Caring For Evidence: Research and Care in an Obesity Outpatient Clinic

Time to care - An ethnographic study of how temporal structuring affects caring relationships in clinical nursing

This article explores how temporal structuring of clinical activities affects nurses' establishment of caring relationships with patients, based on an ethnographic study in a Norwegian cancer ward in January-June 2017. By drawing on practice-based perspectives on time and care, the article shows how 'medical time', 'patient time' and 'hospital time' represent three distinct but interconnected clinical rhythms affecting caring relationships. In this way, the article provides insights into how caring relationships are established in nurses' intermediate role as temporal agents, accommodation various temporal structures associated with the biomedical and person-centred care models. Second, it contributes insights into how caring practices are temporally structured and reproduced in a hospital context. Finally, the article describes factors that influence different ways of structuring time, emphasising the need for temporal reflexivity and flexibility in meeting patients' care needs, and the role time to care plays in facilitating this.

Operating (on) the self: transforming agency through obesity surgery and treatment

In this article, I describe the processes through which patients diagnosed with 'morbid obesity' become active subjects through undergoing obesity surgery and an empowerment lifestyle programme in a Dutch obesity clinic. Following work in actor-network theory and material semiotics that complicates the distinction between active and passive subjects, I trace how agency is configured and re-distributed throughout the treatment trajectory. In the clinic's elaborate care assemblage - consisting of dieticians, exercise coaches and psychologists - the person is not only actively involved in his/her own change, the subject of intervention is the self as 'actor': his/her material constitution, inclinations and feelings. The empirical examples reveal that a self becomes capable of self-care only after a costly and laborious conditioning through which patients are completely transformed. In this work, the changed body, implying a new, potentially disruptive reality that patients must learn to cope with, is pivotal to what the patient can do and become. Rather than striving to be disembodied, self-contained liberal subjects that make sensible decisions for their body, patients become empowered through submission and attachment and by arranging support.

How differences matter: tracing diversity practices in obesity treatment and health promotion

Diversity has become a buzzword in medical care, denoting a re-evaluation of what it means to attend to differences among human bodies and lives. Questions about what types of differences matter and how they should be defined have become important normative and analytical challenges. Drawing on two case studies, we show how differences between patients and patient-collectives are not simply waiting to be recognised and addressed but also enacted within situated healthcare practices. Although concerns with diversity are present in both cases, they take different forms. In a Viennese health-promotion project for obese clients, care practices are both based on and reproduce large-scale categories that divide the population into distinct subgroups with specific needs. Conversely, in an outpatient clinic for bariatric surgery patients, a technical fix-oriented procedure leads to concerns over diversity becoming an add-on realised by tending to each patient's idiosyncrasies and personal stories. By tracing the practices of diversity and the tensions they produce, we show how classifications and understandings of human difference are based on infrastructures that enable and constrain them. Furthermore, we discuss how they become consequential in healthcare, thereby indicating the importance of remaining reflexive about the political implications of diversity discourse and practice.