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"Making sense of difference" : the social organization of intergroup relations in health care provision Reimer Kirkham, Sheryl Marie

Abstract

Despite growing evidence of racialized health care experiences and inequitable health outcomes for patients of Colour, theoretical and practice responses have not typically addressed these concerns. This ethnographic study approached this problem by examining the social organization of intergroup relations in health care provision, beginning with the standpoints of nurses and patients. Over one year, the investigator conducted 220 hours of field work and interviews with 30 health care providers and five patients on three surgical units in two hospitals. Through this process of research, intergroup relations in health care provision were revealed as more complicated than commonly represented. Under ideal conditions, intergroup provider-recipient encounters illustrated "connected care", marked by respectful interpersonal connections, an understanding of the illness experience from the patient's perspective, and a holistic grasp of the patient's health care needs. Interpretive lenses were employed by nurses to make sense of "difference" and influenced how they provided intergroup care. However, various factors negatively influenced the provision of connected care. Depending on their interpretive lenses, individual nurses might participate in racialized discourses and practices. Recent trends brought about by health care reform, along with longstanding issues such as functional approaches, the immediate nature of nurses' work, and biomedical dominance, came together in particular ways to constitute nurses' work as disjunctured and "heavy", and mitigated connected care, especially to patients who did not speak English. Institutional and community contexts, shaped by professional and public discourses, also mediated intergroup relations in significant ways. The social construct of race was mobilized in health care settings in subtle but damaging ways as common applications of the construct of culture and interpretations of "difference" often drew on colonial notions of race, thereby reinforcing longstanding patterns of domination and inequities. In light of these findings, re-conceptualized theoretical approaches are recommended for more realistic and nuanced understandings of intergroup relations and transformative health care practices. Critical consciousness must be fostered among nurses in order to facilitate connected intergroup care, challenge existing work environments, and confront racializing discourses and practices.

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