Diagnosing by anticipation: Coordinating patient trajectories within and across social systems

Anticipation is a fundamental aspect of social life and, following Weber, the hallmark of social action-it means trying to take others' responses to our actions into account when acting. In this article, we propose and argue the relevance of anticipation to the sociological study of diagnosis. To that end, we introduce and elaborate on the concept of diagnosing by anticipation. To diagnose by anticipation is to consider diagnoses as cultural objects imbued with meaning, to anticipate how others will respond to their meaning in situ and to adapt the choice of diagnosis to secure a desired outcome. Unlike prognosis, which seeks to predict the development of a disease, diagnosing by anticipation entails seeking to predict the development of a case and the effect of different diagnostic categories on its trajectory. Analytically, diagnosing by anticipation therefore involves a shift in diagnostic footing, from trying to identify what the case is a case of, to trying to identify which diagnosis will yield the desired case trajectory. This shift also implies a stronger focus on the mundane organisational work of operating diagnostic systems and coordinating case trajectories within and across social systems, to the benefit of the sociology of diagnosis.

Protocol for 'virtual presence': a qualitative study of the cultural dialectic between loneliness and technology

INTRODUCTION

Most research on loneliness comes from the health sciences, statistically seeking to measure the health-related effects of feeling alone or isolated. There is a need to expand on this understanding and explore loneliness as a more complex social phenomenon. In this article, we present a qualitative design for studying the intersection between loneliness, technology and culture. Conceptualising this as the cultural dialectic between loneliness and technology, we aim to unpack the reciprocal ways by which understandings of loneliness shape technology, while technologies also affect society's understandings of loneliness. In elucidating this dialectic, we aim to develop new knowledge and a novel theoretical framework for understanding loneliness and its technological solutions, which, in turn, can enable better solutions to contemporary problems of loneliness.

METHODS AND ANALYSIS

We will adopt a qualitative approach that combines interviews, participant observation and textual analysis to explore loneliness and its technological solutions from the perspectives of policy-makers, producers, professionals and users in Norway and the UK. The data will be analysed through an analytical framework combining insights from discourse theory and philosophical debates on presence, which will allow us to capture and rethink fundamental assumptions about loneliness and technology. Outcomes will be revised understandings of loneliness, relevant to researchers, entrepreneurs, policy-makers, clinicians, educators and the broader public.

ETHICS AND DISSEMINATION

The project has been evaluated and approved by the data protection officer at Oslo Metropolitan University and by the Norwegian Social Science Data Services. Additional ethical approval for data collection in the UK has been provided by the University of Oxford Interdivisional Research Ethics Committee. Informed consent will be obtained from all participants. Findings will be disseminated through peer-reviewed publications, international conference presentations and lay media.

Do nurses rate diseases according to prestige? A survey study

AIMS

To see whether nurses rate diseases according to prestige and, if so, how their ratings compare to the disease prestige hierarchy previously uncovered among physicians.

DESIGN

Cross-sectional survey.

METHODS

In 2014, 122 nurses in a continuing education programme for healthcare personnel in Norway rated a sample of 38 diseases according to how prestigious they see these as being among healthcare workers in general.

RESULTS

The nurses were found to rank myocardial infarction, leukaemia, and brain stroke at the top of the prestige hierarchy and depressive neurosis, anxiety neurosis, and fibromyalgia at the bottom. Their rankings overlap significantly with those previously documented for physicians and suggest that nurses assess the diseases through a 'cure' rather than a 'care' perspective on health care.

CONCLUSION

The nurses ordered diseases in a prestige hierarchy and their rankings are strikingly like those of physicians. The findings are of significant relevance to nursing practice and set a new course for future research into prestige and nursing culture.

IMPACT

The findings should encourage nurses - individually and collectively - to reflect on whether and how notions of disease prestige influence their decision-making. By showing that nurses as well as physicians are able to rate diseases according to prestige, the study suggests new avenues for future disease prestige research.

