The Poetics of Professionalism Among Dialysis Technicians

Abstract

The vast majority of care for end-stage renal disease (ESRD) patients is provided by skilled (but not formally educated) paraprofessional technicians. Using Goffman's (1959) framing of the performance of self in everyday discourse, this study examines discourse from dialysis technicians and technical aides to explore these paraprofessionals' construction and performance of professional identity and professional communication within the context of an outpatient dialysis clinic. Themes of professionalism—individualized care, vigilance, teamwork, and emotion management—are illustrated via poetic transcription of interviews with technicians. I contend that such representation offers validity equal to that of traditional research accounts while embodying alternative representational strengths.

Notes

¹Most of the staff members and patients were aware of far more of my identity than merely my status as a researcher. Staff and patients asked me many questions about my position as a university professor and about my personal life, including my marriage, pets, and leisure activities, and I answered them freely. In addition, because I walk with a limp and my right leg is disfigured (due to several operations), staff and patients asked me questions about my health, and I disclosed my status as a cancer survivor (see Ellingson, 1998). My personal disclosures appeared to enhance my rapport with my participants and facilitated the development of trust between us. Moreover, I felt an ethical obligation to reciprocate with personal information when I ask my participants to share their lives with me. However, I did avoid discussing the research questions of my study, and explained only that I was interested in documenting mundane communication in the unit (which I often referred to as “what you do all day”).

² This joke refers to the fact that patients are required to radically limit their fluid intake in between dialysis treatments. Patients are weighed before and after treatment, with the difference in their weights attributed to the amount of fluid removed during dialysis. Hence, this PCT is joking that having a lot of money in the patient's pocket would make the patient falsely appear to have gained excessive weight between dialysis treatments. While the premise of the humor may not work well for those outside the world of dialysis, this comment generally would be considered appropriate and effective humor by the staff and patients of the unit I observed.

³ Unfortunately, unpleasant patients are not uncommon within dialysis care. ESRD is most prevalent among minority and economically disadvantaged populations who lack health insurance; hence, they often are often angry about the previous lack of treatment that contributed to the onset of ESRD. In addition, ESRD is a side effect of substance abuse, and people with addictions to illicit substances tend to be noncompliant, difficult patients. Finally, life on dialysis is not easy; it involves many side effects, drastically restricted diet and fluid intake, and the loss of much independence. Such limitations may induce normally pleasant patients to act out in anger and frustration (Friedman, 2001).