Purpose

The purpose of this paper is to show that the categorization of elderly patients as vulnerable is affected by health-care service interactions with caregivers, which may increase, reduce or even negate entirely elderly patients’ vulnerable status.

Design/methodology/approach

The paper reports the results of a qualitative study based on in-depth interviews conducted with a large and varied sample of health-care personnel in charge of elderly patients in two hospital geriatric departments in France.

Findings

Findings show that the limits of the service-dominant logic approach when the service (care) relationship concerns vulnerable individuals who are, completely or partially, unable to take part in the co-creation of the service and the roles played by caregivers as resource integrators (intermediaries, facilitatorapomediaries and transformativeapomediaries) and that this affects the categorization of elderly patients as vulnerable.

Research limitations/implications

The results enrich knowledge about the service relationship with vulnerable people by showing that the categorization of elderly patients as vulnerable is not immutable but stems from the dynamics among actors that may variously “reify it” (contribute to its internalization), “reduce it” (enable access to aspects of normal life), or “neutralize it” (help free this cohort from their categorization as vulnerable).

Practical implications

The findings provide insights for care providers by stressing the need to raise awareness among hospital staff regarding their active role in affecting the categorization of elderly patients as vulnerable through their care practices. In the context of public health policies, the findings show that the regulatory injunction to empower patients to preserve their well-being tends to produce the opposite effect on the frailest patients, who are unable to participate in their care pathway.

Originality/value

The research shows that categorization as vulnerable, in the health-care services context, is affected by the care interactions between caregivers and elderly patients. The support provided to hospital staff in this context helps to maintain patients’ well-being and dignity.

中文翻译：

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护理人员的医疗保健实践对老年患者易受伤害分类的影响

目的

本文的目的是表明老年患者的弱势分类受到医疗服务与护理人员互动的影响，这可能会增加、减少甚至完全否定老年患者的弱势地位。

设计/方法/方法

本文报告了一项定性研究的结果，该研究基于对法国两家医院老年病科负责老年患者的大量不同样本的卫生保健人员进行的深入访谈。

发现

研究结果表明，当服务（照料）关系涉及完全或部分无法参与服务的共同创造的弱势个体以及照料者作为资源整合者所扮演的角色时，服务主导逻辑方法的局限性（中介、协助中介和变革中介），这会影响将老年患者归类为弱势群体。

研究限制/影响

结果丰富了关于与弱势群体的服务关系的知识，表明将老年患者归类为弱势群体并不是一成不变的，而是源于行为者之间的动态，这些行为者可能会以不同的方式“具体化”（促进其内化）、“减少它”（使他们能够接触到正常生活的方方面面），或“中和它”（帮助这群人摆脱他们被归类为易受伤害的类别）。

实际影响

研究结果强调需要提高医院工作人员对他们在通过护理实践影响老年患者分类为弱势群体方面的积极作用的认识，为护理提供者提供了见解。在公共卫生政策的背景下，研究结果表明，赋予患者权力以保护其健康的监管禁令往往会对最虚弱的患者产生相反的影响，他们无法参与他们的护理途径。

原创性/价值

研究表明，在医疗保健服务环境中，将其归类为弱势群体会受到护理人员与老年患者之间护理互动的影响。在这种情况下向医院工作人员提供的支持有助于维护患者的福祉和尊严。