Health: recent issues

Enacting death in the intensive care unit: medical technology and the multiple ontologies of death

Hadders, H. — Mon, 19 Oct 2009 04:21:15 PDT

This article explores various ways health personnel enact death in connection with mechanical ventilation treatment withdrawal in the intensive care unit (ICU) at Trondheim University Hospital. The main focus is on sedated terminal patients who undergo mechanical ventilator treatment withdrawal and relatives’ presence at this time. Mol’s (2002) praxiographic orientation of the actor-network approach is followed while exploring this medical practice. Utilizing this interdisciplinary science and technology studies approach this article describes what Timmermans and Berg (2003) have called ‘ technology-in-practice’. Thus the main focus of the analysis is on medical interventions, and enactments of death within medical practice. The article argues against a ‘social essentialist’ approach to medical technology, which views technology as a passive force empowered by social relations. It explores how various enactments of death are intrinsically linked with and shaped by the use of medical technology within clinical practice. A praxiographic inquiry into how death is enacted carefully takes notice of how medical practice and techniques make death audible, tangible, visible, knowable and real. Mol’s praxiographic approach also enables a description of how the multiple enactments of death connect within end-of-life care through various forms of coordination. This article is based on interviews with 28 nurses and two physicians in a Norwegian intensive care unit.

A metasynthesis of midwives' experience of hospital practice in publicly funded settings: compliance, resistance and authenticity

O'Connell, R., Downe, S. — Mon, 19 Oct 2009 04:21:15 PDT

Worldwide, increasing percentages of women are giving birth in centralized hospitals in the belief that this maximizes safety for themselves and their babies. In parallel, there is international recognition that the number of birth interventions used in the routine care of labouring women is rising. This is fuelling concern about iatrogenesis, and, particularly, maternal and infant morbidity and mortality. It also has an adverse impact on the economics of health care. National and international policy characterizes midwives as the guardians of normal childbirth. This guardianship appears to be failing. The objective of this metasynthesis is to explore midwives’ perceptions of hospital midwifery with a focus on labour ward practice to examine professional discourses around midwifery work in the current modernist, risk averse and consumerist childbirth context. Based on an iterative search strategy, 14 studies were selected for the metasynthesis. Three overarching themes were identified: ‘power and control’; ‘compliance with cultural norms’; and ‘attempting to normalize birth’. Most midwives aimed to provide what they characterized as ‘real midwifery’ but this intention was often overwhelmed with heavy workloads and the normative pressure to provide equitable care to all women. This raises questions of authenticity, both in terms of midwives living out their beliefs, and in terms of acknowledgement of the power to resist. The theoretical insights generated by the metasynthesis could have resonance for other professional and occupational groups who wish to offer autonomous individualized services in an increasingly risk-averse target driven global society.

Identities under construction: Women hailed as addicts

Aston, S. — Mon, 19 Oct 2009 04:21:15 PDT

Despite continuing investigations of the efficacy of Canadian addiction treatment services and supports across a range of health care settings and socio-cultural groups, many systemic, geographic and ideological barriers to service provision for women still exist. Determining how current services and supports can become more congruent with women’s gender-specific needs is a current research focus. Drawing on Butler’s reformulation of Althusser’s interpellation, this article explores the power of hailing, where hailing power lies, and how hailing operates in discourses about addiction that appear in women’s talk of their encounters with addiction services and supports. The article briefly outlines Butler’s understanding of interpellation and examines ways by which gender operates as both condition and effect in women becoming addicts. I argue that women’s narratives reveal patterns of interaction that intersect and generate complex social meanings and identities, and serve to get women’s attention in terms of seeing themselves as addicts. Further, I argue that powerful competing discourses concerning gender and the medicalization of addiction, hailed through these interactions, are taken up as lived realities by some women and resisted by others. Knowing how women are hailed to take up as their own, or resist, aspects of traditional and gendered discourses within addiction treatment and recovery communities can inform gender-compassionate service provision.

