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Bodies that care: A microethnography of family caregivers of older adults (Ph.D. thesis, 2013)

This study examines the lived reality of women caregivers of older adults. Using a microethnographic approach and videographic data collection in the homes of five caregiver - care receiver dyads, the research provides a n ew account of family
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    Bodies that care: A microethnography of family caregivers of older adults Marjorie Silverman School of Social Work McGill University, Montreal August 2013 A thesis submitted to McGill University in partial fulfillment of the requirements of the degree of Doctor of Philosophy © Copyright by Marjorie Silverman, 2013   2 Table of Contents ABSTRACT 5   ACKNOWLEDGEMENTS 6   CHAPTER ONE: INTRODUCTION 7   1.1)   R  ESEARCH CONTEXT  10   T HE CURRENT CONTEXT OF FAMILY CARE PROVISION  10 T HE PLACE OF THE BODY WITHIN SOCIAL GERONTOLOGY  13 1.2)   A IMS OF THE RESEARCH AND GUIDING QUESTION  17   1.3)   T HESIS O UTLINE  19   CHAPTER TWO: LITERATURE REVIEW 22   2.1)   L ITERATURE ON CARE  23   M ETHODOLOGY FOR LITERATURE REVIEW  23 T HEME 1   -   F AMILY C AREGIVING /E LDERCARE  25 T HEME 2   -   C ARE PRACTICES  31 T HEME 3    –    G ENDER AND CARE LABOUR   36 G APS IN THE CAREGIVING LITERATURE  44 2.2)   S OCIAL S CHOLARSHIP ON THE B ODY  45   M ETHODOLOGY FOR THE LITERATURE REVIEW  46 S OCIAL SCHOLARSHIP ON THE BODY  –   REVIEW AND PERTINENT THEMES  47 E MBODIED SOCIOLOGY  53 G APS IN THE SOCIOLOGY OF THE BODY LITERATURE  57 CHAPTER THREE: CONCEPTUAL FRAMEWORK 59   3.1)   E MBODIMENT  60   3.2)   P IERRE B OURDIEU  63   H ABITUS  64 C APITAL  67 3.3)   E RVING G OFFMAN  70   I  NTERACTION R  ITUALS  72 P ERFORMANCE  73 3.4)   T ENSION BETWEEN B OURDIEU AND G OFFMAN  76   3.5)   A PPLICATION OF B OURDIEU AND G OFFMAN TO CAREGIVERS  78   CHAPTER FOUR: METHODOLOGY 85   4.1)   R  ESEARCH QUESTION  85   4.2)   T HE MICROETHNOGRAPHIC APPROACH  86   I  NFLUENCES ON MICROETHNOGRAPHY  89 M ETHODS OF ANALYSIS WITHIN A MICROETHNOGRAPHIC APPROACH  91 4.3)   R  ESEARCH DESIGN OF THE CURRENT STUDY  93   R  ECRUITMENT STRATEGY  96 S AMPLE AND POPULATION  98 L ENGTH OF FIELDWORK   100   3 E THICAL CONSIDERATIONS AND PROCESS  102 4.4)   D ATA COLLECTION  103   U SE OF VIDEO  103 P ARTICIPANT OBSERVATION  105 S UPPLEMENTARY SOURCES OF DATA  107 D ATA COLLECTION CHALLENGES  108 R  EFLEXIVITY AND SOCIAL LOCATION  112 4.5)   D ATA ANALYSIS  115   E STABLISHING RESEARCH VALIDITY  121 4.6)   S TRENGTHS AND LIMITATIONS OF THE MICROETHNOGRAPHIC METHOD  122   CHAPTER FIVE: PRESENTATION OF THE CAREGIVER – CARE RECEIVER DYADS 125   5.1)   R  EBECCA AND M OLLY  125   5.2)   L ILLIAN AND R  OBERT  129   5.3)   S USAN AND E LI  132   5.4)   M ARIE AND J EAN  134   5.5)   B ONNIE AND D AVE  137   CHAPTER SIX: RAW DATA 140   6.1)   I NITIAL CODES  141   6.2)   P RELIMINARY CONCEPTS  168   6.3)   F INAL THEMES  175   CHAPTER SEVEN: FINDINGS 178   7.1)   T HE CAREGIVER  HABITUS   178   T HE EVERYDAY ,  LIVED REALITY OF THE  HABITUS   180 G ENDERED TASKS INTEGRAL TO THE CAREGIVER  HABITUS   183 D IFFICULTY ACCOMPLISHING CAREGIVER EXPECTATIONS  185 7.2)   B ECOMING VERSUS PERFORMING THE CAREGIVER  HABITUS   188   P ERFORMANCE REVEALED THROUGH DISSONANCE BETWEEN VERBAL AND NONVERBAL EXPRESSIONS  188 P ERFORMANCE ON THE FRONT AND BACK STAGES  191 P ERFORMANCE LINKED TO INTEGRATION OF THE  HABITUS   193 7.3)   E MOTIONAL LABOUR   194   E MOTIONAL LABOUR INTEGRAL TO THE CAREGIVER  HABITUS   195 E MOTIONAL LABOUR EXPRESSED