The Fractured Self: Deconstruction of Role Identity as a Consequence of Health Care Reform
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of the Nightingale matron had the patient’s welfare as central, and in this paper we show that the patient has been replaced by productivity outcomes as the centerpiece of success – a shift that has fractured the Nightingale template, and with it, the sense of self that incumbents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
Dr. Marilyn Orrock
Lecturer, Health Services Management
Prof. Jocalyn Lawler
Dean, Faculty of Nursing and Midwifery, The University of Sydney