Advertisement

A Practical Ethics of Care: Tinkering with Different ‘Goods’ in Residential Nursing Homes

  • Katharina MoltererEmail author
  • Patrizia Hoyer
  • Chris Steyaert
Original Paper

Abstract

In this paper, we argue that ‘good care’ in residential nursing homes is enacted through different care practices that are either inspired by a ‘professional logic of care’ that aims for justice and non-maleficence in the professional treatment of residents, or by a ‘relational logic of care’, which attends to the relational quality and the meaning of interpersonal connectedness in people’s lives. Rather than favoring one care logic over the other, this paper indicates how important aspects of care are constantly negotiated between different care practices. Based on the intricate everyday negotiations observed during an ethnographic field study at an elderly nursing home in Germany, the paper puts forth the argument that care is always a matter of tinkering with different, sometimes competing ‘goods’. This tinkering process, which unfolds through ‘intuitive deliberation’, ‘situated assessment’ and ‘affective juggling’ is then theorized along the conceptualization of a ‘practical ethics of care’: an ethics which makes no a priori judgments of what may be considered as good or bad care, but instead calls for momentary judgments that are pliable across changing situations.

Keywords

Professional logic of care Relational logic of care Ethics of care Practical ethics Tinkering Residential nursing homes 

Notes

Acknowledgements

We would like to express our sincere gratitude to the section editor Raza Mir and the anonymous reviewers who have guided our revision process in a most constructive and collegial manner. Moreover, we would like to thank Gazi Islam and Marianna Fotaki for their friendly reviews and helpful comments of an earlier version of this paper, which was presented at the 33rd EGOS Colloquium (2017) in Copenhagen. We would especially like to thank our colleagues Mark Laukamm, Julia Nentwich, Christina Lüthy, Björn Müller and Florian Schulz who supported us with their substantial feedback during our writing process. Funding was provided by the Swiss National Science Foundation.

