Flexible therapeutic landscapes of labour and the place of pain relief

Towards cultural landscapes of care

This paper sets out a theoretical agenda for Cultural Landscapes of Care. It highlights the importance of engaging the cultural vectors within different 'care-ful geographies', in order to highlight the role of culture as both a lens of knowing a meaningful way of life, and a critical hermeneutic. Through revisiting discussions around everyday practices of care, both in this journal and elsewhere, we outline a research agenda that re-engages culture with inquiries into the relations between place and care, including spatialities of care, ethics and justice. We call for a shift to thinking with culture and its moral dimensions in order to make sense of the tensions, ambiguities and boundaries of care marked by austerity, neoliberalism and globalisation. We therefore coin the term 'cultural landscapes of care' to advance an agenda that is contextually and culturally sensitive, and committed to understanding what good care means in diverse trans-local contexts. Gathering together the papers in this collection, we show how culture 'filters' through meaningful everyday care practices. We argue for an understanding of culture as a toolkit and a condition for ethical encounters of care. Thus, we translate situated examples of caring experiences into a global standpoint of care-ful geography.

"Old friend and powerful cadre": Doctor-patient relationships and multi-dimensional therapeutic landscapes in China's primary hospitals

A positive doctor-patient relationship is believed to play a key role in the healing process in clinics. While challenges to the doctor-patient relationship are a global concern, complex social contexts which introduce familial collectivism and totalitarian bureaucracy to maintain a doctor's authority have complicated doctor-patient relationships in China. This study delineates a multi-dimensional therapeutic landscape of hospitals in China, focusing on the doctor-patient relationship performances used to improve patients' healing experiences. Based on fieldwork in two primary hospitals in Eastern China, we find that primary hospitals in China are not only professional spaces, but hybrids of professional and non-professional spaces. In these spaces, both professional and other discourses in various forms of social-environmental engagement affect therapeutic experiences. Varying time and space in hospitals allow doctors to construct multi-dimensional therapeutic landscapes vis-a-vis patients to secure patients' compliance with their recommendations, and thus improve health outcomes. We argue that these dimensions may also cause negative therapeutic experience such as unnecessary health care. This study contributes to the literature on therapeutic landscapes of health care by providing a critical view on the construction of multi-dimensional therapeutic hospital landscapes. Furthermore, it links the critical health geographies literature with China's broader social context to explicate the cultural and social transformation of health care spaces in contemporary China. Findings from this study inform both theoretical and empirical debates regarding therapeutic landscapes of health care by embedding the professional spaces of health care into broader geographical discourses. This calls for health professionals to reflect on ethical concerns in multi-dimensional health care landscapes.

The geographies of digital health - Digital therapeutic landscapes and mobilities

Digital technologies have long impacted the field of health, causing fundamental changes for the geographies of the production, movement, and consumption of health. Despite this, there is limited health geography engagement with digital health, and an understanding of how digital health affects the spatialities of health remains underdeveloped. Here, using autoethnography, I reflect on personal encounters with digital health in the UK to initiate analytical attention into the geographies of digital health. I demonstrate that digital health technologies are interconnected and increasingly structure access to health, impacting the equality of health; and that digital health disrupts existing, and creates new, therapeutic landscapes and mobilities.

Evaluating the literature of therapeutic landscapes with an emphasis on the search for the dimensions of health: A systematic review

Health geography emphasizes landscape capacity as a perspective for examining health dimensions. Much of this emphasis is on the concept of therapeutic landscapes. In the last two decades, changes in the therapeutic landscapes concerning health, as well as why and how the development of the emphasis on the dimensions of the health in the landscape in proportion to the temporal-spatial course of literature in this field can be considered. The framework of the present study is based on a systematic review of therapeutic landscapes in the geography of health in the last two decades. This systematic literature review followed the PRISMA guidelines. Searching for "Therapeutic Landscapes" term at Science Direct and PubMed, screening, 56 eligible articles were selected in the journal Social Science and Medicine, and Health and Place. The results of the systematic review, aiming to search for the health dimensions of the therapeutic landscape, and recognize main gaps, identified three main issues: scale and range of users of therapeutic landscapes, the position importance of experiences in therapeutic landscapes, therapeutic landscapes as the holistic paradigm. The results of the research show that in recent years, attention to multiple dimensions of health, especially non-physical relationships of therapeutic landscapes and multiple dimensions of health, has been considered more and more by researchers. Personal-social perceptions and experiences are also continually evolving, so the concept of therapeutic landscapes and its relationship to health is considered living and dynamic.

