How place matters: unpacking technology and power in health and social care

Abstract

The devolution of care into nontraditional community-based settings has led to a proliferation of sites for health and social care. Despite recent (re)formulations of 'evidence-based' approaches that stress the importance of optimizing interventions to best practice by taking into account the uniqueness of place, there is relatively little guidance in the literature and few attempts to systematically 'unpack' key dimensions of settings most relevant to policy, practice and research. In this paper, we explore how place matters for health and social care. In effect, we propose making place the lens through which to view practice, and not simply an interesting sideline focus. We focus specifically on (a) the emplacement of power relations in health and social care in and across settings; and (b) the pervasive (and often unrecognised) influence of technology on and in place (both 'mundane' and more visible 'high' technologies) as arguably among the most significant and pervasive (and often overlooked) dimensions of place pertinent to health and social care in both traditional (institutional) and nontraditional (community) settings. Drawing on diverse disciplinary literatures, we seek to make visible certain issues and bodies of work that health professionals may not be aware of, and which often remain inaccessible to practitioners and applied researchers on account of their density, complexity, and specialised terminology. In particular, drawing on the rich tradition of cultural studies, we advance the culture of place as a rubric for understanding the complex interrelationship between power, technology, culture, and place. Several fruitful avenues for place-sensitive research of health and social care practice (and its effects) are suggested.

Moving beyond local practice: Reconfiguring the adoption of a breast cancer diagnostic technology

“…relocating pathology; creating a new 'satellite' pathology lab next door to theatre; using 'runners' to take the biopsy to the pathology lab and return with the results, which added to costs. In line with our findings, previous studies have pointed out the ways in which new technologies, such as BLNA, have the potential to modify the form, structure and range of settings and communication methods used within healthcare practice (Poland et al, 2005;Andrews and Evans, 2008).…”

Doing ‘technological time’ in a pediatric hemodialysis unit: An ethnography of children

“…Researchers and theorists (Almerud, Alapack, Fridlund & Ekebergh, 2008;Barnard, 2002;Barnard & Sandelowski, 2001;Bennett, 2010Bennett, , 2011Bevan, 1998Bevan, , 2000McGibbon & Peter, 2008;Poland et al, 2005;Sandelowski, 2002;Tranter et al, 2009;Wynn, 2002;Zitzelsberger, 2004) have called for more research to investigate the nature and effects of technologies in and on specific places of care. Some studies explored nurses' views (Bull & FitzGerald, 2006;Marck, 2000;McGibbon & Peter, 2008;Tranter et al, 2009) and Allen et al (2011) andNagle (1998) identified the need to investigate similarities and differences between care recipients' and providers' perspectives of technologies and their settings.…”

‘A bed in the middle of nowhere’: Parents' meanings of place of death for adults with cystic fibrosis

“…However, home and hospital ward environments continue to become more fluid for these 'new' ageing populations through the movement of more 'simple' routine technologies such as intravenous drug equipment into the home setting (Poland et al, 2005). Through routine home care provided throughout the lifespan, home space for this population may already be considered as a quasi-clinical context.…”