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Montgomery CM, Docherty AB, Humphreys S, McCulloch C, Pattison N, Sturdy S. Remaking critical care: Place, body work and the materialities of care in the COVID intensive care unit. SOCIOLOGY OF HEALTH & ILLNESS 2024; 46:361-380. [PMID: 37702219 DOI: 10.1111/1467-9566.13708] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/24/2023] [Indexed: 09/14/2023]
Abstract
In this article, we take forward sociological ways of knowing care-in-practice, in particular work in critical care. To do so, we analyse the experiences of staff working in critical care during the first wave of the COVID-19 pandemic in the UK. This moment of exception throws into sharp relief the ways in which work and place were reconfigured during conditions of pandemic surge, and shows how critical care depends at all times on the co-constitution of place, practices and relations. Our analysis draws on sociological and anthropological work on the material culture of health care and its sensory instantiations. Pursuing this through a study of the experiences of 40 staff across four intensive care units (ICUs) in 2020, we provide an empirical and theoretical elaboration of how place, body work and care are mutually co-constitutive. We argue that the ICU does not exist independently of the constant embodied work of care and place-making which iteratively constitute critical care as a total system of relations.
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Affiliation(s)
- Catherine M Montgomery
- Science, Technology & Innovation Studies, University of Edinburgh, Edinburgh, UK
- Centre for Biomedicine, Self and Society, University of Edinburgh, Edinburgh, UK
| | - Annemarie B Docherty
- Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK
- Diagnostics, Anaesthetics, Theatres and Critical Care, NHS Lothian, Edinburgh, UK
| | - Sally Humphreys
- Critical Care and Research & Development, West Suffolk NHS Foundation Trust, Suffolk, UK
- School of Health and Social Work, University of Hertfordshire, Hertfordshire, UK
| | - Corrienne McCulloch
- Diagnostics, Anaesthetics, Theatres and Critical Care, NHS Lothian, Edinburgh, UK
| | - Natalie Pattison
- School of Health and Social Work, University of Hertfordshire, Hertfordshire, UK
- Nursing, East and North Hertfordshire NHS Trust, Stevenage, UK
| | - Steve Sturdy
- Science, Technology & Innovation Studies, University of Edinburgh, Edinburgh, UK
- Centre for Biomedicine, Self and Society, University of Edinburgh, Edinburgh, UK
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Rhodes T, Ruiz Osorio MP, Maldonado Martinez A, Restrepo Henao A, Lancaster K. Exhausting care: On the collateral realities of caring in the early days of the Covid-19 pandemic. Soc Sci Med 2024; 343:116617. [PMID: 38277763 DOI: 10.1016/j.socscimed.2024.116617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 01/28/2024]
Abstract
We explore care as a site of multiplicity and tension. Working with the qualitative interview accounts of nineteen health care workers in Colombia, we trace a narrative of 'exhausting care' in the early days of the Covid-19 pandemic. Accounts relate exhausting care to working without break in response to extraordinary demand, heightened contagion concern, the pressures of caring in the face of anticipated death, and efforts to carry on caring in the face of constraint. We bring together the work of John Law (2010, 2011) on 'collateral realities' with Lauren Berlant's (2011) thesis of 'cruel optimism' to explore care as a site of practice in which the promise of the good can also become materialised as harm, given structural conditions. Through the reflexive narrative of 'carrying on' in the face of being 'worn down' by care, a narrative which runs through health care worker accounts, we draw attention to the collateral realities of exhausting care as personal and political, at once a practice of endurance and extraction. We argue that the exhausting care that relates to the extraordinariness of the Covid-19 pandemic also resides in the ordinariness, and slower violence, of the everyday. The cruel optimism of care is a relation in which the labour of care reproduces a harmful situation.
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Affiliation(s)
- Tim Rhodes
- London School of Hygiene and Tropical Medicine, London, UK.
