Programme

(T088)
Policy and Care (or Care-Full Policy): exploring practices, collectives and spaces
Location 131
Date and Start Time 01 September, 2016 at 09:00
Sessions 3

Convenors

  • Vicky Singleton (Lancaster University) email
  • Claire Waterton (Lancaster University) email
  • Ingunn Moser (Diakonhjemmet University College) email
  • Hilde Thygesen (VID Scientific University) email
  • Monica Greco (Goldsmiths, University of London) email

Mail All Convenors

Discussant Michael Schillmeier (University of Exeter)

Short Abstract

This track asks how policies relate with care in diverse: domains of practice, cultural locations and historical moments. It explores how care and policy are and can be woven together and how theorising 'care' with 'policy' opens up these categories in ways that have transformative potential.

Long Abstract

While 'policy' can be seen as a historically, culturally and politically specific form of care, the relationship between policy and care has been shown to be complex and frequently problematic. Today, there is widespread public, professional and political realisation that 'policies' (which we understand to be complex socio-technical and material-semiotic collectives) are not care-full enough and may promote relations of harm. We invite contributions that explore how policy relates with care in diverse domains of practice, in varied geographical and cultural locations and at different historical moments. The policy domains might include: human and animal health, disability, waste management, environment, food safety, climate migration, economics. Theoretical and empirical contributions are welcome, including those based on historical, cultural, feminist, and economic research. The contributions could speak to the following questions:

1. How do theories associated with care and caring help us open up questions about what policy is/could be?

2. What is cared for and what is neglected? (e.g. time, materiality, lifecycles, geographical specificity)

3. How do different practices of policy promote care and/or harm? (e.g. through standards, protocols, grids, schedules, audits, assessments, targets, disciplinary procedures).

4. How does context matter? What relations and spaces promote forms of caring and/or harm?

The session has three aims:

• to collectively explore in what diverse ways 'care' and policy are and can be woven together;

• to attend to situated empirical examples;

• to show how theorising 'care' and 'policy' together helps open up both these categories in ways that have political and transformative potential.

SESSIONS: 3/4/4

This track is closed to new paper proposals.

Papers

Conjunctions of policy and care in German community mental health care services

Author: Milena Bister (Humboldt Universität zu Berlin)  email

Short Abstract

The obligatory psychiatric care system of the city of Berlin sets the framework for service provision in community mental health care. This paper engages ethnographically with the conjoined articulations of policy and care in these services as induced by accountability measures.

Long Abstract

In Berlin, public mental health care services in the community sector form part of the cities obligatory psychiatric care system. This policy mandates a certain variety of community care facilities with specified capacities every year. Welfare authorities (re-)assign places in the services to the clients annually via a standardized form, the so-called Treatment and Rehabilitation Plan. The form has been introduced in the 1990ies to insert principles of individualized care.

Based on an ethnographic study in community mental health care services in 2013, this paper highlights how policy and care are conjoined, that is mutually enacted and kept apart, in daily service provision. Building on material-semiotic theory within STS, I will argue that it is especially accountability measures, such as the Plan and electronic service documentation, which support a dominant conjunctive relation between mental health care policy and daily care practices. Finally I will suggest how conjoining policy and care through accountability significantly shapes what it means to care and be cared for in the spaces of contemporary German community mental health care.

Moving Policy: Caring for physical activity in dementia care

Author: Annelieke Driessen (London School for Hygiene and Tropical Medicine)  email

Short Abstract

I argue that two policies on physical activity in dementia care isolate ‘good’ from ‘bad’ physical activity, thereby neglecting their interweaving in practice and argue that addressing both ‘matters of care’ together, policies may become more care-full.

Long Abstract

Policies, in their goals, tend to foreground particular 'goods' or 'bads' that require intervention.

In 2012 the Dutch Inspection of health care urged nursing homes to implement measures to increase residents' physical activity levels to at least 30 minutes per day. Physical activity is herein posited as 'good'; the question is how it may be increased. Simultaneously, policy on 'problem behaviour' in dementia care, that talks of 'wandering' or 'walking away', point to the potentially problematic nature of physical activity in dementia care. The urgent question here is how to reduce it without restricting residents' freedom. Both are matters of care (Puig de la Bellacasa 2011).

