The sociological literature on pharmacy is sparse, relative to that on physicians and nurses, especially in light of recent changes in the nature of health care and pharmacy's expanded 'clinical' role. Moreover, some of this literature presents contradictory perceptions of the clinical pharmacy role; some are perceiving it as encroaching on physicians' role boundaries, while others perceive its few new tasks to be delegated. This article is based on extended participant observation of clinical pharmacists in two northeastern teaching hospitals in the U.S. Data are presented on the clinical tasks the pharmacists performed, the potential boundary conflicts they posed for other members of the medical team, the resolutions of these conflicts, and the role boundaries perceived by relevant participants. From this analysis it is argued that the literature on pharmacy's boundary encroachment is not so much contradictory as incomplete. Implications for pharmacy and the analysis of role boundaries is discussed in conclusion.
The hospice philosophy of care for the terminally ill emphasizes patients' control over their remaining time. This article is based on approximately three years of participant observation research in several hospice settings where the practice of providing patients control, or autonomy, during their remaining life and dying was explored. The findings suggest that, despite the best efforts of hospice staff, attempts to fulfill the goals of this philosophy were constrained by several factors: efforts at symptom control, patient residence, patient disease state, and staff limit setting. Examples, implications, and the staff's attempts at solution are discussed.
Negotiated order theory was initiated about twenty‐five years ago within the interactionist perspective as an alternative to the dominant perspective of organizational behavior as structurally determined. Since that time, the theoretical framework has proven itself to be a viable means of understanding individual relationships within their larger contexts, for understanding the relationship between process and structure. This theoretical perspective is particularly appropriate for analyzing the attempts of hospital pharmacists to negotiate an expanded, more “clinical” role for themselves on the medical team. This article presents data gathered through extensive participant observation of pharmacists in two hospital settings as it applies to negotiated order theory.
The hospice philosophy involves making terminal patients as comfortable as possible, empowering them with control of the time they have left, but neither hastening nor postponing death. The passage of Oregon's Death with Dignity Act in November of 1994, and the failure of the 1997 ballot measure to repeal it, made physician-assisted suicide another option for terminally ill people in that state, and focused increased attention on a conflict seemingly inherent in the hospice philosophy. We conducted interviews with 60 hospice providers, 43 in Oregon and, for comparison, 17 in the northeast, for their responses to this situation. The data reported here reflect some of the social and individual influences that come to bear as hospice providers attempt to resolve their dilemma.
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