Death work: Staff perspectives on the care of terminally ill patients in an acute care hospital.
Item
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Title
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Death work: Staff perspectives on the care of terminally ill patients in an acute care hospital.
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Identifier
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AAI9020759
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identifier
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9020759
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Creator
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Goodman, Harriet Gouline.
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Contributor
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Adviser: Irwin Epstein
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Date
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1990
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Language
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English
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Publisher
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City University of New York.
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Subject
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Social Work | Sociology, Individual and Family Studies | Sociology, Public and Social Welfare
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Abstract
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This dissertation is a qualitative study of the perspectives of doctors, nurses, and social workers on terminally ill patients in their care. The methods used for this study were participant observation and focused interviews with professionals about dying patients whom they identified as "difficult to manage." Fifteen patients were suggested, nine of whom had metastatic cancer and six of whom had AIDS. Eight physicians, ten nurses, and thirteen social workers were formally interviewed. The data for this study were collected in the mid-1980's at a prestigious medical center in a large urban city. The investigator was a research assistant with a medical service providing symptom management for dying patients in this hospital.;A "Typology of Ideal, Routine, and 'Toxic' Patients" was developed based on qualitative data gathered from this study. It describes three terminally ill patient types in relation to professional needs for cure or symptom amelioration, routinized work, and personal gratification. "Ideal" patients exceeded workers' expectations for response. "Routine" patients conformed to normative expectations and presented conventional problems. "Toxic" patients disrupted routines, had unattractive personal or disease characteristics, and questioned professional authority.;Merton's theory of anomie (1968) was used to analyze professional responses associated with death work. Doctors and nurses were most frustrated when their curative interventions failed. Social workers found more goal congruity with death work and were frequently successful in supportive interventions with dying patients and their families.;AIDS patients posed different problems for professionals than metastatic cancer patients. All professional groups were concerned about HIV exposure. The mass media were a major source of information even for highly educated professionals. Homophobic and punitive responses to AIDS patients were frequently observed and frankly expressed by several informants. Some staff stated that increased contact diminished homophobia. As with all dying patients, expressions of gratitude for staff efforts and/or heroic behavior earned AIDS patients and families the label of "ideal." The exploratory nature of this study, limited sample, and single study site make these findings only suggestive. Nevertheless, findings from this study point to the need for support of professional work with the dying, particularly in an environment of increasing numbers of AIDS patients.
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Type
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dissertation
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Source
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PQT Legacy CUNY.xlsx
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degree
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D.S.W.
