Abstract
The purpose of this thesis is to investigate how the co-operation among the professionals (catering officers, doctors and nursing staff) and the relations between professionals and patients influence the patient's food intake and the related risk of malnutrition during hospital admission.
The primary sociological approach is based on the theories of the French sociologist Pierre Bourdieu. Particularly in the use of the concepts: habitus, capital, bodily hexis, field, doxa, symbolic violence and distinction; and also in focusing on the differences in strategies of social groups, which depend on their position in the social space, that means according to total sum and composition
of capital. The theory of Bourdieu is critical, and is focused on relations, central for the understanding of what happens particularly between the nurses’ nursing field and the doctors' biomedical treatment field, and especially the influence of this on the professional groups' relationship to the patient. The empirical part is divided into four:
In the first part, by using a questionnaire, a great difference in taste as to which foods are desired between groups with different levels of education is found. The menu of the hospital is close to the patients' taste. The patients are not trained or have short-termed training, and a rather rigid diet system ('meatballs, potatoes, gravy') pleases them. The tastes of the doctors, nurses and nursing
aides are different from each other, but especially different from the patients’. The higher educated, the 'lighter' and the more wishes for a varied menu, and the farther wishes from the hospitals menu.
Far more it is seen that professionals with the shortest education aim at the eating pattern of the more highly educated.
In the second part a comparison between the professionals' and the patients' attitudes to the importance of the patient’s diet is made on the basis of text studies of the development of the social standard of how rational eating habits ought to be organized, and on the basis of the recommendations
of the Danish hospital diet. It is found that the dietary notions of the patients lie within the culture of everyday life, meaning that taste and enjoyment are central. Unlike this the dietary ideas of the professionals first and foremost lie within a biomedical discourse in which nutrition is central.
However it shows that no one really has a knowledge that covers the sophisticated, biomedical words: No professional knows what they stand for in practice, and the more biomedical speech, the less practical knowledge. The professionals' expectations of the hospital’s diet are that it be like their own taste. Furthermore the professionals with the shortest education aim at the speech of the more highly educated. And the professionals' knowledge exists within a health-nutrition-discourse, while there is little knowledge of a disease-nutrition-discourse, and of a cultural dimension in the patient's every day life. This implies that there is no professionalism on nutrition, food and meals
for hospitalized people. Then no plan for the patient’s caring for himself (‘egenomsorg’) can be prepared, and the professional staffs cannot guide the patients in avoiding malnutrition. The lack of knowledge on the basis of the biomedical dominance, open the way for a medicalization of the food
- meaning oral supplements rich in energy and protein can take the place of the food.
The third part deals with the organization and divisions of labour concerning diet. It is found that nutrition, food and meals are not part of the treatment, the doctors are not engaged with the matter. The organization of the nurses' care does not give the right conditions for establishing care starting from the patient's needs either. The organization is standardized hierarchal - influenced by the biomedical understanding. This causes the staff to watch neither the patient's food intake nor weight loss. Lack of care causes malnutrition only to be realized at patients 'caught' by standard procedures at the hospitalization, where disease and prognosis indicate - and all signs point to -
malnutrition. And only when malnutrition is already distinct.
The fourth part deals with interactions. It is found that professional staffs give the patient the understanding that they should 'choose' and 'chiticize', as the professionals do themselves based on their own taste. Very few patients do 'criticize', though – being in a state of dependence on the professionals.
They don't want to trouble anybody - or they do not have the energy. The very few patients who do 'criticize', for example, that they cannot eat the food offered, however, realize that it has no consequences: They are not heard. And neither do they have the knowledge about what to ask for or to choose among. And even worse: Neither have the professionals - they have not familiarized
themselves with the choices from the kitchen. The lack of professionalism and the lack of established care relations leave the patients in the lurch concerning nutrition and food. The rhetoric results in the patients feeling they themselves were responsible for their weight loss.
Conflicts among professionals as well as short-termed trained groups’ aiming at the taste and speech and tasks - and associated prestige - of long-termed trained groups cause the care of the patients
becomes subordinate to a biomedical doxa. Then diet is the concern of no subject-group. The professional groups distance themselves from both diet and kitchen as well as the patients, whose wishes and needs lie outside the biomedical doxa - in an everyday life understanding.
