Open Access Te Herenga Waka-Victoria University of Wellington
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Misfits: An ethnographic study of extremely fat patients in intensive care

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posted on 2021-11-14, 22:55 authored by Hales, Caroline

Critically ill fat patients pose considerable healthcare delivery and resource utilisation challenges which are often exacerbated by the patients’ critical condition and types of interventional therapies used in the intensive care environment. Added to these difficulties of managing care is the social stigma that is attached to being fat. Intensive care staff not only have to attend to the specific needs of the critically ill body but also navigate, both personally and professionally, the social terrain of stigma when providing care to this patient population.  The purpose of this research was to explore the culture and influences within the intensive care setting in which doctors and nurses cared for fat patients. A focused ethnographic approach was adopted to elicit the specific knowledge and ‘situated’ experiences of caring for critically ill fat patients from the perspectives of intensive care staff. The setting for this study was an 18 bedded tertiary intensive care unit (ICU) in New Zealand. Participant observation of care practices and interviews with intensive care staff were undertaken over a four month period. This study adopted an insider perspective throughout the research process as the study site was also my place of work. The dual tensions of the nurse and researcher position are reflexively explored through the thesis.  Key findings from this research reveal how fat patients were considered to be ‘misfits’ in the ICU as a result of not fitting the physical, medical, and social norms of intensive care practices. Staff managed their private perceptions of fatness during care situations through the use of emotional labour, behavioural regions, and face-work. Through the construction and presentation of the professional and private ‘face’, staff were able to establish positive social experiences for fat patients.  This study has brought new understandings of fatness; often percieved as the last socially accepted form of discrimination. Conceptualising fat patients as ‘misfits’ in the intensive care setting, reveals the performances of staff in managing the social awkwardness of fat stigma. The implications of this for healthcare is the provision of clinical services that are fit for purpose and a reconceptualisation of how staff use emotional labour in order to deliver non-discriminatory care to socially stigmatised fat patients.


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Date of Award



Te Herenga Waka—Victoria University of Wellington

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Author Retains Copyright

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Degree Grantor

Te Herenga Waka—Victoria University of Wellington

Degree Level


Degree Name

Doctor of Philosophy

ANZSRC Type Of Activity code

970111 Expanding Knowledge in the Medical and Health Sciences

Victoria University of Wellington Item Type

Awarded Doctoral Thesis



Victoria University of Wellington School

Graduate School of Nursing, Midwifery and Health


de Vries, Kay; Coombs, Maureen