A Hospice in Change by Martin Lipscomb

Author:Martin Lipscomb [Lipscomb, Martin]
Language: eng
Format: epub
Tags: Social Science, Sociology, General
ISBN: 9781134637096
Google: VYpmAQAAQBAJ
Publisher: Routledge
Published: 2013-10-15T04:52:17+00:00

Increasing medical engagement

The number of medical staff engaged at the hospice rose dramatically during the study period. Short-term fluctuations preclude overly declarative statements. However, while the hospice engaged just two doctors in its early years, upwards of six and seven (part and full time) medical staff were engaged at any one time between T2 and T3. Rising numbers of medical staff can be interpreted, in part, as an outcome or effect of organisational re-designation. Put simply, re-designation caused doctor numbers to increase at the hospice.

NURSING DIRECTOR G:a We have a phenomenal amount of doctors at the moment. I mean that’s, this last twelve months, isn’t it, really, if you look at it.

For nurses, engaging more medical staff produced two forms of contradictory situational logic. First, insofar as the presence of more medical staff contributes to the development or focus upon physical care, it exposes, in socio-cultural interaction, those cultural system structural contradictions previously described. For most agents (medical and nursing) these contradictions remain necessary and corrective. However, in relation to medical engagement, nurses strongly antagonistic to the second of each of the propositional statements detailed on p. 91, describe forms of social and socio-cultural interaction (SI and S-C) that might, in the forcefulness of their presentation, suggest commensurability with eliminatory contingent logics.

Second, increased medical engagement is itself a socio-structural development since it alters the dynamic of doctor-nurse corporate or professional relations within the hospice. In disturbing the respective authority, power or ‘territorial mandate’ (Taube et al., 2003) of medical and nursing positions and roles within the organisation, raised medical engagement provoked contradictory forms of social interaction among doctors and nurses that appeared to exist irrespective of previously described pro- and anti-change perspectives. Thus, even nurse interviewees not antagonistic to other changes critically note the consequences of the expansion in medical input.

Doctor–nurse relations have long attracted professional and sociological interest (e.g. Warelow, 1996; Oughtibridge, 1998; Porter, 1998: Ashworth, 2000; Manias and Street, 2001; Coombs and Ersser, 2004; Fitzsimmons et al., 2005). Attention has focused, among other things, on gender (Jones, 1994; Gjerberg and Kjølsrød, 2001; Davies, 2003), conflict (Mackay, 1993) and the effect that changing doctor–nurse relations have on other professional groups (Jones, 2003). In discussing positions and roles, sociological texts tend to link commentaries regarding medical power to descriptions of the medicalisation thesis (e.g. see Armstrong, 1994, or Nettleton, 1995)20 and, while these issues are not overtly explored in this study, the palliative literature recognises their potential significance (see, for example, Biswas, 1993; Field, 1994; Corner and Dunlop, 1997; Mola, 1997; Clark and Seymour, 1999; Cobb, 2001; Hockey, 2001; Seymour, 2001; Janssens et al., 2002; Woods, 2002, 2007; Sandman, 2005). Here it is merely noted that, first, the descriptors ‘medicalised’ and ‘medicalisation’ are often used loosely and without clarification.21 Second, it has been claimed that medical training in the UK and elsewhere is, with regard to palliative care, erratic, sparse and biomedically focused and, in consequence, non-specialist medical staff may lack a holistic or social perspective (what Macleod, 2003, p. 123, terms the “art” of palliative care) (Schulman-Green, 2003; Oneschuk et al.

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