Advertisement

Transfer Practices During Acquired Brain Injury Rehabilitation: A Descent in the Medical Hierarchy

  • Karin HøjbjergEmail author
  • Ingrid Egerod
  • Ingrid Poulsen
Chapter

Abstract

This chapter explores the role of healthcare organizations and their professionals in producing and reproducing inequality in health. Ethnographic fieldwork and interviews were conducted with key professionals involved in transferring patients with acquired brain injury from acute to subacute, and from subacute to stable rehabilitation. Our analytical framework combines Bourdieu’s theory of practice with Abbott’s concepts of jurisdiction. The study revealed a descent in specialization level and financial resources during patient trajectories, as well as changing patterns of decision-making practices affecting transfer. Paradoxically, many resources are available to save patients’ lives during the acute stage, but resources dwindle as the patient approaches long-term rehabilitation, thus perpetuating inequality in healthcare.

References

  1. Abbott, A. (1988). The system of professions – An essay on the division of expert labor. Chicago: University of Chicago Press.CrossRefGoogle Scholar
  2. Abbott, A. (2005). Linked ecologies – States and universities as environments for professions. Sociological Theory, 23, 245–274.CrossRefGoogle Scholar
  3. Album, D., Johannessen, L. E., & Rasmussen, E. B. (2017). Stability and change in disease prestige: A comparative analysis of three surveys spanning a quarter of a century. Social Science & Medicine, 180, 45–51.CrossRefGoogle Scholar
  4. Andersen, K. K., Dalton, S. O., Steding-Jessen, M., & Olsen, T. S. (2014). Socioeconomic position and survival after a stroke in Denmark, 2003 to 2012: Nationwide hospital-based study. Stroke, 45(12), 3556–3560.  https://doi.org/10.1161/STROKEAHA.114.007046.CrossRefGoogle Scholar
  5. Anke, A., Andelic, N., Skandsen, T., Knoph, R., Ader, T., Manskow, U., et al. (2015). Functional recovery and life satisfaction in the first year after severe traumatic brain injury: A prospective multicenter study of a Norwegian national cohort. Journal of Head Trauma Rehabilitation, 30(4), E38–E49.  https://doi.org/10.1097/HTR.0000000000000080.CrossRefGoogle Scholar
  6. Bambra, C. (2012). Social inequalities in health: The Nordic welfare state in comparative context. In J. Kvist, J. Fritzell, B. Hvinden, & O. Kangas (Eds.), Changing social equality: The Nordic welfare model in the 21st century (pp. 143–164). Bristol: Policy Press.Google Scholar
  7. Bossen, C., Danholt, P., & Klausen, M. (2016). Diagnoser som styringshybrider Diagnoserelaterede grupper i sundhedsvæsenet. Tidsskrift for Forskning i Sygdom og Samfund, 13(25).  https://doi.org/10.7146/tfss.v13i25.24995.
  8. Bourdieu, P. (1990). The logic of practice. Stanford: Stanford University Press.Google Scholar
  9. Bourdieu, P. (1994). De tre former for teoretisk viden (M. Nørholm & K. A. Petersen, Trans.). In S. Callewaert, P. Bourdieu, M. Munk, M. Nørholm, & K. A. Petersen (Eds.), Pierre Bourdieu: Centrale tekster indenfor sociologi og kulturteori (pp. 72–108). Copenhagen: Akademisk. Original work published as: Bourdieu, P. (1973). The three forms of theoretical knowledge. Social Science Information, 12(1), 53–80.Google Scholar
  10. Bourdieu, P. (1997). Af praktiske grunde: omkring teorien om menneskelig handlen [Practical reason: On the theory of action]. Copenhagen: Hans Reitzels.Google Scholar
  11. Bourdieu, P. (2000a). Homo academicus (Reprint). Stanford: Stanford University Press.Google Scholar
  12. Bourdieu, P. (2000b). Pascalian meditations. Oxford: Polity Press.Google Scholar
  13. Bourdieu, P. (2002). Distinction – A social critique of the judgement of taste. London: Routledge.Google Scholar
  14. Bourdieu, P., & Passeron, J. C. (2000). Reproduction in education, society and culture (New ed.). London: Sage.Google Scholar
