研究報告1 “Emotional Labour and Art of Caring; What’s the Evidence?”
Pam Smith（University of Surrey）
(* In bellow, numbers in parentheses indicate the numbers of the slides that Dr. Smith was referring to in her talk. The actual images of these slides are collected in the end of this paper.)
Oh, this is the recorder. Thank you, thank you. This slide (#1), I think you all have there is really just to show us what areas we will cover this afternoon looking at definitions of emotional labor, but also the evidence that we need to collect to understand the emotions. Also I will talk about some of the research trends that have looked at the different type so of emotional labor in different types of work contexts and organizations, and then the impact that this will have on practice and education.
This (#2) just summarizes. We are looking at emotions and feelings, emotional labor and the concept of emotional intelligence and maybe how those two concepts relate. This (#3) is about the evidence; the three E's which we will return to in a few slides, where we are looking at evidence which looks at effectiveness, efficiency and equality. And it is within the equality of evidence we can find emotions.
This quote (#5) I think you will find very interesting, it was work that was being done at the early time that Arlie Hochschild, a sociologist, was doing the groundbreaking work of emotional labor.
Hilary Graham, also a sociologist in England, was looking at the work particularly that women did in the homes and in the professional jobs as careers. This quotation (#4) from Hilary Graham is very interesting because she transmits to us that when we talk about care we are talking about both our emotions and our feelings.
And in the next slide (#6), this is moving forward with the work of Arlie Hochschild, who worked with flight attendants and debt collectors, where she was showing that in commercial settings the work, the emotional work, would be paid for. And in order to produce a product, then the worker had to induce or suppress their feelings in order to sustain an outward appearance, so that might be smiling or appearing happy, or cheerful, or as the debt collectors, angry, or threatening that produced in others a feeling. In the case of the flight attendants, it was to make someone feel cared for in a convivial, safe place. And the convivial, safe place, and the care, was for me very important to try and understand the work of nursing.
This next slide (#7) just explains more about the mechanism of emotional labor within the workplace and the importance of the organization to induce the emotional labor. And the next slide (#8) shows how the worker does this. Within the organization there are certain feeling rules that must be adhered to. And very important to these may be deep or surface acting. There may be variations in different contexts as to how this is recognized. It was interesting to see that when we look at cancer nursing, there may be two types of emotional labor required. For those patients who are needed to be treated then it has to be very acute type of care. For those patients who are not going to be recovering it has to be palliative and caring, to help people to meet their death.
So how do we look for evidence? We have already heard about the work of Cochran, who is looking at effectiveness and efficiency and equality in this example of someone who needs the acute care and the other person who needs the care to meet their death (#8). These two may be very different types of emotional labor, but both of them need there to be humanity in the approach, and the importance of kindliness and the ability to communicate must underpin the technical care.
So, uh, the next slide (#9) develops this idea further, but particularly with nursing and the importance of developing the therapeutic relationship with the patient, which is a way to seek that evidence is through looking at emotional labor of that relationship.
But it is not enough for the individual to do it on their own. This is why we have to look at how emotions and organizations operate (#10). And through looking at the way emotions operate within organizations, we need to be able to describe the quality of care; we need to be able to see who are the leaders, who can support and promote the morale; and from that we can see the good effects that will have on everybody in the organization, the staff, the students and the patients.
This slide (#11) is really just to summarize the components of emotions within organizations and the importance of leadership in very complex activities. This slide (#12) just summarizes some very important work that has been repeated, but it just shows how important morale is within organizations, and what high morale will do to improve quality and staff and patient outcomes. So this is just one example of very important early research that showed the importance of morale, for which I think we can understand the emotional labor within the organization that produces quality care and quality environment for staff working.
Now we will look at the next slide (#13). I just wanted to show you this. I am very interested in my emotional labor work to look at what images convey about the emotional work that is going on by different occupational groups, different organizations. This is how nursing looked in the UK, in the United Kingdom, in 1970. Uniforms, very formal, the head nurse was able to give the orders to the student nurses, they would then know what to do.
This (#14) is a very different image: we cannot see here who is the leader. Maybe all the nurses are the leaders. We can see there is communication with the patients, between the nurses and the family of the patients. There are no hats, so maybe this indicates there is a different type of emotional labor that is being manifest in this image.
This (#15) is really just to give you an example, in our National Health Service (1), which may be the second or third largest employer in the world. There are national surveys since 2003 each year until now. It is found that the staff ——— and these are the staff that you found in that image—are very proud to work at the NHS. They work hard and they're happy, but they are also stressed, abused and they feel bullied, which is what professor Helen Cowie sensei will talk to you about in a few minutes.
This (#16) is a quote from my research in 1992. It shows the caring ward and maybe we are seeing in this quote and in the next quote something of the NHS paradox. So it is this idea that the emotional labor of the leader cares for the students so they are able to care. So the next slide (#17) shows the paradox, the opposite. So this is in the environment where the leader may make the student fear, the nurse fear, and so the nurse says this is not a good way to learn. So this may be the negative emotional labor that makes it difficult to care if you fear. This slide (#18) just confirms the findings, more recently, that good morale among staff is very important for patients, and team-working is very important for the good working relationships.
This slide (#19), which is nearly at the end of the presentation, just confirms how important the role of emotions is in nurse's work, and the promotion of a safe culture, of which again, Professor Helen Cowie sensei's work demonstrates. And we recently participated in a study of overseas nurses, which showed that they had to undertake emotional labor in order to operate, in sometimes, a very hostile environment.
And then, finally, two slides to summarize. Just really to show us that in the NHS 2008, although there are these paradoxes within the NHS, now there is top priority on promoting good communication (#20). And final slide (#21): there will now be research that looks for indicators to show compassionate care, effectiveness of care, and a safe culture in which to work. In summary, maybe we can use the concept of emotional labor to measure compassionate care, effective care, and a safe culture in which to care.
Pam Smith, July 2008
（1） The National Health Service is the publicly funded health care system in the UK. In the present context, it refers to the hospitals and other medical institutions supported and run by the system.
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