title: Everyday practices at the medical ward: a 16-month ethnographic field study.
abstract: BACKGROUND
  Modern hospital care should ostensibly be multi-professional and person-centred, yet it still seems to be driven primarily by a hegemonic, positivistic, biomedical agenda. This study aimed to describe the everyday practices of professionals and patients in a coronary care unit, and analyse how the routines, structures and physical design of the care environment influenced their actions and relationships.
  
  
  METHODS
  Ethnographic fieldwork was conducted over a 16-month period (between 2009 and 2011) by two researchers working in parallel in a Swedish coronary care unit. Observations, informal talks and formal interviews took place with registered nurses, assistant nurses, physicians and patients in the coronary care unit. The formal interviews were conducted with six registered nurses (five female, one male) including the chief nurse manager, three assistant nurses (all female), two cardiologists and three patients (one female, two male).
  
  
  RESULTS
  We identified the structures that either promoted or counteracted the various actions and relationships of patients and healthcare professionals. The care environment, with its minimalistic design, strong focus on routines and modest capacity for dialogue, restricted the choices available to both patients and healthcare professionals. This resulted in feelings of guilt, predominantly on the part of the registered nurses.
  
  
  CONCLUSIONS
  The care environment restricted the choices available to both patients and healthcare professionals. This may result in increased moral stress among those in multi-professional teams who work in the grey area between biomedical and person-centred care.
authors: Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. axel.wolf@gu.se
authors: Axel
authors: A
authors: Wolf
authors: Inger
authors: I
authors: Ekman
authors: Lisen
authors: L
authors: Dellenborg
mesh_terms: D000884:Anthropology, Cultural; D002391:Catchment Area, Health; D002983:Clinical Competence; D003219:Confidentiality; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006757:Hospital Units; D006785:Hospitals, University; D006801:Humans; D007902:Length of Stay; D008297:Male; D008505:Medical Staff, Hospital / Q000592:standards; D010348:Patient Care Team / Q000592:standards; D018802:Patient-Centered Care; D010561:Personnel Staffing and Scheduling; D017064:Process Assessment, Health Care / Q000592:standards / Q000706:statistics & numerical data*; D036301:Qualitative Research; D017678:Sex Distribution; D013548:Sweden; D000078329:Workforce