Expression and Reception of Gratitude in Healthcare
The expression and reception of gratitude is a significant dimension of interpersonal communication in care-giving relationships. Although there is a growing body of evidence that practising gratitude has health and wellbeing benefits for the giver and receiver, gratitude as a social emotion made in interaction has received comparatively little research attention. To address this gap, my research draws on a portfolio of qualitative methods to explore the ways in which gratitude is constituted in care provision in personal, professional, and public discourse. This research is informed by a discursive psychology approach in which gratitude is analysed, not as a morally virtuous character trait, but as a purposeful, performative social action that is mutually co-constructed in interaction.
I investigate gratitude through studies that approach it on a meta, meso, macro, and micro level. Key intellectual traditions that underpin research literature on gratitude in healthcare are explored through a metanarrative review. Six underlying metanarratives were identified: social capital; gifts; care ethics; benefits of gratitude; staff wellbeing; and gratitude as an indicator of quality of care. At the meso (institutional) level, a narrative analysis of an archive of letters between patients treated for tuberculosis and hospital almoners positions gratitude as participating in a Maussian gift-exchange ritual in which communal ties are created and consolidated. At the macro (societal) level, a discursive analysis of tweets of gratitude to the National Health Service at the outset of the Covid-19 pandemic shows that attitudes to gratitude were dynamic in response to events, with growing unease about deflecting attention from risk reduction for those working in the health and social care sectors. A follow-up analysis of the clap-for-carers movement implicates gratitude in embodied, symbolic, and imagined performances in debates about care justice. At the micro (interpersonal) level, an analysis of gratitude encounters broadcast in the BBC documentary series, Hospital, uses pragmatics and conversation analysis to argue that gratitude is an emotion made in talk, with the uptake of gratitude opportunities influencing the course of conversational sequencing. The findings challenge the often-made distinction between task-oriented and relational conversation in healthcare.
Moral economics are paradigmatic in the philosophical conceptualisation of gratitude. My research shows that, although balance-sheet reciprocity characterised the institutional culture of the voluntary hospital, it is hardly ever a feature of interpersonal gratitude encounters. Instead, gratitude is accomplished as shared moments of humanity through negotiated encounters infused with affect. Gratitude should never be instrumentalised as compensating for unsafe, inadequately renumerated work. Neither should its potential to enhance healthcare encounters be underestimated. Attention to gratitude can participate in culture change by affirming modes of acting, emoting, relating, expressing, and connecting that intersect with care justice.
My findings speak to gratitude as a culturally salient indicator of what people express as worthy of appreciation. It calls for these expressions to be more closely attended to, not only as useful feedback that can inform change, but also because gratitude is a resource on which we can draw to enhance and enrich healthcare as a communal, collaborative, cooperative endeavour.