Socialization and ideal expectations for the health professional role in the provision of quality terminal care for the urban elderly

摘要

This study investigates socialization and ideal expectations for the health professional role in the provision of quality terminal care. Guiding the research are role theory, socialization theory, and Talcott Parsonsu27 (1951) pattern variables. The research was conducted in three phases. The first phase involved development of an analytical framework elaborating upon Parsonsu27 five pattern variables, which were first conceptualized as dimensions describing the ways in which roles could vary. Specific indicators for each of the pattern variables were developed. Typologies characterizing (1) the medical, or conventional, model and (2) the holistic model (specifically, the hospice model) for the provision of health care based on these indicators then were developed. Using the analytical framework, the second and third phases consisted of: (1) a content analysis of the physician and nurse socialization literature to determine the role prescriptions learned by these health professionals; and (2) a content analysis of open-ended interviews with a group (N = 94) of terminally ill elderly patients (n = 17), family members (n = 38), and health professionals (n = 39) from 10 urban health care programs (five conventional and five hospice) to identify ideal role expectations for the health professional. Major findings were that: (1) Parsonsu27 pattern variables, with elaboration, can provide a useful framework for role analysis; (2) physicians and nurses appear to be socialized to a number of role prescriptions consistent with the medical model, although there is evidence of conflicting socialization (to both models) for some role prescriptions; (3) respondentsu27 expectations generally were consistent with those prescribed by the hospice model with some notable exceptions; (4) the role expectations of the three groups of respondents were more congruent than was expected, although subgroupsu27 (conventional versus hospice) expectations tended to differ. Implications of the findings for: (1) role analysis; (2) socialization of health professionals to minimize role strain and conflict with patients and families; (3) continued implementation of conventional and hospice models for the provision of quality terminal care; (4) assessment of the quality of terminal care are explored; and (5) further research are explored.