Janet Rankin

The social organization of a sedentary life for residents in long-term care

Worldwide, the literature reports that many residents in long-term care (LTC) homes are sedentary. In Canada, personal support workers (PSWs) provide most of the direct care in LTC homes and could play a key role in promoting activity for residents. The purpose of this institutional ethnographic study was to uncover the social organization of LTC work and to discover how this organization influenced the physical activity of residents. Data were collected in two LTC homes in Ontario, Canada through participant observations with PSWs and interviews with people within and external to the homes. Findings explicate the links between meals, lifts and transfers, and the LTC standards to reveal that physical activity is considered an add-on program in the purview of physiotherapists. Some of the LTC standards which are intended to product good outcomes for residents actually disrupt the work of PSWs making it difficult for them to respond to the physical activity needs of residents. This descriptive ethnographic account is an important first step in trying to find a solution to optimize real activities of daily living into life in LTC.

Reflections of a Novice Institutional Ethnographer

Institutional ethnography (IE) was developed by Dorothy E. Smith, a Canadian sociologist, in the 1980s. This method of inquiry helps to uncover how the everyday experiences of people in local settings are organized by and linked to the work of others. The purpose of this article is to provide newcomers to IE with insights gained from the first authors learning as a novice institutional ethnographer. These insights stem from her doctoral thesis, which examined how the promotion of physical activity is socially organized in long-term-care homes. The benefits of using IE are considered and the challenges encountered in trying to understand and use this method of inquiry are examined. Strategies used to overcome the challenges are discussed.

Nurses’ knowledge and deliberations crucial to Barcoded Medication Administration technology in a Dutch hospital: Discovering nurses’ agency inside ruling

This article shows how Barcoded Medication Administration technology institutionally organizes and rules the daily actions of nurses. Although it is widely assumed that Barcoded Medication Administration technology improves quality and safety by reducing the risk of human error, little research has been done on how this technology alters the work of nurses. Drawing on empirical and conceptual strategies of analysis, this qualitative study used certain tools of institutional ethnography to provide a view of how nurses negotiate Barcoded Medication Administration technology. The approach also uses elements from practice theory in order to discern how technology operates as a player on the field instead of being viewed as a ‘mere’ tool. A literature review preceded participant observation, whereby 17 nurses were followed and data on an orthopaedic ward were collected over a period of 9 months in 2011 and 2012. Barcoded Medication Administration technology relies on nurses’ knowledge to mediate between the embedded logics of its design and the unpredictable needs of patients. Nurses negotiate their own professional logic of care in the form of moment-to-moment deliberations which subvert the ruling frame of the barcoded system and its objectified model of patient safety. The logic of Barcoded Medication Administration technology differs from the logic of nursing care, as this technology presumes medication distribution to be linear, even though nurses follow another line of actor-bound safety practices that we characterize as ‘deliberations’.

Interrogating the Rights Discourse and Knowledge-Making Regimes of the “Movement for Global Mental Health”

This chapter is written in the context of the “scaling up” of the movement for global mental health. Looking at a program that began benignly, the authors trace its gradual deterioration, particularly focusing in on what happens when a conflation occurs between people’s rights being honored and their receiving of “psychiatric treatment.” This timely critique points in the direction of alternatives to the increasingly objectified and globalized notions of “the right to mental health,” arguing for a return to the more open processes with which this movement began.