Fear, Boldness, and Familiarity: The Therapeutic Landscapes of Undocumented Latina Immigrants in Atlanta, Georgia

Drawing from 56 semi-structured interviews, this article details how undocumented Latina immigrants living in Atlanta, Georgia, in 2013 cultivated health and well-being in an insecure environment. In addition to the myriad challenges that immigrants face in accessing health care in their new communities, undocumented immigrants living in Atlanta at that time faced the legal barrier presented by Georgia’s new “show me your papers” law, which imbued public space with the risk of deportation for those who are undocumented. This law complicated health care access by making the trip to the doctor’s office risky. Immigrants’ health care decisions were thus shaped by the “geography of fear” that permeated their new communities. This fear presented itself not only in public space but also in clinics and hospitals, where many immigrants feared – and sometimes received – bad treatment. Despite the obstacles fear and immigrant policing presented, many of the women I interviewed showed boldness in their health care decisions, staking their claim to medical attention where they saw fit. Additionally, many maintained transnational networks and continued with familiar health practices from home. Combined, these strategies worked to create complex and shifting “therapeutic landscapes” in an environment permeated by insecurity and fear.

Therapeutic micro-environments in the Edgelands: A thematic analysis of Richard Mabey's The Unofficial Countryside

The concept of therapeutic landscapes, as introduced by Gesler, has had a significant impact on what has become a reformed geography (or geographies) of health. Research in this field has developed the number and type of sites that have been characterised as therapeutic landscapes. A wide range of environments have now been explored through the analytical lens of the 'therapeutic landscape'. This research further expands current descriptions of such environments by exploring Edgelands as therapeutic micro landscapes. Edgelands refer to the neglected and routinely ignored interfacial zone between urban and rural that are a routine characteristic of the urban fringe resulting from dynamic cycles of urban development and decay. Using a hybrid method of thematic analysis incorporating both inductive and deductive approaches, this research explores Richard Mabey's seminal work on this topic, The Unofficial Countryside. Previous examinations of the features of therapeutic environments are therefore scrutinised to explore both scale and the possibility of further extending the kind of environments that may be described as therapeutic to include Edgelands. This approach is informed, in part, by principles of mindfulness, a historically Eastern, but increasingly Western approach to exploring oneself and the environment. This research identifies that these overlooked and neglected landscapes are in fact vibrant, resilient and enthralling environments teeming with life, renewal and re-birth. Examination reveals that there are three crucial outcomes of this research. The first relates to the issue of scale. Mabey's book provides evidence of the importance of micro environments in providing a therapeutic environmental focus. Secondly, this research explores the potential of mindfulness as an approach in Geography. Lastly, this research also identifies Edgelands as therapeutic sites and calls for an increased understanding and appreciation of their potential.

The inpatient psychiatric unit as both a safe and unsafe place: implications for absconding

Absconding from acute psychiatric inpatient units is a significant issue with serious social, economic, and emotional costs. A qualitative study was undertaken to explore the experiences of people (n = 12) who had been held involuntarily under the local mental health act in an Australian inpatient psychiatric unit, and who had absconded (or attempted to abscond) during this time. The aim of the study was to explore why people abscond from psychiatric inpatient units, drawing on published work from health geography on the significance of the person-place encounter, and in particular the concept of 'therapeutic landscapes'. The findings show that the inpatient unit is perceived as a safe or unsafe place, dependent on the dialectical relationship between the physical, individual, social, and symbolic aspects of the unit. Consumers absconded when the unit was perceived as unsafe. Forming a therapeutic relationship with staff, familiarity with the unit, a comfortable environment, and positive experiences with other consumers all supported perceptions that the unit was safe, decreasing the likelihood of absconding. Findings extend existing work on the person-place encounter within psychiatric inpatient units, and bring new knowledge about the reasons why consumers abscond. Implications for practice are discussed.

Professional centred shared decision making: patient decision aids in practice in primary care

BACKGROUND

Patient decision aids are increasingly regarded as important components of clinical practice that enable shared decision making (SDM) and evidence based patient choice. Despite broad acceptance of their value, there remains little evidence of their successful implementation in primary care settings.

METHODS

Health care practitioners from five general practice surgeries in northern England participated in focus group sessions around the themes of patient decision aids, patient and practitioner preferences and SDM. Participants included general practitioners (n = 19), practice nurses (n = 5) and auxiliary staff (n = 3). Transcripts were analysed using a framework approach.

RESULTS

We report a) practitioners' discussion of the current impetus towards sharing decisions and their perspectives on barriers to SDM, and b) the implementation of patient decision aids in practice and impediments such as lack of an evidence base and time available in consultations.

CONCLUSION

We demonstrate two orientations to sharing decisions: practitioner-centred and patient-centred with the former predominating. We argue that it is necessary to rethink the changes required in practice for the implementation of SDM.