Gatekeeping and legitimization: how informal carers' relationship with health care workers is revealed in their everyday interactions.
OBJECTIVE
This study explores the relationship between informal carers of older people, and health care workers within the context of a hospital ward. Through an analysis of their language-based encounters the purpose of the study was to identify the discursive processes involved in face-to-face informal carer-health care worker interactions, during the course of carers' visits to one elderly care rehabilitation hospital ward.


METHODS
An ethnomethodological research design, which encompassed the concerns of conversation analysis and the study of institutional interaction, was used. The study involved videotape recording informal carers naturally occurring spontaneous interactions with a range of health care workers on the ward. Data collection was carried out for between 1 and 3 hours, two to three times a week over a period of 3 months. The data comprised: 30 dyadic and group interactions involving 19 different carers and 25 different health care workers, including nurses (qualified and unqualified), physiotherapists, occupational therapists, dieticians, ambulance personnel, housekeepers and nursing auxiliaries. Detailed transcriptions of the data were produced and analysis was undertaken using a modified conversation analysis approach.


RESULTS
Analysis revealed that a central aspect of the way the relationship between informal carers and health care workers is framed is by the way information and access to information is obtained. This paper examines some of the aspects of informal carer-health care worker discourse, which denote both parties as gatekeepers. In doing so it considers the roles that legitimatization of competence and knowledgeability have in facilitating informal carers interactions with health care workers.


CONCLUSIONS
We conclude that the accomplishment of legitimacy is largely a collaborative undertaking on behalf of health care workers and informal carers. The implications of these findings for carers, health care workers, policy and future research are discussed.
May
J
J
Health Research Unit, School of Health and Rehabilitation Sciences, University of Southampton, Southampton, UK. judith.may@schs.nhs.uk
Ellis-Hill
C
C
Payne
S
S
D000328:Adult; D000368:Aged; D017028:Caregivers / Q000523:psychology*; D003142:Communication; D003299:Cooperative Behavior; D005190:Family / Q000523:psychology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017008:Negotiating; D009633:Nonverbal Communication; D015404:Nursing Methodology Research; D009741:Nursing Staff, Hospital / Q000523:psychology*; D010564:Personnel, Hospital / Q000523:psychology*; D011209:Power, Psychological; D011368:Professional-Family Relations; D012017:Referral and Consultation / Q000592:standards*; D012660:Semantics; D014743:Videotape Recording