In order to further emphasise the special demands of care work and the particular needs and learning potentials associ-ated with the occupation, I shall proceed with a discussion of the diametrically opposed logics, which become part of the orientation of the care personnel. By extension I shall intro-duce the concept of ‘exemplary learning’ and present some reasons that justify its application in care training and learn-ing in professional life.
As a result of my analyses and interpretations of care work-ers’ comments on my fi lms about care for the elderly, I have come to the conclusion that some of the complexity and the
confl icts in care work can be explained by the fact that the practical care of the elderly is constituted in a fi eld of tension between three reciprocal systems of logic. One is an ideologi-cal logic, where the care for the elderly is normatively con-stituted as an ethical, humanistic, and pedagogical project.
This logic, which can be found in political slogans and in the educational programmes, expresses wishes and expectations that the care workers refl ectively apply themselves, offering nurture and care, including social and pedagogical actions.
The other logic is a rational, service minded logic, which de-mands an effi cient solution to a societal problem, presented in such a way that the recipients are perceived as consumers, and where the relation between system and consumer is con-tractual. And while the ideological logic upgrades care as paid work, the rational, service oriented logic downgrades care as paid work, which of course infl uences the possibilities of re-cruitment of workers who wish to remain in the occupation.
The third logic I have chosen to call subjective ascription of meaning. The term is indicative of a subjective logic, which against all odds and in spite of the ideological as well as the rational logic shapes the care workers’ actions. This logic is determined by the individual’s gender and personal history, and it is of course moreover formed by the two other systems of logic, while also going beyond those. With the term subjec-tive ascription of meaning I mean partly that the individual caregiver subjectively interprets any situation, relation, and experience, and partly that any caregiver uses her so-called practical common sense and her feelings in every concrete sit-uation. In so doing she sees a deeper sense in the work, which primarily consists in contributing to the other person’s life with something good and by virtue of this action knowing in her heart that it is an effort which is useful to society. When she subsequently explains her actions, she constructs—with the help of the two other systems of logic—some practical, professional rationales, which completely justify her actions.
In more psychodynamic terms one could describe the subjec-tive ascription of meaning as a construction created during
processes of transference, since every subject through her in-ternal world colours her picture of the exin-ternal world and through internalisation or introjection of the external world constructs her own internal world. The transference, which can be said to be the main source of the subjective ascription of meaning, is present as an element for everyone and in all relations throughout one’s entire life. This does not, however, reduce the world to a subjective construction. The objective reality is there, but the subject’s experience of the meaning of reality originates within (Chodorow 1999).
Concerning the subjective ascription of meaning in a learn-ing perspective, one could say that it expresses the condition that every subject on the basis of a personal perspective of signifi cation, which constructs emotional patterns and sty-listic preferences (basic assumptions), interprets objects and the meaning of events. The personal perspective of mean-ing is founded durmean-ing childhood socialisation and changes (through processes of learning) continually throughout life in interactions with the societal conditions (Mezirow 1990).
In an overall perspective the three systems of logic can sub-stantiate and legitimate the system at large in such a way that its immediate representation is relatively logical and harmonious.
It is, however, hard work for the care workers to get the various demands posed by these systems of logic to add up. As a result care workers’ as well as care recipients’ basic human needs are occasionally violated. For this reason care workers must be en-couraged to understand the contexts shared between political, personal, psychodynamic, and existential aspects of care work.
They should develop what I shall later refer to as a sociologi-cal mode of thinking, and they should be supported in their efforts to address the modern paid care occupation—precisely as a paid work challenged by diametrically opposed logical sys-tems and demands—but also as a prospect of self-development, and as a widely respected opportunity to unfold the need to have a meaningful relationship with other people.
These ideas are rooted in Oskar Negt’s paradigm of ‘exem-plary learning’. Negt takes his point of departure in
Wagen-schein’s concept of the exemplary principle, where students learn about holistic concepts through a good understand-ing of individual aspects (parts) of the subject. However, in Negt’s paradigm, the holistic concept is ‘the totality of a so-ciety’s production and reproduction process that is organised through the sharing of work and seen in its historical dimen-sion; the ‘parts’ is the sociological fact, which is relevant to the life of society, the classes, and the individual human be-ings’ (Negt 1981:44). Accordingly the whole is not in Negt’s paradigm (as it was in the original exemplary principle) a sub-ject or an issue. On the contrary, the holistic concept is the totality of the societal production and reproduction process-es, which should be seen in their historical dimensions. This part is the empirical, social fact relevant to the learners. This relevance is not limited to the learners as individuals. It also concerns the occupational groups of care workers as wider col-lectivities and the society in general.
