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"Discretion remains the rule": A multilevel study of emotional requirements in a public hospital

"La discrétion reste la règle" : Étude multi-niveaux des exigences émotionnelles dans un hôpital public

Abstract : Purpose: As specific emotional arenas, hospitals are characterized by the interweaving of various emotional requirements, arising from different sources of norms, rules, or guidelines. This study aims to highlight an often-overlooked dimension of emotional labor in healthcare by describing the coexistence of emotional rules (i.e. feeling and/or display rules) through a multilevel perspective (institutional level, cluster/department level, service level, ward level, professional level). Study Design/Methodology/Approach: These emotional requirements for nurses and nursing assistants are investigated through three sets of data (observation, interviews, and internal documents) in a French public hospital, focusing on two hospital services: three long-term care units (primary field of investigation), and five adult medical emergency wards (secondary field of investigation). Findings: The results of the analysis show the pervasive nature of emotional requirements which are intertwined and more or less implicit/explicit according to the level analyzed. In addition to organizational rules, professional and social emotional rules contribute to shaping emotional requirements, particularly through rules of "empathetic expression" and those of retenue bienveillante. Research Limitations/Implications: This research has contributed to showing the dynamic nature of emotional requirements and their appropriation and modulation by healthcare professionals. The qualitative methodology used allows for unique insights but limits the generalization of results. Originality/Value: This research has addressed various gaps in the existing literature by describing emotional requirements through a multilevel analysis, by outlining a set of rules that had not been previously described (retenue bienveillante) and by including the population of nursing assistants as well as nurses in a study on hospital emotional labor. Future research could envisage spatial analysis of emotional labor to help better understand emotional requirements’ variability according to emotionalized zones.