Att arbeta i dödens närhet - Rutiner och ritualer i äldreomsorg

Sammanfattning: Working in the presence of death - Routines and rituals in the care for older people This study is based mainly on observations and interviews accomplished on two occasions with nursing assistants employed at two group living units for older people suffering from dementia in Sweden. The interviews and observations were carried out one year apart, before and after a project that also included supervision of managers and nursing assistants. I interviewed 12 nursing assistants, 8 of them in two occasions. In a supplementary study, that was part of another research project at another unit for older people, I have performed group interviews on two occasions with two managers and four nursing assistants. The questions used in the later study were the result of questions raised by the first project and were especially concerned with how being close to death affects the staff and their daily work. The aim was an attempt to describe and analyse the daily work practice of nursing assistants at special units for older people. Questions that assisted me in formulating the material were 1) what function do working routines have for the staff, 2) what is the relationship between working routines and the habits of the older people and 3) what is the relationship between the work of the nursing assistants and the frailty, the dying process of the older people? Apart from a description of the daily routines based on empirical studies, the report contains an introduction of the attitudes to ageing, the dying process and the death, as well as a summary of existing, relevant and closely related research. An attempt to summarise my interpretations and conclusions from the empirical studies went like this: The function of routines is, among other things, to maintain an illusion of predictability. Routines are also a function to give a feeling of security at work. The dying process in this context forms a natural part of daily work. The group living units in this study were, for ideological reasons, architectonically formed to afford no space for staff or, according to Goffman’s (1963) concept of "backstage", somewhere staff can retire for a break, rest or reflection. I consider working with older people suffering from dementia to be an extremely demanding work and I am surprised that screens and backstage areas that exist in most other service and care facilities are absent in this case. My interpretation of the function of routine tasks is that they can be seen as a kind of mental screen, you can "shut yourself in" with the necessary tasks and justifiably be inattentive towards the older people, because of the tasks that must be done. This inattentiveness can often be seen as showing consideration, when a friendly nod is given without participating in a more demanding communications scenario.