HLTB03 Midterm Notes: Health, Illness, and Health Care in Canada
¾ This climate has generated extensive cost constraint measures within health care. Thus, in the 1990s hospital units
and entire hospitals were close, community services shuffled, and health care staff moved around or dismissed at
unprecedented rates. Only recently has Canadian research begun to evaluate the impact of these changes.
¾ Canadian data also portray increasing nursing workloads, with reduction in the quality of care and problems with
trust, commitment, and morale.
workforce, increased workload, loss of clinical leadership, and shortages of skilled health care providers, morbidity
and mortality rises, and patient satisfaction is reduced.
¾ Nurse satisfaction is also reduced, and there are now serious problems with nurse illness, injury, and attrition.
¾ The impact of corporatized health care reform is not uniform across all citizens.
¾ As cost savings in health care reform are achieved primarily through lower wages, poorer care, and a shift of costs and
responsibility to patients and their families, women, racialized people, those with debilitating conditions, those who
are impoverished, and those who are homeless are most affected.
¾ Why had a corporate ideology, with its aforementioned problems, taken such hold in Canada? An ideology is a set of
¾ A corporate ideology has taken hold in Canada and is largely taken for granted.
¾ In health care, Canada has allowed its commitment to the common good to be replaced by corporatism. And, as
¾ What has been taken for granted must be made visible if nurses and other health care providers are to work beyond
constraints to their ability to provide good and ethical care (in other words, constraints to their moral agency), and if
the nation is to move toward the more equitable health care system that most Canadians desire and all deserve.
Corporatism at the Level of Patient Care
¾ Both the ideologies and the practices of the corporate culture of health care are played out at the level of direct
¾ The research cited earlier indicates that each cost constraint measure has a direct impact on nursing practice, creating
more work, more uncertainty, and less control over how nursing time is spent.
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resulted in an increase in patient acuity and turnover, which in turn directly affect nursing workload.
¾ Nurses find themselves caring for more acute patients and processing more patients more quickly.
¾ Further, with less contact between direct care providers and management, nurses generally have less impact on
decision making. Moving nurses to unfamiliar patient care areas and replacing registered nurses with practical nurses
and/or care aides dilutes levels of skill, placing heavier responsibilities on the remaining staff.
An Ideology of Scarcity
¾ Nurses participate in the corporate ideology and organize their work to maximize a certain kind of efficiency.
¾ One of the most profound ways that the ideas and images of corporatism are enacted at this level is through an
ideology of scarcity.
¾ Ideas and images of resources as scarce and unattainable abound in the day-to-day world of nursing practice. And
these ideas and images in turn drive practices that emphasize certain kinds of streamlining and efficiencies. So, for
example, nurses might put diapers on competent adults because they do not have time to assist them to the toilet,
justifying such practice as arising out of the necessity of scarce resources.
¾ Nurses identified their attention to the nonphysical needs of patients as the aspect of care that suffered the most,
both during the provision of routine care and when patients experienced significant emotional crises.
¾ Nurses talked about the ways they routinely curtailed their conversations and attention to the emotional needs of
patients and as researchers we observed nurses letting patients know that they were busy so that patients did not
expect to engage in conversation.