Negotiating the identities of allied healthcare professionals in the age of ‘superdiversity’ in healthcare

Abstract

In this paper we focus on the roles and identities of nurses in intercultural healthcare encounters to examine how the sociocultural ‘superdiversity’ of patients impacts on the roles that the nurses undertake in their professional practice. In contrast to much earlier work on identity construction in workplaces, which tends to focus on those workers who are at the ‘forefront’ in their professional context, such as leaders, specialists or experts, this paper explores the roles and identities of nurses who are often referred to as ‘allied’ professionals (Sampson, 2008). In spite of the nurses’ central role in healthcare services and their importance for achieving good patient outcomes, there is only very little research that focuses on these allied healthcare professionals (e.g. Candlin & Candlin, 2007; Candlin, 2011). In line with recent approaches we acknowledge that the concepts of role and identity are closely related, “mutually sustaining” (Hall et al. 1999: 294) and discursive ly constructed (e.g. Holmes et al. 1999; Roberts & Sarangi 1999). Thus, the identities that individuals construct for themselves and each other are closely related to the expectations associated with their respective roles in a specific context. Research on the roles of nurses in healthcare settings has emphasized that nurses’ performance often goes beyond those roles that are institutionally assigned to them and include “more fluid” specific roles that they perform to address specific patient needs. The roles identified and described in the literature include, for example, that of healer, carer, educator, advisor, counsellor, manager, and advisor (Candlin, 1997). We draw on a corpus of more than 120 interactions between nurses and patients which were video-recorded in a prenatal clinic in Hong Kong where pregnant women undergo screening for fetal abnormalities as part of their routine prenatal care. The nurses are Hong Kong Chinese while the patients originate from all continents. Using a social constructivist framework, we show that in these intercultural encounters the nurses perform a variety of different roles which are closely linked to their professional identities and which appear to be specific to this intercultural context. Our particular focus is on the roles of cultural broker and co-decision maker which the nurses regularly perform in these encounters. As cultural broker the nurses explicate and negotiate culturallyinfluenced ideas and assumptions about prenatal testing, as well as potential options and consequences of any choices the patients make. As co-decision makers, on the other hand, they assist and sometimes guide the patients in making their choices - in particular in those cases where the patients have only limited social and family networks available. We show how these roles have a strong impact on the ways in which the nurses construct their professional identities at different stages in the interactions with their patients in this intercultural context.