Learning should hence take its point of departure in so-cially experienced facts (the parts), which concern the learn-ers as subjects embedded in societal relations (the whole). A precondition for the learners’ self-understanding as individ-uals shaped by and shaping society and history is that they acquire a sociological mode of thinking (Negt 1981). This consists in transgressing the usual scientifi c (professional) di-visions, thereby becoming aware of structural connections, and changing a non-political conception of social relations to a political understanding. Through this sociological mode of thought, learning which otherwise might seem chaotic, can become motivating and build potential for change.
Negt emphasises that one should not confuse or equate ex-emplary learning with case methods in the teaching. He does, however, suggest that in exemplary learning one should work with cases from occupational life. Cases can originate from and describe people’s objective situation in their workplace whether it be e.g. about accidents at work or court cases relat-ing to work: ‘Above and beyond the function as ‘approach’, the case studies offer the possibility (…) of establishing a
disciplinary interpretation of certain case conditions through collective learning processes, in which all learners partici-pate. This may later make it easier to control what has been learned.’ (1981:46).
In the quote above Negt does not explain what he means by controlling what has been learned, so I shall choose to consider this as a possibility—when talking about ‘real’ cases from everyday life—to establish what actually happened or may happen in the case at hand. Alternatively I shall see it as a possibility to maintain that there should be a connection and a social reality in the case (that insights and suggestions do not dissociate themselves from concrete reality in discon-nected or idealistic ways).
Building on Negt’s above-discussed ideas on exemplary learning, I introduce the notion ‘lifelong exemplary learning’
to conceptualise the prospects for educational processes in care work. By modifying Negt’s concept I wish to emphasise the lifelong aspect. Negt talks about exemplary cases. I pre-fer the expression ‘an exemplary theme’, because this con-cept suggests more fl exibility with regard to the content. The issue is not necessarily that someone formulates a case, but that something is described in a thematic way. (For a detailed discussion of the theoretical approach and its foundation, see Hansen 2006.) Inspired by Negt, I have formulated criteria, which defi ne an exemplary theme as a theme that:
• Originates from the learning subjects (for example from givers and recipients of care)
• Has subjective meaning to the learning subjects
• Is supported by psychic energy
• Goes beyond the individual and the subjective to the collective and societal level
• Is suitable for refl ections, which create a critical consciousness and emancipation
The understandings of care and of the care work’s ideals, pos-sibilities, and problems, which I have found in my research, show that there is a need for learning processes, which can
help care personnel deal with emotions in new ways, and un-derstand themselves and the work in a larger societal context.
The problems show that the learning processes must engage with quotidian life and its subjective meanings. However, to prevent the process from becoming therapeutic, and in order not to reinforce the present tendency to cumbersome indi-viduality, subjectivity, and intimacy (Ziehe 1989, 2003) it is essential that the learning goes beyond the individual and his or her subjective emotions and experiences.
Conclusion
There are many explanations to the crises in the care work sector in the Nordic countries: the multiple stress loads and the opposed demands of care work, the relatively low status it is ascribed in society, and its bad reputation due to press reports on quality issues in elderly care all bear some of the blame. The situation calls for change. This chapter has raised the argument that a tenable strategy in recruiting and keeping care workers within elderly care must encompass perspectives for the organisation of the care work. The care organisation should offer the care workers more adequate support with re-gard to coping with the various demands and stress loads, in-cluding the buffer role, in which they invariably fi nd them-selves. In short, the care work must have intrinsic relevant and desirable possibilities for lifelong learning and personal development. This is necessary in order to help the present care workers to deal with the work, and to provide care work with an appealing image that will attract young people of today. As a rule this age group only applies for and remains in a job if it is experienced as meaningful, widely respected, and providing opportunities for personal development.
Care work is complex and fraught with stress loads, and care personnel must perform a balancing act between diamet-rically opposed roles and systems of logic. I have shown in this chapter, however, that care work offers quite signifi cant, yet unexplored, potentials for learning. I have indicated that
a strategy for recruiting and maintaining employees in elder-care should focus on the potentials of the elder-care work in order to support the lifelong learning and development of the care personnel. Furthermore such a strategy should recognise and honour the care personnel’s desire to have meaningful rela-tions with others. The learning in the care educational sys-tem and occupation should assist the care personnel in deal-ing with the work as modern wage labour, as well as honour modern people’s expectation to occupational life.
I have pointed out that such learning should unfold as ex-emplary learning processes, characterised by an application of the learners’ own themes, i.e. applying their own experiences as points of departure, introducing something that has subjec-tive signifi cance to them, and which is supported by psychic energy. In addition there is the demand that learning based on experience must go beyond the individual with a view to understanding his or her own situation in a societal context.
