Care and Criminology Copyright Carol Dimon 2013
Criminology which involves the exploration of reasons for committing crime, would appear to be the antithesis to care. Yet the subject and research findings have immense relevance. This article will explore this relevance, highlighting the need for broad literature searches and consideration of work done within other fields.
Poor care has always occurred with the field of care (Robb 1967) within the UK and overseas . Whilst the nature of poor care may differ and reasons for it, it occurs within all areas to some degree; whether it is medication errors, failure to write in records, neglect or direct abuse. It may also be unintentional or intentional.
The delivery of poor care could be considered as a crime- that is, moral and legally unacceptable behaviour. In care, this could address many cases from failure to give a patient a drink to direct a abuse; as in criminology. It is acknowledged that what is considered to be poor care does vary between individuals considering such factors as culture (Dimon 2013). Could the consideration of criminology also extend beyond care staff themselves? Consider managers for example who may face conflicting demands between care and budget or wish to protect their role thus avoiding any aspect of controversy. Way beyond we have registration bodies, politicians and professional bodies who also may have vested interests and do influence the provision and quality of care (Dimon 2013 ).
Criminology could certainly apply to staff behaviour; criminological research has addressed gender differences which has implications for care, in which the majority of care staff and nurses are female. Females for example, are considered to undertake less crime but rely more on group (gang) membership (Steffensmeier, Allan 1996 in Dimon 2013 ). This means that males are more likely to lead in cases of crime and women more likely to follow the rest. Men also commit more serious crimes than women. However there have been cases in care of women care assistants and nurses, committing serious abuse (Marsden 2013). In some cases it is accepted that the individual was suffering from some form of psychiatric illness . There are also additional factors to consider such as social background and expectations.
One theory of relevance in particular is Sykes and Matza (1957) techniques of neutralisation. This link to behaviour has been recognised by Woods ( 1990 ) in education and Martin (1984) regarding care.They propose that “delinquent behaviour is learned—in the process of social interaction. “Techniques of neutralization” refer to justifications for behaviour. Of relevance is consideration of a sense of guilt. The authors also describe admiration and respect for “law-abiding persons”. The individual to whom misbehaviour is directed is also a factor; the author discuss an example of not stealing from friends. One would think this applied to care; not mistreating patients , relatives and other staff members. Yet the overriding work ethic and neoliberalstic political influence, demands that all individuals be contributors towards society. Hence the more vulnerable and dependent, may be regarded to a less degree. The authors suggest that demands of conformity made by such as family or society, does actually influence behaviour. However, they do note, that some individuals may be careful not to be identified. Hence in care, the actions of some staff members are undertaken in isolation from other people or behind closed doors. Or they will not admit when something has been wrong. Although there are factors to consider such as fear and guilty conscience.
Some individuals for example , conform more than others . Is this then to be regarded as a form of deviance which begets a label ? Becker (1973) does raise this point; an individual could be labelled as deviant if he or she is not performing an illegal act and so fails to fit in. Whilst the intentional delivery of poor care may be classed from a social perspective as deviant, within the work area it may not be deviant if it is common practice. Within care, this is applicable when lower standards may be accepted as the norm ( Prielippet al (2010) in Dimon 2013). Whilst Sykes and Matza do refer to children, the theory is of immense relevance. Within education more recently, there has been a huge amount of research concerning behaviour of students (Beaman et al 2007). Applying this to care, we may begin to identify why certain behaviour occurs. It may not always be due to a low staff levels but also upbringing and lack of knowledge.
Merton (1968) too discusses the adaptation of individuals within society. He identifies conformity, Innovation, Ritualism, Retreatism And Rebellion . Hence the influences of society do affect an individual; do they conform or do they retreat ? This too may be applied to a team of staff. Whilst the majority of people prefer to work as a group, hence conform, there are some individuals who prefer to remain independent and challenge the beliefs of the group. Such individuals may become isolated ( Hess 1972). An effective manager needs to be aware of such factors and the individual needs of staff.
Additional factors include self control; if individuals lack self control they may be more likely to react to situations of stress which is known to be high in care, anger or lack of tolerance to particularly vulnerable people. In order to care constantly, despite challenges, it may well be that staff require a great degree of self-control, in addition to support. Vazsonyi, Huang (2010) did study this with regards to deviance and children. It is stated that individuals who are low in self- control are “impulsive, insensitive, physical, risk-taking, short-sighted and nonverbal (Gottfredson Hirschi 1990 in Vazsonyi, Huang 2010). It is important however, not to generalise or make assumptions based on this.
Many may suggest that such behaviour is determined by one’s possession of a conscience or moral awareness; hence the guilt factor. To what degree is this innate or influenced by external factors? Dahlqvist et al (2007) applied a perception of conscience questionnaire to 444 nurses, nurses assistants and physicians in Sweden in order to explore the relevance of conscience to ethical dilemmas and the multiple factors involved such as culture and regulations. Fear of punishment is also a factor. Countries such as Iran are orientated around this with their use of executions for example. Applying this point to care, whilst cases of abuse may result in imprisonment (Chorley and Greenhill 2012) , some cases are unreported for several reasons . Also care assistants are not registered. When individuals are registered they are at risk of being removed from the professional register for cases of poor care.There are examples where positive deviance approaches, have been applied to promote high quality care . This approach involves recognising high performing hospitals for example,as measured by such as survival rates (Bradley et al 2009).
When interviewing staff or creating teams or the off duty, considerations of staff behaviour needs taking into account in addition to actual numbers and skills of staff. For example, having s strong leader who is caring and separating same gender staff as far as possible.
It may not always be possible to do this however, due to low levels of applicants or staff shortages when any staff member on shift is welcome. Yet it could be enabled by such as psychological testing at interview and a manager who knows the individual staff members. Such factors especially need consideration at night when there are lower staff numbers.
Accepting a criminological perspective towards poor care may promote acceptance and recognition of the existence of poor care. Many individuals and organisations, are afraid or ashamed, to acknowledge that it does exist and try to protect the image of the nurse or carer as a saint.
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