The choreographies of the elimination of faeces-An ethnographic study of the institutionalized body care practices of older people in different health care settings.

AIM: To explore the choreographies of the elimination of faeces of older people to gain insight into the institutionalized practices of body care of older people in hospitals and long-term care settings. DESIGN: A qualitative ethnographic study, drawing on a perspective of socio-material theory. Reported in accordance with the Standards for Reporting Qualitative Research. METHODS: A total of, 30 women and 11 men aged 80 years and above needing assistance with body care in a hospital ward, 2 nursing homes and home care and 32 care workers participated. Four individual interviews with older people and three focus group interviews with care workers were conducted, in addition to 135 h of participant observations, from December 2020 to September 2021. Data were analysed using a situational analysis approach. RESULTS: The assistance with the elimination of faeces is a multiplicity of ongoing dynamic practices where different actors interrelate. Dominating actors are time, space, materialities, different ideals and professional knowledge. The choreographies aim at order the elimination of faeces to happen at the right time at the right place, to provide dignified care. CONCLUSION: To assist older people with the elimination of faeces is complex institutionalized practices. The study argues for a greater focus on the ongoing relations between human and non-human actors to provide new understandings of an underexplored phenomenon in nursing. IMPACT: What problem did the study address? The elimination of faeces of older people as part of body care is an underexplored phenomenon in nursing, often subject to stigma and taboo, and delegated to other healthcare workers than registered nurses. Internationally, there are challenges in the delivery of fundamentals of nursing care to older people across healthcare settings. Few studies have explored body care as an institutionalized practice across different settings, taking into consideration the contextual aspects of care as well as the involvement of non-human actors in the care practices. What were the main findings? Multiple human and non-human actors are involved when older people need assistance with the elimination of faeces. Time, space, materialities, different ideals and professional knowledge are important actors. The elimination of faeces is not a homogeneous practice but ongoing, dynamic, and multiple practices. The context of care practices related to the elimination of faeces is not an outer macro level distant from care, but part of the ongoing daily practices of body care. Where and on whom will the research have an impact? The findings can inspire researchers and clinicians to develop a new understanding of fundamental care needs. The study offers a critical perspective on possibilities for providing care, since political ideals and governance are active actors in daily care practices. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution. The study was conducted during the COVID-19 pandemic; restrictions limited the access to involving patients and care workers in the research process. An advisory board consisting of leaders from the different settings was a part of the design process and in the interpretation of data. RECOMMENDATIONS FOR FURTHER RESEARCH: The socio material theoretical perspective has a potential to unfold the complexities in nursing care practices focusing on aspects that are underexplored in nursing research.

Understanding digital health: Productive tensions at the intersection of sociology of health and science and technology studies.

In this editorial introduction, we explore how digital health is being explored at the intersection of sociology of health and science and technology studies (STS). We suggest that socio-material approaches and practice theories provide a shared space within which productive tensions between sociology of health and STS can continue. These tensions emerge around the long-standing challenges of avoiding technological determinism while maintaining a clear focus on the materiality and agency of technologies and recognising enduring sets of relations that emerge in new digital health practices while avoiding social determinism. The papers in this Special Issue explore diverse fields of healthcare (e.g. reproductive health, primary care, diabetes management, mental health) within which heterogenous technologies (e.g. health apps, mobile platforms, smart textiles, time-lapse imaging) are becoming increasingly embedded. By synthesising the main arguments and contributions in each paper, we elaborate on four key dimensions within which digital technologies create ambivalence and (re)configure health practices. First, promissory digital health highlights contradictory virtues within discourses that configure digital health. Second, (re)configuring knowledge outlines ambivalences of navigating new information environments and handling quantified data. Third, (re)configuring connectivity explores the relationships that evolve through digital networks. Fourth, (re)configuring control explores how new forms of power are inscribed and handled within algorithmic decision-making in health. We argue that these dimensions offer fruitful perspectives along which digital health can be explored across a range of technologies and health practices. We conclude by highlighting applications, methods and dimensions of digital health that require further research.

Beyond the realist turn: a socio-material analysis of heart failure self-care.