THROUGH BODY MANAGEMENT  197 7.4)   I NTERSUBJECTIVITY AND RELATIONAL BOUNDARIES  200   C LOSENESS VERSUS FUSION  201 E RUPTIONS AS RESISTANCE TO FUSION  203 7.5)   P HYSICAL CAPITAL :   I NVESTMENT AND DIVESTMENT  207   D IVESTMENT AS A MORAL EXCHANGE  208 D IVESTMENT AS RESISTANCE  210 CHAPTER EIGHT: DISCUSSION AND CONCLUSION 213   8.1)   R  EVIEW OF THE FINDINGS :   T HE SUBJECTIVE LIVED EXPERIENCE OF CARE  213   8.2)   C AREGIVING ,  AGING AND THE BODY  217   T HE BODY CONNECTS CAREGIVING ,  AGING ,  GENDER  ,  AND EMOTION  217   4 E MBODIMENT CONTRIBUTES TO AN UNDERSTANDING OF CAREGIVING  221 8.3)   C LINICAL PRACTICE WITH CAREGIVERS :   A  MORE COMPREHENSIVE VISION OF CAREGIVERS ’  REALITIES AND EXPERIENCES  223   I MPLEMENTING IN - DEPTH INTERVENTION FOR CAREGIVERS  223 O BSERVING CAREGIVERS ’  BODILY EXPRESSIONS  224 O BSERVING CAREGIVERS IN THE HOME  225 C HANGING THE MESSAGES GIVEN TO WOMEN CAREGIVERS  227 8.4)   B ENEFITS AND CHALLENGES OF MICROETHNOGRAPHIC RESEARCH AND AVENUES FOR FUTURE RESEARCH WITH CAREGIVERS  228   M ICROETHNOGRAPHY VALIDATES SEEMINGLY MUNDANE PERSONAL ACTS  229 M ICROETHNOGRAPHY ALLOWS PRIVILEGED ACCESS TO INTIMACY  230 A VENUES FOR FUTURE RESEARCH  232 8.5)   C ONCLUSION  233   APPENDIX A: RECRUITMENT DOCUMENT 238   APPENDIX B: CONSENT FORM 239   APPENDIX C: CONVERSATION ANALYSIS NOTATION 243   APPENDIX D: QUESTIONS ASKED OF THE DATA DURING CODING 245   APPENDIX E: ORIGINAL FRENCH VERSION OF SCENES WITH 246   MARIE AND JEAN FROM CHAPTER SEVEN 246   REFERENCES 248     5 Abstract This study examines the lived reality of women caregivers of older adults. Using a microethnographic approach and videographic data collection in the homes of five caregiver - care receiver dyads, the research provides a new account of family caregiving. Grounded in a conceptual framework of embodiment, as articulated  by social theorists Pierre Bourdieu and Erving Goffman, the data illustrates that seemingly banal gestures and expressions expose the intimate, often hidden, reality of caregiving. The findings reveal a gendered caregiver habitus  characterized by emotional labour, performance, body management, health divestment, and vacillating boundaries between the caregiver and care receiver. The project validates the everyday experiences of women caregivers, proposes recommendations for improved clinical practice, and bridges scholarship on caregiving and the sociology of the body. Cette étude examine la réalité vécue par les proches aidantes de personnes âgées, à partir d’une approche microethnographique et des données vidéographiques filmées au domicile de cinq dyades proches aidantes – aidé. La recherche fournit un nouveau calvas de prestation de soins familiaux. Ancré dans un cadre conceptuel d’« embodiment », tel que défini par les sociologues Pierre Bourdieu et Erving Goffman, les données recueillies démontrent que les gestes et expressions, de prime abord banals, révèlent une intimité, souvent cachée, des soins prodigués. Les résultats dévoilent un habitus  influencé par le genre des aidants qui se caractérise en fonction du travail émotionnel, de la performance, de la gestion du corps, d’un désengagement en matière de santé personnelle, et des frontières poreuses dans la relation entre la proche aidante et l’aidé. Le projet valide les expériences quotidiennes vécues par des proches aidantes, recommande des pistes pour améliorer la pratique clinique et dresse des ponts académiques entre l’étude des soins familiaux et celle de la sociologie du corps.
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