Project

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'Doing death' and 'doing diversity' in nursing homes

English title 'Doing death' and 'doing diversity' in nursing homes
Applicant Znoj Heinzpeter
Number 139365
Funding scheme NRP 67 End of Life
Research institution Institut für Sozialanthropologie Universität Bern
Institution of higher education University of Berne - BE
Main discipline Ethnology
Start/End 01.06.2012 - 31.03.2017
Approved amount 395'604.00
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All Disciplines (2)

Discipline
Ethnology
Sociology

Keywords (8)

migration; doing death; end-of-life; nursing homes; community; ethnographic research; exchange theory; doing diversity

Lay Summary (German)

Lead
Altersheime werden zunehmend zu Sterbeinstitutionen für hochbetagte und pflegebedürftige Menschen. Dieses Projekt untersucht, wie sich die zunehmende Vielfalt von Lebenswelten auf die Gestaltung des Lebensendes in Altersheimen auswirkt.
Lay summary

Hintergrund
Wenn Heimbewohner und -bewohnerinnen nicht mehr uneingeschränkt in der Lage sind, ihre Wünsche und Bedürfnisse für ein "gutes Sterben" zu äussern, übernimmt dabei insbesondere das Pflegepersonal eine tragende Rolle. Für die Heime ergibt sich in der heutigen Gesellschaft zudem die Notwendigkeit, sich mit der ausgeprägten Diversität von Bewohnerschaft und Personal auseinanderzusetzen, insbesondere solchen mit Migrationshintergrund.

Ziel
Das Projekt beabsichtigt, das soziale Handeln und die kulturellen Deutungen des "guten Sterbens" im Altersheim auszuleuchten. Es interessiert sich dafür, wie mit gesellschaftlicher Diversität, insbesondere im Migrationskontext verfahren wird. Dabei wird untersucht, wie sich die Vergemeinschaftung respektive die Individualität im Alltag gestaltet. Methodisch wird eine offene ethnographische Forschungsstrategie gewählt. Geforscht wird in drei Typen von Abteilungen, die unterschiedliche Formen von Vergemeinschaftung aufweisen. Die Forschenden gehen davon aus, dass die verschiedenen Formen der Vergemeinschaftung unterschiedliche Ausgestaltungen des Lebensendes hervorbringen.

Bedeutung
Die Studie soll ein besseres Verständnis davon gewinnen, wie gesellschaftliche Diversität das Lebensende im Altersheim strukturiert und wie die involvierten Akteure dabei interagieren. Dieses Verständnis trägt dazu bei, Elemente einer kompetenten beruflichen Handlungsfähigkeit und entsprechende Grundlagen für ein "gutes Lebensende" in der Gegenwart zu formulieren.

Direct link to Lay Summary Last update: 18.06.2013

Lay Summary (French)

Lead
Les résidences pour personnes âgées se transforment de plus en plus souvent en institutions où meurent des personnes très âgées et dépendantes de soins. Ce projet de recherche étudie comment la diversité des sociétés modernes, c’est-à-dire la multiplication des modes de vie de toutes sortes, influe sur la structure de la fin de vie en résidence pour personnes âgées.
Lay summary

Contexte
Lorsque les personnes vivant en résidence pour personnes âgées ne sont plus entièrement en mesure d’exprimer leurs souhaits et leurs besoins concernant le "bien mourir", c’est en particulier le personnel soignant qui joue un rôle capital. Dans la société d’aujourd’hui, les résidences doivent de plus faire face à la grande diversité de leurs habitantes et habitants ainsi que de leur personnel, personnes issues de l'immigration en particulier.

But
Le projet vise à éclaircir l’action sociale et les interprétations culturelles du "bien mourir" dans les résidences pour personnes âgées. Il s’intéresse aux réponses apportées à la diversité sociale, en particulier dans un contexte de migration. Ce faisant, il étudie comment la collectivité et l’individualité sont structurées au quotidien. La méthode est celle d’une stratégie de recherche ethnographique ouverte. La recherche a lieu dans trois types de services, présentant différentes formes de collectivité. Les chercheurs supposent que les différentes formes de collectivité débouchent sur différentes manières de structurer la fin de vie.

Portée
L’étude entend améliorer la compréhension de la manière dont la diversité sociale structure la fin de vie dans les résidences pour personnes âgées et comment les acteurs impliqués interagissent ce faisant. Cette compréhension contribuera à la formulation d’éléments d’une activité professionnelle compétente ainsi que de bases pour le "bien mourir" à l’époque actuelle.

Direct link to Lay Summary Last update: 18.06.2013

Lay Summary (English)

Lead
Nursing homes are increasingly becoming dying institutions for very elderly persons in need of care. This study examines how the diversity of modern societies - that is, the increasing variety of ways of life - is affecting how the end of life is handled in nursing homes.
Lay summary

Background
When nursing home residents are no longer completely able to express their wishes and needs for a "good dying", the nursing staff in particular takes on a supporting role. For the nursing homes, there is also in today’s society a necessity to deal with the marked diversity of residents and personnel, especially those with an immigration background.

