LA RECONSTRUCCIÓN DE LA VIDA TRADICIONAL DESDE LA

any treatments:

It’s an added bonus when the husband is there. …But if they’re not, then it’s different. I don’t think they don’t care, I just think that’s a typical man. He’s out doing the gardening and looking after things, or going to the grocery store, and he’ll do what his wife needs him to do, but he’s not there to be the information giver….Another thing is with physical care- like dressing changes-I would

expect… that if the man had a wound that the wife would do the dressing versus if the wife had the wound, the man do the dressing - not as likely. It does happen, but not as likely (Melanie, nurse).

Female clients also did not expect that their husbands would provide physical or intimate care:

I’m just thankful I’ve got nurses and care people to help as things get worse…. I don’t think Gerry [husband] would…wash me, or completely bathe me. I don’t think he would do that. I don’t think so (Barb, client).

Furthermore, men exempted themselves from care activities. Jeff, a male caregiver, did not partake in his wife’s home visits with the nurse, though he set up the appointments.

He stated: “I get everything started and then I go away, just get out of the way…. Then they [nurse and ill wife] talk and do their thing….” (Jeff, male caregiver). Jeff left the women to “do their thing,” which clearly delineated the “other” and the taken-for-granted belief that care work is women’s work. He refrained from being involved in home visits,

and as his wife stated, he did not look at her incisions, drains, or dressings. As female clients and nurses did not expect men to provide physical care, men at times were not considered to be caregivers to their ill wives, even if they may have wanted to contribute to the care. From this perspective, men may have missed opportunities to care for their wives and develop intimate and meaningful moments during a time when their wives may have greater need for emotional connectedness.

While men were exempted from care work, they also at times were constrained by female caregivers from providing physical care, or cleaning and cooking. As women closely tied their identities to home and obligations to care for their family members and themselves, they excluded men from certain care tasks. Gerry attempted to help with the cooking and cleaning, but his wife, Barb, would intervene:

I try to help her all I can, but …I say, “Well, I’ll do that.” and I turn my back for one minute, and she is knee deep in it. I say, “What are you doing? I told you I would do it.’” What can you do? (Gerry, male caregiver).

I observed that Barb took pride in her home, closely linking the cleanliness and decor with her identity as a woman. Consistent with agency discourses in describing the home

as comforting, Barb ensured that the house was meticulously presented, even as she was experiencing discomfort and pain. As a consequence of cultural and familial norms that compel women to meet gendered expectations and avoid social censure, men were often excluded from care tasks traditionally held by women. In this way, men were

disadvantaged, as they were not able to fully participate in caring for their wives. Furthermore, these actions may have inhibited men from learning how to assume

household tasks, which they may need to undertake in future after they became widowed. It may be that participants’ advanced ages influenced this exemption as they were in a

generation in which there was a tendency to follow norms distinctly delineating the gendered division of household labor.

Finally, men were at times exempted from conversations related to care. While engaged in intense discussions with the female caregiver about medications and

treatments, nurses often excluded male clients from these conversations. As a male client indicated:

The nurse would come….She would have, not private talks with Laura, but talked a lot to her, rather than to me. She took my blood pressure, my temperature, and made sure that everything was okay. But a lot of discussion was between the nurse and Laura….And so it got to the point that they were developing a conversation and I - as a joke - would turn around and say, ‘Hey, I’m the one that you came to see, not Laura’ (Stan, male client).

I also observed during nursing home visits that men were often excluded from care conversations, as nurses addressed caregivers’ knowledge gaps and biomedical issues. Nurses would often face solely toward the female client and would engage with the male caregiver only if asking a specific question about the care.

Additionally, I observed that nurses would often engage in social conversations with female clients and caregivers, whereas conversations with men were often limited. Helen described the social relationship she had with a female caregiver, Laura:

[With Laura], we have a social [relationship] –but we keep it therapeutic too– but because she was in retail with clothes, she showed me how to tie a scarf, showed me where to go clothes shopping…. There’s a social and a therapeutic level… and she knows I’m a mother…and a grandmother and [like me] she babysits a lot too (Helen, nurse).

There may have been a tendency for nurses to associate closely with women rather than men because of gendered roles and behaviours. Nurses’ relationships with men may have been more distant, exempting men from conversations related to giving or receiving care and discussions around coping and emotions. As client-caregiver-nurse relationships influence experiences (Ward-Griffin, McWilliam, & Oudshoorn, 2012a, 2012b) and access to resources (Stajduhar, Funk, Roberts et al., 2010), participants’ reification of

gendered exemptions may have ultimately disadvantaged men.

In summary, gender exemptions simultaneously advantaged and disadvantaged men. While exempted from care work, men also may have missed opportunities to contribute to and be a part of the care for their wives. Because of traditional attitudes and beliefs of men to be strong and self-sufficient, men also were excluded from care

conversations. Thus, gendered expectations and exemptions shaped experiences, resulting in both benefits and harms to men and women in hospice palliative home care.