The discussion presented in this chapter is based on a study where I investigated Danish care workers’ understanding of care work and the way they perceive themselves as care work-ers, including how and under which conditions they handle the daily care relations (Hansen 2006). An important element in the research was to let small groups of care workers observe, comment, and discuss some fi lmed examples of care praxis.
The groups were controlled as little as possible in order to see what was observed and commented on spontaneously, as well as which issues would cause discussion in the groups—and how. All the participants’ comments and discussions were re-corded on tape and video. A critical hermeneutical interpreta-tion of the material showed some essential, formative ideals, motives, conditions and possibilities in concrete and practical elder care. This provided me with the possibility to identify learning potentials located subjectively, individually, and col-lectively in care staff as part of their complex and confl ictual work and living conditions.
Among some of the care workers who observed and com-mented on my fi lms, there was for instance a spontaneous and heated discussion about the use of gloves when assisting with personal hygiene. The discussion began during a fi lm se-quence where a social- and health care helper helps an elderly man in a shower. The group of fi ve female spectators focused their attention on the fact that the care worker was not wear-ing gloves. ‘I could not have done that,’ one of the spectators commented and explained to the other people in the group that if she herself had been a care recipient, she would have preferred that the caregiver had worn gloves in such a situ-ation. Her comment was: ‘I feel that you cross a line by not wearing gloves. You get too close to me. If you are wearing
gloves, then there is a layer in between, you know what I mean—wearing gloves creates a distance between us and I don’t feel that you touch me directly…’
There was not consensus in the group with regard to this attitude. Some of the women felt that one should always use gloves when assisting with personal hygiene. Others felt that gloves should only be applied in certain situations. One of the women expressed this in the following way: ‘I only wear gloves with patients who have skin problems or the like…
when I wash them below I always wear gloves and also when I apply remedial ointment, but not when applying ordinary moisturising lotion… no.’
This remark prompted the fi rst woman to protest: ‘It is not because I do not want to touch them,’ and a third woman in the group seconded her: ‘You do it for the client’s sake.’
However, the woman who only wanted to apply gloves in certain situations was not convinced: ‘It can also be the other way round. It depends on who it is… if I was lying there and someone put on gloves, just because they were going to touch me, it could also be like that…’
The observers’ discussion became long and intense, but re-gardless of whether or not the women spoke for or against a general use of gloves, they, as a matter of consequence, re-sorted to arguments, which were entirely supported by the ideal of taking the elderly people’s emotions into due con-sideration. Indirectly they were, however, clearly also voicing their own concerns regarding touch. I interpret this as an ex-pression of the fact that the women for various reasons repress and place a taboo on their own feelings and needs, which are strongly affected in the care work. At one point the discussion nevertheless touched upon the question of the signifi cance of the gloves with regard to protecting the care workers against the intimate contact. This aspect of the situation was only sporadically voiced in explicit terms. However, the attentive listener would soon realise that the participants themselves inadvertently opened up a discussion of ambivalent emotions related to the encounter with the aging body.
The forceful psychic energy inherent in the discussion is an example of the fact that care personnel needs to talk about the body, touching, aging, and death, as well as about taboos in the care work and about societal expectations to the care workers. All these issues are relevant material for learning pro-cesses in the fi eld.
‘Occupational identity’ is yet another example of a theme, which appeared in my research as a good point of departure for learning through experiences from one’s own work. The term occupational identity expresses my categorisation of a number of different statements and discussions which oc-curred among the observers in my research, when they were asked to talk about anything that came to mind, while they watched my fi lms about care work. As it happened, one of the groups had a long discussion prompted by a take in the fi lm, where a nurse refers to a social- and health care helper as a home help person. In this discussion the women voiced the concern that it is annoying, even hurtful, to be called a home help person, when one is trained as a social- and health care helper or assistant. Furthermore they found it even more hurt-ful when nurses, who are acquainted with care training, do not use the right terms. The following excerpt from the dis-cussion shows some of the issues at stake:
HD: ‘That [home help] is an old concept, you know.’
SI: ‘It is an old concept and that is why we have to move on.’
KG: ‘In fact it would almost be the equivalent of her using the term
‘domestic help’, I think. That would be just as offensive to me.’