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Harrison M, Lancaster K, Rhodes T. The fluid hospital: On the making of care environments in COVID-19. Health Place 2023; 83:103107. [PMID: 37683402 DOI: 10.1016/j.healthplace.2023.103107] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023]
Abstract
This paper explores the boundary-making practices enacted by the hospital. Taking a hospital in Sydney, Australia, as our case, we investigate how the hospital holds together as a care environment through the coordinating movements of many materials, spaces, bodies, technologies, and affects. Drawing on interviews with hospital healthcare workers involved in care, research, and management related to COVID-19, we examine the multiplying effects of these movements to trace the ways in which the hospital is (re)made in relation with pandemic assemblages. We accentuate the material affordances of care environments and how care is adapted through the reshaping of the spaces and flows of the hospital. Through this, we highlight how care providers can work with the fluidity of the hospital, including through reorganizing routines and spaces of care, engaging with communication technologies to enact care at many scales, and remaking mundane materials as medical objects in the evolving care environment.
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Affiliation(s)
- Mia Harrison
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia.
| | - Kari Lancaster
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - Tim Rhodes
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia; London School of Hygiene & Tropical Medicine, London, UK
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Plyushteva A. Negotiating dignity in public geography: The ethics of public engagement in pandemic times. AREA (OXFORD, ENGLAND) 2023; 55:53-61. [PMID: 37057037 PMCID: PMC10083941 DOI: 10.1111/area.12818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 06/21/2022] [Accepted: 06/29/2022] [Indexed: 06/19/2023]
Abstract
In this paper, I reflect on some of the ethical dimensions of public engagement with geographic research. The paper draws on my recent experience of a project entitled 'Not working from home', which sought to make visible the everyday experiences of essential workers during the COVID-19 pandemic. The project was intended as a space for essential workers to document their daily lives using text, images and video, enabling them to engage with each other, while also informing the wider public about the everyday challenges of not working from home during the pandemic. The paper discusses some of the ethical implications and challenges of conducting this project, drawing on a critical engagement with dignity as an ethical framework for public engagement. I discuss the implications of calling workers 'essential', the role of collective and professional identities explored by the participants, and the impact of offering rewards. I also ask some broader questions on the role that the concept of dignity might play in the ethics of public engagement with research in human geography.
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Affiliation(s)
- Anna Plyushteva
- School of Geography and the EnvironmentUniversity of OxfordOxfordUK
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Paradoxes of pandemic infection control: Proximity, pace and care within and beyond SARS-CoV-2. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:100110. [PMID: 35693450 PMCID: PMC9170590 DOI: 10.1016/j.ssmqr.2022.100110] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/17/2022] [Accepted: 05/27/2022] [Indexed: 01/12/2023]
Abstract
From the adoption of mask-wearing in public settings to the omnipresence of hand-sanitising, the SARS-CoV-2 pandemic has brought unprecedented cultural attention to infection prevention and control (IPC) in everyday life. At the same time, the pandemic threat has enlivened and unsettled hospital IPC processes, fracturing confidence, demanding new forms of evidence, and ultimately involving a rapid reassembling of what constitutes safe care. Here, drawing on semi-structured interviews with 63 frontline healthcare workers from two states in Australia, interviewed between September 2020 and March 2021, we illuminate some of the affective dimensions of IPC at a time of rapid change and evolving uncertainty. We track how a collective sense of risk and safety is relationally produced, redefining attitudes and practices around infective risk, and transforming accepted paradigms of care and self-protection. Drawing on Puig de la Bellacasa's formulation, we propose the notion of IPC as a multidimensional matter of care. Highlighting the complex negotiation of space and time in relation to infection control and care illustrates a series of paradoxes, the understanding of which helps illuminate not only how IPC works, in practice, but also what it means to those working on the frontline of the pandemic.
