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Cross, Jane 
ORCID: https://orcid.org/0000-0002-7003-1916, Backhouse, Tamara ORCID: https://orcid.org/0000-0001-8194-4174, Hammond, Simon P 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 |
| UEA Research Groups: | Faculty of Medicine and Health Sciences > Research Groups > Dementia & Complexity in Later Life Faculty of Social Sciences > Research Centres > Centre for Research on Children and Families Faculty of Medicine and Health Sciences > Research Centres > Norwich Institute for Healthy Aging Faculty of Medicine and Health Sciences > Research Centres > Institute for Volunteering Research Faculty of Medicine and Health Sciences > Research Centres > Population Health |
| Depositing User: | LivePure Connector |
| Date Deposited: | 18 Oct 2022 16:31 |
| Last Modified: | 19 Oct 2023 03:27 |
| URI: | https://ueaeprints.uea.ac.uk/id/eprint/89168 |
| DOI: | 10.1017/S0144686X22000927 |
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