‘Who does this patient belong to?’ Boundary work and the re/making of (NSTEMI) heart attack patients

Helen Cramer, Jacki Hughes, Rachel Johnson, Maggie Evans, Christi Deaton , Adam Timmis, Harry Hemingway , Gene Feder, Katie Featherstone

Research output: Contribution to journalArticle (Academic Journal)peer-review

7 Citations (Scopus)
299 Downloads (Pure)

Abstract

This ethnography within ten English and Welsh hospitals explores the significance of boundary work and the impacts of this work on the quality of care experienced by heart attack patients who have suspected non–ST segment elevation myocardial infarction (NSTEMI) /non-ST elevation acute coronary syndrome. Beginning with the initial identification and prioritisation of patients, boundary work informed negotiations over responsibility for patients, their transfer and admission to different wards, and their access to specific domains in order to receive diagnostic tests and treatment. In order to navigate boundaries successfully and for their clinical needs to be more easily recognised by staff, a patient needed to become a stable boundary object. Ongoing uncertainty in fixing their clinical classification, was a key reason why many NSTEMI patients faltered as boundary objects. Viewing NSTEMI patients as boundary objects helps to articulate the critical and ongoing process of classification and categorisation in the creation and maintenance of boundary objects. We show the essential, but hidden, role of boundary actors in making and remaking patients into boundary objects. Physical location was critical and the parallel processes of exclusion and restriction of boundary object status can lead to marginalisation of some patients and inequalities of care.
Original languageEnglish
Pages (from-to)1404-1429
Number of pages26
JournalSociology of Health and Illness
Volume40
Issue number8
Early online date28 Jun 2018
DOIs
Publication statusE-pub ahead of print - 28 Jun 2018

Keywords

  • emergency care
  • heart disease
  • hospitals
  • ethnography
  • quality of care

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