The commensuration of pain: How nurses transform subjective experience into objective numbers

Commensuration-the transformation of different qualities into a common metric-has recently received increased scholarly attention. While mostly studied at the meso- or macroscale, this article extends the focus to microscale commensuration. Based on fieldwork in a Norwegian emergency medical service, the article analyses how nurses rated patients' pain intensity on a scale from zero to ten. While nurses were instructed to score pain by combining patients' self-report with their own 'objective' assessment, the article finds that their actual assessments relied almost solely on the latter. After exploring nurses' objections against the use of self-report, the article reconstructs the principles, methods and beliefs underlying nurses' 'objective' approach to pain scoring. In so doing, the article demonstrates how a fundamental aspect of human experience was filtered through nurses' professional gaze-to the advantage of some patients and the disadvantage of others. The article also advances theorising on microscale commensuration, thus providing guidance for future studies of how the world is transformed through the everyday production of numbers.

Narratives and gatekeeping: making sense of triage nurses' practice

It is well documented that emergency service staff consider some patients to be 'inappropriate attenders'. A central example is 'trivia', denoting patients with medical problems considered too 'trivial' to warrant attention. Although research has repeatedly shown that frontline staff violate guidelines in turning away 'trivial' patients, existing research has paid insufficient attention to why staff are willing to engage in guideline-violating gatekeeping, which may put both themselves and 'trivial' patients at risk. To address this issue, the present article explores nurses' narratives about 'trivial' patients - referred to in this context as 'GP patients' - drawing on fieldwork data from a Norwegian emergency service. The article reconstructs three narrative clusters, showing that nurses' gatekeeping is motivated by concerns for the patient being turned away, for nurses and more critically ill patients, and for the service they work for. Some of the issues embedded in these narratives have been under-analysed in previous research - most importantly, the role of identity and emotion in nurses' gatekeeping, and how patient narratives can function as 'social prognoses' in nurses' assessments. Analysis of these narratives also reveals an antagonistic relationship between nurses and 'trivial' patients that contradicts nurses' ethical guidelines and indicates a need for healthcare reform.

Beyond guidelines: discretionary practice in face-to-face triage nursing

This article draws on ethnographic data from a Norwegian emergency primary care clinic (EPCC) to explore nurses' discretionary application of guidelines. Specifically, it analyses nurses' discretionary use of the Manchester Triage System (MTS) when performing face-to-face triage, that is, assessing the urgency of patients' complaints. The analysis shows how nurses assessed patients at odds with MTS prescriptions by collecting supplementary data, engaging in differential diagnostic and holistic reasoning, relying on emotion and intuition, and allowing colleagues and patients to influence their reasoning. The findings also show how nurses' reasoning led them to override guidelines both overtly and covertly. Based on this evidence, it is argued that nurses' assessments relied more on internalised 'triage mindlines' than on codified triage guidelines, although the MTS did function as a support system, checklist and system for supervisory control. The study complements existing research on standardisation in nursing by providing an in-depth analysis of nurses' methods for navigating guidelines and by detailing how deviations from those guidelines spring from their clinical reasoning. The challenges of imposing a managerial logic on professional labour are also highlighted, which is of particular relevance in light of the drive towards standardisation in modern healthcare.

Stability and change in disease prestige: A comparative analysis of three surveys spanning a quarter of a century

In this paper, we present a comparative analysis of three survey studies of disease prestige in medical culture. The studies were conducted in 1990, 2002 and 2014 using the same research design. In each of the three rounds, a sample of Norwegian physicians was asked to rate a set of 38 diseases on a scale from 1 to 9 according to the prestige they believed health personnel in general would award them. The results show a remarkable stability in the prestige rank order over 25 years. The top three diseases in all three surveys were leukaemia, brain tumour and myocardial infarction. The four lowest ranked were fibromyalgia, depressive neurosis, anxiety neurosis and hepatocirrhosis. The most notable change concerns apoplexy (brain stroke), which moved from a rank of 33 to 29 and then to 23 over the three rounds. We argue that the stable pattern, as well as this change, substantiate the interpretation of previous research, i.e. that the prestige of a disease is affected by the localization of the affected organ or body part, the effect and style of its typical treatment, and the social attributes of the typical patient. Analysing physicians' shared evaluations of different diseases, the paper contributes to the cultural understanding of disease conceptions in medicine. Understanding these conceptions is important because disease prestige may influence decision-making in the healthcare sector.