In this paper, in the material semiotic tradition, I discuss how these two policies employ different knowledge traditions to highlight different aspects of life on the ward. I argue that by isolating 'good' physical activity from 'bad' physical activity, the policies neglect their interweaving in practice. I present ethnographic examples of practices in which this interweaving is visible: for instance, increasing activity classes decreased wandering; a resident who is taken for a walk, stops searching 'home' afterwards. I argue that, instead of imposing norms on practitioners, addressing both 'matters of care' together, policies may become more care-full.

Good Nurse In Training: 'Carefully' developing an ethical model of the simulated patient

Author: Ivana Guarrasi (University of California, San Diego)  email

Short Abstract

Based on ethnographic observations in the simulation laboratory this paper argues that normative notions of “ethic of patient care” in the situated training of nursing competence become a masked system of morals bound by checklists, protocols, and practices of standardization.

Long Abstract

Training in clinical skills informed by the ethics of care is central in human simulation in nursing. This paper examines current tensions and difficulties faced by educators in designing nursing laboratory simulations, in which students would benefit from interactions with real humans within the standardized patient (individuals trained to portray a patient) model of clinical simulations. Considering cultural perspectives of care and ethic of care, this paper critiques the programmatic care orientation of nursing clinical skills training in the laboratory.

Based on ethnographic observations in the laboratory I argue that despite institutional assertions of socializing student nurses into acquiring and practicing a caring role, normative notions of "ethic of patient care" in the training for nursing competence become a masked system of morals bound by checklists, protocols, and practices of standardization. The standardized patients' subjectivity is meticulously trained and heavily surveilled, following institutional commitments of objective, reliable and valid measures of the ethical dimension in the students' performances. In effect, simulation educators base their practices on abstract moral principles that can be judged and evaluated based on rational categories that assert care as a universal standard, and not by an ethic of care that takes as central subjective caring, relationships, and compassion of an "interconnected self." I suggest that in nursing simulations an ethic of care is rather situated in the tension between the opposite imperatives of care and justice (Ganis, 2011), privileging the latter under a normative notion of good care stipulated by policy

Digitized HPV vaccination communication as promising and troubling care

Author: Lisa Lindén (University of Gothenburg)  email

Short Abstract

This paper attends to digital “participatory” HPV vaccination campaigns as realizations of “care-full” county council communication policies. I discuss Facebook and app devices, experts and publics as assembling care collectives that enable and trouble policy visions of care.

Long Abstract

Devices enable and distribute care, but they can also participate in troubling and unsettling care. In attending to HPV vaccination campaigns as realizations of county council communication policies in Sweden, in this paper I draw upon my PhD thesis (Lindén 2016) to discuss two digital media communication initiatives as assembling care collectives of digital devices, experts and publics. In the county council communication policies, smartphone apps and social media are embraced as devices that allow for public engagement, care accessibility and "target group" adjusted communication. Accordingly, digital media is promised to enable "good care", and, what could be described as, "care-full" policies. By relating to recent feminist STS work on care (e.g. Martin et al. 2015), I discuss what is cared for in, and through, this promise of digital media as enabling "good care", what, and who, is neglected, and what trouble this generates.

I draw upon communication on a HPV vaccination campaign Facebook site, a "HPV app" campaign (incl. responses from users), and interviews with county council professionals working with these two campaigns. Based in this, I discuss how devices, experts and different publics, simultaneously, enable and trouble county council (policy) visions of care. In doing so, I define Facebook devices (i.e. social buttons) and the HPV app as "care enablers" (Eidenskog 2015) that participate in realizing "care-full" policies. I also discuss them as "care troublers" that help disturbing and unsettle such visions of care, and that enact alternative versions of what "good care" is.

Compassion in health care: Unsettling generalisations

Authors: Vicky Singleton (Lancaster University)  email
steve mee (university of cumbria)  email

Short Abstract

Compassion is a key focus of British health policy. However, critiques suggest that it is the latest buzzword, with little meaning in practice. We tell stories about compassion as situated and alert to otherness-in-relation in order to open up possibilities for more ‘care-full’ policy.

