has become part of the managerial power/knowledge discourse and an instrument for making nurses toe the financial bottom-line. (shrink)

Working in and around the ‘chain of command’: power relations among nursing staff in an urban nursing homeBy most accounts, the discipline of nursing enjoys considerable hegemony in US nursing homes. Not surprisingly, the ethos of this setting is influenced, in large part, by nursing’s value system. This ethos powerfully impacts both the residents who live in nursing homes and the staff who work there. Using ethnographic methods, this project explored power relations among nursing assistants and nurses in an urban (...) nursing home in the United States. Factors contributing to tensions among nursing staff were the stigma attached to nursing homes and those who work in them, as well as the long history of class conflict and power struggles within the discipline of nursing. The latter struggles, in turn, reflected nursing’s quest for professional status in the face of medicine’s hegemony over health‐care. Ultimately, these factors coalesced to produce a local work environment characterized by conflict — and by aides’ resistance to nurses’ domination. (shrink)