WANDERING THE WARDS : an ethnography of hospital care and its consequences for people living ... with dementia

__Wandering the Wards__ provides a detailed and unflinching ethnographic examination of life within the contemporary hospital. It reveals the institutional and ward cultures that inform the organisation and delivery of everyday care for one of the largest populations within them: people living with dementia who require urgent unscheduled hospital care. Drawing on five years of research embedded in acute wards in the UK, the authors follow people living with dementia through their admission, shadowing hospital staff as they interact with them during and across shifts. In a major contribution to the tradition of hospital ethnography, this book provides a valuable analysis of the organisation and delivery of routine care and everyday interactions at the bedside, which reveal the powerful continuities and durability of ward cultures of care and their impacts on people living with dementia. \*Shortlisted for the Foundation for the Sociology of Health and Illness Book Prize 2021\* Cover Half Title Series Page Title Page Copyright Page Dedication Table of Contents Preface Acknowledgements Chapter 1: Ward cultures of care Cultures of care and their consequences Cultures of attribution Cultures of care and institutional ‘looping’ Visibilities and invisibilities Cultures of care and systemic inequalities Timetables, rules, and restraint The work of bedside care Note Chapter 2: Ward life Learning the ‘rules’ of the ward Entering the institution Entering these wards Technology within these wards Recording practices Organisation and staffing of these wards Staffing within these wards Soundscapes and senses People living with dementia within these wards Chapter 3: Visibilities and invisibilities Seeing invisibilities The invisible cascade of impacts Cultures of not belonging Visibility and stripping practices Technologies to promote visibility and attention Discussion: Visibilities and invisibilities Note Chapter 4: Recognition and attribution of dementia at the bedside Introduction Nosographic categories The significance of the acute setting for the recognition and attribution of dementia Recognition and attribution of dementia within these wards ‘Memory checks’ at the bedside Informal recognition of bays and cohorts of patients Categories and naming in the recognition of ‘dementia’ Stickiness of the label and recognition of dementia Recognition of the impacts of the ward environment Constructing dementia as high dependency Ward expectations and the dismissal of a formal diagnosis Discussion Chapter 5: Tightening of the timetables and the organisation of bedside care Introduction Timetables and their impacts on people living with dementia Competing and clashing timetables of the wards Ordering, structure, and fragmentation at the bedside Motion, pace, and fear of ‘falling behind’ Timetables shaping cultures of care Conforming to requirements of etiquette and a neat and tidy ward Restoring and tightening of the timetables Breakdown and strategies of reactive care Discussion: The timetables on the ward Chapter 6: Bedside talk and communicating the ‘rules’ of the ward Introduction Working in silence Rigid and repetitive talk Standardised routines and strategies at the bedside The rules of the ward Instructions for following the rules of the ward All are required to meet the rules of the ward Discussion Note Chapter 7: Organisational cultures of containment, restriction and restraint Introduction Intensification, contagion, and ‘collective disturbance’ An ordinary and taken-for-granted aspect of ward cultures Ward life experienced as incarceration Privileges and permissions Institutional cultures of restraint Cultures of containment in maintaining the timetables Containment, restriction, restraint, and cascade iatrogenesis Outsourcing restraint Discussion Chapter 8: Wandering the wards Understandings of behaviour, permissions and privileges A normal response to an abnormal world Cultures that contain, restrict, and restrain ward staff Cultures of change: Interventions intensify and reinforce current cultures Continuities of the ward and involvement of people living with dementia References Index This book is open access and will be available on www.bloomsburycollections.com. Based on ethnographic research within hospitals across England and Wales over a four-year period, this book provides a detailed and unflinching examination of the world of the hospital ward and the everyday cultures of ward life; the organisation, routines and patterns of bedside care within it; and its consequences for patients and staff. Katie Featherstone and Andy Northcott offer a major new addition to the tradition of hospital ethnography. Featherstone and Northcott explore a key contemporary transformation in our hospitals, the experiences, impacts, and consequences, of an increasing significant population of people living with dementia who require unscheduled acute hospital care. This book (supported by the National Institute for Health Research) contributes to our understandings of cultures of care, the practical recognition and attribution of dementia, understandings of ageing and the erosion of the person and the body, and the classification of the mind and behaviour within the contemporary institution "Wandering the Wards provides a detailed and unflinching ethnographic examination of life within the contemporary hospital. It reveals the institutional and ward cultures that inform the organisation and delivery of everyday care for one of the largest populations within them: people living with dementia who require urgent unscheduled hospital care. Drawing on five years of research embedded in acute wards in the UK, the authors follow people living with dementia through their admission, shadowing hospital staff as they interact with them during and across shifts. In a major contribution to the tradition of hospital ethnography, this book provides a valuable analysis of the organisation and delivery of routine care, and everyday interactions at the bedside, that reveal the powerful continuities and durability of ward cultures of care, and their impacts on people living with dementia"-- Provided by publisher