Compliance with Ethical Standards

Conflict of interest

All authors declared that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

References

  1. Abma, T. A., & Baur, V. E. (2015). User involvement in long-term care. Towards a relational ethics approach. Health Expectations, 18(6), 2328–2339.CrossRefGoogle Scholar
  2. Anderson, B. (2005). Practices of judgement and domestic geographies of affect. Social & Cultural Geography, 6(5), 645–659.CrossRefGoogle Scholar
  3. Baldassar, L., & Merla, L. (2013). Transnational families, migration and the circulation of care: Understanding mobility and absence in family life. New York: Routledge.CrossRefGoogle Scholar
  4. Ball, M. M., Lepore, M. L., Perkins, M. M., Hollingsworth, C., & Sweatman, M. (2009). “They are the reason I come to work”: The meaning of resident–staff relationships in assisted living. Journal of Aging Studies, 23(1), 37–47.CrossRefGoogle Scholar
  5. Banerjee, A., Armstrong, P., Daly, T., Armstrong, H., & Braedley, S. (2015). “Careworkers don’t have a voice:” Epistemological violence in residential care for older people. Journal of Aging Studies, 33, 28–36.CrossRefGoogle Scholar
  6. Barnett, C., & Land, D. (2007). Geographies of generosity: Beyond the ‘moral turn’. Geoforum, 38(6), 1065–1075.CrossRefGoogle Scholar
  7. Benner, P. (2000). The wisdom of our practice. American Journal of Nursing, 100(10), 99–103.Google Scholar
  8. Boelsma, F., Baur, V. E., Woelders, S., & Abma, T. A. (2014). “Small” things matter: Residents’ involvement in practice improvements in long-term care facilities. Journal of Aging Studies, 31, 45–53.CrossRefGoogle Scholar
  9. Bourdieu, P. (1990). The logic of practice (R. Nice, Trans.). Stanford: Stanford University Press.Google Scholar
  10. Bourdieu, P. (1998). Practical reason: On the theory of action. Stanford: Stanford University Press.Google Scholar
  11. Brugère, F. (2006). La sollicitude. La nouvelle donne affective des perspectives féministes. Esprit, 123–140.Google Scholar
  12. Brykczynski, K. A. (1998). Clinical exemplars describing expert staff nursing practices. Journal of Nursing Management, 6(6), 351–359.CrossRefGoogle Scholar
  13. Card, C. (1999). On feminist ethics and politics. Kansas: University Press of Kansas.Google Scholar
  14. Cloke, P., Johnsen, S., & May, J. (2005). Exploring ethos? Discourses of ‘charity’ in the provision of emergency services for homeless people. Environment and Planning A, Economy and Space, 37(3), 385–402.CrossRefGoogle Scholar
  15. Cloke, P., Johnsen, S., & May, J. (2007). Ethical citizenship? Volunteers and the ethics of providing services for homeless people. Geoforum, 38(6), 1089–1101.CrossRefGoogle Scholar
  16. Darling, J. (2010). “Just being there…”: Ethics, experimentation, and the cultivation of care. In B. Anderson & P. Harrison (Eds.), Taking-place: Non-representational theories and geography (pp. 241–260). Surrey: Ashgate Publishing.Google Scholar
  17. Desmond, M. (2014). Relational ethnography. Theory and Society, 43(5), 547–579.CrossRefGoogle Scholar
  18. De la Bellacasa, M. P. (2012). “Nothing comes without its world”: Thinking with care. Sociological Review, 60(2), 197–216.CrossRefGoogle Scholar
  19. Dreyfus, H. L., & Dreyfus, S. (2005). Peripheral vision: Expertise in real contexts. Organization Studies, 25(5), 779–792.CrossRefGoogle Scholar
  20. Fox, N. (1999). Beyond health, postmodernism and embodiment. London: Free Association Press.Google Scholar
  21. Gilligan, C. (1982). In a different voice: Psychological theory and women’s development. Cambridge: Harvard University Press.Google Scholar
  22. Greenwood, D. (2007). Relational care: Learning to look beyond intentionality to the ‘non- care-intentional’ in a caring relationship. Nursing Philosophy, 8(4), 223–232.CrossRefGoogle Scholar
  23. Held, V. (2006). The ethics of care: Personal, political, and global. Oxford: Oxford University Press.Google Scholar
  24. Hennion, A., & Vidal-Naquet, P. A. (2017). Might constraint be compatible with care? Home care as a situational ethics. Sociology of Health & Illness, 39(5), 741–758.CrossRefGoogle Scholar
  25. Kittay, E. F., & Feder, E. K. (2003). The subject of care: Feminist perspectives on dependency. Oxford: Rowman & Littlefield Publishers.Google Scholar
  26. Krzywoszynska, A. (2015). What farmers know: Experiential knowledge and care in vine growing. Sociologia Ruralis, 56(2), 289–310.CrossRefGoogle Scholar
  27. Lake, S., Rudge, T., & West, S. (2015). Making meaning of nursing practices in acute care. Journal of Organizational Ethnography, 4(1), 64–79.CrossRefGoogle Scholar
  28. Lawrence, T. B., & Maitlis, S. (2012). Care and possibility: Enacting an ethic of care through narrative practice. Academy of Management Review, 37(4), 641–663.CrossRefGoogle Scholar
  29. McCormack, D. P. (2003). An even of geographical ethics in spaces of affect. Transactions of the Institute of British Geographers, 28(4), 488–507.CrossRefGoogle Scholar
  30. McCormack, D. P. (2005). Diagramming practice and performance. Environment and Planning D: Society and Space, 23(1), 119–147.CrossRefGoogle Scholar
  31. McMurray, R. (2011). The struggle to professionalize: An ethnographic account of the occupational position of advanced nurse practitioners. Human Relations, 64(6), 801–822.CrossRefGoogle Scholar
  32. McMurray, R. (2015). Care as politics. In A. Pullen & C. Rhodes (Eds.), The Routledge companion to ethics, politics and organizations (pp. 318–334). New York: Routledge.Google Scholar
  33. Merleau-Ponty, M. (1962). The phenomenology of perception. London: Routledge.Google Scholar
  34. Mol, A. (2006). Proving or improving: On health care research as a form of self-reflection. Qualitative Health Research, 16(3), 405–414.CrossRefGoogle Scholar
  35. Mol, A. (2008). The logic of care: Health and the problem of patient choice. New York: Routledge.CrossRefGoogle Scholar