Spaces of care in the third sector: understanding the effects of professionalization

Carey, G., Braunack-Mayer, A., Barraket, J. — Mon, 19 Oct 2009 04:21:15 PDT

Increasingly the health and welfare needs of individuals and communities are being met by third sector, or not-for-profit, organizations. Since the 1980s third sector organizations have been subject to significant, sector-wide changes, such as the development of contractual funding and an increasing need to collaborate with governments and other sectors. In particular, the processes of ‘professionalization’ and ‘bureaucratization’ have received significant attention and are now well documented in third sector literature. These processes are often understood to create barriers between organizations and their community groups and neutralize alternative forms of service provision. In this article we provide a case study of an Australian third sector organization undergoing professionalization. The case study draws on ethnographic and qualitative interviews with staff and volunteers at a health-based third sector organization involved in service provision to marginalized community groups. We examine how professionalization alters organizational spaces and dynamics and conclude that professionalized third sector spaces may still be ‘community’ spaces where individuals may give and receive care and services. Moreover, we suggest that these community spaces hold potential for resisting the neutralizing effects of contracting.

Food allergy and food intolerance: towards a sociological agenda

Nettleton, S., Woods, B., Burrows, R., Kerr, A. — Mon, 19 Oct 2009 04:21:15 PDT

This article asks what sociological insights an analysis of food allergy and food intolerance might afford. We outline the parameters of debates around food allergy and food intolerance in the immunological, clinical and epidemiological literatures in order to identify analytic strands which might illuminate our sociological understanding of the supposed increase in both. Food allergy and food intolerance are contested and contingent terms and it is salient that the term true food allergy is replete throughout medico-scientific, epidemiological and popular discourses in order to rebuff spurious or ‘nonallergic’ claims of food-related symptoms. Complexity theory is introduced as a means of gaining analytic purchase on the food allergy debate. The article concludes that the use of this perspective provides a contemporary example of the ‘double hermeneutic’, in that the meanings and interpretations of contemporary explanations of food allergy are both permeated by, and can be made sense of, through recourse to complexity thinking.

Book review: The circulation of children: Kinship, adoption, and morality in Andean Peru Jessaca B. Leinaweaver. Durham, NC: Duke University Press, 2008. ISBN13 978--0--8223--4197--0 (pbk) $US21.95

Swift, K. — Mon, 19 Oct 2009 04:21:15 PDT

Book Review: Injury: The politics of product design and safety law in the United States Sarah S. Lochlann Jain. Princeton, NJ: Princeton University Press, 2006. 214 pp. ISBN 9780691119076 (pbk) $US22.95

Patterson, P., Rock, M. — Mon, 19 Oct 2009 04:21:15 PDT

Effects of exposure to the suffering of unknown persons on health-related cognitions, and the role of mood

Karademas, E. C. — Thu, 20 Aug 2009 06:30:16 PDT

The purpose of the present study was to examine whether exposure to the suffering of unknown persons, as an inevitable part of life, influences cognitions about health. Our assumption was that exposure to suffering affects cognitions in a negative way, as well as this influence being exerted directly and through negative mood. Eighty-nine participants were randomly assigned to two groups. The experimental group was exposed to a series of photos presenting situations of human suffering, whereas the control group was exposed to a series of photos showing relaxing situations. Participants in the experimental group reported higher health anxiety and health value, and lower internal health locus of control, in comparison to the control group. No differences were found in self-rated health. Exposure to suffering affected cognitions directly and through decrease in positive mood. It seems that an ‘in vitro’ exposure to human suffering activates a cognitive and emotional reaction, which affects evaluations about self and personal well-being.

Illness explanations among patients with medically unexplained symptoms: different idioms for different contexts

