Indispensable yet invisible: An ethnographic study of carer roles in infection prevention in a South Indian hospital

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Title: Indispensable yet invisible: An ethnographic study of carer roles in infection prevention in a South Indian hospital
Authors: Surendran, S
Castro-Sanchez, E
Nampoothiri, V
Joseph, S
Singh, S
Tarrant, C
Holmes, A
Charani, E
Item Type: Journal Article
Abstract: Objectives: We investigated the experiences and roles of patient carers in infection-related care on surgical wards in a South Indian hospital, from the perspective of healthcare workers (HCW), patients, and their carers. Methods: Ethnographic study including ward round observations (138 hours), face-to-face interviews (44 HCW, 6 patients/carers) and review of documents. Data (field notes, interview transcripts) were coded in NVivo 12 and analysed using principles of grounded theory. Data collection and analysis were iterative, recursive and continued until thematic saturation. Results: Carers play important yet unrecognised infection-related care roles. Institutional expectations of families are formalised in policies which demand that inpatients are accompanied by a relative at all times. Such intense presence embeds families in the patient care environment, as demonstrated by their high engagement in direct personal care (e.g. bathing patients) and clinical tasks (e.g. wound care). Carers actively participate in discussions on patient progress with HCWs, including post-discharge advice. Controlling the patient’s home environment carers decide on therapeutic options on patient behalf. There is a misalignment between how carers are positioned by the organisation (through policy mandates, institutional practices, and HCWs expectations), and the role that carers play in practice, resulting in their role, though indispensable, remaining invisible and unrecognised. Conclusion: Current models of patient and carer involvement in Infection Prevention and Control (IPC) are poorly aligned with settings such as India, where a wider support network has a role in patient care, reflecting the specific socio-cultural and contextual aspects of care. Culture-sensitive IPC policies which embrace the roles that patient’s families play are urgently needed.
Date of Acceptance: 14-Apr-2021
ISSN: 2059-7908
Publisher: BMJ Publishing Group
Journal / Book Title: BMJ Global Health
Copyright Statement: This paper is embargoed until publication. Once published it will be available fully open access.
Sponsor/Funder: ESRC
Economic & Social Research Council (ESRC)
Funder's Grant Number: ES/P008313/1
Publication Status: Accepted
Embargo Date: publication subject to indefinite embargo
Appears in Collections:Department of Infectious Diseases