Opening up conversations: Collaborative working across sociomaterial contexts in nursing in London

AIM

To discuss nurses' use of networks to address nursing recruitment and retention in London, UK.

DESIGN

Qualitative evaluation of the Capital Nurse programme reporting on 30 narrative interviews with executive, clinical and student nurses in 2019.

RESULTS

Executive nurses within the Capital Nurse programme recognized the importance of sociomaterial contexts in the health and social care system in London and worked strategically across these contexts to achieve change. Supported through the Capital Nurse programme, executive nurses from health organizations across London initiated collaborative working to improve recruitment and retention. Primarily by designing and delivering sociomaterial products (organizational and educational) to support nurses to build a career in London. Drawing on ideas from actor network theory, in particular sociomaterial contexts, nurses' actions at all levels to develop and sustain networks to address nursing recruitment and retention across the NHS in London are described.

CONCLUSIONS

Capital Nurse supported collaborative working both within single organizations and across organizations in London. There is evidence of change in how nurses across the capital work together to improve patient care, improve recruitment and retention. Findings may resonate with nurses in other settings who seek to address the problem of recruitment and retention. They show how nurses coming together in networks to effect changes in practice can work successfully.

IMPACT

Nurses' use of networks led to novel models of communication and action to address the problems of recruitment and retention in London. We argue that sociomateriality should be considered outside the clinical practice setting, as part of nurses' professional development and organizational practice, that is how they plan their career, how they address recruitment and retention, how they communicate across organizations about nursing issues.

NO PATIENT OR PUBLIC CONTRIBUTION

This was an evaluation of a staff development project in London, which sought to elicit nurses' experiences of participation in Capital Nurse.

Microfoundations of Data-Driven Antimicrobial Stewardship Policy (ASP)

This paper introduces a comprehensive framework that elucidates the microfoundations of data-driven antimicrobial stewardship programs (ASPs), specifically focusing on resource-constrained settings. Such settings necessitate the utilization of available resources and engagement among multiple stakeholders. The microfoundations are conceptualized as interlinked components: input, process, output, and outcome. Collectively, these components provide a comprehensive framework for understanding the development and implementation of data-driven ASPs in resource-constrained settings. It underscores the importance of considering both the social and material dimensions when evaluating microbiological, clinical, and social impacts. By harmonizing technology, practices, values, and behaviors, this framework offers valuable insights for the development, implementation, and assessment of ASPs tailored to resource-constrained environments.

Be prepared and do the best you can: a focus group study with staff on the care environment at Swedish secure youth homes

PURPOSE

This study examined staff members' experiences of the institutional care environment within secure youth homes.

METHODS

Data were collected through three focus group discussions with 17 staff members at two secure youth homes. Subsequently, a thematic analysis was conducted.

RESULTS

The analysis indicated two main themes: risk management and damage control in a restricted environment and compensating and reconstructing ordinariness-trying to make the best of it; each theme had three subthemes. The care environment seems to be experienced by staff as characterized by conflicting demands, thus constituting a gap between needs and what is possible to achieve-a balancing act that constitutes a constant struggle.

CONCLUSIONS

The staff members' constant struggle could be interpreted as conflicting moral and instrumental demands; they know what the youths need, but the environment of the secure youth homes demands the decorous behaviour of sociomaterial control practices-rather than care practices.

Towards an ethical multiplicity in low back pain care: Practising beyond the biopsychosocial model