  15. Devaux, M., & de Looper, M. (2012). Income-related inequalities in health service utilisation in 19 OECD countries, 2008–2009 (OECD health working papers, No. 58). Paris: OECD Publishing.  https://doi.org/10.1787/5k95xd6stnxt-en.
  16. Eikemo, T. A., Bambra, C., Joyce, K., & Dahl, E. (2008). Welfare state regimes and income-related health inequalities: A comparison of 23 European countries. The European Journal of Public Health, 18(6), 593–559.CrossRefGoogle Scholar
  17. Engberg, A. W., Liebach, A., & Nordenbo, A. (2006). Centralized rehabilitation after severe traumatic brain injury – A population-based study. Acta Neurologica Scandinavica, 113(3), 178–184.CrossRefGoogle Scholar
  18. Guldager, R. (2018). Inequality in neurorehabilitation: Different practices among patients and relatives during rehabilitation after stroke and severe traumatic brain injury: A qualitative study. Doctoral dissertation, Aalborg Universitetsforlag.Google Scholar
  19. Hammersley, M., & Atkinson, P. (2007). Ethnography: Principles in practice. London: Routledge.CrossRefGoogle Scholar
  20. Husted, H., Jensen, C. M., Solgaard, S., & Kehlet, H. (2012). Reduced length of stay following hip and knee arthroplasty in Denmark 2000–2009: From research to implementation. Archives of Orthopaedic and Trauma Surgery, 132(1), 101–104.  https://doi.org/10.1007/s00402-011-1396-0.CrossRefGoogle Scholar
  21. Kamper-Jørgensen, F., & Rasmussen, J. G. (2008). Ulighed i behandling [Inequality in healthcare]. In F. Diderichsen, J. G. Rasmussen, & N. Döllner (Eds.), Den tunge ende: sandheden om ulighederne og uretfærdighederne i den danske sundhed: debatbog (pp. 27–45). Copenhagen: Dagens Medicin Bøger.Google Scholar
  22. Larsen, K., Cutchin, M. P., & Harsløf, I. (2013). Health capital: New health risks and personal investments in the body in the context of changing Nordic welfare states. In I. Harsløf & R. Ulmestig (Eds.), Changing social risks and social policy responses in the Nordic welfare states (pp. 165–188). London: Palgrave Macmillan.CrossRefGoogle Scholar
  23. Mackenbach, J. P., Stirbu, I., Roskam, A.-J. R., Schaap, M. M., Menvielle, G., Leinsalu, M., & Kunst, A. E. (2008). Socioeconomic inequalities in health in 22 European countries. New England Journal of Medicine, 358(23), 2468–2481.CrossRefGoogle Scholar
  24. National Board of Health. (2011). Hjerneskaderehabilitering – en medicinsk teknologivurdering [Brain injury rehabilitation – A medical technology assessment]. Copenhagen: National Board of Health.Google Scholar
  25. Reay, D. (1998). ‘Always knowing’ and ‘never being sure’: Familial and institutional habituses and higher education choice. Journal of Education Policy, 13(4), 519–529.CrossRefGoogle Scholar
  26. Walford, G. (2009). For ethnography. Ethnography and Education, 4(3), 271–282.CrossRefGoogle Scholar
  27. Willis, K., Collyer, F., Lewis, S., Gabe, J., Flaherty, I., & Calnan, M. (2016). Knowledge matters: Producing and using knowledge to navigate healthcare systems. Health Sociology Review, 25(2), 202–216.  https://doi.org/10.1080/14461242.2016.1170624.CrossRefGoogle Scholar
  28. World Medical Association. (2018). Declaration of Helsinki – Ethical principles for medical research involving human subjects. https://www.wma.net/policies-post/wma-declaration-of-helsinki-ethical-principles-for-medical-research-involving-human-subjects. Accessed 4 July 2018.

Copyright information

© The Author(s) 2019

Authors and Affiliations

  • Karin Højbjerg
    • 1
    Email author
  • Ingrid Egerod
    • 2
  • Ingrid Poulsen
    • 3
  1. 1.Department of Learning and PhilosophyAalborg University CopenhagenCopenhagenDenmark
  2. 2.Intensive Care Unit, RigshospitaletUniversity of CopenhagenCopenhagenDenmark
  3. 3.Department of Neurorehabilitation, RigshospitaletUniversity of CopenhagenCopenhagenDenmark

Personalised recommendations