NHS managers as rhetoricians: a case of culture management?

In the wake of Peters and Waterman's In Search of Excellence few NHS managers are unaware of culture management as a tool for shaping organisational change. Yet the first wave of post-Griffiths studies found little evidence of ‘culture management’ in action. This paper draws on data from an ethnographic study carried out in 1988–90 to suggest that the symbolic facet of management action is an important, though neglected, element in the 1991 NHS reforms. It argues that rhetorical skills Iwere a valuable resource for general managers overseeing the change process, and explores some of the ways in which rhetoric may have influenced cultural adaptation. However, many of the specific claims of the ‘excellence genre’, including ideas about the importance of strong, homogeneous cultures, are rejected. Rhetoric is an aspect of micro-political struggles over meaning, which rarely result in straightforward cultural ‘manipulation’, and are more likely to re-shape organisations through pragmatic accommodation than to win the hearts and minds of members.     

South Africans' experiences of being old and of care and caring in a transitional period

This focused ethnographic study aimed to illuminate a group of South Africans' experiences of being old and of care and caring in a transitional period. With a growing number of older people in Africa, studies on the individual experiences may help to develop care which is more sensitively based on the needs for older people in a changing Southern Africa context. Data were collected through group and individual in-depth interviews and participant observations which involved 16 individuals, aged 52-76. Data were analysed using a qualitative content analysis. The study showed two interrelated themes reflections on life and ubuntu - an orientation towards others. Findings were discussed from the viewpoint of the theory of gerotranscendence, showing similarities as well as differences, possibly due to societal and cultural differences. Shortage of formal care for older people living in poor conditions in Southern Africa, gave rise to the discussion for the need of a contextualized development of gerontological care. To enhance knowledge on the theory of gerotranscendence and develop guidelines for nursing in home-based care/community-based care in a South African context may be a first step to support older people in their process towards gerotranscendence.     

Empathy, inclusion and enclaves: the culture of care of people with HIV/AIDS and nursing implications

AIM: This paper reports an empirical research study investigating specific features of the culture of care on a specialized unit supporting people living with human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS). BACKGROUND: The anxiety felt by healthcare workers coming into contact with people living with HIV and AIDS (PLWHA) has been recognized in numerous studies. There is often an amplified notion of threat and a worldview fuelled by stereotypes, which inevitably leads to negative attitudes and stigmatization. METHODS: An ethnographic approach was used, including a 14-month period of observation and 31 semistructured interviews. The data were collected during 2000 and 2001 in a large teaching hospital in the United Kingdom. FINDINGS: Carers working on this unit who regularly contributed to the care of this client group had a broad range of experience and in many cases had chosen to work in the field. They worked within a social context that had a high level of egalitarianism, a view of PLWHA that appeared more positive and less pejorative than others, and a strongly empathetic approach accompanied by close engagement with the client group. CONCLUSION: Using nursing staff specially prepared for the care of PLWHA could be the most effective way to minimize stigma and discrimination against this client group in the healthcare sector.     

'Handing over': transmission of information between nurses in an intensive therapy unit

Transferring end of shift information between nurses via both verbal and written routes in an intensive therapy unit (ITU) setting is complex and multifaceted. Some authors have taken ethnographic approaches and explored the verbal handover as an example of a nursing ritual. The written route involves various textual materials, which, in addition to conveying essential information about the patient's status, also represent other messages. This article considers two key areas of end of shift information transmission - verbal bedside handovers and written accounts - arguing that in addition to the manifest purposes of transferring essential information between nurses, both modes of reporting also have important latent functions. It will explore and interpret elements of ritual and symbolism inherent in both forms of handover. The article reports on particular findings from a larger ethnographic study of nursing culture, which was accomplished through participant observation over a 12-month period in ITU. Subsidiary components of the ethnography were the interviews with 15 nurses and the examination of documentary material. The findings suggest that both verbal and written reports, in addition to ensuring that nurses taking over the care of the patient receive the necessary information to enable them to safely provide continuity of care, also convey essential meanings and articulate group values. Both modes of handover reporting are also visual and/ or audible symbolic representations of nursing care in ITU and as such confirm and validate that care, expressing the value of nursing work in this unit.     

Needles in the Haystacks: The Social Context of Initiation to Heroin Injection in Rural Ohio

Although there has been much research on the social context of heroin injection, little has been reported outside of major urban areas. This article examines contextual factors associated with initiation to heroin injection in rural Ohio, based on semistructured qualitative interviews and focus groups involving 25 recent heroin injectors (12 women, 13 men) recruited from three contiguous counties between June 2002 and February 2004. Curiosity about the drug's effects, the growing pressures of drug dependence and economic need, and the influence of intimate and group relations were all identified as factors that offset fears commonly associated with injection. This study complements other research on the social ecology of heroin injection and may contribute to improved services for injection drug users in rural areas and small communities.     

‘Le moment de la lune’. An auto‐ethnographic tale of practice about menarche in a children’s hospital

Introduction: Auto‐ethnographic accounts can highlight unsaid moments of professional practice. In this case, my auto‐ethnographic tale ‘Le moment de la lune’ re‐inscribes subjugated knowledge about menstruation and occupational therapy practice in the era before adolescent wards. Methods: This fictional tale is written in direct dialogue with an article that was published in this journal at a particular point in my own career as an occupational therapist. In the tale I am ‘writing in’ what was not written about in my article and in occupational therapy generally. This ‘writing‐in’/re‐inscribing is the research method. Findings: My previous article ‘Normal spaces’ published in this journal in 1985, was organised around principles and generalities of youth‐specific practice. The original article had little locating the personal or evoking the body and a heavy reliance on the literature. Issues of gender and culture were largely absent, or, perhaps, ‘written out’. The corresponding tale of embodied sexuality, ‘Le moment de la lune’, articulates something of local complex practice and the particularity of individual therapeutic work to do with menstruation in self‐care. Discussion: Points of tension in ‘Normal spaces’ are elaborated and I explain how ‘Le moment de la lune’ problematises supporting menarche in a children’s hospital. Now practice has moved on with dedicated adolescent wards in all major children’s hospitals. Nevertheless, occupational therapy practice around issues of menstrual self‐management is still under‐documented. Writing about unspoken moments of practice can have ethical implications for expanding the ways occupational therapy practice can be written and understood.     

The Kangaroo Program at a Brazilian maternity hospital: the preterm/low-weight babies' health-care under examination

The Kangaroo Program, originally developed in Colombia, was adopted as a public policy by the Brazilian Unified Health System (SUS) in 2000, in an effort to improve maternal and infant health in the country. This article aims to examine the Kangaroo Program as it is practiced and carried out at a maternity hospital in the northeastern Brazilian region. Through an institutional ethnographic approach, research demonstrates that the Kangaroo Program has been effective in saving lives and improving some of the infants' health outcomes. However, research also demonstrates that: (i) the socioeconomic profile of mothers in the Kangaroo Program, (ii) conflicting relationships between healthcare workers and users, and (iii) lack of socioeconomic and emotional support are impairing the adequate implementation of the program. Due to the low literacy level of most of these mothers, institutional power is used as a form of social control to keep mothers uninformed about the possibility of leaving the maternity wards. In a two-tier health system, this controlling behavior is part of existing social inequities, as the Kangaroo Program is a choice in the private health system but tends to be mandatory at SUS maternity hospitals across Brazil.