Can equity in care be achieved for stigmatized patients? Discourses of ideological dilemmas in perioperative care

• Published in: BMC Health Services Research
• Main Authors: Maria Härgestam, Lenita Lindgren, Maritha Jacobsson
• Format: Article in Journal/Newspaper
• Language: English
• Published: BMC 2024
• Subjects: Discrimination; Discourse psychology; Equity; Ideological dilemma; Perioperative care; Stigmatization; Public aspects of medicine; RA1-1270; Northern Sweden
• Online Access: https://doi.org/10.1186/s12913-024-10580-5; https://doaj.org/article/a6ca52dd216c4a0398562a3e14dd800b

Abstract Background In the perioperative care of individuals with obesity, it is imperative to consider the presence of risk factors that may predispose them to complications. Providing optimal care in such cases proves to be a multifaceted challenge, significantly distinct from the care required for non-obese patients. However, patients with morbidities regarded as self-inflicted, such as obesity, described feelings of being judged and discriminated in healthcare. At the same time, healthcare personnel express difficulties in acting in an appropriate and non-insulting way. In this study, the aim was to analyse how registered nurse anaesthetists positioned themselves regarding obese patients in perioperative care. Methods We used discursive psychology to analyse how registered nurse anaesthetists positioned themselves toward obese patients in perioperative care, while striving to provide equitable care. The empirical material was drawn from interviews with 15 registered nurse anaesthetists working in a hospital in northern Sweden. Results Obese patients were described as “untypical”, and more “resource-demanding” than for the “normal” patient in perioperative care. This created conflicting feelings, and generated frustration directed toward the patients when the care demanded extra work that had not been accounted for in the schedules created by the organization and managers. Conclusions Although the intention of these registered nurse anaesthetists was to offer all patients equitable care, the organization did not always provide the necessary resources. This contributed to the registered nurse anaesthetists either consciously or unconsciously blaming patients who deviated from the “norm”.