| 1. |
- Reichenpfader, Ursula, 1969-, et al.
(author)
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Embedding hospital-based medication review : The conflictual and developmental potential of a practice
- 2019
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In: Journal of Health Organization & Management. - : Emerald Group Publishing Limited. - 1477-7266 .- 1758-7247. ; 33:3, s. 339-352
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Journal article (peer-reviewed)abstract
- Purpose: The purpose of this paper is to explore the embedding of hospital-based medication review attending to the conflictual and developmental nature of practice. Specifically, this paper examines manifestations of contradictions and how they play out in professional practices and local embedding processes.Design/methodology/approach: Using ethnographic methods, this paper employs the activity-theoretic notion of contradictions for analyzing the embedding of medication review. Data from participant observation (in total 290?h over 48 different workdays) and 31 semi-structured interviews with different healthcare professionals in two Swedish hospital-based settings (emergency department, department of surgery) are utilized.Findings: The conflictual and developmental potential related to three interrelated characteristics (contested, fragmented and distributed) of the activity object is shown. The contested nature is illustrated showing different conceptualizations, interests and positions both within and across different professional groups. The fragmented character of medication review is shown by tensions related to the appraisal of the utility of the newly introduced practice. Finally, the distributed character is exemplified through tensions between individual and collective responsibility when engaging in multi-site work. Overall, the need for ongoing ￜrepairￜ work is demonstrated.Originality/value: By using a practice-theoretical approach and ethnographic methods, this paper presents a novel perspective for studying local embedding processes. Following the day-to-day work of frontline clinicians captures the ongoing processes of embedding medication review and highlights the opportunities to learn from contradictions inherent in routine work practices.
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| 2. |
- Reichenpfader, Ursula, 1969-
(author)
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Embedding Medication Review in Clinical Practice : Reconceptualising Implementation Using a Practice Theory Perspective
- 2019
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Doctoral thesis (other academic/artistic)abstract
- The hospital is a critical setting with respect to medication safety and quality of medication therapy. Medication review, the structured assessment of an individual patient’s medications with the aim of improving therapy, has been advocated as a strategy to reduce medication-related harm. Although programs of medication review have been widely introduced, its implementation has encountered difficulties. While seemingly a rather straightforward concept, processes to identify current medication use and reconcile different medication lists have been complicated by organizational, interprofessional, or technical factors. There is, thus, a need to better understand medication review implementation. However, it is also important to critically consider how the implementation of healthcare interventions is generally understood, and what theoretical or conceptual considerations inform implementation efforts. Studying organizational and social phenomena as they unfold in practice has the potential to shed light on how these everyday activities are generated, how they are adapted over time, and what consequences this has on social and organizational processes.The purpose of this thesis is to develop an alternative perspective on studying the implementation of a healthcare intervention in routine care. More specifically, this thesis aims to theorize the embedding and practicing of medication review in routine hospital work. Theorizing, here, refers to empirically and theoretically exploring phenomena based on cases of local medication review implementation.Drawing on empirical case examples of medication review implementation in southeast Sweden, an ethnographic approach is employed conducting participant observation, informal conversations and semi-structured interviews with different healthcare professionals in two hospital settings, as well as semi-structured interviews with patients from three different hospital settings. A so-called toolkit approach for practice theory is employed, using a range of different practice-theoretical concepts to empirically study practice.The empirical findings point to the centrality of dealing with medication-related problems when conducting and embedding medication review. Both practicing and embedding medication review were shaped by how medication-related problems and potential medication harms were constructed, contested, and negotiated in practice. Practitioners’ everyday actions and practices revealed different meanings attached to the concept of medication-related problem bringing to the fore the contested and conflictual nature of the practice. Also, insight was provided into how practices to embed medication review in routine hospital work unfolded, revealing material-discursive and reflective practices, but also silent modes of legitimizing the ‘non-practicing’ of medication review in a highly structured way.This thesis provides an alternative perspective on studying the implementation of a healthcare intervention and challenges various assumptions underpinning implementation research. Instead, a broadened perspective is suggested directing attention to the practical and situated knowing involved, the local processes of negotiating objectives in practice, as well as to the meaning-making required when practitioners engage with a practice. Finally, there are opportunities to learn from implementation processes, when frontline practitioners involved in embedding medication review are able to reflect on adapting medication review to make routines better fit the local context.
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| 3. |
- Reichenpfader, Ursula, 1969-, et al.
