The Fractured Self: Deconstruction of Role Identity as a Consequence of Health Care Reform

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With its roots immersed in symbolic interactionism, identity theory contends that one’s concept of self is composed of multiple identities within one’s social structure, and that the experiences within one’s role identity are important for emotional and psychological wellbeing. Identity theory provides a firm conceptual linkage between self-esteem and psychological distress – a concept we have termed ‘the fractured self’. This paper reports on current research being undertaken in Australia which explores the role identity of the senior nurse manager. We argued that the health care reform agenda, which commenced in the mid-1980s, signaled the deconstruction and subsequent demise of the role identity of the Nightingale matron some 160 years after it was a major factor in successfully reforming health care. The role construction of the Nightingale matron had the patient’s welfare as central, and in this paper we show that the patient has been replaced by productivity outcomes as the centerpiece of success – a shift that has fractured the Nightingale template, and with it, the sense of self that incumbents embody as senior nurse managers. This paper will illuminate our concept of ‘the fractured self’ drawing upon data from the research.


Keywords: Identity theory, Role deconstruction, Fractured self, Health care reform, Senior nurse managers
Stream: Sociology, Geography
Presentation Type: Paper Presentation in English
Paper: Fractured Self, The


Dr. Marilyn Orrock

Lecturer, Health Services Management
Faculty of Nursing and Midwifery, The University of Sydney

Camperdown, New South Wales, Australia

Marilyn completed her nurse education in Broken Hill in 1970 and has extensive experience in nursing and health services management in both remote rural and tertiary referral hospitals, before joining the Faculty of Nursing and Midwifery. Her clinical background includes all critical care areas, operating theatres and labour wards. Her major area of clinical experience and preference is emergency and trauma nursing. She holds qualifications in nursing, midwifery, psychology, education and health services management. Her main research interests are leadership and health services management.

Prof. Jocalyn Lawler

Dean, Faculty of Nursing and Midwifery, The University of Sydney
Camperdown, New South Wales, Australia

Jocalyn began her nursing career in Broken Hill in outback Australia, in 1967. She holds qualifications in nursing, social science and education and took Doctor of Philosophy from the University of New South Wales in 1989. Her research interests concern the experience of illness, methodologies for nursing research, nurses' social and interpersonal management of the body, and the reasons why nurses work is poorly understood and invisible.Jocalyn took up her position as Professor of Nursing at The University of Sydney in 1992; and she has been Dean of the Faculty of Nursing and Midwifery since 1999.

Ref: I08P0001