Ansvarshierarki i lægemiddelomsorgen på plejehjem

Abstract

Polypharmacy—taking several medicines at the same time—is a well-known phenomenon among elderly people which has mainly been studied quantitatively to define how many medicines are too many. This article moves beyond the numerical definitions of polypharmacy to explore the everyday practices of medicine management. Through ethnographic fieldwork at tow Danish nursing home, we seek to understand how medicines actively shape the daily lives of nursing home residents and the care provided by their caregivers. Inspired by Science and Technology Studies, we analyze how medicines actively shape care practices and relationships between the caregivers and the residents, and how the residents experience taking several medicines at the same time. The ideal of ‘rational pharmacotherapy’ prescribes that the right patient receives the right medicines, yet our empirical vignettes show that caregivers’ strivings towards this ideal limit the possibilities of involving the residents in their own treatment. We argue that the focus on correct and safe medicines handling creates hierarchies of responsibility among the care staff in such a way that the professional groups closest to the residents have the greatest responsibility, but no authority to act independently or make any decisions about the residents’ medicine intake. We argue that the hierarchies of responsibility fragment the care work and marginalize the residents’ experience of their medicine intake. With the concept of ‘medicine empathy’, we present and discuss an approach to medicine management which does not take the experiences of caregivers or residents for granted. Instead, medicine empathy demands recognition across hierarchies of responsibility and considers the involvement of the medicine user as a valuable task in itself, requiring prioritization of time, resources and attention.