The biopsychosocial model is currently considered by most researchers and clinicians to be the best approach to low back pain (LBP) care. The model was popularised in LBP care in response to some clear deficiencies in earlier biomedical approaches and is now widely recommended in clinical guidelines and policy statements. Yet the biopsychosocial approach has also been critiqued for its narrow conceptualisation and application. In this article, we explore how attending to the multidimensionality of LBP in practice goes beyond a biopsychosocial approach. We engaged with 90 ethnographic observations of clinical practices, 22 collaborative dialogues with clinicians, and eight consultatory meetings with people with experience of LBP to consider the sociomaterialities of clinical practices in two settings: a private physiotherapy practice and a public multidisciplinary pain clinic. Drawing on the work of Annemarie Mol and Rosi Braidotti, our analyses suggest that sociomaterial practices, involving human and non-human actors, produced multiple objects of clinical attention and ethical concerns about how to attend to this multiplicity well. We argue that the multiplicity of LBP is attended well by reimagining: (1) clinical settings as 'becoming more-than-sterile environments' where objects, furniture and elements such as tears and laughter help to provide a relational, welcoming and comfortable space to all bodies with LBP; (2) differences through 'becoming minoritarian' where considering power relations allows actions towards connectiveness and belonging; and (3) disciplinary boundaries through 'becoming interdisciplinary within' where actions expand traditional scopes of practice. The flux of these multiple becomings moves clinical practice and conceptualisations beyond the biopsychosocial approach to consider a new ethico-onto-epistemological approach to LBP care. They invite clinical practices that engage with an ethical multiplicity of LBP care, providing a better understanding of how places, objects, emotions, power, bodies and professions are interconnected and come together in everyday practice.

Digital health: A sociomaterial approach

The notion of digital health often remains an empty signifier, employed strategically for a vast array of demands to attract investments and legitimise reforms. Rather scarce are attempts to develop digital health towards an analytic notion that provides avenues for understanding the ongoing transformations in health care. This article develops a sociomaterial approach to understanding digital health, showing how digitalisation affords practices of health and medicine to cope with and utilise the combined and interrelated challenges of increases in quantification (data-intensive medicine), varieties of connectivity (telemedicine), and unprecedented modes of instantaneous calculation (algorithmic medicine). This enables an engagement with questions about what forms of knowledge, relationships and control are produced through different manifestations of digital health. The paper then sets out, in detail, three innovative strategies that can guide explorations and negotiations into the type of care we want to achieve through digital transformation. These strategies embed Karen Barad's concept of agential cuts suggesting that responsible cuts towards the materialisation of digital health require participatory efforts that recognise the affordances and the generativity of technology developments. Through the sociomaterial approach presented in this article, we aim to lay the foundations to reorient and sensitise innovation and care processes in order to create new possibilities and value-centric approaches for promoting health in digital societies as opposed to promoting digital health per se.

Planning Library Instruction Research: Building Conceptual Models with Theoretical Frameworks

Engagement with theories and theoretical frameworks in the planning and conduct of research about library instruction, in conjunction with the existing evidence base, can help researchers develop coherent conceptual models to justify the research approach and importance of the research produced. This column describes some of the limitations of common evaluation approaches that lack explicit theoretical framing and provides definitions of concepts that allow practitioners and researchers alike to explore and understand the complexities of educational encounters. Using an illustrative study with a theoretical framework applying sociomaterialism and related theories, this article presents arguments for in-depth explorations of informatics education through qualitative research.

Supporting and Studying Organizational Change for Introducing Welfare Technologies as a Sociomaterial Process

Welfare technologies (WT) for older people is a rapidly expanding sector that offers a way to tackle the challenge of an aging population. Despite their promise in terms of advances in care services and financial savings, their use is still limited. Their design and implementation remain problematic, as they require changes in working practices through coordination among a multiplicity of actors. In order to address these challenges, the need for change is often expressed in terms of a lack of working methods appropriate to their scope. This has led to a proliferation of different toolkits, guidelines, models, etc.; however, these methods often imply a linear understanding of an implementation project and thus fail to take into consideration the emergent and situated character of the processes that lead up to the adoption of welfare. The aim of this article is to propose an alternative means of providing support for the introduction of these technologies by initiating a process for organizational change. The term “change” is understood here as something that is produced by practitioners—in collaboration with researchers—and not brought by researchers to practitioners. To this end, using the tradition of intervention research as inspiration, a learning process at the crossroads of different practices and objects was initiated. The center of attention of this article’ is the sociomaterial process by which different communities of practitioners interact on the co-creation of a checklist. This is a new working method in which the focus is not the artifact in itself but how it emerges through successive interactions and iterations among different objects, practitioners and researchers, resulting in a joint sociomaterial process that reconfigures power relations and the work objective associated with WT. In other words, a new working method artifact is developed in a process in which practitioners, researchers and contextual objects interact and become one with each another.

