Niels Christian Mossfeldt Nickelsen

Intervention as workplace learning

Purpose The purpose of this paper is to illustrate how workplace interventions may benefit from a simultaneous focus on individuals’ learning and knowledge and on the situatedness of workplaces in the wider world of changing professional knowledge regimes. This is illustrated by the demand for evidence-based practice in health care. Design/methodology/approach The paper is based on a case study in a public post-natal ward in a hospital in Denmark in which one of the authors acted as both a consultant initiating and leading interventions and a researcher using ethnographic methods. The guiding question was: How to incorporate the dynamics of the workplace when doing intervention in professionals’ work and learning? Findings The findings of the paper show how workplace interventions consist of heterogeneous alliances between politics, discourse and technologies rather than something that can be traced back to a single plan or agency. Furthermore, the paper proposes, a road down the middle, made up by both an intentional and a performative model for intervention. Originality/value Intervention in workplaces is often directed towards changing humans, their behaviour, their ways of communicating and their attitudes. This is often furthered through reflection, making the success of intervention depend on individuals’ abilities to learn and change. In this paper, it is shown how intervention may benefit from bringing in workplace issues like different professional knowledge regimes, hierarchical structures, materiality, politics and power.

Shifting boundaries in telecare – the nurse-doctor relationship

Purpose Telecare is a growing practice defined as diagnosis, treatment and monitoring among doctors, nurses and patients, which is mediated through ICT and without face-to-face interaction. The purpose of this study is to provide empirically based knowledge about the organization of the use of ICT and dilemmas of this increasingly common practice in healthcare. Design/methodology/approach The study draws on observations, interviews and desk research in relation to a large €4.5m pilot project at four hospitals in Copenhagen regarding care of 120 patients with chronic obstructive pulmonary disorder (COPD). The empirical study was carried out over four months. Online video consultations were observed alongside workshops focusing on nurses’ photo elucidation of the telecare practice. The analytical ambition was to start the study in the middle of things and explore the emergent design of telecare. Findings Telecare not only embraces new standards and possibilities for professional responsibility and accountability for nurses but also alters the relationship between doctors and nurses. This leads to a dilemma we characterize as “paradoxical accountability”. Originality/value The study draws on Star’s notion of “infrastructure”. In this perspective, infrastructure comprises human and non-human conduct embedded in organizational conventions, relations and sites. The analysis demonstrates that nurses are not only exposed to a new responsibility as all-round case managers but they also have less access to clinical decision makers. The notion of “paradoxical accountability” is developed to account for this dilemma.