Since the learning should take its point of departure in the participant’s concrete quotidian, I have not been able to out-line the contents of a plan or a curriculum for such learn-ing. I have, however, suggested that one fi nds material for the themes of learning by increasing the awareness of direct and indirect statements about everyday life made by students or trained care workers.
It goes for all exemplary learning processes that these in one way or other must embrace the interaction between the subjective, the individual (cognitive and emotional), and the structural. Either way exemplary themes in care training and in care practice will always be concerned with the question of psychosocial forces, which motivate as well as create problems in the relations between caregiver and care recipient. In this way there will be a focus on the learners’ own investigations of situations where care actions express reciprocity, solidarity and recognition, what constitutes a relation, and what posi-tive and/or negaposi-tive issues motivate the individual and the group of care workers to participate in relations with aging and ill people.
The care work sector of the future should position itself clearly when it comes to offering inherent opportunities for learning, so the individual and groups of care workers can ex-perience personal and professional development and thereby participate actively in the development of the fi eld. In other words, it is about engaging the care personnel actively and al-lowing it to infl uence the development of a practice that they feel like being part of.
Note
1 The care involved in the relation between the carer and the recipient of care for the elderly will in some way always involve pedagogical tasks and deal with learning and development. Whether or not the care situa-tion is regarded as a charitable relasitua-tionship, as part of medical treatment and nurture, or as a contractual service obligation, a caregiver must be able to mediate, motivate, and involve as well as support the care recipient in the building and maintenance of a number of important competences. In this view pedagogy are perceived as a tool to enable another human being to perform or understand a certain issue. This view of the role of pedagogy offers a fruitful agenda for both research and development of care work, but in this chapter I do not focus on these pedagogical aspects of care work, as I wish to address the potential of the pedagogical perspective for enhancing quality care.
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A Crisis of Recognition in Care Work for Elderly People?
Looking at Professional, Bodily and Gendered Hierarchies for Explanations
Anne Liveng
Paid care work for elderly people can be analysed as inscribed in three hierarchies: A professional hierarchy, a bodily or ‘dirt’
hierarchy, and a gendered hierarchy. In all three hierarchies care work is ranked low. According to Kari Wærness’ (1982) seminal work, Nordic literature on care has discussed the spe-cifi c logic of care work as rationality of care. This kind of ori-entation towards the relations of care is an important motiva-tion for women who are being trained for the basic posimotiva-tions in the social and health sector. Care orientation, recognised by research as a central element in the motivation of the employ-ees in the fi eld, seems to be under great pressure, existing in spite of political and organisational intentions (Nabe-Nielsen 2005). This ‘concealment’ of the motivation and rationality of care can be considered a consequence of the low ranking of this kind of work (Christensen 2003). Thus the hierarchi-cal position has severe implications for care workers. Most im-portantly, the knowledge of careworkers is seldom recognised.
The typical knowledge of care workers at the lowest levels of hierarchies is a product of their commitment to constructing care as a relation between specifi c people rather than as a per-formance of a set of impersonal tasks. However, neither those interested in professionalising care work, nor those concerned with care organisations generally acknowledge their specifi c form of knowledge as a resource for developing care.
The situation described above could be identifi ed as a ‘cri-sis of recognition’. With reference to a comparison of long-term developments in the advantages and burdens of specifi c jobs in the public sector, Hanne Marlene Dahl (2002) argues that while a higher degree of economic recognition of care work for the elderly has emerged, the rationality of care is still not properly recognised. A need for controlling the work care workers carry out in their daily care of the elderly is expressed as a part of the very way basic care work is organised. The re-cent initiative ‘Common Language’ (Fælles sprog) is an exam-ple of this. The Common Language initiative was launched in 1998 by Kommunernes Landsforening, which is the pub-lic employers’ association in Denmark. Common Language
aims at standardising ratings of the level of functioning of the individual citizen, standardising services offered by the municipality, and standardising estimation of municipal key fi gures. One of the consequences has been uniform time mea-sures for the tasks carried out by social and health care help-ers working in the home-based care for the elderly. As the ini-tiative restricts the possibilities of the care worker to estimate which tasks are most important to carry out and for how long,
aims at standardising ratings of the level of functioning of the individual citizen, standardising services offered by the municipality, and standardising estimation of municipal key fi gures. One of the consequences has been uniform time mea-sures for the tasks carried out by social and health care help-ers working in the home-based care for the elderly. As the ini-tiative restricts the possibilities of the care worker to estimate which tasks are most important to carry out and for how long,