Abuse and disrespect of family members in pediatric hospital wards in Sierra Leone: The role of emotional culture and spatial practices for emotion management.

Delayed care seeking is a major source of pediatric mortality in low-income countries. Disrespect and abuse by healthcare providers are widely recognized as critical barriers to care, but few studies consider how these problems manifest in pediatric care settings. Based on interviews and observations of 110 nurses on pediatric hospital wards in Sierra Leone, this study suggests that nurses likely exacerbated problems of delayed care seeking by publicly blaming and berating parents and other family members. These expressions of anger and frustration violated professional expectations that nurses manage their emotions to create a caring environment for patients. To understand the nurses' actions, I analyzed the emotional cultures of these wards, including the norms, beliefs, artifacts, and practices that governed which emotions were considered appropriate and acceptable. I found evidence of complex and often contradictory emotional cultures from three possible sources: global contemporary professional nursing culture, an apparent residual influence of British colonial medicine, and the emotional expressiveness of Sierra Leonean society. These three sources contained conflicting expectations for emotion management, which may have contributed to instances of disrespect and abuse toward patients' families. However, when nurses were able to create momentary private space in otherwise intensely public wards, they did not express anger toward patients' families; instead, they adhered to professional norms of compassion and comportment. This research identifies spatial practices for emotion management and suggests a renewed focus on emotional culture to help reduce disrespect and abuse of patients and families.