For patients living with chronic illnesses, self-care has been linked with positive outcomes such as decreased hospitalisation, longer lifespan, and improved quality of life. However, despite calls for more and better self-care interventions, behaviour change trials have repeatedly fallen short on demonstrating effectiveness. The literature on heart failure (HF) stands as a case in point, and a growing body of HF studies advocate realist approaches to self-care research and policymaking. We label this trend the 'realist turn' in HF self-care. Realist evaluation and realist interventions emphasise that the relationship between self-care interventions and positive health outcomes is not fixed, but contingent on social context. This paper argues socio-materiality offers a productive framework to expand on the idea of social context in realist accounts of HF self-care. This study draws on 10 interviews as well as researcher reflections from a larger study exploring health care teams for patients with advanced HF. Leveraging insights from actor-network theory (ANT), this study provides two rich narratives about the contextual factors that influence HF self-care. These descriptions portray not self-care contexts but self-care assemblages, which we discuss in light of socio-materiality.

The Role of Common Ground on Object Use in Shaping the Function of Infants' Social Gaze.

Although infants' social gaze has specific communicative functions, it remains unclear what they are. In this conceptual analysis paper, we provide a theoretical framework for the study of the functional aspects of eye gaze in early childhood. We argue that studying the communicative functions of infants' eye gaze involves three premises: the centrality of the object, the importance of common ground on object use, and the role of parental interpretations. The ability to communicate intentionally begins when infants start referring to external objects. Beyond dyadic - infant-parent - emotional sharing, infant social gaze within the infant-parent-object triad becomes an increasingly complex communicative modality. As the predominant type of communicative referents in infancy, objects are thus central to early communication. Although they have affordances, objects are used in conventional ways shared between users (i.e., common ground). Parents transmit to infants the socio-cultural use of objects, which infants progressively learn and master. Accordingly, we argue that within early triadic interactions, the communicative function of infants' eye gaze is shaped by the knowledge that the infant and the parent share on the socio-cultural use of the referent (i.e., the object). Importantly, before young children develop their ability to convey clear communicative functions, including with eye gaze, the interpretations and responses that parents provide to infants' early communicative acts play a major role. Relying on these premises, we argue that when referring to objects for which the infant and the parent share common ground, the function of the infant's social gaze becomes communicatively meaningful for the parent. The knowledge on the communicative referent (i.e., the object) shared between the infant and the parent thus shapes the course of communicative behavior, constitutes and reflects the interactive function of gaze, and cues parents into tailoring their communicative response according to the infant's developmental needs. Through this theoretical framework for the study of the communicative function of infant eye gaze, an emphasis is put on the key role that socio-materiality plays in early communicative development.

Concerted Creativity: Emergence in the Socio-(Im)Material and Intangible Practice of Making Music.

The purpose of this article is to explore how the basic conception of 'emergence' informs the study of creativity as a socio-material practice. Initially, the article explicates how creative processes, products and performances involve not only tangible, but also intangible and social elements. Secondly, the theoretical conception of creativity as socio-material and the general philosophical notion of emergence are introduced. Inspired by the idea that a 'whole' is other than the sum of its 'parts' and by examples primarily from the world of music, the article argues that the relationship between subject and object - the main analytical focus of studies on creativity as a socio-material practice - is fundamentally embedded in an emergent process. The article concludes by highlighting how emergence theory acknowledges the performance or product as an intangible material for creative processes of musicians, and that studies of the socio-materiality of creative practices clearly involving tangible, intangible and social elements must refer to the emergent process through which the creative product or performance evolves meaning. The theoretical framework suggested is relevant for researchers interested in exploring how materials, social settings and physical environments are involved in creative processes.

Concerted Creativity in the Digital Age: How do we Crack the Code ?

The purpose of the present article is to contribute to the development of a socio-material, situated conceptualization of creativity, in exploring music making as it becomes meaningful in performative emergence processes of the digital age. It uses the creative practices of musicians to analyse and discuss the qualities of 'digital materials' in a creative setting, today very often playing a critical role in the production and performance of music. Methodologically, the analysis is based on interviews with professional musicians performing at Roskilde Festival and observations inspired by the autoethnographic approach. The study concludes that creative musical emergence in performance situations of the digital age depends on an openness towards a fragility, imperilling the situation and 'cracking' the digital materiality.