HD: ‘Actually, they are home help staff who worked as domestic help.’
KG: ‘Yes, precisely.’
HD: ‘They helped the clients clean, especially if the housewife was not capable of doing so herself, and washed their clothes; that is what it was like then. Today we also do the nursing.’
KG: ‘Yes, precisely.’
HD: ‘And a home help person does not do that, because a home help person is not trained to do so.’
Formally speaking, the term ‘home help person’ as a reference to an occupation became obsolete in 1992, when an educa-tional reform merged fi ve Danish care and nursing training courses into two new educational branches of which one was an education as social- and healthcare helper (a 14 months training programme) and the other was as social- and health care assistant (20 months further training). In my view the word ‘home helper’ is strictly speaking a nice term compared to the system-oriented terms ‘social- and healthcare helper’
and ‘social- and health care assistant’. However, this term is, like the women say, an outdated concept. It reminds them of the domestic help persons, who cleaned, and they wish to dis-tance themselves from this role. Social- and health care help-ers and -assistants embrace the (basic) nursing aspect and this is an important element in their occupational identity. In the section above relating their discussion, I have only included a small extract of a debate, which touched on many subjects.
It clearly indicated that stories about the lives of housemaids, domestic helpers, and home help persons, etc. are both inter-esting and relevant as narratives about a certain practice. Due to the combination of historical distance and the topicality of the themes, the narratives are saturated with refl ections and invitations, which endow the battles won, the issues under threat, and the battles worth fi ghting with transparency and actuality.
Reading the excerpt above, it is evident that it is important to the women, that they, as opposed to the home help corps, embrace the nursing aspect. These women do not react to the fact that their broad interdisciplinary competences are ren-dered invisible when they are labelled home help staff, a term in which issues related to social functions and health disap-pear. What actually matters to them is the fact that they have embraced the nursing aspect, which has higher status than other tasks. This raises the question whether it is advisable that it is a nursing orientation, which should attract the new generation of employees, or whether it were advisable that other aspects related to the care work get a better image?
My research further indicates that occupational identity is related to the individual’s life and subjective ascription of meaning to his or her work. Above and beyond these issues there are questions related to traditions and structurally deter-mined defi nitions of which competences are allocated to vari-ous occupations, what tasks they are actually capable of per-forming, and which tasks they wish to perform. In a further perspective the theme also encompasses very basic cultural as-sumptions about gender, care, and the societally constituted view on the elderly, since the contents of the education for elderly care refl ect the views on the elderly peoples’ needs and wishes held by contemporary culture.
As a fi nal example of a theme, which developed during the discussions among the participants in my research, I shall mention the question of giving and receiving recognition.
The need for recognition and problems associated with this need surfaced in the context of various values, ideals, reasons, and feelings related to injustices such as those expressed in the following discussion, which I referred to above: ‘Nor do I think that the education is given recognition, you know…
and—how should I put it—given credit and exposure if it con-tinues to be called ‘home help’.’
When questions of recognition arise in the care workers’
refl ections on their daily experiences, there is fertile ground for learning processes that create insight into the motives be-hind actions such as doing something—consciously or uncon-sciously—with the ulterior motive of achieving recognition and status. At the same time the question of recognition in-vites a critical stance with regard to the possibilities of achiev-ing recognition from colleagues and management. This would be a precondition for avoiding a situation, where the indi-vidual care worker experiences a dependence on the recogni-tion dispensed by the care recipient, thereby unconsciously creating a state of dependence. Insight into motives devel-ops this type of competence which Honneth (2003a; 2003b) calls ‘sense of moral context’. This refers to an understanding of the fact that your own, as well as other people’s actions
are not transparent and completely controllable and cannot be interpreted from the point of view of universal principles.
Instead they should be understood in the context of the indi-vidual’s relations in the past, the present, and the future. This process expands the horizon, describing what and whom one can recognise, tolerate, and respect.
When care workers discuss for example problems of recog-nition of their professional competences and personal quali-fi cations (a subject often touched upon by the participants in my research), it is an obvious pedagogical task to get them to associate their discussion with an investigation of how needs for recognition, and problems related to achieving recogni-tion, are related to personal issues, professional traditions, re-lations to colleagues, the conditions of the care work, and so-cietal relations in general.