Space, time, and emotion in the community pharmacy
Introduction
Spaces in community pharmacies are constantly being ‘woven together out of ongoing stories’ (Massey, 2005, p. 131) in spacetime as the various professionals, staff and pharmacy users interact around the pivotal point of the counter which divides the shop activities from the metaphorically and sometimes literally closed off professional space of the dispensary. The counter serves as the place where sales are made and medicines dispensed; it also protects the professional space from the public (Rapport et al., 2009) and acts as the point where customers negotiate with ‘gatekeeper’ staff about waiting times for prescriptions or direct access to speak to the professionals in the dispensary. Scenes of varying complexity evolve from moment to moment with all present seeking to manage the conflicting demands of their needs, responsibilities and roles. All of these acts of managing are negotiated through spacetime and involve overt and covert emotional entanglements. These spatial, temporal, emotional entanglements are currently being stretched with the expansion and extension of pharmacists' roles in New Zealand where this study is located. We are concerned in this paper with what Pile (2010) terms the space in-between and how emotions, space and time bend and flex in the space between people and between people and things to produce therapeutic events – to function as therapeutic landscapes – or not.
Geographers have been instrumental in expanding the investigation of place and settings for health and health care in a wide variety of ways. Space prevents a full review, but see for example Curtis (2004) on health inequality and place, Gesler and Kearns (2005) on culture, place and health – including landscapes of healing, Glover and Parry (2009) on the role of ‘third places’ and Kearns (1993) on the importance of moving beyond the biomedical in understandings of health and place. The literature on therapeutic landscapes, see for example Conradson (2005), Curtis et al. (2007), Gesler (1992), Smyth (2005), Williams (2007), and Wood et al. (2015) is especially important in the context of this research with its explicit argument that the production, maintenance and negotiation of health and wellbeing involves far more than reductionist biomedically-inflected, emotionless and placeless absence-of-disease approaches. Community pharmacy is a largely neglected area in qualitative health geography with a few notable exceptions; see Rapport et al. (2009). These health care spaces are important settings at least partially because they have one of the lowest barriers to entry of any such formal health care setting, requiring no appointments as primary care does, or triage process as is the case in emergency secondary care settings. The community pharmacy is a ‘landscape’ that can at once be seen as one which may facilitate healing in the biomedical sense, but also one through which more holistic practises related to health promotion and the quest for well-being are enacted via the use of complementary medicines. This is not to suggest that wellbeing always relies upon the ingestion of something.
Section snippets
Theorising time, space and emotion in the community pharmacy
Seeking health care is a spatio-temporal activity. Health-related transactions conventionally occur in particular places; the buildings that house health activities assume a significance of their own (Gesler and Kearns, 2005). Community pharmacies are an example of spaces which are, using Crang’s (2005, p. 204) words, ‘created through actions’. They are a prosaic example of the ways that a ‘building produces its site’ (Wigley, 1993 p. 61 cited in (Crang, 2005, p. 204)).1
Method
We began our study by investigating the social and spatial context in which community pharmacy operates, with particular interest in the contrasting perspectives of the pharmacists who work in them and the public who visit them. A qualitative approach was chosen as the most appropriate method to gain in-depth data in this relatively under-researched field. Approval was granted for the study by the [University of Otago] Human Ethics Committee.
A purposive sampling strategy was used to select 20
Time in the community pharmacy
Understanding the tensions that matter in the tangle of things, events and people that make up an encounter in a community pharmacy requires a particular way of looking. Adam’s (1998, p.11) timescape perspective allows for the investigation of ‘temporal features of living’ and we would add working. She calls timescapes ‘the embodiment of practiced approaches to time’ (ibid). This is not to imply that ‘practiced approaches to time’ are static and waiting to be revealed, but simply that they are
Spaces: contesting boundaries, negotiating spaces
The physical space of a community pharmacy witnesses an ever changing assemblage of actions and actors coming together in unpredictable ways for a complex mix of purposes and functions. Members of the public use the pharmacy to have prescriptions filled, to get advice from the pharmacist, and buy over-the-counter medicines or other products on sale, sometimes several of these in the one visit. The staff that work in the pharmacy similarly fill a variety of roles and take on different identities
Emotion
Time and spacescapes were not simply neutrally negotiated. For both pharmacists and members of the public emotion mediated their experiences. The world of work is often conceived of as a space ‘unmarked by emotion’ (McDowell, 1997, p. 34). When emotion is discussed the focus is often on such concepts as emotional labour (Hochschild, 1983). McDowell (1997) argued that the stock exchange trading floor was a site in which usual expectations to control emotions at work were relaxed. The emotions
Concluding comments
At a time when there is external pressure for professional groups to alter their roles, there is a key role for geographers in investigating in depth the ways that the tangle of spacetime events calls forth identities in ways that may serve to fuel or snuff the desire for change. Focusing on the themes of time, space and emotion as we have done in this paper has allowed us to capture some of the ways that in the unfolding of the event – one which involves entering a spacetime negotiation in the
Acknowledgements
This research would not have been possible without funding from the Canterbury Medical Research Foundation and the willing participation of the people we interviewed. We are grateful for both of these.