Long Abstract

Compassion is acknowledged by practitioners and patients as crucial to 'good care' and it is a focus of current British health care policy. Recent exposures of failures of care are diagnosed as a consequence of lack of compassion (Francis 2013) and there is an explicit policy focus on putting 'compassion at the heart of healthcare' (DOH, 2013; NHS England, 2014). This is a welcome change in policy priorities, towards quality and every day ethics of care and away from targets and quantifiable outcomes (Berwick, 2014). However, critiques suggest that compassion is the latest buzzword in policy and professional training and has little meaning, especially in terms of promoting good care in locations of practice. Compassion is a more elusive entity than, for example, reducing waiting lists. It is responsive to individual patients' needs in specific contexts and is difficult to measure and quantify. We tell stories about compassion in a number of locations of care practice - a general community practice, a hospice, a roadside where a paramedic responds to an accident and a policy document. The stories articulate compassion as an effect of everyday practices and relations, unsettling collaborations and on-going negotiations. The stories show limits of, and require critique of, the generalisation of compassion. They narrate good care as embodied, curious practices that are alert to otherness-in-relation (Haraway, 2008). Finally we reflect on telling stories as a method for producing policy as more 'care-full'.

Care at the food bank: exploring policies, practices and normativities

Author: Hilje van der Horst (Wageningen University)  email

Short Abstract

This paper explores a food bank in the Netherlands and unravels the forms of care that are encountered there. It compares normativities as established in this grass root poverty alleviation with normativities in national poverty policies.

Long Abstract

Many Western countries have seen the emergence and spread of food banks over the last decades. In the Netherlands food banks have been founded as local, grass root initiatives since 2002 and reach an ever growing number of households with very low spendable incomes. For this paper I draw from fieldwork in a particular food bank in the Netherlands consisting of interviews with food receivers and food bank volunteers, as well as observation of various food bank related practices. The objective of this, and most other food banks in The Netherlands, is two sided. The organization distributes food past the expiration date and other unsellable products to households with very low spendable incomes to help the environment and simultaneously reduce food scarcity.

I unravel the kinds of care that are practiced in this food bank. Care is found in setting guidelines to ensure food safety, in reassuring people that they can eat food past the expiration date and in attending to people's feelings of shame about coming to the food bank. However, in some cases, harm and care prove to be intimately related. While distributing food past the expiration date was established as care for the environment, it also caused harm in receivers who felt they were degraded by eating 'waste'.

I conclude by comparing the diverse normativities about what counts as good and what as bad care in the food bank to such normativities in national policies on poverty, food safety and food waste.

Culture of Care and organisational culture in animal research facilities

Author: Annabella Williams (Understanding Animal Research)  email

Short Abstract

Through focus interviews I consider how the interactions and practices of staff working in facilities for research animals contribute to an organisational 'culture of care'. This paper presents initial findings of how cultural interactions in the animal research sector affect capacity for care.

Long Abstract

Within organisations that use animals in scientific research establishing a culture of care is a considered a core function of the Animal Welfare Body, as established in Directive 63/2010/EU, yet the interactions that either create or undermine an organisational culture of care in animal facilities are not well understood. While there is extensive discussion about the need for care to be an intrinsic part of culture in animal facilities there is currently little formalised practice.

This paper considers how people working in and with animal facilities contribute to the culture of care in their organisations, and the key factors that influence this culture. The research is based in a series of focus groups with animal technicians and scientists, supplemented by interviews with key stakeholders from the animal research sector.

The study will:

• Consider and identify key features and indicators of a caring culture

• Develop understanding of what steps can be taken to influence and lead a culture of care within an animal science setting

This work will consider how the interactions of people who make up an organisation contribute to its culture, and influence the capacity for caring practice, reflecting on current understanding about culture of care post-Francis inquiry to consider how practices in the animal research sector can benefit from these ideas.

Between local specificities and general goals: the overweight prevention programme of an ambitious municipality

Author: Else Vogel (Linköping University)  email

Short Abstract

This paper explores what it may mean for a policy program to be sensitive to the local specificities of the problem it targets. Detailing the ‘community approach’ of an overweight prevention programme, I analyse the translations between participants’ varied concerns and the policy’s general target.