Risor, M. B. — Thu, 20 Aug 2009 06:30:16 PDT

Patients with medically unexplained symptoms (MUS) are often considered to be strictly confined to thinking about their symptoms as having only a physical etiology. However, several studies have shown, that the patients also apply other explanations for their sufferings. The aim of this study is to analyse the social construction of illness explanations among patients with MUS, and to illustrate the use of explanatory idioms as being dependent on space, time and setting, legitimizing each idiom. The study is based on repeated, semi-structured, qualitative interviews with nine informants during a period of 1.5 years. A thematic content analysis was performed on a pragmatic and phenomenological basis. We found, that patients with MUS employ at least four different explanatory idioms defined as: (1) the symptomatic idiom; (2) the personal idiom; (3) the social idiom; and (4) the moral idiom. All idioms play an important role in the process of creating meaning in the patients’ everyday life. The symptomatic idiom is mainly used at clinical consultations in primary care, but it is not the only idiom of significance for the patients. Simultaneously other idioms exist and gradually become important for especially patients with MUS due to the lack of valid diagnoses and treatment opportunities. Clinical settings, however, call for the employment of the symptomatic idiom and a discrepancy is found between the general practitioners’ notion of the bio-psycho-social model and the patients’ everyday life idioms.

Accounts of disruptions to sexuality following cancer: the perspective of informal carers who are partners of a person with cancer

Gilbert, E., Ussher, J. M., Hawkins, Y. — Thu, 20 Aug 2009 06:30:16 PDT

There is a growing body of research showing that cancer impacts upon the sexuality of informal carers in a couple relationship with a person with cancer. However, this research is primarily focused on partners of a person with gynaecological or breast cancer, within a framework where the physiological effects of cancer on sexual performance are the focus. We conducted semi-structured interviews with 20 informal carers in a couple relationship with a person with cancer, across a range of cancer types. The aim was to explore accounts of changes to sexuality and intimacy post-cancer, in the context of discursive constructions of sexuality and the caring role. Our findings show that partners’ sexual experiences were shaped by absence of desire in the person with cancer; the stress and exhaustion associated with caring tasks; the repositioning of the person with cancer as childlike or as an asexual ‘sick patient’; and the belief that there were expectations about ‘acceptable’ sexual conduct in the context of cancer caring. Carers accepted the diminishment of their sexual relationship, but expressed feelings of disappointment, anger and sadness about this loss. It is concluded that it is vital that support services are developed, so that couples may develop new sexual strategies, and cope more effectively with potential disruptions to their sexual and intimate relationship.

'A potential fifth column': conflicts and struggles for control in the context of local NHS privatization

Aldred, R. — Thu, 20 Aug 2009 06:30:16 PDT

This article uses case study data to discuss how a new procurement policy (Local Improvement Finance Trust, or LIFT) in English primary care may affect general practitioners’ control over their work. LIFT, a series of 51 public—private partnerships, will enable over the medium term a shift towards the corporate ownership of surgeries and the creation of polyclinics or ‘onestop-shops’. In this article, I explore the struggles over work autonomy and control within these new LIFT structures, as expressed by clinicians and managers in meetings and in research interviews. More generally, I consider how the findings inform debates over the changing position of professionals within increasingly financialized ‘local health economies’.

Book review: The making of Our bodies, ourselves: How feminism travels across borders: Kathy Davis. Durham, NC & London: Duke University Press, 2007. 277 pp. ISBN 978 0 8223 4066 9 (pbk) $US22.95

Bell, S. E. — Thu, 20 Aug 2009 06:30:16 PDT

Book Review: Economics for everyone: A short guide to the economics of capitalism J. Stanford. Black Point, Nova Scotia: Fernwood Publishing, 2008. CAD$24.95

McLaren, L. — Thu, 20 Aug 2009 06:30:16 PDT

Call for papers: Special Issue of health: Volume 15, Number 2 Publication date: March 2011 'Another way of knowing: art, disease, and illness experience'

Radley, A., Bell, S. — Thu, 20 Aug 2009 06:30:16 PDT

Editorial

Traynor, M. — Tue, 02 Jun 2009 09:07:41 PDT

Negotiating the neurochemical self: anti-depressant consumption in women's recovery from depression

