| 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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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. ; 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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| 4. |
- Reichenpfader, Ursula, et al.
(author)
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Our surgeons want this to be short and simple: practices of in-hospital medication review as coordinated sociomaterial actions
- 2018
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In: Studies in Continuing Education. - : ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD. - 0158-037X .- 1470-126X. ; 40:3, s. 323-336
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Journal article (peer-reviewed)abstract
- Medication review, a systematic assessment of a patients medicines by a health care professional, is intended to prevent medication-related harms. A critical element of medication review concerns whether medication review is conducted in a coordinated way. This article draws from a case example of implementing medication review in two surgical wards of a Swedish regional hospital and aims to analyse how medication review is being accomplished with respect to the coordination of its actions. Using a practice-based ethnographic approach, we present several coordination mechanisms by illustrating how practices are connected to materials involved in medication review. Also, we show how common orientations, ends, and understandings expressed in different medication review practices contribute to the coordination of the practices. In conclusion, this article highlights the complexity of establishing and sustaining medication review as a coordinated practice in routine health care. By closely examining sociomaterial connections, this article sheds new light on the neglected issue of artefacts and arrangements in constituting and transforming a highly complex medication practice.
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| 5. |
- Wickström, Anette, 1959-
(author)
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"I hope I get movie-star teeth" : Doing the exceptional normal in orthodontic practice for young people
- 2016
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In: Medical Anthropology Quarterly. - Malden, MA, USA : Wiley-Blackwell. - 0745-5194 .- 1548-1387. ; 30:3, s. 285-302
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Journal article (peer-reviewed)abstract
- Orthodontics offer young peole the chance to improve their bite and adjust their appearances. The most common reasons for orthodontic treatment concern general dentists', parents' or children's dissatisfaction with the esthetics of the bite. My aim is to analyze how esthetic norms are 'done' during three activities preceding possible treatment with fixed appliances. The evaluation indexes signal definitiveness and are the essential grounds for decision-making. In parallel, practitioners and patients refer to self-perceived satisfaction with appearances. Visualizations of divergences and the improved future bite become part of an interactive process that upholds what I conceptualize as 'the exceptional normal'. Insights into thie process contribute to a better understanding of how medical practices intended to measure and safeguard children's and young people's health at the same time mobilize patient to look and feel better. The article is based on an ethnographic study at two orthodontic clinics.
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| 6. |
- Wickström, Anette, 1959-, et al.
(author)
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Nyanserad förståelse av ungas psykiska ohälsa
- 2019
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In: Elevhälsa. - Stockholm. ; , s. 6-12
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Journal article (pop. science, debate, etc.)abstract
- En stor del av den statistik som ligger till grund för medialt uppmärksammade rapporter om ökande psykisk ohälsa bland unga representerar inte alltid psykisk ohälsa utan övergående besvär kopplade till ungdomars vardagliga utmaningar. Detta kan leda till att ungas mående medikaliseras och att insatser som ska främja psykisk hälsa riskerar att hamna snett.
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| 7. |
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| 8. |
- Wickström, Anette, 1959-
(author)
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Schoolgirls' healt agency : Silence, upset and cooperation in a psycho-educational assemblage
- 2018
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In: International Journal of Qualitative Studies on Health and Well-being. - : Taylor & Francis. - 1748-2623 .- 1748-2631. ; 13:1, s. 1-12
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Journal article (peer-reviewed)abstract
- Purpose: Since the millennium, manual-based preventive health programmes, drawing on psychological models of behaviour management, have dominated psycho-educational practices in school. The aim of this article is to study the health agency of 13-year-old schoolgirls participating in a programme for improving schoolchildren’s psychological health in Sweden.Method: Drawing on Deleuze and Guattari’s theories of assemblages, the interaction between schoolchildren, teachers, the manual and psycho-educational techniques is scrutinized. The methodology of assemblage ethnography is used in the analysis of video observations of 13 course meetings.Results: Three salient attitudes in relation to the possibilities built up for the schoolgirls are identified—silence, upset and cooperation. The girls’ acts and stories question the psycho-centric, individualized and gender-normative approach used in psycho-educational programmes and make visible the relational and contextual aspects of schoolchildren’s psychological health.Conclusion: Children depend on multiple factors for their agency; the institutional networks they are involved in both allow and restrict their actions. The study demonstrates that focusing on children as health actors, in the sense that agency develops in the assemblages children take part in, can complement the knowledge base and question the predominant framing of psychological health.
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| 9. |
- Wickström, Anette, 1959-
(author)
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Virginity Testing as a Local Public Health Initiative: A 'Preventative Ritual' More Than a 'Diagnostic Measure'
- 2019. - 2
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In: Cultural Anthropology. - Oxford : Oxford University Press. - 9780190925239 ; , s. 313-320
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Book chapter (peer-reviewed)abstract
- This chapter focuses on virginity testing in Nkolokotho in northeastern rural KwaZulu Natal. I argue that testing is a strategy that involves the deployment of collective pressure and symbolic means both to increase the individual’s and the community’s responsibility for sexual relations, and to strengthen girls’ and women’s positions at a time of chronic HIV/AIDS. In the absence of effective measures against AIDS, inhabitants try to find alternative ways to protect young people. An older tradition that emphasizes the status of virgin girls and the significance of the collective is used in a strategy that incorporates HIV blood tests. I show how virginity testing is a ‘preventive ritual’ more than a ‘diagnostic measure’, while emphasizing how both South African and Western projects aimed at improving the situation are grounded in perspectives that sometimes collide with how local people conceive of both relationships and sexuality.
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| 10. |
- Wickström, Anette, 1959-
(author)
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Virginity Testing as a Local Public Health Initiative: A 'Preventative Ritual' More Than a 'Diagnostic Measure'
- 2016. - 1
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In: Cultural Anthropology. - Oxford : Oxford University Press. - 9780190253547 ; , s. 148-155
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Book chapter (peer-reviewed)abstract
- This chapter focuses on virginity testing in Nkolokotho in northeastern rural KwaZulu Natal. I argue that testing is a strategy that involves the deployment of collective pressure and symbolic means both to increase the individual’s and the community’s responsibility for sexual relations, and to strengthen girls’ and women’s positions at a time of chronic HIV/AIDS. In the absence of effective measures against AIDS, inhabitants try to find alternative ways to protect young people. An older tradition that emphasizes the status of virgin girls and the significance of the collective is used in a strategy that incorporates HIV blood tests. I show how virginity testing is a ‘preventive ritual’ more than a ‘diagnostic measure’, while emphasizing how both South African and Western projects aimed at improving the situation are grounded in perspectives that sometimes collide with how local people conceive of both relationships and sexuality.
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