Mwale Shadreck, Northcott Andy, Featherstone Katie
Geller Institute of Ageing and Memory, University of West London, Ealing, UK.
Sociol Health Illn. 2025 Jan;47(1):e13869. doi: 10.1111/1467-9566.13869.
A longstanding body of public enquiries and research identifies people living with dementia experience systemic inequalities within hospital settings, concluding a focus on improving care cultures is required. Drawing on a 3-year multi-sited hospital ethnography, this paper examines everyday cultures of care in NHS acute hospital wards to interrogate how ethnicity, gender and social class intersects to shape the care of people living with dementia. Drawing on Collins' concept of intersectionality and the relational nature of power, the analysis reveals that while cared for by diverse teams of healthcare professionals, a patients' age, ethnicity, gender and social class, as interconnected categories, influences the tightening of ward rules for some people living with dementia and the granting of significant privileges for others. Focussing on walking within the ward, with a large number of people living with dementia classified as 'wandering', we explore ways in which intersectional identities informed who was granted privileges to leave the bedside and 'wander' the ward, and who experienced further control. The paper concludes that institutional racism and attitudes to gender, social class and ageing permeate the routine organisation and delivery of care within NHS acute hospital wards to significantly impact people living with dementia, and in turn, increases the consideration of care pathways that emphasise their discharge to institutional settings.
长期以来，大量的公众调查和研究表明，痴呆症患者在医院环境中经历系统性不平等，得出结论认为需要专注于改善护理文化。本文借鉴了一项为期3年的多地点医院人种志研究，审视了英国国民医疗服务体系（NHS）急症医院病房日常护理文化，以探究种族、性别和社会阶层如何相互交织，从而塑造对痴呆症患者的护理。借鉴柯林斯的交叉性概念以及权力的关系本质，分析表明，虽然由不同的医疗专业团队提供护理，但患者的年龄、种族、性别和社会阶层作为相互关联的类别，会影响对一些痴呆症患者病房规则收紧，而对另一些患者则给予重大特权。以病房内的行走为重点，大量痴呆症患者被归类为“徘徊者”，我们探讨了交叉身份如何决定谁被赋予离开床边在病房“徘徊”的特权，以及谁受到进一步管控。本文的结论是，制度性种族主义以及对性别、社会阶层和衰老的态度渗透到NHS急症医院病房护理的日常组织和提供过程中，对痴呆症患者产生重大影响，进而增加了对强调将他们转至机构环境的护理途径的考量。
