Accountability and performance optimization are intended to improve the performance of homecare services (HS) but do not seem to have the desired effects. The lack of decision-making latitude of professionals and, consequently, their insufficient responsiveness would be at fault. This responsiveness is, however, part of their role as change agent, a role that is poorly invested. This article has three objectives : 1) To synthesize knowledge on the role of accountability and performance optimization in the practice of HS professionals ; (...) 2) To describe the role of change agent ; and 3) To explore its teaching. (shrink)

In this paper, we explore the idea of digital technologies as truth‐bearers in health care and argue that devices like SenseCam, which facilitate reflection and memory recall, have a potentially vital role in healthcare situations when questions of veracity are at stake (e.g., when best interest decisions are being made). We discuss the role of digital technologies as truth‐bearers in the context of nursing people with dementia, as this is one area of health care in which the topic of truth‐telling (...) has been hotly debated. People with dementia have been excluded from research studies and decisions that affect their lives because they are not regarded as truth‐bearers—that is, as being capable of giving truthful accounts of their experiences. Also, considerable research has focused on the ethics of lying to and deceiving people with dementia. Given their increasing prominence in healthcare settings, there has been surprisingly little discussion of what role digital technologies might play in relation to these questions of truth and deception. Drawing on theories from science and technology studies (STS), we explore their possible future role in some of the truth‐making processes of health care. In particular, we discuss the potential value of constraints on use of SenseCam to support the accounts of people with dementia as part of their care. (shrink)

In this paper, we make explicit the changing configurations of power relations that currently characterize the Brazilian Emergency Care System (SAMU) team in Belo Horizonte, Brazil. The SAMU is a recent innovation in Brazilian healthcare service delivery. A qualitative case study methodology was used to explore SAMU’s current organizational arrangements, specifically the power relations that have developed and that demonstrate internal team struggles over space and defense of particular occupational interests. The argument advanced in this paper is that these professionals (...) are developing their work in conditions of exposure, that is, they are always being observed by someone, and that such observational exposure provides the conditions whereby everyday emergency care practices are enacted such that practice is shaped by, as well as shapes, particular, yet recognizable power relationships. Data were collected through the observation of the SAMU’s work processes and through semi‐structured interviews. Research materials were analyzed using discourse analysis. In the emergency care process of work, visibility is actually embedded in the disciplinary context and can thus be analyzed as a technique applied to produce disciplined individuals through the simple mechanisms elaborated by Foucault such as hierarchical surveillance, normalizing judgment, and the examination. (shrink)

Increasing pharmaceutical industry presence in health care research and practice has evoked critical social, political, economic, and ethical questions and concern among health care providers, ethicists, economists, and the general citizenry. The case example presented of the ‘marketization’ of nursing practice not only reveals the magnitude of the purview of the pharmaceutical industry, it demonstrates how that industry imparts effect upon the organization of nursing work, an area of health care professional practice where the ethical polemic of pharmaceutical industry involvement (...) and influence has been largely ignored, and the profession of nursing conspicuously silent. Drawing on a Foucauldian dispositive analysis that troubled the complex apparatus responsible for the production of knowledge and action in the neurology subspecialty of multiple sclerosis (MS), the case discloses how the pharmaceutical industry has created compliance and adherence as clinical imperatives in the practice of MS nursing. The case makes explicit the conscious transformative self‐action undertaken by MS nurses as a result of their subjectivation (marketization) and demonstrates how MS nurses have become pawns in pharmaceutical industry strategic games of power, truth, identity, and wealth creation by turning their clinical practice settings into heterodiscursive spaces of surveillance and persuasion. MS nurses have become instruments of the pharmaceutical industry, and their clinical practices ordered, organized, limited, constrained, and marketized as a result. (shrink)

Foucauldian discourse analysis (FDA) is a methodology that is well suited to inquiring into nursing knowledge and its organization. It is a critical analytic approach derived from Foucault's histories of science, madness, medicine, incarceration and sexuality, all of which serve to exteriorize or make visible the ‘positive unconscious of knowledge’ penetrating bodies and minds. Foucauldian discourse analysis (FDA) holds the potential to reveal who we are today as nurses and as a profession of nursing by facilitating our ability to identify (...) and trace the effects of the discourses that determine the conditions of possibility for nursing practice that are continuously shaping and (re)shaping the knowledge of nursing and the profession of nursing as we know it. In making visible the chain of knowledge that orders the spaces nurses occupy, no less than their subjectivities, FDA is a powerful methodology for inquiring into nursing knowledge based on its provocation of deep critical reflection on the normalizing power of discourse. (shrink)