Meal procedures in institutions for elderly people: a theoretical interpretation.

In a study of mealtimes in institutions for elderly people the organization of meals was found to be task-oriented rather than patient-oriented in ways which failed to meet the needs of patients. The aim of the current paper is to examine and explain the institutional organization of meals, drawing on Goffmans' theory of institutionalized culture, Elias' theory of civilization, Douglas' theory of purity and order, and Bourdieus' key-concept 'habitus'. The method entails a secondary analysis of previous research carried out in a rehabilitation and long-term hospital. This second analysis indicates that elderly patients coming to the ward with their individual meal customs were met by caregivers with an institutionalized culture. Meals in the ward were organized in line with the organization of family meals in society, and both the elderly people and the nurses strove towards civilized manners, purity and order. The demands implicit in these cultural practices kept the elderly patients silent. By failing into line, they suffered from their loss of habitus. In contrast nurses' habitus was accomplished by carrying out procedures automatically. Consequently, the combination of patients' lost habitus and nurses' working habitus resulted in defective nursing, where the purpose of nursing is the fulfilment of patients' social, personal and material needs.