title: "Careworkers don't have a voice:" epistemological violence in residential care for older people.
abstract: Drawing on feminist epistemologies, this paper attends to the way the reductionist assumptions have shaped the organization of nursing home carework in manners that are insufficient to the needs of relational care. This paper is informed by a study involving nine focus groups and a survey of Canadian residential care workers (141 RNs, 139 LPNs and 415 frontline careworkers). Four major themes were identified. Reductionist assumptions contributed to routinized, task-based approaches to care, resulting in what careworkers termed "assembly line care." Insufficient time and emphasis on the relational dimensions of care made it difficult to "treat residents as human beings." Accountability, enacted as counting and documenting, led to an "avalanche of paperwork" that took time away from care. Finally, hierarchies of knowledge contributed to systemic exclusions and the perception that "careworkers' don't have a voice." Careworkers reported distress as a result of the tensions between the organization of work and the needs of relational care. We theorize these findings as examples of "epistemological violence," a concept coined by Vandana Shiva (1988) to name the harm that results from the hegemony of reductionist assumptions. While not acting alone, we argue that reductionism has played an important role in shaping the context of care both at a policy and organizational level, and it continues to shape the solutions to problems in nursing home care in ways that pose challenges for careworkers. We conclude by suggesting that improving the quality of both work and care will require respecting the specificities of care and its unique epistemological and ontological nature.
authors.affiliation: Re-imagining Long-term Residential Care, York University, York Lanes, 359A, 4700, Keele St., Toronto, Ontario M3J 1P3, Canada. Electronic address: balbertb@yorku.ca.
authors.forename: Albert
authors.initials: A
authors.lastname: Banerjee
authors.affiliation: Department of Sociology and Women's Studies, York University, 4700 Keele St., Toronto, Ontario M3J 1P3, Canada. Electronic address: patarmst@yorku.ca.
authors.forename: Pat
authors.initials: P
authors.lastname: Armstrong
authors.affiliation: School of Health Policy and Management, York University, 4700 Keele St., Toronto, Ontario M3J 1P3, Canada. Electronic address: dalyt@yorku.ca.
authors.forename: Tamara
authors.initials: T
authors.lastname: Daly
authors.affiliation: Carleton University, 6 St. Anne's Road, Toronto, Ontario M6J 2C1, Canada. Electronic address: hugh.armstrong@carleton.ca.
authors.forename: Hugh
authors.initials: H
authors.lastname: Armstrong
authors.affiliation: School of Social Work, Institute of Political Economy, Carleton University, Canada. Electronic address: Susan.Braedley@carleton.ca.
authors.forename: Susan
authors.initials: S
authors.lastname: Braedley
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D017028:Caregivers / Q000941:ethics / Q000523:psychology*; D005260:Female; D017144:Focus Groups; D006707:Homes for the Aged / Q000941:ethics / Q000458:organization & administration*; D006801:Humans; D019359:Knowledge; D008134:Long-Term Care; D009735:Nursing Homes / Q000941:ethics / Q000458:organization & administration*; D011369:Professional-Patient Relations / Q000941:ethics; D036301:Qualitative Research; D014754:Violence; D016526:Workload / Q000523:psychology / Q000706:statistics & numerical data; D017132:Workplace / Q000592:standards
keywords: Care; Epistemology; Nursing home; Quality; Regulation; Violence; Work organization