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Involving patients in learning practices on pain management in TelehealthbyAnette Lykke Hindhede, UCSF, Center for Health Research, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark;Department of Public Health, University of Copenhagen, Copenhagen, DenmarkVibeke Harms Andersen, Department of Culture and Learning. Aalborg University, Copenhagen, Denmark.Across the developed world, including the Nordic countries, health policies encourage patients to take greater responsibility for their healthcare (Armstrong 2014). Patient participation involves being engaged in the planning of care and exchanging knowledge, setting own goals and carrying out self-management activities. As for digital health technologies, they also increasingly reconstitute patients as rational and reflexive agents that weigh up available knowledge, make choices about their healthcare needs, and competently engage in the digital management of their health (Lupton 2014). However, patients may find themselves in a precarious situation with the responsibilities delegated to them.In this paper, we focus on how patients learn new practices of understanding and handling a mobile application (app) for pain management. The app offers surgical patients opportunities to participate in the production of pain-related knowledge post-surgery. With the app, they are asked to report e.g. pain intensity, pain location, pain quality, and pain’s impacts on daily life directly into the e-health platform of the hospitals. Based on the writings of Kemmis et al (2013), we understand learning as a process of initiation into new practices, that are related to other practices in ´practice ecologies´. These practice ecologies enable or constrain what happens in practices of learning. In the project, we conduct observation of the formal teaching sessions pre-surgery at hospitals, where patients learn to manage the app - or in Kemmis’ terms are being ‘stirred into practice’. More precisely, we focus on the way in which various patients position and locate themselves in relation to other patients and to the healthcare professionals in patterns of doings, sayings and relatings and how ´practice architectures´ support and provide resources for these practices. This is followed by interviews with the patients one-week post-surgery, where we inquire their new practices with the pain app and their new role as co-creators of health-related data and how traces of previous experiences are being taken up in new practices after discharge. This knowledge contributes to the Nordic educational research in how patients learn to become ‘digitally engaged’ in their own medical care practices. Moreover, it adds to the use of practice theory in new educational contexts. In particular, our research provides new insight into the way in which patient education practices may or may not create affordances that enable them to be “translated” or “transferred” into new sites (such as patients homes) where they can be integrated with rather than competing with other practices.ReferencesArmstrong, D. (2014). Actors, patients and agency: a recent history. Sociology of health & illness, 36(2), 163-174.Kemmis, S., Wilkinson, J., Edwards-Groves, C., Hardy, I., Grootenboer, P., & Bristol, L. (2013). Changing practices, changing education. Springer Science & Business Media.Lupton, D. (2014). Digital sociology. Routledge.

Hvordan kan sundhedsprofessionelle med bevidsthed og viden om egen sundhedskapital bidrage til reduktion af ulighed i sundhedspraksis?

Purpose: This paper aims at examining who is perceived as relatives in rehabilitation of severe brain injured young adults since engaging relatives is crucial for social participation/the social life situation of the injuredMethods:A longitudinal qualitative study explored the perceptions and engagement of relatives throughout a rehabilitation trajectory of eight young adults with a severe acquired brain injury from three different perspectives: those of the professionals, the closest relatives and the injured. We apply a sociological theoretical framework concerning friendship . A social network analysis (SNA) methodology is used to capture, visualise and analyse the young adults’ perceptions of their social relations. Results: The ties engaged during the rehabilitation process are not only based on the young adults’ perceptions of their close network ties but rather is determined by professionals and parents. In some cases, this leads a reduction of the larger social network with the risk of the young adult’s social isolation. Conclusion:Institutions and professionals play a decisive role in maintenance of young adults’ social network also after rehabilitation. The authors therefore suggest an expansion of the term “relative” as well as considering these ties as dynamic.

