Disjunctures in practice: ethnographic observations of orthopaedic ward practices in the care of older adults with hip fracture and presumed cognitive impairment

Cross, Jane ORCID: https://orcid.org/0000-0002-7003-1916, Backhouse, Tamara ORCID: https://orcid.org/0000-0001-8194-4174, Hammond, Simon ORCID: https://orcid.org/0000-0002-0473-3610, Penhale, Bridget ORCID: https://orcid.org/0000-0002-8487-0606, Scheibl, Fiona ORCID: https://orcid.org/0000-0002-9115-1247, Lambert, Nigel, Varley, Anna, Fox, Chris and Poland, Fiona ORCID: https://orcid.org/0000-0003-0003-6911 (2022) Disjunctures in practice: ethnographic observations of orthopaedic ward practices in the care of older adults with hip fracture and presumed cognitive impairment. Ageing & Society. ISSN 0144-686X

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Abstract

Organisational priorities for health care focus on efficiency as the health and care needs of populations increase. But evidence suggests that excessive planning can be counterproductive, leading to resistance from staff and patients, particularly those living with cognitive impairment. The current paper adds to this debate reporting an Institutional Ethnography of staff delivering care for older patients with cognitive impairment on acute orthopaedic wards in three National Health Service hospitals in the United Kingdom. A key problematic identified in this study is the point of disjuncture seen between the actualities of staff experience and intentions of protocols and policies. We identified three forms of disjuncture typified as: ‘disruptions’, where sequenced care was interrupted by patient events; ‘discontinuities’, where divisions in professional culture, space or time interrupted sequenced tasks; and ‘dispersions’, where displaced objects or people interrupted sequenced care flow. Arguably disruption is an integral characteristic of care work; it follows that to enable staff to flourish, organisations need to confer staff the autonomy to address systemic disruptions rather than attempt to eradicate them. Ultimately, organisational representations of ‘good practice’ as readily joined up, impose a care standard ‘stereotype’ that obscures rather than clarifies the interactional problems encountered by staff.

Item Type: Article
Faculty \ School: Faculty of Medicine and Health Sciences > School of Health Sciences
Faculty of Social Sciences > School of Education and Lifelong Learning
Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User: LivePure Connector
Date Deposited: 18 Oct 2022 16:31
Last Modified: 24 Oct 2022 16:34
URI: https://ueaeprints.uea.ac.uk/id/eprint/89168
DOI: 10.1017/S0144686X22000927

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