Moral Economy and Moral Capital in the Community of Clinical Practice

Moral economy and moral capital: A new approach to understanding health systems

Healthcare systems can be considered moral economies in which moral capital in the form of expectations toward norms, values, and virtues are exchanged and traded. Moral capital, as a concept, is an extension of Bourdieu's forms of symbolic, and in particular, cultural capital. This research set out to identify forms of moral capital evident in the accounts of health professionals and patients within the distinctive healthcare systems of Germany, New Zealand, and the Unites States. Here, we provide an overview of 15 forms of moral capital that were identified. An important form of moral capital is equality. The global coronavirus pandemic has illuminated inequalities in healthcare systems across the world. We suggest considering moral capital as a useful tool to reform healthcare systems and make the provision of healthcare a more equitable enterprise.

Troublemaking in hospitals: performed violence against the healthcare professions in China

Yi Nao describes a type of violence displayed in Chinese hospitals which involves organised disturbances led by patients' relatives and/or Yi Nao gangs. Drawing on media reports of Yi Nao, we argue that the phenomenon of Yi Nao transforms hospitals into 'power arenas' in which a struggle over moral and political resources (capital) takes place between patients, Yi Nao gangs, doctors, government agencies, and hospital management. Two interrelated rules that are crucial to understanding the ad hoc local strategies of the actors involved in Yi Nao are examined: the 'publicity rule', and the 'rule of risk-avoidance'. We also argue that the political discourse of 'stability' has been internalised by the officials in the Chinese government and public hospitals in mediating social disputes. At the same time, Yi Nao actors use this discourse to creatively adapt to social resistance, as reflected in the disposition to use performative disturbance in pursuit of material or symbolic compensation.

Gratitude in Health Care: A Meta-narrative Review

Research into gratitude as a significant sociological and psychological phenomenon has proliferated in the past two decades. However, there is little consensus on how it should be conceptualized or investigated empirically. We present a meta-narrative review that focuses on gratitude in health care, with an emphasis on research exploring interpersonal experiences in the context of care provision. Six meta-narratives from literatures across the humanities, sciences, and medicine are identified, contextualized, and discussed: gratitude as social capital; gifts; care ethics; benefits of gratitude; gratitude and staff well-being; and gratitude as an indicator of quality of care. Meta-narrative review was a valuable framework for making sense of theoretical antecedents and findings in this developing area of research. We conclude that greater attention needs to be given to what constitutes "evidence" in gratitude research and call for qualitative studies to better understand and shape the role and implications of gratitude in health care.

"I Knew I Could Make a Difference": Motivations and Barriers to Engagement in Fighting the West African Ebola Outbreak Among U.S.-Based Health Professionals

The 2014 West African Ebola outbreak was unprecedented in scale and required significant international assistance. Many U.S.-based health professionals traveled to West Africa to participate in the response, whereas others considered participation, but ultimately decided against it. This study explores motivators, facilitators, and barriers to international health care worker mobilization. We conducted 24 semistructured in-depth interviews and one focus group discussion with clinical and nonclinical responders and nonresponders. Responders reported feeling duty-bound to help, confidence in their training, and prior experience in humanitarian response. Media coverage was perceived to create environments of stigma and misinformation. Supportive workplaces and clear leave of absence policies facilitated engagement, whereas unsupportive workplaces posed barriers. Although nonresponders were included in the study, the dynamics of nonresponse were less clear and warrant further exploration. Understanding how to support health professionals in responding to outbreak situations may improve mobilization in future public health crises.

The moral discourse of HIV providers within their organizational context: An ethnographic case study

OBJECTIVE

Providers make judgments to inform treatment planning, especially when adherence is crucial, as in HIV. We examined the extent these judgments may become intertwined with moral ones, extraneous to patient care, and how these in turn are situated within specific organizational contexts.

METHODS

Our ethnographic case study included interviews and observations. Data were analyzed for linguistic markers indexing how providers conceptualized patients and clinic organizational structures and processes.

RESULTS

We interviewed 30 providers, observed 43 clinical encounters, and recorded fieldnotes of 30 clinic observations, across 8 geographically-diverse HIV clinics. We found variation, and identified two distinct judgment paradigms: 1) Behavior as individual responsibility: patients were characterized as "good," "behaving," or "socio-paths," and "flakes." Clinical encounters focused on medication reconciliation; 2) Behaviors as socio-culturally embedded: patients were characterized as struggling with housing, work, or relationships. Encounters broadened to problem-solving within patients' life-contexts. In sites with individualized conceptualizations, providers worked independently with limited support services. Sites with socio-culturally embedded conceptualizations had multidisciplinary teams with resources to address patients' life challenges.

CONCLUSIONS AND PRACTICE IMPLICATIONS

When self-management is viewed as an individual's responsibility, nonadherence may be seen as a moral failing. Multidisciplinary teams may foster perceptions of patients' behaviors as socially embedded.