The boundaries of care
The boundaries of care

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The boundaries of care

5 Distance and closeness

A lot of emotional labour is concerned with getting the right balance between being close, friendly and warm, and maintaining a proper distance. Lawler writes about learning emotional control by sticking to a set procedure and cultivating an ‘air of detachment’ (1991, p. 126). In terms of care work it is never quite clear which side to err on – being too cold would be seen as unprofessional, but so is being too familiar.

Click to read Jocelyn Lawler on 'Body Care and Learning to do for Others [Tip: hold Ctrl and click a link to open it in a new tab. (Hide tip)] '.

Activity 2 Learning to manage embarrassing situations

0 hours 45 minutes

Now read the extract from the course reader (click on "view document" above) Lawler has written about the way nurses learn to manage their embarrassment and the discomfort of their patients. Jot down some notes about your own experiences.

Here are some pointers to help you.

  • In his study, Lawler describes the background of the nurses he interviewed. If you do caring work, either in a paid or unpaid capacity, how do you think your own background has equipped you? Has it helped or made it more difficult for you to be comfortable around other people's bodies and bodily functions? If you need help with intimate care yourself, has this been made more or less embarrassing for you as a result of the way you were brought up?

  • The nurses interviewed by Lawler all have particular stories to tell about their first bed-baths, dead bodies and so on. Do you have any particularly vivid experiences relating to your own initial experiences of caring or being cared for?

  • Have you ever been in hospital or had any intimate procedure carried out? Did it help you if you had a sense of the nurse following a set procedure, or would you rather they had asked you how you wanted something done, or how you would have done it yourself? If you are a carer, do you have a routine? Does it help you? Do you think it makes things less embarrassing for other people?

  • If you are, or have been, a carer, have you learnt to switch off your emotions or do you sometimes find things harrowing, disgusting or unpleasant? What do you do then? Do you pretend, or do you avoid the person who needs your help? If you are on the receiving end of care, do you like your carer to keep their distance or do you prefer more of the human touch?

  • Language is mentioned in Lawler's study because that is a particular stumbling block when it comes to discussing bodily functions or sexuality. What kind of vocabulary do you feel most comfortable using at home – or at work? For example, children have their own vocabulary of ‘wees’ and ‘poohs’ while other people may use medical terminology.

Discussion

You probably came up with some very personal anecdotes in response to this activity. Keep these in mind as we explore why these areas are so difficult.

Lawler describes the context in which nurses work as a ‘social vacuum’. Care workers like Marie often have even less structure. Their role is not one other people recognise. They may be called something quite vague like a ‘support worker’ or a ‘house companion’. When they are not providing physical care they are supposed to act as a friend or equal to the person they are caring for, which means they have to switch in and out of roles and vary the distance between them as they perform different aspects of their work. They also have to maintain this very responsive personal touch even when they are responsible for looking after a group of people whose needs have to be juggled and balanced.

When people make decisions in this kind of environment there are no clear markers and after a while there is a tendency to forget what the normal rules are. One study on this subject explored how women care staff manage distance around the sexuality of men with learning difficulties. It describes:

… how acutely aware some women staff are of the contradictions within their role … when it comes to performing their caring responsibilities without compounding the risk of sexual harassment from their male clients.

(Thompson et al., 1997, p. 574)

Walking the tightrope between being too distant and too familiar, several women acknowledged the double messages they give out to the men they care for. For example, one woman said she wouldn't be this nice to any other man unless she was going to have a sexual relationship with him. Here we see that the expectations of her role as a carer cut across the way a woman of her age would normally expect to behave with men, leaving her, and her clients, confused. To continue Marie's story, later in the year Richard developed quite a crush on her, which she handled by telling him emphatically about her boyfriend Barry. In Thompson et al.'s study this was described as a common strategy and one way of re-establishing distance.

The paper by Thompson et al. also considers the organisational context within which much care work takes place: a predominantly female workforce with men occupying management roles. They describe the lack of support from managers and the unspoken expectation that women will cope with this aspect of the work, on their own. If a man service user misunderstands, the woman carer is invited to think it is her fault and something she should get right herself, not a function of the situation she has been put in. Even when the sexual behaviour of service users is seriously outside what any other women would expect to deal with at work, it is played down and not taken seriously. The authors comment on:

Women's work?
Figure 3

… the differential power which men and women staff hold within their organisations to frame behaviour such as this as a ‘problem’ rather than to see it subsumed as a routine part of the work.

(Thompson et al., 1997, p. 580)

Steps have been taken to try and address some of these issues. The Training Organisation for the Personal Social Services (TOPSS) has issued guidance for residential social care managers on the induction of new care staff in a publication entitled The First Six Months (TOPSS, 2002). This will enable managers to show that they are meeting the new standards that have been set for residential care by the National Care Standards Commission.

We have so far considered the issue of boundaries from the point of view of paid carers. Doing intimate things for someone you do know and have an ongoing relationship with can be just as difficult to manage. Oliver (1983) writes about the experiences of wives caring for disabled husbands. She tells how wives are expected to take on the role of carer with little help. Their presence and assumed willingness to care often lead to their husbands being discharged earlier from hospital and sent home with fewer aids or support services than a single person would have, or than a woman being cared for by her male partner. Rather than being treated as a person in her own right, ‘the wife’ is not able to negotiate what she will and will not do. Oliver writes of one woman who despite being:

… extremely distressed by the very intimate tasks she now had to do for her husband, like wiping his bottom, was told by the examining doctor [when she applied for attendance allowance] that what she was doing was ‘no more than any wife should’. She broke down completely when the doctor left, and when her husband's application was turned down, forbade him to appeal, in order that she should not be put through such a humiliating ordeal again.

(Oliver, 1983, p. 77)

In this case embarrassment had a real financial as well as an emotional cost. Crossing boundaries is also an issue for men who take on the role of ‘carer’; for example, a father might find himself coming into contact with his disabled daughter's menstruation in a way other fathers would not. Family members and care workers find themselves being asked to stretch to meet an ideal no matter how pressed they are or how unrealistic the expectations on them.

Key points

  • Intimate care is seen as both ‘low status’ and ‘women's work’ (not a coincidence).

  • ‘Emotional labour’ is more than just managing emotions. It refers to the work of maintaining at least the fiction of a close, supportive role in a relationship which is not reciprocal.

  • Care workers are constantly crossing and rebuilding boundaries: hence the tension between closeness and distance in their relationships with service users.

  • The lack of clear boundaries presents problems in relation to sexual behaviour as well as to intimate care.

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