Materials matter: Understanding the importance of sociomaterial assemblages for OSCE candidate performance

INTRODUCTION

The OSCE is a sociomaterial assemblage-a meshing together of human and material components producing multiple effects. Materials matter because they shape candidate performance, with potentially calamitous career consequences if materials influence performance unjustly. Although the OSCE literature refers to materials, few papers study the sociomateriality of OSCEs. Therefore, we explored OSCE stakeholders' talk about sociomaterial assemblages to better understand their importance for candidate performance.

METHODS

We conducted 15 focus groups with OSCE candidates (n = 42), examiners (n = 20) and simulated patients (n = 17) after an Australian postgraduate nursing OSCE. Sociomateriality informed our team-based framework analysis of data.

RESULTS

Participants identified a multiplicity of OSCE materials (objects, technologies and spaces) thought to matter for candidate performance. Candidates' unfamiliarity with materials and missing or malfunctioning materials were reported to yield numerous negative impacts (eg cognitive overload, negative affect, time-wasting), thereby adversely affecting candidate performance. Both examiners and candidates made micro-adjustments to sociomaterial assemblages during the OSCE in order to make it work (eg candidates saying what they would do rather than doing it). Sometimes, such tinkering extended so far that sociomaterial assemblages were ruptured (eg examiners ignoring rubrics to help pass candidates), potentially influencing OSCE standardisation.

DISCUSSION

Our novel empirical study extends previous conceptual work by illustrating wide-ranging sociomaterial assemblages influencing OSCE candidate performance. Further research is now needed employing sociomaterial approaches to further elucidate sociomaterial entanglements in diverse OSCEs. We encourage OSCE stakeholders to become more attuned to the productive nature of materials within all stages of OSCE design and implementation.

When the Place Matters: Moving the Classroom Into a Museum to Re-design a Public Space

In this case-report we describe an experience where alternative places – rather than the classroom – are exploited to implement learning processes. We maintain that this experience is a good example of materiality because it focuses on a project where students had the opportunity to re-design a public space. To this aim, various objects and tools are used to support discussions and exchanges with new stakeholders. Our theoretical vision combines Piaget’s and Vygotsky’s tradition with an innovative framework called the Trialogical Learning Approach (TLA). From such theoretical background an idea of materiality emerges, that refers to material in combination with the social relationships developed around the material. Our case-report concerns a participatory project run by Rete Dialogues, a national school network focusing on global citizenship education. Our research question is: how can this project highlight the connection between the TLA and socio-materiality? Since 2017, around 200 students (age 7–16) and 20 teachers from different schools have been engaged in tackling the degradation of an important square in Rome. The project – “Dialogues in the Square” (DiS) was developed with several stakeholders that contributed to the understanding of critical issues influencing the maintenance of the square, in the perspective of planning, and possibly implementing improvements proposed by students. Crucial is the cooperation with two important urban art projects: (i) the pilot-project MACRO-ASILO, run by the MACRO museum in Rome and aimed at connecting the world of art with the city life; (ii) the “building sites” of the Rome Rebirth Forum, inspired by the world-known artist Michelangelo Pistoletto’s “third paradise” methodology, that encourages responsibility and action taking on sustainability through art. Drawing on data collected through direct observations and video recordings, we aim to show and make sense of the connection between the TLA and socio-materiality, highlighting three key elements: the flexible use of mediation tools, the overcoming of the dichotomy between individual and collective learning through reflection, and the re-shaping of social practices.

