Accessing Treatments: Managing the AIDS Epidemic in Ontario

Smith, George Winston

doi:10.3138/9781442657502-004

Cited by 25 publications

(13 citation statements)

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“…Few academics who conduct institutional ethnographic investigations have carried out research that moves forward in community settings and aims primarily at community audiences. For exceptions, see Pence's (forthcoming) work on 'safety audits' and domestic violence, Campbell's (1998 research on independent living for people with disabilities and G. Smith's (1995;Mykhalovskiy & Smith, 1994) work on ASOs and social service and treatment access issues.…”

Section: Institutional Ethnography Social Movements and Community-bamentioning

confidence: 96%

“…For example, IE's understanding of the social world as produced through people's ongoing, coordinated activities can run counter to common-sense ways of thinking. George Smith (1995) describes how his empirical study of HIV treatment access in Ontario produced a way of knowing that was counterintuitive for many ASO workers. His research emphasizes how lack of treatment access was linked with government failure to establish an infrastructure for delivering experimental treatments.…”

Section: Institutional Ethnography Social Movements and Community-bamentioning

confidence: 98%

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Troubling ruling discourses of health: Using institutional ethnography in community-based research

Mykhalovskiy¹,

McCoy²

2002

Critical Public Health

105

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This article responds to a recent call for detailed analyses of research processes that link the intellectual resources of the academy with communities and popular movements. Our discussion focuses on our experiences with the Making Care Visible (MCV) Project, a communitybased, qualitative research initiative conducted in Toronto, Canada, that explored the work people living with HIV/AIDS (PHAs) do to look after their health. This article focuses on the doing of the MCV Project and, in particular, on our use of the concept 'health work'. Our central aim is to demonstrate how the concept methodologically grounded the politics of our research efforts at various stages of our work. To this end, we describe how we used the concept in starting our research, selecting participants and carrying out interviews. Drawing on interview excerpts from Making Care Visible: Antiretroviral Combination Therapy and the Health Work of People Living with HIV/AIDS, we also describe a set of reading practices that helped produce an analysis of the social organization of health work and the ruling character of formal discourses of knowledge about treatment decision making. Overall, our discussion suggests how a particular form of critique is made possible by the conceptual coordination of research practice through the notion of health work.

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Section: Institutional Ethnography Social Movements and Community-bamentioning

confidence: 96%

Section: Institutional Ethnography Social Movements and Community-bamentioning

confidence: 98%

Troubling ruling discourses of health: Using institutional ethnography in community-based research

Mykhalovskiy¹,

McCoy²

2002

Critical Public Health

105

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“…Researchers have pursued institutional ethnographic explorations along these lines in a variety of fields, such as education, social work, and nursing and health research. A particular contribution of institutional ethnographic research is the alternative it offers to what George Smith (1995, 22) identified as ‘speculative accounts’ that blame troubling situations on opaque abstractions (‘red tape’) or the attitudes of institutional functionaries (‘homophobia’). Through an exploration of the actual institutional processes that blocked access to experimental drugs for the treatment of HIV/AIDS (1995) or organized police raids on gay bath houses (1988), Smith showed that what happened in these cases did not spring primarily from the attitudes of the individuals who worked in the system but took shape across a complex network of relations in which policies, legislation and describable, documentary forms of reporting played a key role.…”

Section: Research Contextmentioning

confidence: 99%

The textual organization of placement into long‐term care: issues for older adults with mental illness

Lane¹,

McCoy

Ewashen³

2010

Nursing Inquiry

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Arranging placement of older adults from hospital mental health units into nursing homes or assisted living facilities can be difficult and protracted. The difficulty in placing these individuals is often attributed to stigma; that is, personnel in nursing homes are reluctant to accept mentally ill older adults because of the fear of mental illness and violence. Using an institutional ethnographic approach, we argue the importance of exploring how nursing home access is organized, especially the institutional process of placement. Our study, examining the process of placing older adults from mental health units into nursing homes or assisted living facilities within a western Canadian city, reveals how three specific textual points within the institutional process of placement do not work well for older adults with mental illness. These textual points include: constructing the older adult as a 'placeable' person, the first-level match and the second-level match. After exploring why the three specific points in the process do not work well for mentally ill individuals, we reconsider the explanation of stigma, and then suggest implications for change.

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“…When taken up by well-funded and well-organised research and activist groups such as groups seeking to improve the safety of women experiencing domestic violence (Pence 1996, Sadusky et al 2010, and groups seeking to improve access to experimental treatment for those with HIV/AIDS (Smith 1995) IE has been a very useful approach with practical outcomes. The findings reported in this paper will be used to raise awareness of problems in RCHs among key stakeholders to hopefully start the process of change, however it is unclear how the findings could be used by the standpoint group to change the complex and powerful institutional practices dominating their working lives.…”

Section: Study Limitationsmentioning

confidence: 99%

“…This is because the way people take up and use powerful forms of knowledge in policy and research is considered key to understanding how the material conditions of the group under study are organised. For example, Institutional ethnographer and Canadian activist George Smith (1995) inquired into the experience of people with HIV/AIDs and the public health response to that group in Ontario Canada in the 1990s. Everyday people affected by HIV/AIDS knew that their condition was not always fatal, they also knew that in places other than Ontario treatments were available which prolonged life.…”

Section: Dnacpr Policymentioning

confidence: 99%

An inquiry into what organised difficult advance care planning conversations in a Scottish residential care home using institutional ethnography

Reid

Kydd

Slade

2018

Journal of Research in Nursing

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This paper provides an institutional ethnographic analysis of how Advance Care Planning (ACP) discussions which included advance decisions about serious illness, hospital admission and Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR) forms were systematically placed into the hands of Senior Social Care Workers (SSCWs) in a Residential Care Home (RCH). RCHs are care settings where there are no on-site nurses and access to hospital and/or community doctors and nurses is limited.The paper traces the organising features of day-to-day work gathered from interviews with SSCWs (n=4) and others (n=6) whose (well-intentioned) work shaped what happened in the RCH. It shows how the experience of SSCWs was socially organised to happen as it did as they (and others) complied with powerful organising texts such as national and local policy document, care plans and audit forms.The paper concludes that although SSCWs decision-making conversations were out of alignment with the national DNACPR policy they cannot simply be described as poor practice. This is because they were socially organised by a complex web of institutional practices related to the occupancy rate in the RCH, the inspection process of the care home scrutiny body, the quality assurance process of the RCH company, the funding of palliative care education, and powerful political and fiscal drives to reduce spending on over 75s. These practices had little to do with the actual care needs of RCH residents or the actual support needs of RCH staff.The paper points towards necessary policy changes. It also highlights how 'competent' work driven by ideological institutional practices can result in ethically troubling situations in day-to-day working life. This emphasises the importance of carefully examining the social organisation of situations typically described as 'poor practice' if we are to understand how they are (re)produced. It also offers a different account of care home deaths than is typically presented in the professional literature.2

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Accessing Treatments: Managing the AIDS Epidemic in Ontario

Cited by 25 publications

References 0 publications

Troubling ruling discourses of health: Using institutional ethnography in community-based research

Troubling ruling discourses of health: Using institutional ethnography in community-based research

The textual organization of placement into long‐term care: issues for older adults with mental illness

An inquiry into what organised difficult advance care planning conversations in a Scottish residential care home using institutional ethnography

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