Aim
This study aims to throw light on the social actions and the cultural interpretations of “good dying” in nursing homes. It will focus on how nursing homes handle social diversity, especially in the immigration context. Here the study will examine how communitisation and individuality take shape. The method will be an open ethnographic research strategy. The study will be conducted in three types of nursing home units that exhibit different forms of communiti-sation. The assumption is that the different forms of communitisation will produce different handling of the end of life.

Significance
The study will gain a better understanding of how social diversity structures the end of life in nursing homes, and how the persons involved interact. This understanding will contribute towards deriving in the present a set of elements of professional competency and the corre-sponding bases for a good end of life.

Direct link to Lay Summary Last update: 18.06.2013

Responsible applicant and co-applicants

Employees

Publications

Publication
Chancengleiche Palliative Care im Migrationskontext?
Salis Gross Corina (2016), Chancengleiche Palliative Care im Migrationskontext?, Suchtmagazin, Themennummer 'Sterben und Tod', Bern.
End-of-life care and rituals in contexts of post-migration diversity in Europe: an introduction.
Hunter Alistair, Soom Ammann Eva (2016), End-of-life care and rituals in contexts of post-migration diversity in Europe: an introduction., in JICS, Special Issue "Intercultural negotiations around dying and death in Europe", 37(2), 95-102.
Negotiating the potato: the challenge of dealing with multiple diversities in elder care
van Holten Karin, Soom Ammann Eva (2016), Negotiating the potato: the challenge of dealing with multiple diversities in elder care, in Schweppe Cornelia (ed.), Routledge, New York, 200-216.
The art of enduring contradictory goals: challenges in the institutional co-construction of a 'good death'.
Soom Ammann Eva, Salis Gross Corina, Rauber Gabriela (2016), The art of enduring contradictory goals: challenges in the institutional co-construction of a 'good death'., in Journal of Intercultural Studies, 37(2), 118-132.
Migrationssensitive Palliative Care – Bedarf und Bedürfnisse der Migrationsbevölkerung in der Schweiz
Salis Gross Corina, Soom Ammann Eva, Sariaslan Emine, Schneeberger Geisler Susanne (2015), Migrationssensitive Palliative Care – Bedarf und Bedürfnisse der Migrationsbevölkerung in der Schweiz, palliativ.ch, Bern.
Chancengleiche Palliative Care. Bedarf und Bedürfnisse der Migrationsbevölkerung in der Schweiz.
Salis Gross Corina, Soom Ammann Eva, Sariaslan Emine, Schneeberger Geisler Susanne (2014), Chancengleiche Palliative Care. Bedarf und Bedürfnisse der Migrationsbevölkerung in der Schweiz., AVM Verlag, München.

Scientific events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
Forschungskolloquium „Caring Communities“, Talk given at a conference Giving and Giving Back in Return. Informelle Tauschbeziehungen am Lebensende im Altersheim und deren Potential für die Caring Communities. 10.12.2016 Bern, Switzerland Rauber Gabriela; Salis Gross Corina;
Fünfte Dialogveranstaltung NFP 67. Das Gute Sterben: Gesellschaftliche Vorstellungen und Ideale Talk given at a conference Lebensende und Diversität im Altersheim 08.12.2016 Bern, Switzerland Rauber Gabriela; Salis Gross Corina; Soom Ammann Eva;
Nationaler Palliative Care Kongress Talk given at a conference Mediterrane Abteilungen - Potenziale und Grenzen segregierter Versorgung für das "Gute Sterben" 16.11.2016 Biel, Switzerland Soom Ammann Eva;
Tagung LangzeitSchweiz Talk given at a conference Lebensqualität am Ende des Lebens, Kriterien für eine gute Begleitung 03.11.2016 Zürich, Switzerland Rauber Gabriela; Soom Ammann Eva; Salis Gross Corina;
Les migrants âgés en Suisse Talk given at a conference Services spécifiques aux migrants âgés / Migrant specific services in Switzerland 06.09.2016 Genève, Switzerland Soom Ammann Eva;
SCHP Swiss Congress for Health Professions, Workshop "Selbstbestimmung Revisited" Talk given at a conference Selbstbestimmtes Sterben in der totalen Institution:Die Praxis im Schweizer Altersheim 01.09.2016 Lugano, Switzerland Soom Ammann Eva;
Workshop "Biographies et réseaux de soutien social (trans)nationaux des migrant(e)s âgé(e)s au Luxembourg" Talk given at a conference Migrationsspezifische Versorgung in der Langzeitpflege: das Beispiel der Schweiz 20.04.2016 Luxemburg, Luxembourg Soom Ammann Eva;
Nationaler Palliative Care Kongress Talk given at a conference Giving and giving back in return. Informelle Tauschbeziehungen am Lebensende im Altersheim und deren Potential für die Palliative Care 02.12.2015 Bern, Switzerland Rauber Gabriela;
14th Congress of the European Association for Palliative Care Poster Migrant Dying – challenges for service providers and needs of the migrant population 08.05.2015 Copenhagen, Denmark Soom Ammann Eva; Salis Gross Corina;
IMISCOE Conference 2014: Immigration, Social Cohesion and Social Innovation Talk given at a conference Challenges in the institutional co-construction of a ‘good death’: migrant dying in Swiss nursing homes 27.08.2014 Madrid, Spain Soom Ammann Eva; Salis Gross Corina;
National conference on research in palliative care Talk given at a conference Migration und Lebensende 26.11.2013 Bern, Switzerland Salis Gross Corina;
IMISCOE Conference 2013: Crisis and Migration – Perceptions, Challenges and Consequences Talk given at a conference Caring for ageing migrants in nursing homes: ‘doing diversity’ while ‘doing death’ 26.08.2013 Malmö, Sweden Rauber Gabriela; Soom Ammann Eva;
International Symposium on Transnational Aging Talk given at a conference Organizing and Experiencing Elderly Care in a Transnational Setting: The Challenge of Dealing with Multiple Diversities 26.09.2012 Mainz, Germany Soom Ammann Eva;
Forschungstreffen "Forschungsplattform Palliative Care D CH" Talk given at a conference Diversität und Lebensende im Altersheim 15.06.2012 Bern, Switzerland Soom Ammann Eva; Salis Gross Corina; Rauber Gabriela;


