The discursive construction of self positioning amongst minority ethnic patients in a hospital ward

Abstract

This paper deals with results from an ongoing research project about how patients and health professionals talk about and enact culture in a specific Danish hospital ward, whether this may have implications for staff–patient relationships and how knowledge of cultural complexities may add value to patient care. The project and this paper are based on a discourse analytic and social constructivist approach and, contrary to some earlier studies focusing on health professionals’ perceptions of culture in relation to the care of minority ethnic patients, this project and paper deal with culture seen from a patient perspective. Data have been collected from interviews with minority ethnic patients and with nurses about the intercultural encounter in an infectious diseases ward, and the analysis focuses on evaluating statements present in the discourses. The analysis aims at studying how such discourses may display the patients’ roles and self positioning, to discuss whether such positions and roles are attributable to culture, language proficiency or social conditions.

Keywords:

• health communication
• intercultural communication
• ethnic minority patients
• appraisal
• narrative inquiry

Notes

1. The research project ‘Cultural Awareness and Good Practice in the Health Sector’ is a part of a large-scale cross-disciplinary project entitled ‘Talking Culture’, funded by the Danish Strategic Research Council.

2. The patients’ personal histories, their illnesses and the reasons for their admittance to the hospital as well as their experiences from other hospitals are left out.

3. The following review is based on a working paper written by the authors of this article, 2009.

4. I = interviewer; D = interviewee. Agency is underlined.

5. Agency is marked in the following examples.

6. Original data example (interpreter): Hun siger, hun synes det var rigtig godt. Fordi hvis det var sket i Afrika, ved hun ikke, hvordan de skulle … hvordan de kunne have klaret det, eller overlevet, fordi han har haft meget ondt. Kun efter 3 dage, så begynder barnet at lege, og det var okay. Der er ikke noget, der ikke er godt. Det hele er godt, synes hun, det hele. Det er godt her fordi hun får sin medicin. Man får også mad.

7. Original data example: Hun sagde det var Gudrun, hun er islænding. Det er fordi, jeg gerne vil sige tak til hende: Mange tak fordi du har reddet mit liv.

8. Translation of the original data example: It's very good. I'm satisfied. They have examined me well. The welcome is positive. You know, here it's a democracy. Because here, you have the right to ask. When I look at myself I'm free. Because, you know, in life you have to be polite. When I call for something they come immediately. But two or three doctors … that makes me happy. Because here, as an example, if you have an appointment at 1 o'clock, it is punctual. Because all the nurses asked me before treating me how I felt, asked about my health. And that makes me happy.

9. Original data example: Jeg føler mig ensom, mange gange. Fordi jeg har ikke ret mange bevægelsesmuligheder.

10. Original data example: Jeg synes … Hvorfor kan de ikke bare flytte til vores … Øh … jeg boede i nummer 6 før, så skal jeg flytte over til nummer 12. Det er fordi, nogle ældre damer, de skal flytte. Hvorfor flytter de ikke bare derind, hvor jeg har boet? I stedet for at flytte os rundt. Sådan tænker vi. De kan bare tænke logisk, ikke sådan?

11. Original data example: Jamen jeg synes, jeg er lidt uenig med dem. Det har jeg fortalt min datter også. En af sygeplejerskerne, jeg kan ikke lide hende. Hun sagde. Jeg har sagt til hende: du skal ikke modsige mig hele tiden. Ikke også? Hvis du modsiger mig hele tiden, så klager jeg til Patientklagenævnet. Gør bare det, sagde hun så. Hun modsiger mig hele tiden, I stedet for at hjælpe mig. Jeg har sagt til hende du har måske taget den forkerte uddannelse har jeg sagt til hende.

12. Original data example (interpreter): Her får du noget, der giver dig energi.

13. Translation of the original data example: I'm eating the Danish food. You have to get used to it. I'm eating the parts I like.

14. Original data example (interpreter): Det var rigtig svært, men de gjorde det bedste de kunne.

15. Translation of the original data example: There are some problems. We manage because I have followed a course in Danish for a week only. I understand a little bit. You have to adjust to people. You have to get an interpreter.

16. Original data example (interpreter): Hun siger der er forskel [mellem DK og Afrika] fordi ligesom Afrika, det er altid manden, der bestemmer … over konen og sådan … Men her i Danmark måske det er ligesom alle … begge parter, de er lige. Ikke nogen, der er større end andre, og der er ikke én, der bestemmer mere end en anden. I Afrika … det er altid lægen øverst. Og så sygeplejersken, det er ned … Det kan hun ikke sige, fordi hun ved ikke.