‘Who does this patient belong to?’ boundary work and the re/making of (<scp>NSTEMI</scp>) heart attack patients

Cramer, Helen; Hughes, Jacqueline; Johnson, Rachel; Evans, Maggie; Deaton, Christi; Hemingway, Harry; Feder, Gene; Featherstone, Katie

doi:10.1111/1467-9566.12778

Cited by 17 publications

(21 citation statements)

References 57 publications

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“…Psychiatrists and nurses in memory clinics (Swallow 2019), and clinical psychologists assessing mental health referrals (Pickersgill 2019) act as boundary actors, managing coordination work and ambiguities over lines of responsibility and accountability (Cramer et al . 2018). Managing the uncertainty work of clarifying service identities and ontologies is easier where alternative services are available, and more difficult where there are fewer services to signpost to or where there are gaps in services.…”

Section: Resultsmentioning

confidence: 99%

Understanding and managing uncertainty in health care: revisiting and advancing sociological contributions

Mackintosh

Armstrong

2020

Sociology Health & Illness

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In this collection we revisit the enduring phenomenon of uncertainty in health care, and demonstrate how it still offers coherence and significance as an analytic concept. Through empirical studies of contemporary examples of health care related uncertainties and their management, our collection explores the different ways in which uncertainty may be articulated, enacted and experienced. The papers address a diverse range of healthcare contexts ‐ Alzheimer’s disease, neonatal surgery, cardiovascular disease prevention, cancer, addiction (use of alcohol and other drugs during pregnancy), mental health/disorders and medical education – and many tackle issues of contemporary relevance, such as an ageing population, and novel medical interventions and their sequelae. These empirical papers are complemented by a further theoretical contribution, which considers the role of ‘implicit normativity’ in masking and containing potential ethical uncertainty. By mapping themes across the collection, in this introduction we present a number of core analytical strands: (1) conceptualising uncertainty; (2) intersections of uncertainty with aspects of care; (3) managing uncertainty; and (4) structural constraints, economic austerity and uncertainty work. We reflect on the methodological and theoretical stances used to think sociologically about uncertainty in health care, and the strengths, silences and gaps we observe in the collection. We conclude by considering the implications of the insights gained for ‘synthesising certainty’ in practice and for future research in this area.

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Section: Resultsmentioning

confidence: 99%

Understanding and managing uncertainty in health care: revisiting and advancing sociological contributions

Mackintosh

Armstrong

2020

Sociology Health & Illness

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“…While energies often support the preservation of hierarchies, boundary crossing can help to bridge organisational and professional divisions (Gieryn, 1983;Star & Greisemer, 1989). It does this by highlighting shared concerns, empowering disadvantaged voices and creating space for transformation of identities and practices (Akkerman & Bakker, 2011;Aungst et al, 2012;Cramer et al, 2018;Edwards & Fowler, 2007;Wang, Piazza & Soule, 2018). Increasing attention has been paid to the characteristics of people who successfully cross boundaries, and new boundary spanning roles within health and care have been developed in recent years, an example being link workers, who play an important role in social prescribing schemes (Gilburt, 2016;Polley, Fleming, Anfilogoff & Carpenter, 2017).…”

Section: Social Movements Propagation and Scalementioning

confidence: 99%

“…Few empirical studies have examined the experiences of artists as boundary spanners in health and care contexts. However, it is acknowledged that boundary spanning work can be difficult and slow, often impeded by professional resistance, cultural differences, lack of shared language, knowledge and role demarcation, siloed training of professionals and lack of training and resources for boundary spanning roles (Aungst et al, 2012;Cramer et al, 2018;Gilburt, 2016).…”

Section: Social Movements Propagation and Scalementioning

confidence: 99%

“…It is not just people, but also objects, that cross boundaries. Boundary objects can be artefacts, such as patient records, that carry specific meanings to different stakeholders (Cramer et al, 2018). Within organisational studies, successful boundary objects are viewed as those that address the requirements of different users while generating dialogue and new meanings as they move back and forth between different sites (Akkerman & Bakker, 2011).…”

Section: Social Movements Propagation and Scalementioning

confidence: 99%

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Social movements and boundary work in arts, health and wellbeing: A research agenda

Daykin¹

2019

NJACH

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Purpose: Despite a growing evidence base and increasing recognition of the connections between arts, health and wellbeing, arts and creativity are some distance from being fully integrated into health and care services. Further, there is a lack of consensus about the best way to develop the evidence base and progress the field. This paper draws on social movement theory and the related field of boundary studies to explore these critical challenges. Design: The paper critically examines the developing international field of arts, health and wellbeing, drawing on a literature from several disciplines including arts and health, social and political sciences, and organisational studies. Findings: While it is important to continue to develop evidence, theories and frameworks are also needed to address strategic questions, such as the relationship between evidence, policy and practice, as well as practical issues of propagation and scale in arts, health and wellbeing. Research limitations: This is a discursive paper. It does not suggest definitive answers; rather, it signals new directions for further empirical research, including studies of social movement theory and boundary work in arts health and wellbeing. Originality/value: A focus on methodology within an evidence-based medicine paradigm has meant that key questions concerning the development and impact of arts projects and programmes in health and wellbeing have been neglected. Social movement theory and boundary studies offer insights into the potential role of arts in reducing divisions, fostering collaboration and contributing to the transformation of health and care policy and practice.

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“…Accordingly, they are important for the organisation of care and a complex aspect of healthcare planning and management (Abbott, 1988, Currie et al ., 2010, Huby et al ., 2014, Jones et al ., 2019, Kessler and Spilsbury, 2019, Nancarrow and Borthwick, 2005). Moreover, as the paper will show, professional boundaries influence day‐to‐day professional practice, collaboration and care delivery (Cramer et al ., 2018, McMurray, 2011, Salhani and Coulter, 2009).…”

Section: Introductionmentioning

confidence: 99%

Professional boundary struggles in the context of healthcare change: the relational and symbolic constitution of nursing ethos in the space of possible professionalisation

Ernst

2020

Sociology Health & Illness

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The paper draws on Bourdieu's conceptualisation of the symbolic order and his little used concept of ethos in order to gain novel understandings of boundary struggles between nursing and medicine as well as internally in nursing. The constituents of boundary struggles are analysed in the context of healthcare transformation, focusing on organisational, institutional and political boundary undertakings. Changing conditions for boundary demarcations and professionalisation include a preference for evidence-based knowledge and practice, seen as a remedy against common problems in health care. The paper shows how nurses use the changes in 'the space of possible professionalisation' in their struggle for professionalisation when they expand their scope of practice and embark on what is conceptualised as a curing ethos, where nursing is understood as a discipline performing practices that lead to cure. However, this is repudiated by the medical profession at all levels. Moreover, curing stands opposed to the caring ethos in nursing and boundary struggles surface as 'ethos confrontation' between caring-and curing-oriented nurses in practice. The boundary struggles analysed in this paper raise important questions about healthcare manageability and the development of sustainable professional environments.

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‘Who does this patient belong to?’ boundary work and the re/making of (NSTEMI) heart attack patients

Cited by 17 publications

References 57 publications

Understanding and managing uncertainty in health care: revisiting and advancing sociological contributions

Understanding and managing uncertainty in health care: revisiting and advancing sociological contributions

Social movements and boundary work in arts, health and wellbeing: A research agenda

Professional boundary struggles in the context of healthcare change: the relational and symbolic constitution of nursing ethos in the space of possible professionalisation

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