(author)
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'In the hospital all is taken care of' : A practice-theoretical approach to understand patients' medication use
- 2020
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In: Sociology of Health and Illness. - : Wiley-Blackwell Publishing Inc.. - 0141-9889 .- 1467-9566. ; 42:1, s. 50-64
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Journal article (peer-reviewed)abstract
- Drawing from case examples of medication review implementation in three hospital settings in Sweden, this article examines patients’ medication use. Based on a practice theory approach and utilising data from interviews with patients and participant observation, we reconstruct three practices of everyday medication use centring on accepting, challenging or appropriating medication orders. This article argues that patients’ medication practices are embedded in wider practice arrangements that afford different modes of agency. Reconceptualising patients’ medication use from a practice‐based perspective revealed the meaning‐making, order‐producing and identity‐forming features of these practices. Also, we illustrated how different modes of agency were achieved in patients’ medication practices, suggesting a fluidity of both the meanings attached to and the identities related to medication use. Our findings have practical implications as these practices of medication use can be transformed when altering the arrangements they are embedded in, thus going beyond the clinical encounter.
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| 4. |
- Reichenpfader, Ursula, 1969-, et al.
(author)
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Medi(c)ation work in the emergency department : Making standardized practice work
- 2018
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In: Professions & Professionalism. - : OsloMet - Oslo Metropolitan University. - 1893-1049 .- 1893-1049. ; 8:2
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Journal article (peer-reviewed)abstract
- Medication review, the systematic examination of an individual patient’s medicines in order to improve medication therapy, has been advocated as an important patient safety measure. Despite widespread use, little is known about how medication review is conducted when implemented in routine health care. Drawing from an ethnographic case study in a Swedish emergency department and using a practice-based approach, we examine how medication review is practically accomplished and how knowledge is mobilized in everyday practice. We show how physicians construct and negotiate medication safety through situated practices and thereby generate knowledge through mundane activities. We illustrate the centrality of practitioners’ collective reflexive work when co-constructing meaning and argue here that practitioners’ local adaptations can serve as important prerequisites to make “standardized” practice function in everyday work. Organizations need to build a practical capacity to support practitioners’ work-based learning in messy and time-pressured health care settings.
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| 5. |
- Bruno de Sousa, Andréa, 1967-
(author)
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A parental perspective on child chronic kidney disease : The lived experience of caregiving in Portugal
- 2021
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Doctoral thesis (other academic/artistic)abstract
- Paediatric chronic kidney disease (CKD) requires complex care and radically transforms the everyday life of the child’s family. This thesis examines parents’ lived experience of dealing with a child’s CKD; how social and economic circumstances impact on families’ opportunities to manage the care; and how parents view and practise their parenthood. The thesis takes inspiration from the phenomenology of practice, material culture studies and parenting culture studies. The research is based on ethnographic fieldwork in a paediatric hospital in Portugal and in the participating families’ home environments. Thematic analysis was used to analyse the empirical material. The first study addresses the ethnographic methods used in the study and the challenges involved in examining parents’ lived experiences of managing caregiving. It demonstrates that the challenges involved in carrying out fieldwork among families in crisis can function as openings for discovering the multifaceted and complicated realities the families encounter. The second study shows that parents use all the available financial and human resources to manage the technically demanding care and create normality. It also shows that, while parents experience becoming confined and close relationships as strained, the mundane practices and social relations of care bring hope and meaning to the family. The third study demonstrates that good parenthood for the participants means focusing on the child’s survival and well-being, and requires constant vigilance and readjustments, what I term “readiness parenting”. This research contributes to creating knowledge about the complexity of caring for a chronically ill child, the relational and material aspects of caregiving and how norms about responsible parenthood are negotiated. It also demonstrates the need for qualitative research methods to understand parents’ lived experiences and create knowledge about their meaning- making, needs and competencies.
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| 6. |
- Bruno de Sousa, Andréa, 1967-, et al.
(author)
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Material and relational challenges of home-based renal care : a parental perspective on child chronic kidney disease
- 2022
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In: International Journal of Care and Caring. - Bristol, United Kingdom : Policy Press. - 2397-8821 .- 2397-883X. ; 6:4, s. 547-563
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Journal article (peer-reviewed)abstract
- Caring for a child with chronic kidney disease (CKD) requires parents to reorganise mundane routines and develop advanced technical skills. Parents’ strategies used to meet these challenges need greater understanding. This article takes inspiration from phenomenology of practice and material culture studies to analyse interviews with parents in Portugal. It shows that, although home-based care leads to worsened social inequities, parents use the available financial and human resources to manage the situation and create normality. While they experience becoming confined and close relationships are strained, the mundane practices and social relations of care bring hope and meaning to the family.
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| 7. |
- Bruno de Sousa, Andréa, 1967-, et al.
(author)
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Readiness parenting: practices of care by parents of children with chronic kidney disease in Portugal
- 2022
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In: Families, Relationships and Societies. - : Policy Press. - 2046-7435 .- 2046-7443.