Fullagar, S. — Tue, 02 Jun 2009 09:07:41 PDT

Anti-depressant treatment can be viewed as an exercise of biopower that is articulated through policies and practices aimed at the reduction of depression, population healthcare costs and effects on labour force productivity. Drawing upon a feminist governmentality perspective, this article examines the discourses that shaped women's experiences of anti-depressant medication in an Australian qualitative study on recovery from depression. The majority of women had been prescribed anti-depressants to treat a chemical imbalance in the brain, manage symptoms and restore normal functioning. One-third of participants identified anti-depressants as helpful in their recovery, while two-thirds were either highly ambivalent about, or critical of, medication as a solution to depression. Thirty-one women who identified the `positive' benefits of anti-depressants actively constituted themselves as biomedical consumers seeking to redress a chemical imbalance. The problem of depression, the emergence of molecular science and the push for pharmacological solutions are contributing to the discursive formation of new subject positions — such as the neurochemically deficient self. Three themes were identified in relation to medication use, namely restoring normality, signifying recovery success and control/uncertainty. Anti-depressant medication offered women a normalized pathway to successful recovery that stood in stark contrast to the biologically deficient and morally failing self. These women's stories importantly reveal the gender relations and paradoxes arising from biopolitical technologies that shape selfhood for women in advanced liberal societies.

The tenacity of the coronary candidate: how people with familial hypercholesterolaemia construct raised cholesterol and coronary heart disease

Weiner, K. — Tue, 02 Jun 2009 09:07:41 PDT

This article considers how people with familial hypercholesterolaemia (FH), an inherited high cholesterol condition, construct FH, high cholesterol and coronary heart disease (CHD). These data are used to explore some of the more prevalent claims about the expansion of genetic explanations for health and illness and its implications. The article draws on 31 interviews with people with FH undertaken at a large lipid clinic, a specialist outpatient clinic, in the north of England. I argue that interviewees tended to distinguish between their own `hereditary' high cholesterol and other people's `lifestyle induced' high cholesterol as a way to establish their own lack of culpability for their condition. At the same time, however, they strongly emphasized the need to take care of themselves, in particular by adhering to appropriate dietary and lifestyle regimes. Interviewees' accounts of CHD were not strongly framed in genetic terms, but tended to conform to established lay notions encapsulated by the idea of the `coronary candidate'. In sum, having FH does not seem to transform these people's understandings of the causes of high cholesterol or CHD. Their experiences were largely accommodated within existing lay frameworks. The analysis contributes to a growing reappraisal of transformative narratives about genetic knowledge.

Diaries from cannabis users: an Interpretative Phenomenological Analysis

Boserman, C. — Tue, 02 Jun 2009 09:07:41 PDT

This article is based on research, which aimed to uncover the meanings behind the experience of cannabis use. Six participants were recruited and asked to keep a diary for 15 days. Data were analysed using Interpretative Phenomenological Analysis (IPA). Four master themes emerged and were explored in detail. These were: `Withdrawing from everyday life', `Indulging in the here-and-now of the emotional body', `The containment of the sacred space' and `Living the addiction'. The author draws on the theoretical insights of Analytical Psychology in an attempt to capture and explain the dynamics emerging from participants' experiences. Throughout the narratives the use of cannabis, commonly regarded as a risky practice, appears to incarnate an attempt to reconnect with the here-and-now of the emotional body, as a way to escape from a convulsive consumeristic society. However, as the author argues, the lack of a conscious integration of the same convulsive consumeristic aspects within the psyche, leads participants into being `possessed' by these same forces, ultimately leading to a repetitive and compulsive addictive behaviour.

Holding onto womanhood: a qualitative study of heterosexual women with sexual desire loss

Hinchliff, S., Gott, M., Wylie, K. — Tue, 02 Jun 2009 09:07:41 PDT

This article explores heterosexual women's accounts of sexual desire loss, particularly the ways in which it can affect their sense of themselves as women. In-depth interviews were conducted with 17 participants recruited through a psychosexual clinic in England, and the data analysed using a material-discursive approach. The findings showed that having sexual desire loss often challenged participants' perceptions of themselves as women. Specific challenges related to dealing with isolation and `otherness', addressing their own feelings of not being `proper wives' because they did not sexually satisfy their partners and maintaining a sense of sexual attractiveness in the absence of sexual desire. Participants responded to these challenges in various ways, often renegotiating their identities as women. The findings are discussed in relation to theorizing women's sexuality and their implications for health care.

