Using Literary Ethnography as a Form of Qualitative Document Synthesis to Explore the Maltreatment of Vulnerable Populations: An Examination of Verbal Neglect and Abuse in Nursing Homes

Introduction A vulnerable population is a group of people a researcher wants to study that has limited resources and is at risk for encountering a lowered level of health status (Flaskerud & Window, 1998). Accessing and examining the social worlds of certain vulnerable populations such as nursing home residents can be highly problematic. This is especially true when they are located in institutional settings with agents of control skeptical of researchers from the outside coming in and observing behavior. When gatekeepers block access and a researcher wants to examine a delicate topic, one ethical, highly feasible way to paint an interpretive picture of everyday life for vulnerable populations involves the use of a literary ethnography. Family members care for a majority of older Americans. However, the United States does have nearly 1.5 million of its population aged 65 and over in nursing homes. Oftentimes, residents in these facilities have a temporary term of stay. Nearly 33% of elderly men and 50% of older women spend at least some time in a nursing home before they die. This type of resident is typically there to recover from a temporary health problem. Others, such as those with serious physical or mental debilitations, stay for longer periods. Many of these residents are 85 years of age or older (Statistical Abstract of the United States, 2007). U.S. nursing homes are notoriously associated with stories of neglect and abuse (see DeFrancis, 2002; Pear, 2002, p. 11). Using results from a study of nursing homes, this paper uses structural ritualization theory to look at verbal neglect and abuse in longterm care facilities with literary ethnography techniques. This paper focuses on two main research questions. What types of verbal neglect and abuse exist in nursing homes? What are some of the causes of verbal abuse and neglect in nursing homes? Though these questions guide this work, one of the paper's main goals is to help readers understand how they can use a literary ethnography to study vulnerable populations and controversial topics like nursing home abuse and neglect. Theoretical Underpinnings This research uses a sociological perspective known as structural ritualization theory (SRT). SRT views ritualized symbolic practices (RSPs) as an essential aspect of social interaction. RSPs are stable actions that shape people's thought patterns and structure social environments. Therefore, RSPs involve repetitive actions that take on and express symbolic meaning (Knottnerus, 1997). Four factors involving RSPs play a part in facilitating social structure repetitiveness, salience, homologousness, and resources. Repetitiveness involves the number of times people perform RSPs in a specific milieu. Salience involves whether or not actors in a designated environment view a RSP as highly important. Homologousness relates to the similarity between actions and symbolic meaning. It is possible that different RSPs in a social setting are similar in meaning and reinforce each other. For example, a college professor might lock the door when class starts every day so late students cannot enter the room. The same professor might ramble at the end of every lecture in order to keep students in class until their official time of release. These two rituals are different forms of behavior, but symbolically similar because they reinforce the professor's authority over students. Resources include any material or nonmaterial means actors need to participate in RSPs (e.g., money or knowledge). With the theory, rank is also a prominent concept. An identified RSP ranks above others when, based on the previously mentioned factors, it is repeated often, is visible, is similar to other RSPs, and people have the necessary resources to engage in it. The higher the rank of the RSP, the more likely it will shape people's cognitive frameworks and set the tone for behavior in a specific context (Knottnerus, 1997). …