Trajectories, biographies and the evolving medical technology scene: labor and delivery and the intense care nursery

Digital mediation of candidacy in maternity care: Managing boundaries between physiology and pathology

This paper brings together scholarship across sociology, media and communication, and human computer interaction to explore the intersection of digital health and the maternity care system. We draw on data (including interviews, focus groups, observations, and analyses of digital media content) from 19 studies involving over 400 women to explore women's experiences of using different forms of digital support such as the Internet, mobile technologies (apps and text messaging), social media, and remote monitoring devices in their reproductive journeys. We use a best fit approach to analysis, mapping our findings to the candidacy framework and notions of trajectory work to understand how women engage in digital health practices to negotiate boundaries between physiology and pathology and to enter dialogue with maternity services during conception, pregnancy and the postnatal period. We propose an integrated revised conceptual framework which explicates intersections between digital and care practices, and micro-level negotiations between women and professionals in the maternal health context. Our revised framework retains the dimensions of candidacy, but it introduces a precursor to the identification of candidacy in the form of 'understanding normality'. It identifies distinct forms of digital work (e.g. information work, navigation work, machine work) which operate across the candidacy dimensions that women (and partners at times) engage in to negotiate legitimacy when entering into encounters with the maternity care system. Operating conditions (norms around expert motherhood; neoliberal discourses around health optimisation, risk and responsibilisation) provide a broader macro-level context, influencing the micro-level dialogic processes between women and healthcare professionals. Our synthesis highlights digital mediation as a useful filter to understand care systems, distribution of lay/professional responsibilities, relational practices and the (dis)enablement of candidacy.

Interdependent Career Types and Divergent Standpoints on the Use of Advanced Technology in Medicine

This paper uses the case of the uneven use of a robotic technology to explain how physicians with similar training come to engage in different medical practices. I develop a conceptual framework in which their decisions to use advanced technologies are informed by "interdependent career types," a concept that incorporates features of the professional social context of physicians' work and the expertise they use, and reflects how medicine distributes expertise via formal and informal referral structures. I draw on data regarding specialized physicians' differentiated use of this technology over five years as well as interviews with those who continue to use the technology and those who have abandoned it. I argue that interdependent career types stratify physicians' standpoints on multiple dimensions of medical work-including those related to their concerns about reputation, inclinations toward risk, and preferences regarding the use of their bodies.

Medical residents' use of narrative templates in storytelling and diagnosis

This paper examines the diagnostic storytelling that medical residents perform in order to situate patients in a story trajectory with an imputed past and future. It is a study of "ordinary" expertise, as practiced by a family practice medical team in a small urban community hospital in the United States. Narrative storytelling-an activity that is at once cognitive and practical-allows residents to identify the sort of disease, the kind of patient, and the likely outcome for this patient, based on what the resident knows about patients like these. Residents acquire a set of narrative templates, or rough outlines, that they deploy when they encounter a new patient or his or her information. Going into an admissions interview, a resident already has a set of "facts" about the patient and his or her complaint. In a process that is routine, habitual, and iterative, a resident starts from this set of facts and draws on his or her repertoire of narrative templates to pursue a line of questioning that starts to define relevance for this patient, a relevance that is revised as the physician begins to settle on a story. These templates make a first organizing pass at answering, "What's going on with this patient?" They provide the preliminary structure, the warp and weft, for building a patient story that holds together long enough to diagnose, treat, and discharge the patient. Diagnostic stories are shaped by what residents think they can do for the patient, practically speaking, and by habitual hospital activity.

The practice of medical technology

In this article, we review 25 years of sociological scholarship published in Sociology of Health and Illness on medical technologies. We divide the literature into three theoretical perspectives: technological determinism views medical technology as a political force to shape social relationships, social essentialism emphasizes how medical technologies are neutral tools to be interpreted in social interactions, and technology-in-practice highlights the dialectic relationship between technology and its users in health care. While the technology-in-practice orientation allows social scientists to critique the high hopes and dire warnings embedded in medical technologies, we argue that the logical next step of this paradigm is to move beyond criticism and influence the creation and implementation of medical technologies.

