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Title: Building reputation : the significance of pain talk in hospice and palliative care team meetings
Author: Arber, Anne M.
Awarding Body: Goldsmiths College, University of London
Current Institution: Goldsmiths College (University of London)
Date of Award: 2004
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The broad aim of my research is to understand from a sociological perspective how palliative care professionals talk about pain. I discuss the development of pain medicine and the concept of 'total pain' within the hospice and palliative care movement. I focus on two main areas within the thesis: pain talk and the negotiation of professional boundaries. I develop a theory of reputation, which links these two analytic ideas and enables one to understand how different types of reputation are constructed. I focus in particular on how specialist nurses in hospice and palliative care develop a reputation in the medical space through talk about pain. Through talk-in-action that focuses on pain, a space is opened up that enables the palliative care team to develop a unique identity around expertise related to pain and other symptoms, and in this way they build a reputation for themselves and for palliative care. Reputation is achieved through the use of rhetorical and linguistic resources. The rules of pain work are made visible in the talk and this enables both competent work and professional identity to be displayed and explored. By use of linguistic and rhetorical resources palliative care professionals' construct their competence by comparison with those who do not have this expertise. Analysis of pain talk enables an understanding of how expertise and identity is negotiated. The expertise that is made visible in the talk is primarily biomedical expertise, but other forms of expertise are also made visible through psychosocial talk. The thesis therefore offers a linguistic analysis of how pain talk enables the members of the palliative care team to build a team reputation as experts in managing pain in the body. Talk about pain shapes the boundaries of professional work with patients in pain. My findings suggest three substantive conclusions. Firstly that the palliative care team accomplish their reputation through pain talk, and that reputation is threatened when pain is difficult to relieve. Thus reputation is primarily achieved by a discourse that shapes pain and symptoms in the body as the primary mode of intervention. Secondly the palliative care team use rhetorical forms of speech to position themselves and their expertise in contrast to non-specialist practitioners and this establishes the collegial positioning of specialist nurses in such settings and achieves reputation for the specialist nurse as an expert in pain work. Thirdly specialist nurses in palliative care use specific linguistic strategies such as telling mystery stories, asking questions and the use of footing to keep a neutralistic positioning to enter into medical discourse and to shape the agenda of talk. These strategies enable interprofessional work in the context of the team. In conclusion 'total pain' is linked with two types of reputation. Firstly the discourse of 'total pain' establishes the reputation of the palliative care movement within a holistic and humanistic framework. Secondly it enables the palliative care movement to construct its medical reputation as a successful speciality in relation to pain and symptom management. These two types of reputation are in tension.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available