Accepted paper:

Distributed specialist health-care services to the patients home, impact on professional and patient roles

Authors:

Gunnbjorg Aune (Sunnaas Rehab. hospital)

Paper short abstract:

Paper long abstract:

Distributed health-care services involve a network of technology, technicians, health care professionals and patients together with economical and institutional frames. Through the mobilization of the notion of "script" I will focus on how the actors involved are delegated certain roles. My interest will be on how roles, tasks and practices among human actors shift. I draw on empiric data from a pilot project where patients with spinal cord injury (SCI) and bedsores are offered weekly specialist consultations in their home in collaboration with the district nurses. Computer based videoconferences are used. The consultations are initiated and operated from the specialist health service in order to follow up "their" patients at home. In doing so the specialists take over the responsibility for the treatment of the bedsores. As a consequence the district nurses' role change from being delegated the evaluation and change of procedures related to the bedsore, to the role as partners in a mutual online discussion. The district nurses keep the "hands-on" tasks like palpating the skin, but the specialists make the decisions. The patients' are moved from a hospital setting into their own home. Avoiding pressure on the bedsore area is one key element of healing bedsores among patients with SCI. Bringing the web camera and real time connection into the home give the specialists opportunity to evaluate the bedsore, but also to regularly control the patients' ability to follow the recommendations, and also to follownhow the district nurses manage the bedsore treatment.

panel D1
Technologies of care and participation: Shifting the distribution of expertise and responsibilities