Young women's use of medicines: autonomy and positioning in relation to family and peer norms

Hansen, D. L., Hansen, E. H., Holstein, B. E. — Tue, 02 Jun 2009 09:07:41 PDT

Medicine use among youths is widespread and on the increase. This is especially true for young females, whose utilization of a variety of medications grows considerably during the teenage years. This user perspective study aims to obtain a greater understanding of what young women perceive as the norms for medicine use at home and among peers, and how these perceptions are reflected in their own use of medicine. In-depth interviews were conducted with 20 young Danish women between the ages of 16 and 20. During the interviews, participants described their perceptions regarding usual medicine taking practices and ideas about appropriate medicine use within their family and peer group. Young women possessed a keen awareness of medicine-related norms, although medicine use was a topic only rarely discussed with others. At the interface of these themes pertaining to family and peer norms, a unifying concept involving growing autonomy in medicine use emerged. This concept consisted of three parts: the great influence of family norms when autonomy was limited, growing autonomy under changing influences and assertion of autonomy and positioning of own behaviour relative to the norm. This study's findings indicate that despite increases in autonomy in medicine use, normative perceptions continued to serve as important reference points for informants' own medicine taking behaviour. Practitioners involved in the health care and promotion of youth may benefit from an increased awareness of the influential role that perceived norms in peer and family contexts can play in young women's use of medicine.

Book review: Encounters with the invisible: Unseen illness, controversy, and Chronic Fatigue Syndrome. Dorothy Wall. Southern Methodist University Press, 2005

Greene, G. — Tue, 02 Jun 2009 09:07:41 PDT

Editorial

Traynor, M. — Tue, 14 Apr 2009 08:48:09 PDT

Implementation of a patient safety incident management system as viewed by doctors, nurses and allied health professionals

Travaglia, J. F., Westbrook, M. T., Braithwaite, J. — Tue, 14 Apr 2009 08:48:09 PDT

Incident reporting systems have become a central mechanism of most health services patient safety strategies. In this article we compare health professionals' anonymous, free text responses in an evaluation of a newly implemented electronic incident management system. The professions' answers were compared using classic content analysis and Leximancer, a computer assisted text analysis package. The classic analysis identified issues which differentiated the professions. More doctors commented on lack of feedback following incidents and evaluated the system negatively. More allied health staff found that the system lacked fields necessary to report incidents. More nurses complained incident reporting was time consuming. The Leximancer analysis revealed that while the professions all used the more frequently employed concepts (which described basic components of the reporting system), nurses and allied health shared many additional concepts concerned with actual reporting. Doctors applied fewer and more unique (used only by one profession) concepts when writing about the system. Doctors' unique concepts centred on criticism of the incident management system and the broader implications of safety issues, while the other professions' unique concepts focused on more practical issues. The classic analysis identified specific problems needing to be targeted in ongoing modifications of the system. The Leximancer findings, while complementing the classical analysis results, gave greater insight into professional groups' attitudes that relate to use of the system, e.g. doctors' relatively limited conceptual vocabulary regarding the system was consistent with their lower incident reporting rates. Such professional differences in reaction to healthcare innovations may constrain inter-disciplinary communication and cooperation.

`Islands' and `doctor's tool': the ethical significance of isolation and subordination in UK community pharmacy

Cooper, R.J., Bissell, P., Wingfield, J. — Tue, 14 Apr 2009 08:48:09 PDT

Empirical ethics research is increasingly valued in offering insights into how ethical problems and decision-making occur in healthcare. In this article, the findings of a qualitative study of the ethical problems and decision-making of UK community pharmacists are presented, and it is argued that the identified themes of pharmacists' relative isolation from others and their subordination to doctors are ethically significant. Semi-structured interviews were conducted with 23 community pharmacists in England, UK. Analysis of interviews revealed that isolation involved separation of pharmacists from their peers, other healthcare professionals, patients and customers. Such isolation is argued to be inimical to ethical practice — impeding ethical discourse as understood by Habermas, resulting in a form of anomie that inhibits the transmission of professional values, leading to a lack of proximity between pharmacist and patient or customer that may impede ethical relationships and resulting, psychologically, in less ethical concern for those who are less close. Pharmacists' subordination to doctors not only precipitated some ethical problems but also allowed some pharmacists to shift ethical responsibility to a prescribing doctor, as in the case of emergency hormonal contraception. The emergence of atrocity stories further supports a culture of subordination that may cause ethical problems. The study has implications for community pharmacy practice in terms of supervision issues, developments such as prescribing responsibilities and how ethical values can be taught and communicated. The potential for isolation and subordination in other healthcare professions, and resultant ethical problems, may also need to be addressed and researched.

