Economization of Home Care in Ontario: A Critical Ethnography of Nursing Actions

• Main Author: Al Chami, Mohamad Hamze
• Other Authors: Foth, Thomas
• Format: Others
• Language: en
• Published: Université d'Ottawa / University of Ottawa 2021
• Subjects: Nursing theory; Managerialism; Critical social theory; Neoliberalism; Recognition; Ethics of care; Axel Honneth; Healthcare policy
• Online Access: http://hdl.handle.net/10393/42670; http://dx.doi.org/10.20381/ruor-26890

Many nursing theorists consider caring the essence of nursing practice. Yet, the meaning of caring is still elusive in nursing theories. This confusion in conceptualizing caring is exacerbated by the neoliberal socio-political and economic transformations of our societies that infuse nursing practice with economic efficiency values ‒ a condition that threatens the ethical dimensions of nursing. This critical study analyzes nursing actions in home care in Ontario and empirically reconstructs the normative dimensions of care based on nurses’ own perceptions of good care. The findings are used to critique current healthcare transformations through a critical theory of nursing actions. This study is situated in the tradition of the Frankfurt critical school and pursues an emancipatory interest. Axel Honneth’s theory of recognition is the principal theoretical foundation complemented by Jürgen Habermas’ theory of communicative action and the interests of knowledge, in addition to the concepts of phenomenology and corporality. It uses critical ethnography as a methodological approach. Data collection included audiotaped semi-structured open-ended interviews with 18 nurses working for two different home care providers in Ottawa. Analysis demonstrates that the patient must be recognized on three dimensions: love, legal rights, and solidarity. Care is a specific form of communicative action in which patients should participate equally in decision making. Nursing actions comprise a hermeneutic-phenomenological dimension of “deep knowing” that respect the corporal and personal needs of the patient. Healthcare transformations and economic efficiency measures reinforce technical and standardized forms of care, which lead to pathologic practices that neglect patients’ corporal needs, thereby reifying patients. Nursing actions combine both technical and corporal aspects that characterize their “double logic.” This study provides elements for a critical theory of nursing actions. Findings highlight that nurses have a vision of how nursing care should look like, but the reality of home care makes it rather impossible to realize this vision. Economization leads to a systematic violation of multiple dimensions of recognition and to reification. Nurses must resist these social pathologies and this study provides some theoretical tools to engage in this struggle.