The entwinement of policy, design and care scripts: Providing alternative choice-dependency situations with care robots.

The use of robots to assist feeding has become important for people with an impaired arm function. Yet, despite large-scale dissemination strategies, it has proven difficult to sustain the use of this technology. This ethnographic study draws on the script approach to discuss the use of robots to assist feeding. The empirical work was done at locations in Denmark and Sweden. Drawing on document studies, interviews, observation of meals and video footage, we discuss (1) policy strategies promoting ideas such as self-reliance; (2) design visions promoting ideas such as empowerment; (3) and three scripts of care: (a) the script of choice, (b) the script of eating alone and (c) the script of eating together. We argue that scripts entwine and give rise to and prevent the use of robots. The study contributes to the script literature and the care robot literature by substantiating that care robots may generate choice-dependency situations for users. Rather than the somewhat overflowing 'self-reliance' and 'empowerment', alternative configurations of choice and dependency emerge, in which some situations fit users better than others. We conclude that although sustaining the use of feeding robots is difficult, in some cases, useful choices arise for both end-users and care providers.

Workshops as Tools for Developing Collaborative Practice across Professional Social Worlds in Telemonitoring.

BACKGROUND: Lately, patients suffering from chronic obstructive pulmonary disease use telemonitoring services from home. We discuss three professional groups' idea of good care in terms of living as a chronically ill patient. METHODS: We scrutinize a workshop consisting of the following: (1) presentation of pre-workshop interviews focusing on good patient flows; (2) presentation of the participants' photos illustrating their idea of the good life with telemonitoring; (3) discussion of what the three social worlds of care can do together. We understand workshops as learning events founded on the symbolic interactionist idea of learning as reflexism. That is, the process where participants make joint action an object of attention. RESULTS: We propose that not only people, but also objects such as applications, gold standards, and financial arrangement are actively involved in hampering collaboration across social worlds. The contribution is a discussion of the contemporary challenges of technological intensification into healthcare processes seen as a learning event. CONCLUSION: Workshops constitute useful tools to understand more of how professional groups seek to adopt new technologies and learn about the larger structure of telemonitoring. Developing joint action among social worlds appears to be one of the main challenges of technologically driven innovation in healthcare.

The infrastructure of telecare: implications for nursing tasks and the nurse-doctor relationship.

Telecare can offer a unique experience of trust in patient-nurse relationships, embracing new standards for professional discretion among nurses, but also reflects an increasingly complicated relationship between nurses and doctors. The study uses ethnographic methodology in relation to a large 5 million euro project at four hospitals caring for 120 patients with COPD. Twenty screen-mediated conferences were observed and two workshops, centring on nurses' photo elucidation of the practice of telecare, were conducted with a focus on shifting tasks, professional discretion, responsibility and boundaries between nurses and doctors. Analytically, the study draws on Star's notion of 'infrastructure' and Mol, Moser and Pols's ideas of care as 'tinkering'. Infrastructure is understood as human and non-human conduct that is embedded into wider organisational conventions, sites and structures. The analysis demonstrates and proposes that, in telecare, greater accountability, discretion and responsibility are imposed on the nurse, but that they also have less access to the means of clinical decision-making, namely, doctors. The article explores how relational infrastructures ascribe the professions they constitute (nurses and doctors) functions of power and accountability and highlights the ethical problem of the nurse being given greater responsibility while simultaneously becoming more dependent on the doctor.