The Nursing Home Community: A Critical Ethnography A nursing home is a community of care ideally designed to provide seniors with a safe and supportive environment in which to receive around-the-clock evidence-based healthcare and ancillary services. Nursing homes are also complex environments, with the residents comprising one distinct social cohort and staff another, with evident hierarchies and roles within the organization. An ethnographic approach to the nursing home community lends insight into the relationships between various parties and stakeholders in the community. Furthermore, the ethnographic methods permit unique qualitative, phenomenological insights into the lived experiences of both staff and residents. Through the window of ethnographic research, it may be possible to recommend changes to nursing home care delivery and improve client perceptions, experiences, and outcomes. Critical analysis of nursing home ethnographic research reveals several primary insights into the structure and culture of the community. Although diverse, the nursing home community demonstrates the importance of ritual and routine in promoting social cohesion and conformity.

Throughout this semester I have applied the tools and principles of ethnographic research to the nursing home community setting as both observer and participant-observer. I used ethnographic methods like in-depth interviews and systematic observations to gather data and interpret findings in light of recent empirical research. The literature reveals the importance of ethnographic methods in nursing home care contexts, especially as unearthing qualitative data helps researchers, policymakers, healthcare administrators, and all other stakeholders “assess such intangibles as quality of life in a nursing home,” (Henderson and Vesperi 2). As a result of the growing integration of ethnography into nursing home research, the concept of “nursing home ethnography as a distinct genre” has ensued, bolstering the efficacy of multidisciplinary empirical research (Henderson and Vesperi 2). At this stage it also becomes important to differentiate between nursing homes in particular and other senior living facilities including assisted living, hospice, and independent living communities (Diamond 1288). Interviews with staff members and administrators revealed the great diversity even within each of these categories, with different nursing homes aspiring to different missions and visions and offering clients various areas of specialization in their locus of care.

While technically an outsider to the nursing...

This experience lent insight into the organizational structure and culture of the nursing home, while also revealing the dynamics that develop between staff and clients/residents and between staff members serving different roles or possessing different statuses in the organization. As expected, the nursing home does demonstrate hierarchy in its organizational structure and yet roles are filled according to the individual’s background and training. Among residents of the nursing home, hierarchies are less formally arranged with variables like length of time spent in the facility, mental and physical health status, engagement with other residents, and age important social determinants of social status. While staff and residents do occupy distinct subcultures within the nursing home community, these two groups inevitably converge in some areas such as through shared symbols and the overarching rules within the organization.
Nursing home life is characterized in part by routine, with both staff and residents subject to the predictability and rigidity of a regimented lifestyle. Staff works around the clock, with night staff a critical component of providing effective and safe nursing home care. Mornings begin with the influx of day shift staff starting at 5:30, with additional staff members arriving successively in staggered shifts. Shifts depend on the role and position of the staff member, with kitchen and cleaning staff arriving the earliest, nursing staff next, and specialized support staff such as physicians and therapists arriving much later. At 6:30, residents begin to wake up on their own, and nursing staff begin a formal walk-through of the nursing home to knock on doors to wake up residents who wish to have breakfast in the main dining room versus in the privacy of their own room. Mealtimes are crucial nodes in the nursing home community temporal setting; residents socialize with each other in the main dining hall at precisely the same times each day, offering a ritualized setting for social interactions. Moreover, many residents cluster in the same social groups as if they were children in high school. The emergence of small groups among the resident population in the nursing home has no real parallel among staff members, who are more task-oriented.

Medications, medical testing, and interventions serve as critical symbols in the nursing home community. Residents have two options for receiving medications, which almost all members do take…