An Old Mechanism, Imitation, Geared for Socio-Material Knowing in a "Day in the Life" of First Graders

This paper adopts sociomateriality as a theoretical lens to further our understanding of how imitation acts to support the use of objects, and in doing so, constitutes a sociomaterial practice. Within a sociomaterial perspective we aimed to perform the analysis of imitation as a powerful way to learn how to use objects embedded into the practices within which the objects are constituted. The contribution of this approach is illustrated using the findings of the application of the quasi-ecological Day in the Life (DITL) methodology to the everyday lives of two 6-year-old children. Within a case-study frame, we traced the children's imitation behaviors focused on the use of objects during an entire day of their life, the various people and practices with which they were associated, the multiple sociomaterial configurations that the objects assume, and the social and material consequences of their use. Imitation appears to be is a complex activity, involving multiple stakeholders who interact in order to facilitate the understanding of various artifacts across diverse knowledge domains, and enhance their interpretive flexibility across communities of practice.

Digging Deeper into Precision/Personalized Medicine: Cracking the Sugar Code, the Third Alphabet of Life, and Sociomateriality of the Cell

Precision/personalized medicine is a hot topic in health care. Often presented with the motto "the right drug, for the right patient, at the right dose, and the right time," precision medicine is a theory for rational therapeutics as well as practice to individualize health interventions (e.g., drugs, food, vaccines, medical devices, and exercise programs) using biomarkers. Yet, an alien visitor to planet Earth reading the contemporary textbooks on diagnostics might think precision medicine requires only two biomolecules omnipresent in the literature: nucleic acids (e.g., DNA) and proteins, known as the first and second alphabet of biology, respectively. However, the precision/personalized medicine community has tended to underappreciate the third alphabet of life, the "sugar code" (i.e., the information stored in glycans, glycoproteins, and glycolipids). This article brings together experts in precision/personalized medicine science, pharmacoglycomics, emerging technology governance, cultural studies, contemporary art, and responsible innovation to critically comment on the sociomateriality of the three alphabets of life together. First, the current transformation of targeted therapies with personalized glycomedicine and glycan biomarkers is examined. Next, we discuss the reasons as to why unraveling of the sugar code might have lagged behind the DNA and protein codes. While social scientists have historically noted the importance of constructivism (e.g., how people interpret technology and build their values, hopes, and expectations into emerging technologies), life scientists relied on the material properties of technologies in explaining why some innovations emerge rapidly and are more popular than others. The concept of sociomateriality integrates these two explanations by highlighting the inherent entanglement of the social and the material contributions to knowledge and what is presented to us as reality from everyday laboratory life. Hence, we present a hypothesis based on a sociomaterial conceptual lens: because materiality and synthesis of glycans are not directly driven by a template, and thus more complex and open ended than sequencing of a finite length genome, social construction of expectations from unraveling of the sugar code versus the DNA code might have evolved differently, as being future-uncertain versus future-proof, respectively, thus potentially explaining the "sugar lag" in precision/personalized medicine diagnostics over the past decades. We conclude by introducing systems scientists, physicians, and biotechnology industry to the concept, practice, and value of responsible innovation, while glycomedicine and other emerging biomarker technologies (e.g., metagenomics and pharmacomicrobiomics) transition to applications in health care, ecology, pharmaceutical/diagnostic industries, agriculture, food, and bioengineering, among others.

Knowing in general dental practice: Anticipation, constraint, and collective bricolage

RATIONALE, AIMS, AND OBJECTIVES

Much of the literature concerned with health care practice tends to focus on a decision-making model in which knowledge sits within the minds and bodies of health care workers. Practice theories de-centre knowledge from human actors, instead situating knowing in the interactions between all human and non-human actors. The purpose of this study was to explore how practice arises in the moment-to-moment interactions between general dental practitioners (GDPs), patients, nurses, and things.

METHOD

Eight GDPs in two dental practices, their respective nurses, 23 patients, and material things were video-recorded as they interacted within clinical encounters. Videos were analysed using a performative approach. Several analytic methods were used: coding of interactions in-video; pencil drawings with transcripts; and dynamic transcription. These were used pragmatically and in combination. Detailed reflective notes were recorded at all stages of the analysis, and, as new insights developed, theory was sought to help inform these.