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Journal article (peer-reviewed)abstract
- Parents of a child with chronic kidney disease (CKD) must safely perform advanced care and treatment while at the same time allowing the child some freedom and maintaining everyday parenting and family tasks. Drawing on interviews with primary caregivers of children with CKD in Portugal, we examine the context of raising a child with CKD and how the parents practise their parenthood. The study takes inspiration from parenting studies and child studies and explores how good parenthood is constructed. Based on thematic analysis, three core themes emerged: protecting the child, involving the child in their treatment, and transferring responsibility. The transformation of life-limiting circumstances into a life that worked well for both parents and their child represents what we call ‘readiness parenting’. Assessing risks, supporting the child’s autonomy, and relating to social norms required constant vigilance and readjustments as well as negotiations about parental responsibility.
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| 8. |
- Kvist Lindholm, Sofia, 1979-, et al.
(author)
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‘Looping effects’ related to young people’s mental health: How young people transform the meaning of psychiatric concepts
- 2020
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In: Global Studies of Childhood. - : Sage Publications. - 2043-6106. ; 10:1, s. 26-38
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Journal article (peer-reviewed)abstract
- Over the past decades, reports from official authorities and the media have suggested that there is a ‘crisis’ in young people’s mental health. However, there is considerable uncertainty regarding how to interpret the data referred to in these alarming reports. The present article draws on ‘the minority voices’ of young people and theories developed by Ian Hacking to undertake a critical analysis of the conceptualisation of young people’s mental health. According to Hacking, systems of classifications formulate general truths about people and frame the suffering of individuals in specific ways. Classification changes people. However, young people are social actors who interact with classifications of their mental health and by doing so they could cause classifications to be redrawn. Hacking refers to these feedback effects as ‘looping effects’. Based on 51 interviews with 15-year-olds, this article explores how young people interact with psychiatric labels associated with their wellbeing such as anxiety and depression. We demonstrate how the participants gave new meaning to these psychiatric labels, devalued and gave nuance to them, and by doing so transformed them into cultural categories rather than diagnostic categories. We discuss the potential looping effects related to young people’s mental health and how the present findings can inform policy practice.
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| 9. |
- Lind, Judith, 1971-, et al.
(author)
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Representations of mental health and mental health problems in content published by female social media influencers
- 2024
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In: International journal of cultural studies. - : Sage Publications. - 1367-8779 .- 1460-356X. ; 27:2, s. 217-233
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Journal article (peer-reviewed)abstract
- When social media influencers (SMIs) describe their experiences of mental health problems, they contribute to the circulation of representations of mental health. The aim of this article is to analyse the ways of talking about mental health problems that are made accessible to a wider audience through the YouTube videos published by four Swedish female SMIs. Our analysis shows that much content related to mental health contains traces of, and contributes to discourses informed by, positive psychology. Mostly, mental health problems are represented as manageable, if only the individual assumes responsibility for her mental wellbeing, but a few videos also contain displays of negativity and resignation. In addition to avoiding association with the unattractiveness associated with negativity, the four SMIs navigate expectations placed on them to encourage confidence and self-love while at the same time expressing modesty. The result is representations of mental health that are multi-layered and complex.
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| 10. |
- Mitchell, Sarah Jane, 1986-
(author)
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Fatherhood Images and Ideals : Transforming, Circulating, and Responding to the Swedish Dads Photo Exhibition
- 2021
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Doctoral thesis (other academic/artistic)abstract
- Between 2016 and 2019, the Swedish state – via the Swedish Institute and Swedish embassies – circulated the ‘Swedish Dads’ photo exhibition to 54 countries. The exhibition was based on a photobook by the same name and featured photographs of Swedish fathers on parental leave with their children. Many Swedish embassies hosting the exhibition combined it with photographs of local fathers and children – as was the case in Zambia and Zimbabwe. In the case of ‘Zambian Dads’, this exhibition was also circulated in Sweden. This thesis problematizes the transnational circulation of the Swedish ideal of progressive, gender-equal fatherhood across a range of local and national contexts where the availability of parental leave – as well as material conditions and family ideals – might be very different from the Swedish context. The aim of this thesis is to contribute critical, interdisciplinary knowledge by examining the transformation, circulation, and negotiation of images and ideals of fatherhood across contexts. Taking a social constructivist approach, the thesis draws theoretical inspiration from parenthood studies, visual culture studies and nation branding studies. Empirical material was collected through a visual ethnography and analysed using visual discourse analysis and thematic analysis. The analysis highlights firstly, that while Swedish dads on parental leave were constructed as ‘ordinary’ in the photobook, they were constructed as ‘exceptional’ in the exhibition circulated by the Swedish Institute. Secondly, photographs of local fathers and children were used to ‘bridge’ the contextual divides between Sweden and countries hosting the exhibition. Finally, representations of progressive fatherhood in Zimbabwe were found to challenge and extend the Swedish ideal beyond the context of the middle-class, nuclear family.
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