Beyond the insider/outsider debate in "at-home" ethnographies: Diffractive methodology and the onto-epistemic entanglement of knowledge production.

In this article, we discuss the practice of conducting research in one's own field, in this case, from a position as a researcher with a nursing background doing fieldwork in a hospital and in one's own organization, an orthopedic surgical department. We show how an "insider" researcher position paves the way for analytical insights about sleep as an institutional phenomenon in the orthopedic surgical infrastructure and how acute and elective patient trajectories differ but build on the same logic, creating the same dynamics of inclusion and exclusion. Through a situated and sociomaterial perspective, we analyze different clinical interactions in which we follow the hospital bed as an example of a central relational element that co-creates sleep as an institutional phenomenon. Inspired by Karen Barad, we demonstrate how to move diffractively when doing and analyzing fieldwork and argue how moving diffractively as a researcher doing fieldwork "at home" is productive and challenges the concept and demand of "distance" as the phenomenological exercise in fieldwork.

Ambiguities in Preventing Infections in Nursing Homes: Care Workers Experiences and Implications for Future Policies.

Preventing infections in nursing homes is highly challenging, given the ambiguous nature of nursing homes as care institutions and places to live. Yet, little is known about how care workers experience preventing infections in this context. Understanding the ambiguities experienced by care workers in nursing homes when enacting infection prevention is crucial to preparing for future health crises. This study investigates and identifies the ambiguities care workers faced and experienced when preventing infections during the COVID-19 pandemic. Interviews and observations were combined to capture narratives and behaviors related to infection prevention and care work. By using thematic analysis, three types of ambiguity were identified: (a) an Ambiguous sense of purpose, (b) Environmental ambiguity, and (c) Information ambiguity. The findings provide a nuanced understanding of the ambiguities care workers face and experience in nursing homes when preventing infections and indicate that such ambiguities impact their behaviors and attitudes. From this study, it is possible to conclude that policymakers must consider nursing homes' ambiguous characteristics in infection prevention programs.

Preventing infections in nursing homes entails performing behaviors related to hygiene in the ambiguous context of being both a home and a care institution.Care workers experience ambiguity of purpose, environmental ambiguity and information ambiguity when preventing infections in nursing homes.Infection prevention policies need to consider nursing homes' ambiguous characteristics to respond to health crises in the future.Particular attention must be paid to the ambiguities experienced by care workers.

Algorithmic assemblages of care: imaginaries, epistemologies and repair work.

In the past decade, the figure of the algorithm has emerged as a matter of concern in discussions about the current state of the healthcare sector and what it may become. While analytical focus has mainly centred on 'algorithmic entities', the paper argues that we have to move our analytical focus towards 'algorithmic assemblages', if we are to understand how advanced algorithms will affect health care. Departing from this figure, the paper explores how an algorithmic system, designed to 'take on' the role of a physiotherapist in physical rehabilitation programmes in Denmark, was designed and made to work in practice. On the basis of ethnographic fieldwork, it is demonstrated that the algorithmic system is a fragile accomplishment and outcome of negotiations between the imaginaries embedded in its design and the ongoing adjustments of IT workers, patients and professionals. Drawing on recent work on the fragility and incompleteness of algorithms, it is suggested that the algorithmic system needs to be creatively 'repaired' to build and maintain enabling connections between bodies in-motion and professionals in arrangements of care. The paper concludes by addressing accountability for the workings of algorithmic systems in medical practice, suggesting that such questions must also be discussed in relation to encounters between algorithmic imaginaries, health professionals and patients, and the various forms of 'repair work' needed to enable algorithmic systems to work in practice. Such acts of accountability cannot be understood within an ethics of transparency, but are better thought of as an ethics of 'response-ability', given the need to intervene and engage with the open-ended outcomes of algorithmic systems.

Patient explanations for non-attendance at type 2 diabetes self-management education: a qualitative study.

AIM: To explore reasons for non-attendance at type 2 diabetes self-management education. METHODS: To elicit the main themes explaining non-attendance, 15 semi-structured interviews were conducted with persons referred to, but not attending, self-management education. Systematic text condensation was applied to code and generate themes subsequently organised under individual and organisational factors. RESULTS: Individual (illness, lack of perceived benefit) and organisational factors relating to schedule (four whole days, time of day, notification) and content (supermarket visit) were cited as reasons for non-attendance. CONCLUSIONS: In this study, patients cited both individual and organisational factors as explaining non-attendance at type 2 diabetes self-management education. Further studies should take into account the importance of timing and of tailoring schedules and content to individuals' life situations and resources. As organisational factors are likely to vary across programmes and settings, more case studies are needed to further elucidate the dynamic relationship between individual and organisational factors to explain non-attendance at type 2 diabetes self-management education.

Representing and intervening: 'doing' good care in first trimester prenatal knowledge production and decision-making.

This article investigates processes of knowledge production and decision-making in the practice of the first trimester prenatal risk assessment (FTPRA) at an ultrasound clinic in Denmark. On the basis of ethnographic material and interviews with professionals facilitating FTPRAs in Denmark, we draw attention to the active engagement of health professionals in this process. Current professional and policy debate over the use of prenatal testing emphasises the need for informed choice making and for services that provide prospective parents with what is referred to as 'non-directive counselling'. Studies focusing on professional practice of prenatal counselling tend to deal mainly with how professionals fail to live up to such ideals in practice. In this article we extend such studies by drawing attention to practices of care in prenatal testing and counselling. In doing so, we identify three modes of 'doing' good care: attuning expectations and knowledge, allowing resistance and providing situated influence in the relationship between the pregnant woman and the professional. Such practices may not be seen as immediately compatible with the non-directive ethos, but they express ways of reducing emotional suffering and supporting a pregnant woman's ability to make meaningful choices on the basis of uncertain knowledge. As such, these practices can be seen as representing another (caring) solution to the problem of paternalism and authoritarian power. In opposition to an ethics aiming at non-interference (non-directiveness) such modes of doing good care express an ethics of being locally accountable for the ways in which programmes of prenatal testing intervene in pregnant women's lives and of taking responsibility for the entities and phenomena that emerge through such knowledge production.

When self-tracking enters physical rehabilitation: From 'pushed' self-tracking to ongoing affective encounters in arrangements of care.

In this paper, I explore what happens when self-tracking technologies and devices travel into the context of physical rehabilitation and come to constitute what Lupton has called 'pushed' self-tracking. By unpacking the processes through which a self-tracking technology is put to use in physical rehabilitation in Denmark, and the kind of relationships patients and healthcare providers establish with and through this technology, I illustrate how a new geography of responsibility is constituted, where responsibility for professional guidance is delegated to the technology and patients are expected to produce and engage in movement data. In contrast to the image of 'pushing' as a single activity where one part (technology) has the authority to push the other (patient) to act in certain ways, I argue that 'the push' is better described as an ongoing and contingent process that evolves through affective and affecting encounters between human (patients, healthcare providers) and nonhuman (technology, algorithms, software) actors. I illustrate that even though responsibility is delegated to the technology, it is unable to make bodies move by itself. Rather, what determines what 'it' becomes and how 'it' comes to act is enabled by the constitution of a wider arrangement of care and the arrangements' ability to affect and respond to particular bodies.