Speaking of Life: Horizons of Meaning for Nursing Home Residents (Communication and Social Order)

In one of his earlier books, Living and Dying at Murray Manor, the author availed himself of ethnographic techniques to explore the experience of life in a nursing home. This volume extends that exploration to an assessment of the quality of long-term care provided to residents of nursing homes, and of the resulting quality of lives. Taking a bottom-up rather than a top-down view, Gubrium presents these qualities in the voices of "the residents themselves, in collaboration with the interviewer. Because many residents have been "long stayers" in nursing facilities, they are confronted with matters of home, family, life history, dependence, isolation, self-worth, even destiny in ways that would be irrelevant in shorter hospital stays. Such matters present significant narrative contexts for conveying the subjective meaning of the quality assurance that has become a leading goal of health care delivery. Two key concepts are employed to organize and interpret the narratives: narrative linkages and horizons of meaning. Narrative linkages refer to the experiences, inside or outside the nursing home, that are drawn upon to communicate subjective meaning. A horizon is the pattern of narrative linkages a resident conveys in speaking of life. The approach and narrative material provide conceptual, methodological, and personal lessons. The issues raised by Gubrium's book are informed by a view of residents as biographically active and by the expectation of narrative diversity. He relates thereby a personal encounter with storytellers who offer the listener the broad range of orientations and special circumstances that continue to make meaning even at the very end of life.