Administering care

The incident

My husband was very ill, and was being cared for at home. We live on a static Traveller site.  My husband was suffering from a number of medical complications which required varied medication.  We were provided a service where a nurse would administer the medication to my husband.  A senior Health Practitioner came to assess this service and decided that this could not continue.  I told the Practitioner that I was unable to read or write and I couldn’t understand the medication.  The Practitioner put an end to this service and I struggled to understand the medication.  I felt really bad because I did not know what to give him specifically in terms of pain relief.  My husband was admitted to hospital three weeks later.

I fear that I could not look after my husband properly in terms of at least being able to give him the right medication.  The Practitioner should have understood that not everyone can read and write, I feel that both my husband’s needs and my needs were ignored.

1. Identities of the actors in the situation

Narrator (Person experiencing the shock): Female, in her late 70s, Irish Traveller, full time home maker and carer of her husband who is in his 80s.  Irish Travellers are a traditionally nomadic group with origins in Ireland who possess a separate identity, heritage and culture to the community in general..

Senior Health Practitioner (Person causing the shock): Female, in her late 40’s, White British.  She is a Senior Health Practitioner.

Husband: Male, late 80s, Irish Traveller, Numerous long term medical conditions including respiratory, cancer, heart condition.

2. Context of the situation

The incident happened at the narrator’s home. It was during a medical assessment with both the narrator and her husband present. The medical assessment was to assess the administration of medication.

3. Emotional reaction

The narrator was shocked that the Senior Health Practitioner failed to listen to her concerns about not being able to read and write.  She was worried about not being able to administer the medicine correctly and therefore care for her ill husband.  The narrator felt angry and helpless as a result of the Senior Health Practitioner’s lack of support.  The narrator was also fearful that she would not be able to administer the medication correctly.

4. Representations, values, norms, ideas, prejudice: The frame of references of the person who experienced the shock.
  • Healthcare – The narrator believes that it is the job of the healthcare practitioner to administer the medicine as it is their role and that they are able to do this better than herself.
  • Ability as a carer – the narrator feels that she is not confident enough as a carer to administer the medicine as she is unable to read the dosage and is unsure of how much to administer and didn’t want to make her husband’s condition worse.
  • Family – Her role has always been a wife and a mother ad she felt it was her duty to look after her husband.
  • Hierarchy – the narrator felt that healthcare professionals were of a higher hierarchy to her so would know best and someone she couldn’t challenge.
5. What image emerges from the analysis of point 4 for the other group (neutral slightly negative, very negative, "stigmatized", positive, very positive, real, unreal) etc?

Negative and dismissive.

6. Representations, values, norms, prejudice: The frame of references of the person or group that is causing the shock / that caused the shock in the narrator.
  • Efficiency – The Senior Health Practitioner maybe felt that due to staff shortages, the carer should be able to administer the medicine instead of a healthcare professional taking the time to travel to the patients’ house daily to administer this.
  • Family responsibility – simple care that does not require medical knowledge or skills should be provided by family members.
  • Lack of awareness of social and cultural context – the practitioner does not have knowledge about the context of travellers, what’s more he does not seem to think such information can be relevant for his decision.  He didn’t realize that some travellers are unable to read or write and the impact this has on patient care.
  • Illiteracy – if the practitioner realized at all that the wife was illiterate, he probably thought that she could manage the deciphering of the text on the medicine without much trouble. He possibly underestimated the difficulty of overcoming illiteracy.
  • Direct / hierarchical communication: during the encounter with the family the practitioner does not find out critical elements that could influence his decision, such as the illiteracy of the wife of the patient. Probably his dominant communication style is one based on direct verbal communication, which contributes to omit such important information.
7. Does the situation highlight any problem concerning the professional practice, or in general about the respect of cultural differences in intercultural situations?

Information about the social and cultural context of patients often seems superfluous to health professionals, even though in some cases such as this there could be critical factors preventing proper healthcare.

A particular difficulty arises when cultural and social categories intersect, and the outsiders are confused on how they should interpret specific patterns or phenomena, such as illiteracy. Is this part of culture? Or a consequence of low social class and lack of education?

Any effort of developing intercultural awareness should also address the question of differences in social class and consequences of poverty.

Healthcare professionals need to understand the consequences of carers and patients not being able to read and write.

Status and role of carers: it is understood that carers play a huge role in particular where there are extra pressures of staff shortages.  Professionals however should be attentive for all the implicit assumptions about carers and make sure to elicit what roles they are and are not happy with, what tasks they can handle and what they cannot.