  36. Mol, A. (2010). Care and its values. Good food in the nursing home. In A. Mol, I. Moser & J. Pols (Eds.), Care in practice: On tinkering in clinics, homes and farms (pp. 215–234). Bielefeld: transcript Verlag.Google Scholar
  37. Mol, A., Moser, I., & Pols, J. (2010). Care: Putting practice into theory. In A. Mol, I. Moser & J. Pols (Eds.), Care in practice: On tinkering in clinics, homes and farms (pp. 7–27). Bielefeld: transcript Verlag.Google Scholar
  38. Moser, I. (2010). Perhaps tears should not be counted but wiped away: On quality and improvement in dementia care. In A. Mol, I. Moser & J. Pols (Eds.), Care in practice: On tinkering in clinics, homes and farms (pp. 277–300). Bielefeld: transcript Verlag.Google Scholar
  39. Nicolini, D. (2013). Practice theory, work, and organization: An introduction. Oxford Oxford: University Press.Google Scholar
  40. Nortvedt, P. (2001). Needs, closeness and responsibilities. An inquiry into some rival moral considerations in nursing care. Nursing Philosophy, 2(2), 112–121.CrossRefGoogle Scholar
  41. Paperman, P. (2004). Perspectives féministes sur la justice. L’Année Sociologique, 54(2), 413–433.CrossRefGoogle Scholar
  42. Paperman, P. (2005). Les gens vulnérables n’ont rien d’exceptionnel. In P. Paperman & S. Laugier (Eds.), Le souci des autres. Ethique et politique du care. Raisons Pratiques (pp. 281–297). Paris: Editions de l’Ecole des Hautes Etudes en Sciences Sociales.Google Scholar
  43. Pols, J. (2005). Enacting appreciations: Beyond the patient perspective. Health Care Analysis, 13(3), 203–221.CrossRefGoogle Scholar
  44. Pols, J. (2006). Accounting and washing: Good care in long-term psychiatry. Science, Technology, & Human Values, 31(4), 409–430.CrossRefGoogle Scholar
  45. Pols, J. (2013). Washing the patient: Dignity and aesthetic values in nursing care. Nursing Philosophy, 14(3), 186–200.CrossRefGoogle Scholar
  46. Pols, J. (2015). Towards an empirical ethics in care: Relations with technologies in health care. Medicine, Health Care and Philosophy, 18(1), 81–90.CrossRefGoogle Scholar
  47. Popke, J. (2009). Geography and ethics: Non-representational encounters, collective responsibility and economic difference. Progress in Human Geography, 33(1), 81–90.CrossRefGoogle Scholar
  48. Purk, J., & Lindsey, S. (2006). Job satisfaction and intention to quit among frontline assisted living employees. Journal of Housing for the Elderly, 20(1–2), 117–131.CrossRefGoogle Scholar
  49. Reckwitz, A. (2002). Toward a theory of social practices: A development in culturalist theorizing. European Journal of Social Theory, 5(2), 243–263.CrossRefGoogle Scholar
  50. Rockwell, J. (2012). From person-centered to relational care: Expanding the focus in residential care facilities. Journal of Gerontological Social Work, 55(3), 233–248.CrossRefGoogle Scholar
  51. Ruddick, S. (1998). Care as labor and relationship. In M. S. Halfon & J. C. Haber (Eds.), Norms and values: Essays on the work of Virginia Held (pp. 3–25). Lanham, MD: Rowman & Littlefield.Google Scholar
  52. Sandberg, J., & Tsoukas, H. (2011). Grasping the logic of practice: Theorizing through practical rationality. Academy of Management Review, 36(2), 338–360.Google Scholar
  53. Schön, D. A. (1983). The reflective practitioner: How professionals think in action. New York: Basic Books.Google Scholar
  54. Sikorska-Simmons, E. (2005). Predictors of organizational commitment among staff in assisted living. The Gerontologist, 45(2), 195–205.CrossRefGoogle Scholar
  55. Simonsen, K. (2010). Encountering O/other bodies: Practice, emotion and ethics. In B. Anderson & P. Harrison (Eds.), Taking-place: Non-representational theories and geography (pp. 221–240). Surrey: Ashgate Publishing.Google Scholar
  56. Thrift, N. (2003). Performance and.... Environment and Planning A: Economy and Space, 35(11), 2019–2024.CrossRefGoogle Scholar
  57. Tronto, J. C. (1993). Moral boundaries: A political argument for an ethic of care. New York: Routledge.Google Scholar
  58. Tronto, J. C. (2010). Creating caring institutions: Politics, plurality, and purpose. Ethics and Social Welfare, 4(2), 158–171.CrossRefGoogle Scholar
  59. Vachhani, S. (2015). Working the grey zones. In A. Pullen & C. Rhodes (Eds.), The Routledge companion to ethics, politics and organizations (pp. 479–493). New York: Routledge.Google Scholar
  60. Van der Borg, W. E., Verdonk, P., Dauwerse, L., & Abma, T. A. (2017). Work-related change in residential elderly care: Trust, space and connectedness. Human Relations, 70(7), 805–835.CrossRefGoogle Scholar
  61. Verkerk, M. A. (2007). Care ethics as a feminist perspective on bioethics. In C. E. A. Gastmans (Ed.), New pathways for European bioethics (pp. 65–81). Antwerpen/Oxford: Intersentia.Google Scholar
  62. Walker, M. U. (2007). Moral understandings: A feminist study in ethics. Oxford: Oxford University Press.Google Scholar
  63. Watson, M. (2017). Placing power in practice theory. In A. Hui, T. Schatzki & E. Shove (Eds.), The nexus of practices: Connections, constellations, practitioners (pp. 169–182). New York: Routledge.Google Scholar
  64. Winance, M. (2010). Care and disability. Practices of experimenting, tinkering with, and arranging people and technical aids. In A. Mol, I. Moser & J. Pols (Eds.), Care in practice: On tinkering in clinics, homes and farms (pp. 93–117). Bielefeld: transcript Verlag.Google Scholar
  65. Yakhlef, A., & Essén, A. (2012). Practice innovation as bodily skills: The example of elderly home care service delivery. Organization, 20(6), 881–903.CrossRefGoogle Scholar

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  • Katharina Molterer
    • 1
    Email author
  • Patrizia Hoyer
    • 1
  • Chris Steyaert
    • 1
  1. 1.Research Institute for Organizational PsychologyUniversity of St. GallenSt. GallenSwitzerland

Personalised recommendations