The infrastructure of telecare: implications for nursing tasks and the nurse‐doctor relationship

Abstract

Telecare can offer a unique experience of trust in patient-nurse relationships, embracing new standards for professional discretion among nurses, but also reflects an increasingly complicated relationship between nurses and doctors. The study uses ethnographic methodology in relation to a large 5 million euro project at four hospitals caring for 120 patients with COPD. Twenty screen-mediated conferences were observed and two workshops, centring on nurses' photo elucidation of the practice of telecare, were conducted with a focus on shifting tasks, professional discretion, responsibility and boundaries between nurses and doctors. Analytically, the study draws on Star's notion of 'infrastructure' and Mol, Moser and Pols's ideas of care as 'tinkering'. Infrastructure is understood as human and non-human conduct that is embedded into wider organisational conventions, sites and structures. The analysis demonstrates and proposes that, in telecare, greater accountability, discretion and responsibility are imposed on the nurse, but that they also have less access to the means of clinical decision-making, namely, doctors. The article explores how relational infrastructures ascribe the professions they constitute (nurses and doctors) functions of power and accountability and highlights the ethical problem of the nurse being given greater responsibility while simultaneously becoming more dependent on the doctor.

Self-care of elderly people with diabetes mellitus and the nurse-patient interpersonal relationship

“…Comprehensive care is something that subsidizes nursing care and is consolidated through embracement and bonding. The construction of the professional-user bond provides for closer relationships, allowing openness to humanized, sensitive and supportive care (13) .…”

“…The interpersonal relationship is an extremely complex and intrinsic construct to nursing care, which requires individual skills of the communicator and the receiver, through tuning and training. However, it is clear that care is often focused on the biomedical model, which prioritizes the disease, procedures and treatments more than the observation of the subject and the relationships that can be built between those who care and those who are care (13) . In this perspective, authors emphasize that, to reinforce the importance of patient-nurse interpersonal relationships, it is essential to reflect on the ideas of theorists such as Imogene King and Hildegard Peplau, who portray the transforming power of nursing relationships (11) .…”

“…The role of nurses in monitoring elderly people with diabetes should be centered on health education, through interventions in nursing consultations, in the waiting room, in social groups, in home visits, in telephone follow-up and in other strategies that can help in the guidance and empowerment of these users, inducing healthy lifestyle habits (12)(13)30) .…”

Telenursing: How do caregivers treat and prevent pressure injury in bedridden patients during the COVID-19 pandemic in Thailand? Using an embedded approach

“…We attempted to bridge the gap between theory and practice that currently exists within telenursing research, 21 , 22 as most studies have focused on in-person medication 23 and paid caregivers. 24 The study showed that there is no ideal context for COVID-19 patients, as the previous studies used a qualitative study, 25 systematic literature review 26 – 28 and quantitative study.…”

Social-Health Operators as Mediators in E-Health System

“…So far, studies on the consequences of ICT on healthcare work have focused on the higherlevel occupations, mainly physicians and nurses (Bagot, Cadilhac, Vu, Moss, & Bladin, 2015;Hallqvist, 2019;Nickelsen, 2019;Vicarelli & Bronzin 2018;Viitanen et al, 2011), while lower-level occupations have received less attention. There is a lack of study on the role of lower occupations in the transition towards an e-health system.…”