Images and image: technology and the social politics of revealing disorder in a North American hospital

Keeping institutional logics in arm’s length: emerging of rogue practices in a gray zone of everyday work life in healthcare

We set out to explore the practice-level cognitive structures and associated practices characterizing the daily routine work of physicians by conducting a qualitative study in the Turkish healthcare field, in which a recent government-led healthcare reform was implemented causing logic multiplicity. Contrary to the accumulated knowledge in institutional logics literature, a bulk of which suggests that actors craft and enact various practices in managing plural and at times conflicting institutional templates strictly within the confines of higher order societal logics, this study shows that while ground level actors may not exercise complete freedom and maneuverability in relation to pre-established social structures, they do incorporate unconventional schemas of action; namely rogue practices, into their embodied practical activity, which over time become routinized in their day-to-day work lives. Unraveling the dynamics of micro-level practices of highly professionalized ground level actors as they pertain to atypical logical orientations substantially advances our understanding of the unknown or unseen side of how and under which conditions certain or various combinations of institutional logics are employed during day-to-day activities.

Em Brasília, mas em Recife: atravessamentos tecnometodológicos em saúde, gênero e maternidades numa pesquisa sobre as repercussões da epidemia do vírus Zika

Resumo Este artigo discute a prática da pesquisa antropológica em saúde em múltiplas dimensões, a partir de nossa primeira estada de campo entre as mães de bebês com síndrome congênita pelo Zika Vírus no Recife em 2016. Os arranjos metodológicos insurgentes foram tão inovadores e desafiadores que nos impulsionaram a refletir sobre as contribuições da pesquisa para o debate teórico sobre pesquisa social em saúde. Por isso, nessas linhas refletimos sobre a prática de pesquisa etnográfica coletiva; a pluralidade de papéis da docente e pesquisadora; autoria e ética dos diários de campo e resultados da pesquisa; o uso do WhatsApp em campo e como campo; e, por fim, as particularidades de uma pesquisa sobre mães quando as pesquisadoras também são mães e, por meio disso, encontram-se e também distanciam. Um esforço sempre ancorado na ideia de tencionar e fazer alargar o que se entende por práticas de pesquisa, sem, contudo, perder em profundidade, compromisso ético e reflexividade.

Predictors of unfavorable outcomes following deep brain stimulation for movement disorders and the effect of hospital case volume on outcomes: an analysis of 33, 642 patients across 234 US hospitals using the National (Nationwide) Inpatient Sample from 2002 to 2011

OBJECT

With limited data available on association of risk factors and effect of hospital case volume on outcomes following deep brain stimulation (DBS), the authors attempted to identify these associations using a large population-based database.

METHODS

The authors performed a retrospective cohort study involving patients who underwent DBS for 3 primary movement disorders: Parkinson’s disease, essential tremor, and dystonia from 2002 to 2011 using the National (Nationwide) Inpatient Sample (NIS) database. Using national estimates, the authors identified associations of patient demographics, clinical characteristics, and hospital characteristics on short-term postoperative outcomes following DBS. Additionally, effect of hospital volume on unfavorable outcomes was investigated.

RESULTS

Overall, 33, 642 patients underwent DBS for 3 primary movement disorders across 234 hospitals in the US. The mean age of the cohort was 63.42 ± 11.31 years and 36% of patients were female. The inpatients’ postoperative risks were 5.9% for unfavorable discharge, 10.2% for prolonged length of stay, 14.6% for high-end hospital charges, 0.5% for wound complications, 0.4% for cardiac complications, 1.8% for venous thromboembolism, and 5.5% for neurological complications, including those arising from an implanted nervous system device. Compared with low-volume centers, odds of having an unfavorable discharge, prolonged LOS, high-end hospital charges, wound, and cardiac complications were significantly lower in the high-volume and medium-volume centers.

CONCLUSIONS

The authors’ study provides individualized estimates of the risks of postoperative complications based on patient demographics and comorbidities and hospital characteristics, which could potentially be used as an adjunct for risk stratification for patients undergoing DBS.

