The Institutional Practice: A study on variations of hospitalizations from nursing homes

Project summary

The project seek to analyze and understand how practice is generated, shared and implemented at nursing homes. Discussions on practice in general are founded on the analysis of specific practices of hospitalizations. The primary theoretical fundament for the project is Pierre Bourdieu’s' theory of practice, while the primary methodological approach is participant observation.

Research literature state that rates of hospitalizations vary considerably between nursing home institutions, also within smaller geographical areas. An objective of this project is to analyze and explain how such differences are generated, with particular emphasis on organizational/institutional characteristics and regimes of nursing home staffs' practice (understood widely).

Explanations, causes and connections are sought after through the analysis of factors on an institutional level and that are connected to practice, rather than exclusively being related to patient characteristics. Such an emphasis seems poignant and relevant, taking current research on the topic into consideration. 

National and international research state that organizational conditions are significantly influential for decisions concerning hospitalizations from nursing homes. Research have not, however, extensively covered such aspects. The research literature on hospitalizations from nursing homes is particularly lacking regarding analysis on the potential interrelatedness of conditions and factors, both on a structural and institutional level, and how such factors can relate to practice, understood as a continuous process, rather than decisions removed from its context.

Both national and international literature point to (unwarranted) high general rates of hospitalization from nursing homes, and to varying rates between institutions.

Based on these premises, this project seeks to analyze and explain the (potentially varying) processes connected to decisions on hospitalization. The study aim to demonstrate how decisions are derived from an "Institutional Practice": implicit, informal, but still shared, effective and adequate. We will argue that "the institutional practice" is developed and implemented locally, in many cases related to the unit rather than the institution, based on a fundamental and encompassing uncertainty to which nursing home staff must relate. We will further argue that the fundamental uncertainty, relevant also for specific decisions on hospitalizations, relates to "continuity" (in many facets), to a larger degree than other conditions analyzed.

Method

Fieldwork, in the form of participant observation, has been conducted at six nursing homes in Norway, and two nursing homes respectively in Canada, The United States, and United Kingdom. The primary methodological approach is supplemented with interviews and statistical data.