RESULTS

We theorized that knowing in dental practice arises as actors translate embodied knowing through sayings and doings that anticipate but cannot predict responses, that knowing is constrained by the interactions of the practice but that the interactions at the same time are a collective bricolage-using the actors' respective embodied knowing to generate and solve problems together.

CONCLUSION

Practices are ongoing ecological accomplishments to which people and things skilfully contribute through translation of their respective embodied knowing of multiple practices. Based on this, we argue that practices are more likely to improve if people and things embody practices of improvement.

Enacting Entangled Practice: Interagency Collaboration in Domestic and Family Violence Work

Interagency collaboration in domestic and family violence (DFV) work is generally assumed to be good practice. This article questions this assumption, suggesting caution in adopting an uncritical pro-collaboration stance, arguing the need to trace the effects of working together on victims/survivors. Employing an innovative sociomaterial approach, this ethnographic study of interagency practice unravels its complexity, showing that not all ways of working together serve the interests of victims/survivors equally. Conceptualizing interagency DFV work as two distinctive, yet entangled, modes of collaboration, the findings have important implications for interagency DFV practice and policy.

Adolescents' participation in their healthcare: A sociomaterial investigation of a diabetes app

OBJECTIVE

This article explores how a diabetes app called Diapplo affected adolescents' participation in their healthcare by investigating adolescents' meaning-making in relation to their use of the app.

METHODS

Using a qualitative single case-study design, we adopted a multimethod responsive approach to data generation that included written data from the app development process, individual and group interviews and observations of the adolescents in the clinical situation. This article presents the results from a qualitative content analysis of group and individual semi-structured interviews conducted with five adolescents diagnosed with type 1 diabetes during and after the four-week test phase of a prototype of the app.

RESULTS

The adolescents appreciated the diabetes app's design and interface and having an overview of their blood glucose values. However, they stated that the app's content only partly met their needs and they considered several of its features unnecessary. They would have liked the app to have a social platform and emphasized that the app should be compatible with their blood glucose monitors and pumps for them to continue using it.

CONCLUSIONS

The participants in our study highlighted the value of social platforms integrated in health apps for patient participation, as well as their preference for health app features that reduced the effort of managing their chronic condition and facilitate greater knowledge. Theories of sociomateriality and material participation helped to account for the challenges of integrating users' perspectives, suggesting the value of early, comprehensive identification and prioritization of users' values when developing mobile health technologies.

Using a sociomaterial approach to generate new insights into the nature of interprofessional collaboration: Findings from an inpatient medicine teaching unit

Today's hospitals are burdened with patients who have complex health needs. This is readily apparent in an inpatient internal medicine setting. While important elements of effective interprofessional collaboration have been identified and trialled across clinical settings, their promise continues to be elusive. One reason may be that caring for patients requires understanding the size and complexity of healthcare networks. For example, the non-human 'things' that healthcare providers work with and take for granted in their professional practice-patient beds, diagnostic imaging, accreditation standards, work schedules, hospital policies, team rounds-also play a role in how care is shaped. To date, how the human and non-human act together to exclude, invite, and regulate particular enactments of interprofessional collaboration has been subject to limited scrutiny. Our paper addresses this gap by attending specifically to the sociomaterial. Drawing on empirical data collected from an Academic Health Sciences Centre's inpatient medicine teaching unit setting in Ontario, Canada, we explore the influence of the sociomaterial on the achievement of progressive collaborative refinement, an ideal of how teams should work to support safe and effective patient care as patients move through the system. Foregrounding the sociomaterial, we were able to trace how assemblies of the human and the non-human are performed into existence to produce particular enactments of interprofessional collaboration that, in many instances, undermined the quality of care provided. Our research findings reveal the "messiness" of interprofessional collaboration, making visible how things presently assemble within the inpatient setting, albeit not always in the ways intended. These findings can be used to guide future innovation work in this and other similar settings.