Making connections: studies of the social organisation of healthcare

This paper explores the questions: What has work published in Sociology of Health and Illness contributed to our understanding of 'healthcare organisation'? What are the key research issues for the future? The paper reviews past articles with these questions in mind and uses the first issue of the Journal as a starting point for identifying themes and issues which have remained relevant throughout the first 25 years of its history. I argue that, though the disparate contributions in this area sometimes fail to build on earlier research, when read together they offer a valuable picture of a complex range of healthcare settings and their social organisation. The importance of insights gained from other areas of sociological work is emphasised and some significant examples are identified. The willingness to cross boundaries into other disciplines is also recognised as a strength and this is seen as an important issue for future research, as is increased attention to international comparative research. In similar vein the author argues that the multiplicity of methodological approaches allows the reader to weigh the value of different kinds of data and to look for common underlying patterns of action. It is suggested that future work could usefully revisit past studies, so that we consolidate and accumulate knowledge of the field and avoid a cycle where we continually retread old ground.

Technology and humane nursing care: (ir)reconcilable or invented difference?

AIM(S) OF THE PAPER: This paper questions the validity of a boundary presumed to exist between technology and humane care. It argues the need for reconciliation of presumed tension(s) between technology and person focused care and the need to reconsider our ways of understanding the relations between technology and nursing.

BACKGROUND/RATIONALE

Recent scholarship in the social sciences related to reproductive and imaging technologies and emergency resuscitation are examined and arguments are presented that question the appropriateness of a humanist view that emphasizes technology on the nonhuman and nonnatural side of a human/nonhuman, nature/artifice divide. It is argued that what determines experiences such as dehumanization is not technology per se but how individual technologies are used and operate in specific user contexts, the meanings that are attributed to them, how individuals or cultural groups define what is human, and the organizational, human, political and economic technological system (technique) that creates rationale and efficient order within nursing, health care and society.

CONCLUSION

The paper concludes by asking whether the commonplace appeal to resolve tensions between humane care and technology has erroneously highlighted technology as the reason for impersonal care, and encourages re-examination of the relationship(s) between technology, humane care and nursing practice.

Untrained, unpaid, and unacknowledged: the patient as worker

This article considers the patient as the central worker in his or her own care. It traces the history of a concept called "illness trajectory," explaining how this concept has been questioned, reformulated, and expanded through research among people with chronic illness. The trajectory concept illuminates the manner in which living with a chronic illness imposes on-the-job training on the unskilled patient as worker, who must learn to integrate biographical work, illness-related work, and everyday life work. That this patient work is unpaid renders it invisible to a society accustomed to valuing work only as it is connected to monetary exchange. Finally, by virtue of this invisible dimension, the work patients do remains unacknowledged and unappreciated by the larger society.

Defensive work in nursing homes: accountability gone amok

This paper contrasts conditions in intensive care nurseries and skilled nursing facilities in order to bring out certain features of organizational functioning in nursing homes. Data stem from a study of three American nursing homes which focused on the circumstances influencing decision-making in the evaluation and treatment of acute illness. DEFENSIVE WORK--work that is institution-protective and/or self-protective-emerged as a dominant process. It is demonstrated that the avoidance strategies which constitute defensive work lead to a progression of counterstrategies and foster skewed priorities. Consequences are: an acceptance of substandard care and a diversion of attention from therapeutic work. The relationship of defensive work to the larger question of how the nation handles its sick elderly is examined in the conclusion of the paper. Recommendations are offered for organizational steps that would re-channel the wasted energy that is spent on defensive work toward more productive therapeutic work.

The work of hospitalized patients

Patient's participation in their own care, conceived as work, is the central theme of this paper. A second theme is the patients' work in relation to technology. A third is: the prevalence of chronic illness and how this relates to patients' work in the service of their own care. Data are from a multi-hospital field-research and interviewing study of technology and patients care, carried out in San Francisco and the Bay Area, California. Questions addressed in this paper include the following: What are the sources of patients' work? What types of work do patients do? How does that work relate to courses of illness and the phases? What is the relation of that work to staff work? Under what conditions is the work visible or invisible to staff? Under what conditions is the work appreciated or not by staff? What are some consequences of patient work for staff work, for the management of the courses of illness, and for the patients' own medical and biographical fates? How does patient work at the hospital relate to patient work done at home?