Vulnerable brains: research ethics and neurosurgical patients

Seven specific challenges in patient vulnerability related to neurosurgical advancement highlight needed augmentations for standards in innovation and research that do not unduly inhibit access to potential therapies while assuring just treatment of patients.

Spectators & spectacles: nurses, midwives and visuality

AIM

In this paper we reflect on how linear perspective vision influences the practice of nurses and midwives and to advance understanding of clinical practice in technologically intensive environments through examination of drawings by nurses and midwives and through critical analysis.

BACKGROUND

There is increasing emphasis on vision in Western culture, and both nurses and midwives spend a great deal of time observing their clinical environment(s). Healthcare practitioners work increasingly in image-based realities and nurses rely on visual skills. Vision and visual representation are central to our practice and are important to examine because we look often at technology to assess people and care.

DISCUSSION

The world in which we practise is one of meaning(s). Technological development is transformative in nature and produces changes that alter the way(s) we give care. Amongst all this change, it is unclear how we practise in environments characterized by increasing technology and it is unknown how nursing and midwifery practice alter as a result.

CONCLUSION

Simple drawings included in this paper highlight an important and shared experience of clinical practice(s). They emphasize the importance and scope of the visual sense and expose practitioner behaviour that has enormous implications for current and future professional development and person-focussed care provision. Experiences described in this paper require further examination and highlight substantial changes to nurse-patient relationships, health care and the way we practise.

Bonesetting and Radiography in the Southern Maya Highlands

Maya bonesetters and their clients have been affected by the entry of radiographic technology into highland Guatemala. Bonesetters rely on a form of embodied knowledge to perform their manual work, the kind of knowledge X-rays threaten to supersede. This article examines how Maya bonesetters are meeting this challenge to their legitimacy and how they are positioning themselves pragmatically within a world of changing biomedical resources and contested health knowledge.

Visible humans, vanishing bodies, and virtual nursing: complications of life, presence, place, and identity

The emergence of the posthuman body and the disappearance of the humanist body serve as background for the rediscovery of the body as resource and problem in nursing. At the precise moment when the fleshy body is deemed increasingly irrelevant and immaterial in cyberspace come divergent moves in nursing toward not only resurrecting this body, but also toward virtual environments of nursing care, where fleshy bodies never encounter each other. The posthuman conflation of bodies and information poses the greatest challenge yet to the secure place, presence, and identity of nursing in health care.

Reembodying qualitative inquiry

Although there are four large categories of research data, qualitative researchers have tended to emphasize interview data. Naive views of the interview, disembodied views of participant observation, and a virtual neglect of the material world have led to qualitative work that is not as full-bodied as it should be. Survey and qualitative researchers often share the realist's assumption that interview responses index some external reality of facts and feelings, respectively. The Western cultural tendency to separate body from mind, and to elevate the mental over the corporeal, has trivialized the extent to which the body is the obvious point of departure for any process of knowing, especially participant observation. This cultural tendency, as well as a weakness for mistaking words for things and for viewing material objects as neutral and mute, contribute to the neglect of the material world.

Real qualitative researchers do not count: the use of numbers in qualitative research

Two myths about qualitative research are that real qualitative researchers do not count and cannot count. These antinumber myths have led to the underutilization of numbers in qualitative research and to the simplistic view of qualitative research as non- or antinumber. Yet numbers are integral to qualitative research, as meaning depends, in part, on number. As in quantitative research, numbers are used in qualitative research to establish the significance of a research project, to document what is known about a problem, and to describe a sample. But they are also useful for showcasing the labor and complexity of qualitative work and to generate meaning from qualitative data; to document, verify, and test researcher interpretations or conclusions; and to re-present target events and experiences. Although numbers are important in the treatment of qualitative data, qualitative researchers should avoid the counting pitfalls of verbal counting, overcounting, misleading counting, and acontextual counting.

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.