Yan Zhe, Luo Baozhen
Department of Contemporary Chinese Studies, University of Würzburg, Am Hubland, 97074 Würzburg, Germany.
Global Health Research Center & Center for the Study of Contemporary China, Duke Kunshan University, No. 8 Duke Avenue, Kunshan, Jiangsu, 215316, China.
J Aging Stud. 2023 Mar;64:101111. doi: 10.1016/j.jaging.2023.101111. Epub 2023 Feb 7.
How Direct Care Workers (DCWs) interpret their work and perform care activities undeniably impacts the well-being of institutionalized older adults. Despite the emotionally charged nature of paid care work, little is known about how Chinese DCWs talk about their work and construct meaning within China's unique social context of a burgeoning institutional care market and changing cultural expectations for long-term care. This study qualitatively explored Chinese DCWs' emotion work as they navigate among institutional pressures and low social recognition in an urban government-sponsored nursing home in central China. Results revealed that DCWs used Liangxin (the good heart/mind) - a ubiquitous Chinese moral notion emphasizing the unity of feeling, thought, and action - as an interpretive framework, including its four dimensions (ceyin, xiue, cirang, and shifei), to inform care practice, manage emotions, and find dignity within what can be personally demeaning and socially devalued work. Our study delineated the processes through which DCWs sympathized with the pain and struggles of the older adults in their care (ceyin xin), shamed unjust attitudes and behaviors embedded in institutional care (xiue xin), delivered family-like relational care (cirang xin), and formed and reinforced principles of good (versus bad) care (shifei xin). We also revealed the nuanced role that the cultural value of xiao (filial piety), working in tandem with liangxin, both shaped the emotional terrain of the institutional care setting and impacted how DCWs engaged in emotion work. While recognizing the effect of liangxin for incentivizing DCWs to provide relational care and renegotiate their role status, we were also alerted to the risks of overburdening and exploiting DCWs who relied solely on their liangxin to meet complex care needs.
直接护理工作者（DCWs）如何理解他们的工作并开展护理活动，无疑会影响到入住养老机构的老年人的福祉。尽管有偿护理工作充满情感因素，但对于中国的直接护理工作者在新兴的机构护理市场以及不断变化的长期护理文化期望这一独特社会背景下，如何谈论他们的工作并构建工作意义，我们却知之甚少。本研究以定性方式探索了中国直接护理工作者在中国中部城市一家政府资助的养老院中，在应对机构压力和社会认可度较低的情况下的情感工作。结果显示，直接护理工作者将“良心”（一个在中国普遍存在的道德观念，强调情感、思想和行动的统一）作为一种解释框架，包括其四个维度（恻隐、羞恶、辞让和是非），以指导护理实践、管理情绪，并在可能被个人视为有辱人格且社会价值被贬低的工作中找到尊严。我们的研究描绘了直接护理工作者同情他们所照顾的老年人的痛苦与挣扎（恻隐心）、对机构护理中存在的不公正态度和行为感到羞耻（羞恶心）、提供类似家庭的关系性护理（辞让心）以及形成并强化良好（与不良相对）护理原则（是非心）的过程。我们还揭示了孝道这一文化价值观与良心协同作用时所发挥的微妙作用，它既塑造了机构护理环境的情感格局，又影响了直接护理工作者开展情感工作的方式。在认识到良心对激励直接护理工作者提供关系性护理并重新协商其角色地位的作用的同时，我们也警惕到仅依靠良心来满足复杂护理需求的直接护理工作者可能面临负担过重和被剥削的风险。