The public health sector in welfare states is increasingly subject to organisational changes, and collaboration between healthcare professionals has long been requested as a way to obtain higher quality and at the same time lower spending in health care. In addition, it has been welcomed as a way to equalize power relations among healthcare professionals. However, many critical perspectives on collaborative practice have emerged over the past. Based on desk research, we investigate the various ways collaborative practice historically has been defined and understood to integrate the knowledge development about collaborative practice into its current state. We find that a broad range of definitions and normative concepts has been proposed. We demonstrate that the various definitions lead to different directions of organising work. We conclude that whether and in what sense a focus on collaborative practice can be said to help improve the delivery of health care depends on the context, the agendas and interests of the involved actors. The public health sector in welfare states is increasingly subject to organisational changes, and collaboration between healthcare professionals has long been requested as a way to obtain higher quality and at the same time lower spending in health care. In addition, it has been welcomed as a way to equalize power relations among healthcare professionals. However, many critical perspectives on collaborative practice have emerged over the past. Based on desk research, we investigate the various ways collaborative practice historically has been defined and understood to integrate the knowledge development about collaborative practice into its current state. We find that a broad range of definitions and normative concepts has been proposed. We demonstrate that the various definitions lead to different directions of organising work. We conclude that whether and in what sense a focus on collaborative practice can be said to help improve the delivery of health care depends on the context, the agendas and interests of the involved actors.

People surviving traumatic brain injury (TBI) often have physical, mental and cognitive disabilities despite the official rehabilitation goal of regaining independence. The mental and cognitive disability negatively impacts their short-term memory, concentration and attention span, leading to frequent mood fluctuations and lack of motivation. Drawing on Braidotti’s (2011) work and conception that all life can be seen as a journey of realisation and ’becoming’, this paper examines the actual practices and representations that constitute the TBI body as an ongoing practical achievement. Based on qualitative interviews with 5 TBI-survivors in their 20s 5 years post-injury, the paper focuses on how the body is used as means of classification, inclusion and differentiation to become somebody. I find an array of strategies and techniques that are adopted to avoid what is perceived as brain-damage behaviours and practices to help the young TBI-survivors’ with the desire for, or achievement of, educational success. These strategies include attempts to moderate fears about academic capabilities and struggles to overcome what they perceive to be the differences between themselves and their peers. As academic performance and social comfort is inconstant and unpredictable, the TBI-survivors incorporate their frustration about bodily limitations with their sense of growth and accomplishment. Giving up goals and accepting bodily limitations is a difficult transition and for some it includes the need to grieve the loss of future plans, confidence, and perceived status. The study concludes that there is a need to acknowledge the heterogeneity of TBI-survivors and their experiences, and viewing them as moving from dependency to independence is de-humanising. People surviving traumatic brain injury (TBI) often have physical, mental and cognitive disabilities despite the official rehabilitation goal of regaining independence. The mental and cognitive disability negatively impacts their short-term memory, concentration and attention span, leading to frequent mood fluctuations and lack of motivation. Drawing on Braidotti’s (2011) work and conception that all life can be seen as a journey of realisation and ’becoming’, this paper examines the actual practices and representations that constitute the TBI body as an ongoing practical achievement. Based on qualitative interviews with 5 TBI-survivors in their 20s 5 years post-injury, the paper focuses on how the body is used as means of classification, inclusion and differentiation to become somebody. I find an array of strategies and techniques that are adopted to avoid what is perceived as brain-damage behaviours and practices to help the young TBI-survivors’ with the desire for, or achievement of, educational success. These strategies include attempts to moderate fears about academic capabilities and struggles to overcome what they perceive to be the differences between themselves and their peers. As academic performance and social comfort is inconstant and unpredictable, the TBI-survivors incorporate their frustration about bodily limitations with their sense of growth and accomplishment. Giving up goals and accepting bodily limitations is a difficult transition and for some it includes the need to grieve the loss of future plans, confidence, and perceived status. The study concludes that there is a need to acknowledge the heterogeneity of TBI-survivors and their experiences, and viewing them as moving from dependency to independence is de-humanising.

