'She doesn’t want to go to hospital. That’s one thing she hates’: Collective performativity in avoidable nursing home to hospital transfers

Makela, P. 2018. 'She doesn’t want to go to hospital. That’s one thing she hates’: Collective performativity in avoidable nursing home to hospital transfers. Journal of Evaluation in Clinical Practice. 24 (5), pp. 1041-1048. https://doi.org/10.1111/jep.12985

Title'She doesn’t want to go to hospital. That’s one thing she hates’: Collective performativity in avoidable nursing home to hospital transfers
TypeJournal article
AuthorsMakela, P.
Abstract

Older people who live with a combination of conditions experience fluctuations over time, which others may interpret as a need for medical attention. For some nursing home residents, this results in transitions in and out of hospital. Such transfers may be arranged without expectation ofimproved quality of life, can be associated with significant morbidity and mortality, and may preclude end-of-life preferences. Factors affecting avoidable hospitalisation for nursing home residents are not well understood. I aim to explore potential drivers, moving beyond deficit explanations relating to funding, training and resources. I use a framework of analysis that firstly considers medicalisation of frailty, as a state of vulnerability that provides focus for others’ action. I then draw on Judith Butler’s theory of performativity, to explore nursing homes as sites of identify work for staff, residents and families. I consider ways subjectivities can be effected through reiterative practice that is compelled by normative conventions. Trouble may arise when citational practice of healthcare staff, and performative acquiescence of residents and families, culminate in an inevitability of hospitalisation when navigating grey areas of assumed clinical risk. Principles of coproduction could present a disruptive opening, to rework power asymmetries and move toward aspirations for residents and their relatives to be at the centre of decisions about care.

KeywordsPerson-centred care; agency; frailty; medicalisation; nursing homes
JournalJournal of Evaluation in Clinical Practice
Journal citation24 (5), pp. 1041-1048
ISSN1356-1294
Year2018
PublisherWiley
Accepted author manuscript
Digital Object Identifier (DOI)https://doi.org/10.1111/jep.12985
Publication dates
Published online03 Jul 2018
Published in printOct 2018

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