Long Abstract

This paper explores what it may mean in practice for a policy program to be caring, as in sensitive to the local specificities of the problem it targets. Drawing on material semiotics, I analyse practices linked to the obesity prevention programme of a large municipality in the Netherlands. The programme's aim is that by 2030 all children in the city will have a healthy weight. Professionals working in health care, social welfare and urban planning are mobilised, and so too are neighbourhoods. Rather than employing top-down solutions to pre-set problems, the program seeks to facilitate bottom-up health initiatives that emerge from the situations, concerns and abilities of the targeted population. In the programme's 'community approach', overweight emerges in close relation with other forms of suffering such as poverty and social isolation. Grounded in the idea that health is more than physical normality, the programme facilitates spaces for caring, such as cooking and walking groups, where a range of 'goods' may be fostered, including fun, togetherness and self-confidence. At the same time, participating in the programme (and receiving public money) comes with certain rules: volunteers must follow certain procedures, attend trainings and evaluate their projects. I analyse the translations between the participants' varied concerns and the policy's general target of decreasing the prevalence of obesity. Such translations are hardly straightforward. They depend on quite particular citizens, able to bridge gaps between different professionals and varied other groups, identify needs and solutions, tinker with material constraints, and care for themselves and others.

Thanapolitics and End-of-Life Care on Three Chinese Immigrant Islands

Author: Harry Yi-Jui Wu (The University of Hong Kong)  email

Short Abstract

This paper traces the socio-cultural origins of end-of-life care and their implication with health policy in Hong Kong, Taiwan and Singapore, where their development is influenced by geo-climatic characteristics and various modernity experiences, primarily the bio-medicalization of end-of-life agenda.

Long Abstract

This paper compares the thanapolitics and their socio-cultural roots concerning the end-of-life care in three immigrant societies, Hong Kong, Taiwan and Singapore. Death and dying have become one of core agenda in medical service provision and health policy. Calls have been made for healthcare providers to actively listen and respond with more knowledge and skill to patients in need. In Asia, too, commissioned by Lien Foundation, Quality of Death Index was developed from 2010 to measure the medical, social resources and public education that are related to the quality of life towards the very end of life among citizens of different countries. According to its second version published in 2015, Taiwan was ranked the highest (83.1) among other Chinese speaking regions, ahead of Singapore (77.6) and Hong Kong (66.6) (EIU 2015), revealing the cross-sectional advances and challenges regarding policy and infrastructure but points to the areas yet to be improved in each measured region. In this paper, I argue, the emergence of end-of-life care services in these three countries is related not only to their similar geo-climatic characteristics, culture as immigrant societies but also to their modernity experiences with urbanization and the introduction of modern medicine. From household cares for hospital amenities, such transformation not only illustrates the change of how life has been valued, governed and treated in these societies is but also how much people in these societies accept and feel at ease with the type of dying originally unfamiliar to them.

Illness and Asylum Policy: Care in a Berlin Psychiatric Clinic

Author: Georgia Samaras (Technical University of Munich)  email

Short Abstract

Psychological illness can lead to a legal residence permit when the suffering is certified by a medical professional. This paper delineates how the practice of writing these documents can interfere with psychological care practices on three different levels.

Long Abstract

For people without a legal residence permit visiting a psychological institution can be more than a strategy to cope with traumatic experiences: Clinics often emerge as locations for the negotiation of the residence permit status as psychologists write reports about their patients' psychological and physical health status. These documents can play a vital role in juridical asylum procedures, as they can significantly aid the process of obtaining a legal residence permit. During ethnographic fieldwork in a psychiatric outpatient clinic in Berlin, I observed how these psychological examining practices interact and interfere with classical care practices of psychological work on three different levels: on a temporal level, concerning the therapeutic moment in which the documents are written; relational, i.e. concerning the therapeutic relationship between psychologist and patient; and on an ontological level, as in this context two very different logics of practice converge: Juridical action follows a true/false deviation, whereas psychology does not know this binary mode of ordering. Besides I will outline how these writing practices are stabilized and converted into practices of helping and healing to reach meaningfulness for therapeutic action. In this context care points to complex politics and asymmetrical power relations, what Martin et al. (2015) name es "care's darker side." Are psychological certificates a form of care that "organizes, classifies, and disciplines bodies" (ebd.) as they silence the refugee's voice? Or is the writing of these documents even an emerging care practice within therapeutic work with refugees?

This track is closed to new paper proposals.