The relationship between semi‐professions in acute and long‐term care of elderly patients

Summary As part of a larger study into the assessment of patients' needs in care of the elderly wards, data were collected from observation and interviews with nurses and doctors, which demonstrated differences in the functioning of the multidisciplinary care team in acute and long‐term care wards. The nurses acted as gatekeepers to other non‐medical members of the team, using a variety of strategies to exclude them from, or include them in patient care. Interview data also revealed a difference in nurses' perceptions of these members in the different care settings. The gatekeeping function of the nurses was not, however, an exercise of power and autonomy, it was rather a demonstration of their allegiance to medical models of care. The medical model, as it was interpreted by the nurses, dictated the perceived relevance of the other professions to patient care, in terms of whether they could contribute to the cure and discharge of patients. The high value placed on cure in both settings was reinforced by consultants' behaviour and attitudes, and, whereas it could be argued that this enhanced the work of the multidisciplinary team in acute care, the impact in long‐term care settings was problematic, leading to conflicts between nurses and physiotherapists. This paper calls for a closer examination of how semi‐professional groups in health care work together, as a strategy for developing alternatives to the medical model.