One in a series of short pieces demonstrating the diverse research in gender and feminist geographies. To comment or to write a post yourself, please contact our Web Coordinator, Louise Rondel at firstname.lastname@example.org We welcome posts by all members of the GFGRG.
I have recently finished twelve months of fieldwork in the NHS, examining care of chronic lung disease patients. This has involved medical ethnography in emergency departments and respiratory wards in hospitals in England and Wales, and interviews with health professionals, patients and carers. My role as a geographer in the context of applied health research has raised a number of challenges and opportunities. One such opportunity has been to integrate geographical approaches with quality improvement methodologies and service evaluation in the public health sector.
In the context of healthcare, existing geographical approaches have included feminist critiques of the gendered nature of care, and the body work and emotional labour which it entails (Dyer et.al., 2008; Batnizky and McDowell, 2011). In an acute context, the emotional labour of nurses (Mauno et.al., 2016), doctors (Kerasidou and Horn, 2016) and healthcare assistants (Lovatt. et.al. 2015) has been addressed. This has been framed in temrs of the positive contribution such labour makes to patients, as well as the wellbeing ‘cost’ to healthcare professionals. Through preliminary analysis of observational and interview study data, a pertinent issue which has emerged is the formation of informal structures of care which families and/or friends often form in times of crisis. These informal and less visible care practices emerge- or adapt- in response to an unexpected admission to hospital. By ‘informal’, I mean that these individuals are not recognised within financial, legal or political frameworks as patient ‘carers’.
Such informal practices of care giving involve friends and/ or family adopting a range of responsibilities including liaising with health professionals about treatment plans, medication, and concerns about patient condition; researching patient illness/treatment/prognosis (and often developing an informal medical expertise); providing patients with transportation, clothing, toiletries, food and reading materials; and of course, providing emotional support to patients. These informal care practices appear to be particularly valuable around patient discharge, supporting the patient in the transition back to the community.
Clearly, such informal care is of enormous benefit to patient wellbeing, but often places a significant burden on the ‘care-giver’, in terms of finance, time, and carer wellbeing. Carers spoke of the demands of this role, reflecting on challenges of negotiating these responsibilities with other caring roles, such as parenting, paid employment and self-care. They also discussed the guilt they felt at having to manage this role at the cost of other responsibilities, and not necessarily being able to commit ‘enough’ time to patient care. These respondents were almost exclusively mothers, sisters, daughters and female friends of patients.
In an overstretched and underfunded NHS, where staff are expected to meet difficult targets with limited resources, the provision of informal structures of care seems more pertinent than ever. The un-quantified contribution that friends and family play in supporting patient care requires further attention. Examination of the hierarchies of power in which informal care is situated, as well as the identity politics of such care will be two avenues that further analysis will explore.
Dr Katherine Morton from the School of Social and Community Medicine, University of Bristol is a member of the GFGRG.