The significance of overlooked objects: Materiality and care at home for people with dementia.

An increase in the number of older people with dementia is currently a trend around the world. In low and middle countries, effective public health services are not yet well-developed, and family care-givers may be overwhelmed by the requirements of care. This paper has two purposes: to share findings from an ethnographic study about family dementia care practices in Brazil and to draw attention to the significance of the materiality of care practices in the family context. The study was conducted in Belo Horizonte, Brazil. We describe the care trajectory of one family and, analysing data using the insights of Actor Network Theory, show the significance of objects in a networked relation of care. In particular, we show how incontinence products such as adult diapers assume different positions in the network, acting as either mediator or intermediary of care in relation to other elements of the network composed of family members and their living situation, the person with dementia herself, the doctor, and Brazilian health policies. Although the diaper is often seen as an ordinary object for care providers, its participation in a care network shapes relations, activating conflict, financial constraint, and disciplining the body of the person with dementia.

Caregiving for the Elderly Person: Discourses Embedded in the Brazilian Practical Guide for the Caregiver.

It is estimated that in 2025, Brazil will have the sixth largest elderly population in the world. Beyond the economic consequences of this projection, this changing demographic portends significant changes in the social realm. The aim of this study was to review and consider a range of government documents, developed during the past thirty years and directed toward elderly Brazilian citizens, to explore the ways that caregivers of older persons are positioned in daily care practices through the discourses such documents deploy. The analysis draws on Foucault's genealogical approach, and begins with a review of the historicity of policies, regulations, and legislation related to older people, followed by an analysis of the discourses embedded in the Practical Guide for the Caregiver, a document created by the Brazilian Ministry of Health to provide guidance to informal caregivers in the actual provision of care to elders. The analysis shows that throughout the Guide, caregivers are portrayed as multifaceted subjects; yet at the same time, three primary positionings for the caregiver and her or his work are emphasized: the almost-angel, the almost-healthcare professional, and the almost-household professional.

Power and practices: questions concerning the legislation of health professions in Brazil.

Developments in professional practice can be related to ongoing changes in relations of power among professionals, which often lead to changes in the boundaries of practices. The differing contexts of practices also influence these changing relations among health professionals. Legislation governing professional practice also differs from country to country. In Brazil, over the past 12 years, in a climate of deep disagreement, a new law to regulate medical practice has been discussed. It was sanctioned, or made into law, but with some notable changes, in July 2013. Of interest to us in this paper are the ways the proposed legislation, by setting out the boundaries and scope of medical practice, 'interfered' in the practices of other health professions, undermining many 'independent' practices that have developed over time. However, even taking into account the multiple routes through which practices are established and developed, the role of legislation that seems able to contradict and deny the historical realities of multiple, intersecting practices should be critically interrogated. In this paper, we use the theoretical resources of poststructuralist thinking to explore gaps, ambiguities, and power relations implicit in the discourses that constituted this law. We argue that although the new law can be understood as a social and political device that will interfere in the organization of other health professions' practices, such legislation is only part of what constitutes change in a consolidated professional practice. And while it is important to understand the effects of such legislation, healthcare practices are also realized or 'made real' through ongoing relations of knowledge and power, including, as we will see in this case, activities of resistance. The problem, then, is to understand the practical arrangements, including legislation, traditions and routines, values and knowledge that come to shape the practices of nursing in a particular context.

Configurations of power relations in the Brazilian emergency care system: analyzing a context of visible practices.

In this paper, we make explicit the changing configurations of power relations that currently characterize the Brazilian Emergency Care System (SAMU) team in Belo Horizonte, Brazil. The SAMU is a recent innovation in Brazilian healthcare service delivery. A qualitative case study methodology was used to explore SAMU's current organizational arrangements, specifically the power relations that have developed and that demonstrate internal team struggles over space and defense of particular occupational interests. The argument advanced in this paper is that these professionals are developing their work in conditions of exposure, that is, they are always being observed by someone, and that such observational exposure provides the conditions whereby everyday emergency care practices are enacted such that practice is shaped by, as well as shapes, particular, yet recognizable power relationships. Data were collected through the observation of the SAMU's work processes and through semi-structured interviews. Research materials were analyzed using discourse analysis. In the emergency care process of work, visibility is actually embedded in the disciplinary context and can thus be analyzed as a technique applied to produce disciplined individuals through the simple mechanisms elaborated by Foucault such as hierarchical surveillance, normalizing judgment, and the examination.

Reflexões sobre relações de poder na prática de enfermagem / Reflexiones sobre relaciones de poder en la práctica de enfermeria / Reflections about power relations in nursing practice

Uma reflexão sobre relações de poder na prática de enfermagem envolve aspectos das práticas cotidianas da equipe de enfermagem e da subjetividade dos sujeitos nelas envolvidos. A prática de enfermagem é muito mais do que uma prática em si. Assume a dimensão do significado atribuído pelos diferentes sujeitos que interagem em seus diversos cenários. Propõe-se, aqui, uma reflexão sobre as relações de poder na prática de enfermagem, considerando sua complexidade, os múltiplos processos que as constituem e as circunstâncias que determinam as formas de se pensar e de se agir em relação a elas. Para isso, é preciso pensar a subjetividade do sujeito, considerando-se como os limites profissionais são estabelecidos e mantidos e quais são os efeitos dessas relações para os sujeitos envolvidos, uma vez que relações de poder são definidas em transformações contínuas.

Una reflexión sobre las relaciones de poder en las prácticas de enfermería envuelve cuestiones relativas a las prácticas cotidianas del equipo de enfermería, y la subjetividad de los individuos participantes de ellas. La práctica de enfermería es mucho más de que una prática, pues incorporam la dimensión del significado atribuído por distintos sujetos que se integran en los diversos escenários donde suceden. Se propone aquí uma reflexión sobre las relaciones de poder en la práctica de enfermería teniendo em vista de su complejidad, los procesos del múltiplo que las constituyan y las circunstancias que determinan las formas de piensar y actuar en relación a ellas. Para esto, hay que pensar la subjetividad del sujeto, teniendo en cuenta como se establecen y se mantienen los límites profesionales, y cuáles son los efectos de estas relaciones para los sujetos implicados, ya que las relaciones de poder son determinadas por continuas transformaciones.

Reflections on power relations in nursing practice involves questions related to the daily practice of nursing staff as well the subjectivity of those involved in them. Nursing practice is more than a practice in itself. It assumes the dimension of meaning assumed by different subjects who interact in the places where it happens. It is proposed a reflection about power relations in nursing practice considering its complexity, the many processes which constitute it and the circumstances that determine the ways of thinking and acting in relation to them. It implies to think about subject's subjectivity, how professional boundaries are established, and which are these relations effects to subjects involved, since power relations are shaped in continuous transformations.

[Reflections about power relations in nursing practice]. / Reflexões sobre relações de poder na prática de enfermagem.

Reflections on power relations in nursing practice involves questions related to the daily practice of nursing staff as well the subjectivity of those involved in them. Nursing practice is more than a practice in itself. It assumes the dimension of meaning ascribed to it by different subjects who interact in the places where the practice takes place. We propose a reflection about power relations in nursing practice, considering their complexity, the many processes that constitute them and the circumstances that determine the ways of thinking about and acting in relation to them. Such reflection implies to think about the subject's subjectivity the way professional boundaries are established, and the effects of these relations upon the subjects involved, since power relations are in continuous transformations.