References (50)
- et al.
The ‘taking place’ of health and wellbeing: towards non-representational theory
Soc. Sci. Med.
(2014) - et al.
Where do young Irish women want Chlamydia-screening services to be set up? A qualitative study employing Goffman's impression management framework
Health Place
(2010) Nonrepresentational theory/nonrepresentational geographies
Landscape, care and the relational self: therapeutic encounters in rural England
Health Place
(2005)- et al.
The reprofessionalisation of community pharmacy? An exploration of attitudes to extended roles for community pharmacists amongst pharmacists and General Practioners in the United Kingdom
Soc. Sci. Med.
(2001) Therapeutic landscapes: medical issues in light of the new cultural geography
Soc. Sci. Med.
(1992)- et al.
A third place in the everyday lives of people living with cancer: functions of Gilda's Club of Greater Toronto
Health Place
(2009) - et al.
“Happy Meals” in the Starship Enterprise: interpreting a moral geography of health care consumption
Health Place
(2000) - et al.
Professional status in a changing world: the case of medicines use reviews in English community pharmacy
Soc. Sci. Med.
(2010) - et al.
“Convenient space” or “a tight squeeze”: insider views on the community pharmacy
Health Place
(2009)
Therapeutic landscapes and First Nations peoples: an exploration of culture, health and place
Health Place
‘Therapeutic landscapes’ and the importance of nostalgia, solastalgia, salvage and abandonment for psychiatric hospital design
Health Place
Timescapes of Modernity: The Environment and Invisible Hazards
Reflexive modernization temporalized
Theory Cult. Soc.
Feedback from community pharmacy users on the contribution of community pharmacy to improving the public's health: a systematic review of the peer reviewed and non-peer reviewed literature 1990–2002
Health Expect.
Understanding the reproduction of health care: towards geographies in health care work
Progress Hum. Geogr.
The salutogenic model as a theory to guide health promotion
Health Promot. Int.
Introduction
Distinction: A Social Critique of the Judgement of Taste
An Invitation to Reflexive Sociology
Using thematic analysis in psychology
Qual. Res. Psychol.
Time: In: Paul Cloke, Ron Johnston (Eds.) space
Health and Inequality: Geographical Perspectives
Therapeutic landscapes in hospital design: a qualitative assessment by staff and service users of the design of a new mental health inpatient unit
Environ. Plan. C
Embodying emotion sensing space: introducing emotional geographies
Soc. Cult. Geogr.
Cited by (13)
Australian community pharmacy service provision factors, stresses and strains: A qualitative study
2023, Exploratory Research in Clinical and Social PharmacyA participatory research approach in community pharmacy research: The case for video-reflexive ethnography
2022, Research in Social and Administrative PharmacyInstruments measuring community pharmacist role stress and strain measures: A systematic review
2021, Research in Social and Administrative PharmacyCitation Excerpt :However, noting their limited effectiveness, analysing the community pharmacist's micro perspective may be useful. This could provide insight into otherwise unseen challenges that community pharmacists face in their work,2,3,7,9,19–27 and which may be hindering the adoption of new patient-facing tasks that pharmacists ideologically approve of, such as professional pharmacy service delivery.28–31 Internationally, there are indicators that community pharmacists may not always have complete behavioural control in their work,7,10,32–37 perhaps because of the pressures of the role system they are socialised to work within.38
Factors affecting community pharmacist work: A scoping review and thematic synthesis using role theory
2020, Research in Social and Administrative PharmacyCitation Excerpt :Concerns about role partner responses to role-making appeared to affect pharmacist decision-making processes, especially as some of these relationships seemed to be perceived as non-existent or insufficiently stable to survive a possible deterioration caused by redefinition of role expectations.60,63,72,82,83 The most often described role set was the pharmacist-patient dyad,27,35,60,64,65,67–69,75,78,79,84–87 which was characterised by incongruity between pharmacist and patient expectations,65–67,71 and the perceived unpredictability of the patient as a role partner27,64,69,75,84,85,87 (e.g. patients were described as both demanding and expecting ‘instant service’ although being also ‘appreciative’).85 Increased patient care associated with clinical responsibilities was linked with job satisfaction; this was posited to be the effect of clinical skill utilisation increasing pharmacist status, increased rapport and participation in the ‘patient journey’.33,63,88
Factors Influencing the Implementation of Interprofessional Collaborative Practice in Teaching Hospital Setting: A Mixed-Method Study
2023, Journal of Advances in Medical Education and ProfessionalismCare in the air? Atmospheres of care in Swedish pharmacies
2023, Journal of Material Culture