Much care work in hospitals is done by people who are not qualified or registered

The kind of activities carried out by unqualified staff (UQS) can be very broad. UQS include care assistants, domestic staff, porters, voluntary workers. The tasks they undertake may differ depending on what ward or at what time of day they are working. Lizz Hart, an anthropologist, spent time working in a hospital as one of the domestic members of staff (1991, p16). She highlights the many areas in which the domestic staff are giving care, i. e. fetching things, tidying around, helping patients to drink and sometimes lifting.

Lifting is very much a nurse’s duty. If a nurse is unavailable, a UQS can offer support. This is an example of how UQS can help the running of a ward. Domestic staff recognise that they do more than is required by their job description. Through Lizz Harts observations and conversations with domestic staff (DS) she observes the time DS spend around the patients (1991, p16). Although DS are not supposed to talk to patients, the time spent around them naturally leads to relationships being made – joking with the patients or spending time listening to them.

This is acknowledged by nursing staff to be useful and even therapeutic. This example illustrates how these two categories of staff, nurses and DS duties overlap , but in a hospital there are many categories of staff, either working permanently on the wards, or visiting the hospital in a professional capacity ie social workers, health visitors. There appears to be a clear hierarchy of staff in a hospital of doctors, nurses, care assistants and domestic staff (I haven’t included the whole myriad of staff this is a very basic example). When looking at their daily routines their jobs overlap.

Nurses being trained in more technical areas, having more responsibility in the treatment of patients, care assistants taking on nurses duties. Mackay (1993, p99) talks of a big divide in attitude between doctors and nurses and I believe this seems to ripple down the hierarchy. Doctors are fundamentally taught that health is approached through a biomedical model. This is a science based theory dealing with the anatomy as a mechanism, dealing directly with the illness. There is much less emphasis on the state of mind or what may have led to the illness.

Although now there is more acknowledgment by doctors of the patients thoughts and feelings they are still under pressure to treat the illness and can come across as detached or even uncaring. Doctors have to take responsibility for decision making and are under great pressure. However this should not mean they ignore the contribution of nursing staff. Mackay (1993, p99) argues this does happen all too often therefore leading to a divide where communication may not be at its most affective , nurses spend more time with patients so could paint a fuller picture of the patients position.

The biggest difference is that doctors are meeting the physical needs whereas the nurses are caring and supporting them through their illness. Mackay says that nurses are treated like doctors assistants and may not get the respect from doctors that they should. This divide can go still further down the hierarchy. Nurse’s face constraints on their care work. A hospital has to run in a routine fashion. (Chernisse1980 p. 87) gives an example of a patient who is suffering psychological depression and that it is impeding his recovery.

When the patient feels he can talk the nurse feels she is really ‘doing nursing’ but the moment is interrupted by the dinner trays being brought round. A nurse’s job description can be a very heavy load. Most of their training has a heavy emphasis on the biomedical mode with caring being something learnt through experience. When I was in hospital giving birth to my daughter I felt I experienced this in a very real way. When I first thought about my birthing plan I was told I would not be able to have a home birth.

This was the first bit of control over my own situation being undermined. I was taken into hospital to be induced as my baby was two weeks late. Throughout the night I kept insisting to staff that labour had started. Three times I was told I must be mistaken on the fourth occasion a midwife said she would give me something to help me sleep. After thirty minutes I realised I had been given something that was making me feel very peculiar and I had no idea what it was. I felt very out of control and dizzy. Again I spoke to a midwife who then told me it was Pethadine.

I was shocked as I had stated on my birth plan that I was specifically not interested in Pethadine, having researched its affects, and decided I would try other methods of pain relief and would only take such a drug as a last resort,. Unfortunatly I was by this time much too tired to argue and was lead back to bed. In the morning after an examination they confirmed labour had started. I was taken to a delivery room and wired to various machines. When I asked to walk around I was told I couldn’t. Gave birth five hours later with no pain relief or undue distress.

As a young healthy woman this is unsurprising. To me this is a very clear example of the bio medical mode working in its most negative form. As a patient I wasn’t listened to, my labour was treated as an illness rather than a natural process. (UQ) staff do not have the formal training and in many senses respond to patients with a more instinctive approach. They spend much time around the patients and are at times more available to listen. Later in hospital I was having trouble settling my daughter. A care assistant offered to help.

She tightly swaddled my daughter and sat with her then telling me to go for a shower. When I returned my baby was fast asleep in her crib. Her experience shone through. The (UQ) staff in a hospital play a big role. But as an (UQ) person they could be vulnerable. The example earlier of a Domestic lifting a patient may be inappropriate. With (UQ) staff taking on nurse’s duties this may leave patients feeling unconfident about their care or indeed they themselves feeling unconfident or under too much pressure.

Lizz Hart” tells us that domestic staff are left to deal with upsetting situations unsupported and “hiding to cry alone”. These are huge drawbacks for (UQ) staff. More support and closer monitoring would compensate for some of these issues. A less rigid system than N. V. Q. could be set up where experience could be gauged and then used more affectively. It is clear to see that (UQ) staff are invaluable. They lighten a nurse’s load, they can offer care to patients that qualified staff don’t always have time for and they help to create a less formal approach to health.

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