The primary sociological approach is based on the theories of the French sociologist Pierre Bourdieu. Particularly in the use of the concepts: habitus, capital, bodily hexis, field, doxa, symbolic violence and distinction; and also in focusing on the differences in strategies of social groups, which depend on their position in the social space, that means according to total sum and composition
of capital. The theory of Bourdieu is critical, and is focused on relations, central for the understanding of what happens particularly between the nurses’ nursing field and the doctors' biomedical treatment field, and especially the influence of this on the professional groups' relationship to the patient. The empirical part is divided into four:
In the first part, by using a questionnaire, a great difference in taste as to which foods are desired between groups with different levels of education is found. The menu of the hospital is close to the patients' taste. The patients are not trained or have short-termed training, and a rather rigid diet system ('meatballs, potatoes, gravy') pleases them. The tastes of the doctors, nurses and nursing
aides are different from each other, but especially different from the patients’. The higher educated, the 'lighter' and the more wishes for a varied menu, and the farther wishes from the hospitals menu.
Far more it is seen that professionals with the shortest education aim at the eating pattern of the more highly educated.
In the second part a comparison between the professionals' and the patients' attitudes to the importance of the patient’s diet is made on the basis of text studies of the development of the social standard of how rational eating habits ought to be organized, and on the basis of the recommendations
of the Danish hospital diet. It is found that the dietary notions of the patients lie within the culture of everyday life, meaning that taste and enjoyment are central. Unlike this the dietary ideas of the professionals first and foremost lie within a biomedical discourse in which nutrition is central.
However it shows that no one really has a knowledge that covers the sophisticated, biomedical words: No professional knows what they stand for in practice, and the more biomedical speech, the less practical knowledge. The professionals' expectations of the hospital’s diet are that it be like their own taste. Furthermore the professionals with the shortest education aim at the speech of the more highly educated. And the professionals' knowledge exists within a health-nutrition-discourse, while there is little knowledge of a disease-nutrition-discourse, and of a cultural dimension in the patient's every day life. This implies that there is no professionalism on nutrition, food and meals
for hospitalized people. Then no plan for the patient’s caring for himself (‘egenomsorg’) can be prepared, and the professional staffs cannot guide the patients in avoiding malnutrition. The lack of knowledge on the basis of the biomedical dominance, open the way for a medicalization of the food
- meaning oral supplements rich in energy and protein can take the place of the food.
The third part deals with the organization and divisions of labour concerning diet. It is found that nutrition, food and meals are not part of the treatment, the doctors are not engaged with the matter. The organization of the nurses' care does not give the right conditions for establishing care starting from the patient's needs either. The organization is standardized hierarchal - influenced by the biomedical understanding. This causes the staff to watch neither the patient's food intake nor weight loss. Lack of care causes malnutrition only to be realized at patients 'caught' by standard procedures at the hospitalization, where disease and prognosis indicate - and all signs point to -
malnutrition. And only when malnutrition is already distinct.
The fourth part deals with interactions. It is found that professional staffs give the patient the understanding that they should 'choose' and 'chiticize', as the professionals do themselves based on their own taste. Very few patients do 'criticize', though – being in a state of dependence on the professionals.
They don't want to trouble anybody - or they do not have the energy. The very few patients who do 'criticize', for example, that they cannot eat the food offered, however, realize that it has no consequences: They are not heard. And neither do they have the knowledge about what to ask for or to choose among. And even worse: Neither have the professionals - they have not familiarized
themselves with the choices from the kitchen. The lack of professionalism and the lack of established care relations leave the patients in the lurch concerning nutrition and food. The rhetoric results in the patients feeling they themselves were responsible for their weight loss.
Conflicts among professionals as well as short-termed trained groups’ aiming at the taste and speech and tasks - and associated prestige - of long-termed trained groups cause the care of the patients
becomes subordinate to a biomedical doxa. Then diet is the concern of no subject-group. The professional groups distance themselves from both diet and kitchen as well as the patients, whose wishes and needs lie outside the biomedical doxa - in an everyday life understanding.
| Originalsprog | Dansk |
|---|---|
| Udgivelsessted | Københavns Universitet |
| Status | Udgivet - 2002 |