Self-organised

Title Date Place
Forschungskolloquium "Caring Communities" 10.12.2016 Bern, Switzerland
Shattering Culture: Diversity in Health Care 25.10.2012 Basel, Switzerland

Knowledge transfer events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
Fünfte Dialogveranstaltung NFP 67 „Das Gute Sterben: Gesellschaftliche Vorstellungen und Ideale“, Talk 08.12.2016 Bern, Switzerland
Nationaler Palliative Care Kongress Talk 16.11.2016 Biel/Bienne, Switzerland
Tagung LangzeitSchweiz Talk 03.11.2016 Zürich, Switzerland
Nationaler Palliative Care Kongress Talk 02.12.2015 Bern, Switzerland


Associated projects

Number Title Start Funding scheme
146391 CommuniCare - Kommunikationsdesign in kultursensiblen Alters- und Pflegeeinrichtungen 01.05.2013 Project funding (Div. I-III)
139365 'Doing death' and 'doing diversity' in nursing homes 01.06.2012 NRP 67 End of Life
166178 Ageing migrants: developing methodological tools for comparative research 01.02.2016 International Exploratory Workshops

Abstract

The research project is focusing on the end-of-life in old age nursing homes and intends to explore the constitution of ‘doing death’ in Swiss nursing homes when the elderly involved are of migrant background. The focus is laid on the co-construction of end-of -life and dying in interactions between residents of migrant background and professional carers involved (often of migrant background themselves), and will thereby analyse processes of ‘doing diversity’ in ‘doing death’. The sequences of these processes, the respective dimensions of dying trajectories and the conflicts arising are made visible within the specific context of migration. The proposed research chooses as a central approach the observation of everyday practices of ‘doing death’ and ‘death work’ by analysing interactions and by embedding them on one hand within the structural contexts of the organization and the relevant subsystems of society, and on the other hand within the contexts of biographical experiences and individual resources of the involved actors. The project chooses an open research strategy that will follow the principles of grounded theory and ethnographic research. The field of research will be entered by studying a group specific department for residents of so-called ‘mediterranean’ background and its ways of community-building. It will be contrasted by research in a department stressing community without defining specific criteria for the integration of residents (a so-called ‘Hausgemeinschaft’) and a department stressing the individuality of each resident, but holding a considerable number of residents with migrant background. There will be varied research methods applied (e.g., participant observation, focused and biographical interviewing, situational analysis).The proposed research project is focusing on migrant elderly end-of-life in nursing homes because we suppose that the specific forms of ‘doing diversity’ by ‘doing community’ within segregative departments may also lead to specific forms of ‘doing death’, which aim at a stronger embeddedness of dying trajectories in social relations of reciprocity and exchange. The study will analyse whether the investment in relationships of social and symbolic exchange and the respective (at least implicit) expectations of the organisation as well as of the residents and their family members will accordingly lead to more visible performances of reciprocity. Reduced feelings of guilt and shame for all the protagonists (staff, residents, family members) are therefore expected to show up as an important outcome of the segregative strategy of the organisation. Furthermore, migrant ‘doing death’ is expected to be particularly negotiable since the potential diversity of symbolic reference systems and daily practice is widened. If the respective resident is limited in his/her capacities to play an active part in negotiating about ‘good dying’ - either due to language competences, which would be migrant specific, or due to degenerative diseases, which are not migrant specific - leaves the field of negotiations up to the professionals within the organization. Strategies of stereotyping the ‘other’ as well as driving nurses, caring aides and other professionals of migrant background into roles of ‘cultural experts’ or ‘transcultural translators’ are expected to be common in such situations. However, the task of negotiating what would be a ‘good dying’ and what measures are appropriate is always at stake in contemporary heterogeneous societies. Therefore we would argue that studying dying processes involving migrant residents is looking at paradigmatic manifestations of doing death in recent contexts of reflexive modernity.
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