In this article, we outline ways of thinking and concepts that addresses the new health regime.We take as an onset Bourdieu’s writings on the socialized body and lifestyles. We then reviewstudies inspired by the French philosopher Michel Foucault’ thinking about bodies and hisconcepts of biopolitics and governmentality. Focus will be on the work by Nikolas Rose andhis thinking about the will to health and identity. Subsequently, we discuss the similaritiesand differences between the two positions. We argue that common to these ways of thinkingis that we must understand bodies as created and creating. However, while the socialphilosophers show overall and general transformations of societies and bodies, Bourdieu’srelational position adds to this description by offering empirical sensitivity to socialreproductions, distinctions and heterogeneous health- and body strategies. In this article, we outline ways of thinking and concepts that addresses the new health regime. We take as an onset Bourdieu’s writings on the socialized body and lifestyles. We then review studies inspired by the French philosopher Michel Foucault’ thinking about bodies and his concepts of biopolitics and governmentality. Focus will be on the work by Nikolas Rose and his thinking about the will to health and identity. Subsequently, we discuss the similaritiesand differences between the two positions. We argue that common to these ways of thinking is that we must understand bodies as created and creating. However, while the social philosophers show overall and general transformations of societies and bodies, Bourdieu’s relational position adds to this description by offering empirical sensitivity to social reproductions, distinctions and heterogeneous health- and body strategies.

Digital transformation is considered a major change process that takes time and often meets employee resistance and avoidance. The outbreak of COVID-19 forced educators and students to skip the gradual transformation and transfer all teaching activities online. The present paper views this phenomenon as an 'extreme' case and a unique opportunity to gather real time data on how students respond to digital transformation with particular focus on student diversity with regard to the digital threshold. Based on a mixed-data survey with students from a graduate master programme during the first three months of the lockdown, we aim at mapping students' online learning experiences in terms of adaptability, learning outcomes and learning climate. The results are held against current exam performance in order to surface possible correlations between students' response to the online transition and their general study performance. Our research hypothesis is that capturing and understanding initial experiences during the sudden transition to online teaching can be of particular value in rethinking university teaching in a digitized perspective. Such experiences convey a response to an actual need for digitized modes of teaching and tap into the procedural knowledge domain. We conclude by reflecting on the value of creating hybrid learning spaces that may respond to specific educational needs under changing conditions.

NO: Dette kapitlet følger oppfordringen om at forskningen bør trekke inn et bredere kunnskapsgrunnlag, som for eksempel fra livsvitenskap og hermeneutiske perspektiver, for å få en bedre produksjon av vitenskapelig begrunnet kunnskap. I dette kapitlet diskuteres begrepet lek-kunnskap med utgangspunkt i en case om sykdomsrisiko og kronisk sykdom. Vi argumenterer for at når kunnskapsinteressen omfatter biologiske, psykologiske og sosiale forhold, fordrer dette en fortolkende integrering av lek-kunnskap og vitenskapelig kunnskap. En slik tilnærming til kunnskapsproduksjon gir bedre innsikt i helseatferd, og kan derfor styrke fokuset på sosiale determinanter for ulikhet i helse.ENG: This chapter follows the suggestion to draw on a broader set of hermeneutical, life science perspectives to get a better and more qualified assessment of scientifically substantiated knowledge. The chapter discusses lay knowledge based on the case of chronic illness and risk of disease. We claim that when the knowledge interest includes biological, psychological and social conditions, this requires an interpretative integration of lay knowledge and scientific knowledge. Such an approach provides better insight into health-related behavior, and therefore promotes focus on the social determinants of health This chapter follows the suggestion to draw on a broader set of hermeneutical, life science perspectives to get a better and more qualified assessment of scientifically substantiated knowledge. The chapter discusses lay knowledge based on the case of chronic illness and risk of disease. We claim that when the knowledge interest includes biological, psychological and social conditions, this requires an interpretative integration of lay knowledge and scientific knowledge. Such an approach provides better insight into health-related behavior, and therefore promotes focus on the social determinants of health