Gatekeeping and legitimization: how informal carers' relationship with health care workers is revealed in their everyday interactions

Aim(s) of the study. This study explores the relationship between informal carets of older people, and health care workers within the context of a hos pital ward. Through ail analysis of their language-based encounters the pur pose of the study was to identify the discursive processes involved in face -to-face informal carer-health care worker interactions, during the course of carers' visits to one elderly care rehabilitation hospital ward. Design. An ethnomethodological research design, which encompassed the conce rns of conversation analysis and the study Of institutional interaction, wa s used. The study involved videotape recording informal carers naturally oc curring spontaneous interactions with a range of health care workers oil th e ward. Data collection was carried out for between 1 and 3 hours, two to t hree times a week over a period of 3 months. The data comprised: 30 dyadic and group interactions involving 19 different caters and 25 different healt h care Workers, including nurses (qualified and unqualified), physiotherapi sts, occupational therapists, dieticians, ambulance personnel, housekeepers and nursing auxiliaries. Detailed transcriptions of the data were produced and analysis was undertaken using a modified conversation analysis approac h. Findings. Analysis revealed that a central aspect of the way the relationsh ip between informal carets and health care workers is framed is by the way information and access to information is obtained. This paper examines some of the aspects of informal carer-health care worker discourse, which denot e both parties as gatekeepers. In doing so it considers the roles that legi timatization of competence and knowledgeability have in facilitating inform al carets interactions with health care workers. Conclusions. We conclude that the accomplishment of legitimacy is largely a collaborative undertaking on behalf of health care workers and informal ca rets. The implications of these findings for carers, health care workers, p olicy and future research are discussed.