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Harrison M, Rhodes T, Lancaster K. How do care environments shape healthcare? A synthesis of qualitative studies among healthcare workers during the COVID-19 pandemic. BMJ Open 2022; 12:e063867. [PMID: 36171049 PMCID: PMC9527744 DOI: 10.1136/bmjopen-2022-063867] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To investigate how care is shaped through the material practices and spaces of healthcare environments during the COVID-19 pandemic. DESIGN Critical interpretive synthesis (CIS) of qualitative research. PARTICIPANTS Studies included qualitative research investigating the experiences of healthcare workers involved in the care of individuals during the COVID-19 pandemic. RESULTS 134 articles were identified in the initial sampling frame with 38 studies involving 2507 participants included in the final synthesis. Three themes were identified in the analysis: (1) the hospital transformed, (2) virtual care spaces and (3) objects of care. Through the generation of these themes, a synthesising argument was developed to demonstrate how material spaces and practices of healthcare shape care delivery and to provide insights to support healthcare providers in creating enabling and resilient care environments. CONCLUSIONS The findings of this study demonstrate how healthcare environments enable and constrain modes of care. Practices of care are shaped through the materiality of spaces and objects, including how these change in the face of pandemic disruption. The implication is that the healthcare environment needs to be viewed as a critical adaptive element in the optimisation of care. The study also develops a versatile and coherent approach to CIS methods that can be taken up in future research.
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Affiliation(s)
- Mia Harrison
- Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Tim Rhodes
- Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Kari Lancaster
- Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
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Hor SY, Burns P, Yong FR, Barratt R, Degeling C, Williams Veazey L, Wyer M, Gilbert GL. 'Like building a plane and flying it all in one go': an interview study of infection prevention and control in Australian general practice during the first 2 years of the SARS-CoV-2 pandemic. BMJ Open 2022; 12:e061513. [PMID: 36123071 PMCID: PMC9485647 DOI: 10.1136/bmjopen-2022-061513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES General practitioners (GPs) and their staff have been at the frontline of the SARS-CoV-2 pandemic in Australia. However, their experiences of responding to and managing the risks of viral transmission within their facilities are poorly described. The aim of this study was to describe the experiences, and infection prevention and control (IPC) strategies adopted by general practices, including enablers of and challenges to implementation, to contribute to our understanding of the pandemic response in this critical sector. DESIGN Semistructured interviews were conducted in person, by telephone or online video conferencing software, between November 2020 and August 2021. PARTICIPANTS Twenty general practice personnel working in New South Wales, Australia, including nine GPs, one general practice registrar, four registered nurses, one nurse practitioner, two practice managers and two receptionists. RESULTS Participants described implementing wide-ranging repertoires of IPC strategies-including telehealth, screening of patients and staff, altered clinic layouts and portable outdoor shelters, in addition to appropriate use of personal protective equipment (PPE)-to manage the demands of the SARS-CoV-2 pandemic. Strategies were proactive, influenced by the varied contexts of different practices and the needs and preferences of individual GPs as well as responsive to local, state and national requirements, which changed frequently as the pandemic evolved. CONCLUSIONS Using the 'hierarchy of controls' as a framework for analysis, we found that the different strategies adopted in general practice often functioned in concert with one another. Most strategies, particularly administrative and PPE controls, were subjected to human variability and so were less reliable from a human factors perspective. However, our findings highlight the creativity, resilience and resourcefulness of general practice staff in developing, implementing and adapting their IPC strategies amidst constantly changing pandemic conditions.
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Affiliation(s)
- Su-Yin Hor
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Penelope Burns
- College of Health & Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
- Faculty of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Faith R Yong
- Safe and Effective Medicine Research Collaborative, School of Pharmacy, Faculty of Health and Behavioural Science, University of Queensland, Saint Lucia, Queensland, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Ruth Barratt
- Sydney Institute for Infectious Diseases, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Chris Degeling
- Centre for Health Engagement, Evidence and Values, School of Health and Society, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, New South Wales, Australia
| | - Leah Williams Veazey
- Sydney Centre for Healthy Societies, School of Social and Political Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Mary Wyer
- Sydney Institute for Infectious Diseases, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Gwendolyn L Gilbert
- Sydney Institute for Infectious Diseases, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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