Oncology clinicians' accounts of discussing complementary and alternative medicine with their patients

Broom, A., Adams, J. — Tue, 14 Apr 2009 08:48:09 PDT

The profile of complementary and alternative medicine (CAM) has risen dramatically over recent years, with cancer patients representing some of the highest users of any patient group. This article reports the results from a series of in-depth interviews with oncology consultants and oncology nurses in two hospitals in Australia. Analysis identifies a range of self-reported approaches with which oncology clinicians discuss CAM, highlighting the potential implications for patient care and inter-professional dynamics. The interview data suggest that, whilst there are a range of consultant approaches to CAM, `risk' is consistently deployed rhetorically as a key regulatory strategy to frame CAM issues and potentially direct patient behaviour. Moreover, `irrationality', `seeking control', and `desperation' were viewed by consultants as the main drivers of CAM use, presenting potential difficulties for effective doctor—patient dialogue about CAM. In contrast, oncology nurses appear to perceive their role as that of CAM and patient advocate — an approach disapproved of by the consultants on their respective teams, presenting implications for oncology teamwork. CAM education emerged as a contentious and crucial issue for oncology clinicians. Yet, while viewed as a key barrier to clinician—patient communication about CAM, various forms of individual and organizational resistance to CAM education were evident. A number of core issues for clinical practice and broader work in the sociology of CAM are discussed in light of these findings.

Making breathing your business: enterprising practices at the margins of orthodoxy

Nicholls, D. A., Walton, J. A., Price, K. — Tue, 14 Apr 2009 08:48:09 PDT

Over the last 30 years there has been a gradual but nonetheless significant shift in the political economy of healthcare in developed countries. The health reforms that have accompanied this shift have had a significant impact upon medicine, nursing and a number of other orthodox health professions, but to date, little work has been done to explore the changing nature of physiotherapy practice. This study draws on Foucault's notion of governmentality to explore the enterprising practices of a new physiotherapy clinic established in Auckland, New Zealand. Drawing on a critical history of respiratory physiotherapy, which had previously been firmly anchored within the public health sector, we show that the actions and practices of the clinic's staff are testing the margins of orthodox physiotherapy practice and exploring the new market possibilities offered by consumer demand for optimal health. The study explores how the physiotherapists at the clinic are problematizing the practices, clinical spaces and clientele associated with orthodox practice, and, most notably, commodifying breathing, to create a space within which it is possible to think about physiotherapy otherwise. This study builds on the instability now surrounding the orthodox health professions and asks if exemplars like that offered in this article provide some meaningful insights into the future for healthcare practice.

Whose body is it anyway? Verbalization, embodiment, and the creation of narratives

Antelius, E. — Tue, 14 Apr 2009 08:48:09 PDT

This article examines the creation of narratives between people with severe disabilities and the personnel working with them. It shows that although a co-created narrative of what it means to be severely disabled (the story of dependence) seems to prevail, another narrative (the story of autonomy ) is also told, where the story of dependence is rejected by the person with disabilities. However, this story of autonomy only becomes clear if we recognize three central claims: (1) there is a connection between where the physical body of the person with disabilities is positioned in space and what he or she is allowed or able to be and do; (2) since the body is a communicative tool, the moving of the body could be interpreted as a narrative, told through the embodiment of space; and (3) the embodied story can challenge existing social structures. The article highlights the inherent struggle for power within narrations and how the creation of alternative narratives can contest existing social structures.

Book review: Deep: Real life with spinal cord injury. Editors: Marcy Epstein and Travar Pettway. Ann Arbor, MI: University of Michigan Press, 2007. 190 pp. ISBN 13 978--0--472--03251--8 (pbk)

Panitch, M. — Tue, 14 Apr 2009 08:48:09 PDT