Modernizing the flow of blood: Biomedical technicians, working knowledge and the transformation of Swedish blood centre practices

The early 1980s saw a 'paradigm change' in how donated blood was handled and used by blood centres, hospitals and pharmaceutical companies. In Sweden, a five-year state-financed R&D programme initiated a swift modernization process, an alleged 'revolution' of existing blood centre practices. In this article, we use interviews and archival material to analyse the role of female biomedical technicians in this rapid technical and organizational change. In focus is their working knowledge, or savoir-faire, of blood, instruments and techniques. We give a detailed analysis of technicians' embrained and embodied skills to create safety in blood and its representations, handle contingencies and invent new procedures and techniques. These transformations are analysed as sociomaterial entanglements, where the doing and undoing of gender, sociomaterial practices, hierarchies of authority and expertise, and emotions are intertwined.

Foregrounding Sociomaterial Practice in Our Understanding of Affordances: The Skilled Intentionality Framework

Social coordination and affordance perception always take part in concrete situations in real life. Nonetheless, the different fields of ecological psychology studying these phenomena do not seem to make this situated nature an object of study. To integrate both fields and extend the reach of the ecological approach, we introduce the Skilled Intentionality Framework that situates both social coordination and affordance perception within the human form of life and its rich landscape of affordances. We argue that in the human form of life the social and the material are intertwined and best understood as sociomateriality. Taking the form of life as our starting point foregrounds sociomateriality in each perspective we take on engaging with affordances. Using ethnographical examples we show how sociomateriality shows up from three different perspectives we take on affordances in a real-life situation. One perspective shows us a landscape of affordances that the sociomaterial environment offers. Zooming in on this landscape to the perspective of a local observer, we can focus on an individual coordinating with affordances offered by things and other people situated in this landscape. Finally, viewed from within this unfolding activity, we arrive at the person's lived perspective: a field of relevant affordances solicits activity. The Skilled Intentionality Framework offers a way of integrating social coordination and affordance theory by drawing attention to these complementary perspectives. We end by showing a real-life example from the practice of architecture that suggests how this situated view that foregrounds sociomateriality can extend the scope of ecological psychology to forms of so-called "higher" cognition.

Video observation in HIT development: lessons learned on benefits and challenges

BACKGROUND

Experience shows that the precondition for the development of successful health information technologies is a thorough insight into clinical work practice. In contemporary clinical work practice, clinical work and health information technology are integrated, and part of the practice is tacit. When work practice becomes routine, it slips to the background of the conscious awareness and becomes difficult to recognize without the context to support recall. This means that it is difficult to capture with traditional ethnographic research methods or in usability laboratories or clinical set ups. Observation by the use of the video technique within healthcare settings has proven to be capable of providing a thorough insight into the complex clinical work practice and its context - including parts of the tacit practice. The objective of this paper is 1) to argue for the video observation technique to inform and improve health-information-technology development and 2) to share insights and lessons learned on benefits and challenges when using the video observation technique within healthcare settings.

METHODS

A multiple case study including nine case studies conducted by DaCHI researchers 2004-2011 using audio-visual, non-participant video observation for data collection within different healthcare settings.

RESULTS

In HIT development, video observation is beneficial for 1) informing and improving system design 2) studying changes in work practice 3) identifying new potentials and 4) documenting current work practices.

CONCLUSIONS

The video observation technique used within healthcare settings is superior to other ethnographic research methods when it comes to disclosing the complexity in clinical work practice. The insights gained are far more realistic compared to traditional ethnographic studies or usability studies and studies in clinical set ups. Besides, the data generated through video recordings provide a solid basis for dialog between the health care professionals involved. The most important lessons learned are that a well considered methodology and clear formulated objectives are imperative, in order to stay focused during the data rich analysis phase. Additionally, the video observation technique is primarily recommended for studies of specific clinical work practices within delimited clinical settings. Overall, the video observation technique has proven to be capable of improving our understanding of the interwoven relation between clinical work practice and HIT and to inform us about user requirements and needs for HIT, which is a precondition for the development of more successful HIT systems in the future.