Thesis Database

 

Thesis Database

Author
Anna Lisa Albers
Year

2010

Supervisors
G.J.E. Gerrits
J.D.M. van der Geest
Key Words
Nursing
Hospital ethnography
Improvising care
Botswana
Thesis

Do nurses care? Een etnografische studie van de verpleegkundige praktijk in het Deborah Retief Memorial Hospital in Mochudi, Botswana

This master thesis is an ethnographic account of the locally specific practice of nursing in the Deborah Retief Memorial Hospital in Botswana. I have gathered the data on which the thesis is based through participant observation and interviews during my fieldwork in DRM Hospital between March and July 2009. In Botswana, like in other African countries, complaints about the behavior of public health care nurses are commonly expressed within society, politics and media. The questions I tried to answer in this thesis focus on these complaints: How can the complaints about the behavior of nurses in the public health care system of Botswana be explained by looking at the daily nursing practice as experienced by the nurses themselves? How can we understand and explain the negative discourse on nurses when we look at the nursing practice from the nurses’ perspective? By using the theoretical orientation of the multilevel perspective and the ideas of the Critical Medical Anthropology I will place the locally specific nursing practice in the wider cultural, social, political, economic and historic context of the country.

In the public debate in Botswana a two-sided image of the nursing profession can be distinguished. On the one hand, nurses are being perceived as hardworking, responsible and altruistic individuals who contribute positively to the nation’s well-being. This image is being informed by international ideas and values about the nursing profession. On the other hand, a very negative image of nurses exists in the public debate: nurses are said to have a negative attitude towards patients and to display rude and disinterested behavior. This negative discourse about nurses is caused by the fact that the nurses in the public health facilities do not always meet the expectations of the professional nursing care that are set by the international positive discourse and nursing standards.

The nurses themselves are well aware of the poor image of their profession in society. The nurses of DRM Hospital say to experience a similar gap between personal expectations of the nursing profession (also based on western theories and values of nursing) and the way they practice the profession in the hospital. The nurses’ account for this by pointing out that the conditions under which they work are suboptimal. In the hospital where they are working they have to deal with shortages in material and supplies and they encounter challenges because of the lack of time and personnel. The experience of the nurses is that they have to improvise in carrying out their daily work to be able to fulfill the duties of their job. According to the nurses, this improvising sometimes means compromising patient care. Combined with low job satisfaction – caused by low salaries, extended responsibilities and tasks, lack of accommodation and self-development possibilities and the allocation system of the government- this negative attitude towards the job could be of influence on the way the nurses treat the patients in the health facility.

A further explanation for the behavior and attitude of the nurses is being given by looking at the processes at work within a bureaucratically organized organization that could cause the individuals working within such an organization not to feel entirely responsible for their own actions. In this thesis, I try to show with the help of the theories of Herzfeld (1992) that the behavior of nurses is partly explainable by looking at these processes. The bureaucratic and hierarchical structure of the organization of the hospital causes a sense of powerlessness among the nurses regarding the conditions under which they work and regarding the management and policy. This feeling of powerlessness gives them the possibility to not completely feel responsible for their own behavior and actions and causes a feeling of indifference amongst the nurses towards the patients that they take care of.

In this thesis, it will become clear that the complaints of the Botswana public about the misbehavior of nurses have to be seen in the light of all these different aspects and that all these developments on different levels of social organization have to be taken into account to be able to understand the daily nursing practice in a public health care setting in Botswana.

Do nurses care? Een etnografische studie van de verpleegkundige praktijk in het Deborah Retief Memorial Hospital in Mochudi, Botswana

Author

Anna Lisa Albers

Year

2010

Supervisors

G.J.E. Gerrits
J.D.M. van der Geest

Key Words

Nursing
Hospital ethnography
Improvising care
Botswana

Thesis

This master thesis is an ethnographic account of the locally specific practice of nursing in the Deborah Retief Memorial Hospital in Botswana. I have gathered the data on which the thesis is based through participant observation and interviews during my fieldwork in DRM Hospital between March and July 2009. In Botswana, like in other African countries, complaints about the behavior of public health care nurses are commonly expressed within society, politics and media. The questions I tried to answer in this thesis focus on these complaints: How can the complaints about the behavior of nurses in the public health care system of Botswana be explained by looking at the daily nursing practice as experienced by the nurses themselves? How can we understand and explain the negative discourse on nurses when we look at the nursing practice from the nurses’ perspective? By using the theoretical orientation of the multilevel perspective and the ideas of the Critical Medical Anthropology I will place the locally specific nursing practice in the wider cultural, social, political, economic and historic context of the country.

In the public debate in Botswana a two-sided image of the nursing profession can be distinguished. On the one hand, nurses are being perceived as hardworking, responsible and altruistic individuals who contribute positively to the nation’s well-being. This image is being informed by international ideas and values about the nursing profession. On the other hand, a very negative image of nurses exists in the public debate: nurses are said to have a negative attitude towards patients and to display rude and disinterested behavior. This negative discourse about nurses is caused by the fact that the nurses in the public health facilities do not always meet the expectations of the professional nursing care that are set by the international positive discourse and nursing standards.

The nurses themselves are well aware of the poor image of their profession in society. The nurses of DRM Hospital say to experience a similar gap between personal expectations of the nursing profession (also based on western theories and values of nursing) and the way they practice the profession in the hospital. The nurses’ account for this by pointing out that the conditions under which they work are suboptimal. In the hospital where they are working they have to deal with shortages in material and supplies and they encounter challenges because of the lack of time and personnel. The experience of the nurses is that they have to improvise in carrying out their daily work to be able to fulfill the duties of their job. According to the nurses, this improvising sometimes means compromising patient care. Combined with low job satisfaction – caused by low salaries, extended responsibilities and tasks, lack of accommodation and self-development possibilities and the allocation system of the government- this negative attitude towards the job could be of influence on the way the nurses treat the patients in the health facility.

A further explanation for the behavior and attitude of the nurses is being given by looking at the processes at work within a bureaucratically organized organization that could cause the individuals working within such an organization not to feel entirely responsible for their own actions. In this thesis, I try to show with the help of the theories of Herzfeld (1992) that the behavior of nurses is partly explainable by looking at these processes. The bureaucratic and hierarchical structure of the organization of the hospital causes a sense of powerlessness among the nurses regarding the conditions under which they work and regarding the management and policy. This feeling of powerlessness gives them the possibility to not completely feel responsible for their own behavior and actions and causes a feeling of indifference amongst the nurses towards the patients that they take care of.

In this thesis, it will become clear that the complaints of the Botswana public about the misbehavior of nurses have to be seen in the light of all these different aspects and that all these developments on different levels of social organization have to be taken into account to be able to understand the daily nursing practice in a public health care setting in Botswana.

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