'We just do the dirty work': dealing with incontinence, courtesy stigma and the low occupational status of carework in long-term aged care facilities.
OBJECTIVE
To systematically examine, describe and explain how continence care was determined, delivered and communicated in Australian long aged care facilities.


BACKGROUND
Incontinence is a highly stigmatising condition that affects a disproportionally large number of people living in long-term aged care facilities. Its day-to-day management is mainly undertaken by careworkers. We conducted a Grounded theory study to explore how continence care was determined, delivered and communicated in long-term aged care facilities. This paper presents one finding, i.e. how careworkers in long-term aged care facilities deal with the stigma, devaluation and the aesthetically unpleasant aspects of their work.


METHODS
Grounded theory.


METHODS
Eighty-eight hours of field observations in two long-term aged care facilities in Australia. In addition, in-depth interviews with 18 nurses and careworkers who had experience of providing, supervising or assessment of continence care in any long-term aged care facility in Australia.


RESULTS
Occupational exposure to incontinence contributes to the low occupational status of carework in long-term aged care facilities, and continence care is a symbolic marker for inequalities within the facility, the nursing profession and society at large. Careworkers' affective and behavioural responses are characterised by: (1) accommodating the context; (2) dissociating oneself; (3) distancing oneself and (4) attempting to elevate one's role status.


CONCLUSIONS
The theory extends current understandings about the links between incontinence, continence care, courtesy stigma, emotional labour and the low occupational status of carework in long-term aged care facilities.


CONCLUSIONS
This study provides insights into the ways in which tacit beliefs and values about incontinence, cleanliness and contamination may affect the social organisation and delivery of care in long-term aged care facilities. Nurse leaders should challenge the stigma and devaluation of carework and careworkers, and reframe carework as 'dignity work'.
Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Deakin University, Melbourne, Vic., Australia. jostaszk@gmail.com, joan.ostaszkiewicz@deakin.edu.au.
Joan
J
Ostaszkiewicz
University of Manitoba, Winnipeg, MB, Canada.
Beverly
B
O'Connell
School of Nursing and Midwifery, Deakin University and Barwon Health and Centre for Quality and Patient Safety Research, Geelong, Vic., Australia.
Trisha
T
Dunning
D000293:Adolescent; D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001315:Australia; D004651:Employment; D005242:Fecal Incontinence / Q000451:nursing*; D005260:Female; D006299:Health Services for the Aged; D006801:Humans; D007407:Interviews as Topic; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000523:psychology*; D057545:Social Stigma; D014549:Urinary Incontinence / Q000451:nursing*; D055815:Young Adult
carework; dignity; incontinence; long-term aged care; role status; stigma