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Dr. Jeannette Pols is senior researcher at the fe
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Jeannette Pols
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In Care at a Distance: On the Closeness of Technology Jeannette Pols Care at a Distance
a
demonstrates that actual care practices employing telecare do not resemble t
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the hopes of the industry and policy makers, nor the nightmares of ethicists.
D
The detailed ethnographic studies of pioneering telecare practices show how i
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nurses and patients re-shape care when they start using telecare devices. The a
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On the Closeness of Technology
book frames urgent questions about the future of telecare and the ways in c
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which innovative care practices can be built on facts rather than hopes, hypes
or nightmares. P
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Pols’s exciting new book provides important insights into how innovative telecare practices
are ‘achieved’ in everyday practice and how ‘uncontrolled’ field studies can be used both to
understand and improve care practices.
Flis Henwood, Professor of Social Informatics in the School of Applied Social Science,
University of Brighton, UK
Jeannette Pols has written a timely and thought-provoking book about what happens when
technologies are used to provide healthcare at a distance. By listening to the experiences
of those who use the technologies, as healthcare providers or as patients, Pols provides a
much-needed balance to the usual focus on efficiency.
Sally Wyatt, Director of the Netherlands Graduate School of Science,
Technology and Modern Culture
Care at a Distance lays out a variety of ways in which long distance health care may work.
Written attentively and with a real sense of engagement, it also offers long distance care.
Intellectual care this time. For you, the captivated reader.
Annemarie Mol, professor of Anthropology of the Body at the University of Amsterdam
www.aup.nl ISBN 978 90 8964 397 1
9 789089 643971 A U P
CareataDistance
CARE &WELFARE
Care and welfare are changing rapidly in contemporary welfare states.
The Care & Welfare series publishes studies on changing relationships
between citizensand professionals, on care and welfare governance, on
identitypoliticsinthecontextofthesewelfarestatetransformations,and
on ethical topics. It will inspire international academic and political de-
batebydevelopingandreflectingupontheoriesof(health)careandwel-
farethroughdetailednationalcasestudiesand/orinternationalcompar-
isons.Thisserieswilloffernewinsightsintotheinterdisciplinarytheory
ofcareandwelfareanditspractices.
series editors
JanWillemDuyvendak,UniversityofAmsterdam
TrudieKnijn,UtrechtUniversity
MoniqueKremer,NetherlandsScientificCouncilforGovernmentPolicy
(WetenschappelijkeRaadvoorhetRegeringsbeleid–WRR)
MargoTrappenburg,UtrechtUniversity,UniversityofAmsterdam
previously published
JanWillemDuyvendak,TrudieKnijnandMoniqueKremer(eds.):Policy,
People,andtheNewProfessional.De-professionalisationandRe-professio-
nalisationinCareandWelfare,2006
ISBN9789053568859
IneVanHoyweghen:RisksintheMaking.TravelsinLifeInsuranceand
Genetics,2007
ISBN9789053569276
Anne-MeiThe:InDeath’sWaitingRoom.LivingandDyingwithDementia
inaMulticulturalSociety,2008
ISBN9789053560778
BarbaraDaRoit:StrategiesofCare.ChangingElderlyCareinItalyandthe
Netherlands,2010
ISBN9789089642240
JanetNewmanandEvelienTonkens(eds.):Participation,Responsibility
andChoice.SummoningtheActiveCitizeninWesternEuropeanWelfare
States,2011
ISBN9789089642752
PatriciaC.Henderson:AIDS,IntimacyandCareinRuralKwaZulu-Na-
tal.AKinshipofBones,2011
ISBN9789089643599
Care at a Distance
On the Closeness of Technology
Jeannette Pols
Coverphoto:RuudMast
Cover design: Sabine Mannel, NEON graphic design company, Amster-
dam
Lay-out:JAPES,Amsterdam
ISBN 9789089643971
e-ISBN 9789048513017(pdf)
e-ISBN 9789048516292(ePub)
NUR 882
©JeannettePols/AmsterdamUniversityPress,Amsterdam2012
Allrightsreserved.Withoutlimitingtherightsundercopyrightreserved
above, no part of this book may be reproduced, stored in or introduced
into a retrieval system, or transmitted, in any form or by any means
(electronic, mechanical, photocopying, recording or otherwise) without
the written permission of both the copyright owner and the author of
thebook.
Contents
Nightmares, promises and efficiencies in care and
research
1 Introduction 11
Thetelecarehype 11
Lackofknowledge 12
Noiseanddust 14
Thisstudy 15
Varioustelecarepractices 16
Studyinginnovativetechnologies 17
Thechapters 20
Part I Norms and nightmares
2 Caringdevices:Aboutwarmhands,coldtechnologyand
makingthingsfit 25
Warmcare,coldtechnologies 25
What(un)makesahuman? 26
PalliativecareinFriesland 27
Situatingmattersofdisease 29
Buildingrelationsthroughthewhitebox 32
Devicesdonotloveus 34
Fittingindividuals 37
Thenotionoffitting 38
Carethatdoesnotfit 40
Modestaesthetics 42
3 Theheartofthematter:Goodnursingatadistance 45
Goodnessoffit 45
Theheartofgoodnursing 46
Goodnursinginpractice 47
Theimportanceofspace 48
Divisionoflabour 49
Keepingupoldstandards:correctingtelecare 51
Telecareasanimprovement:changingnorms 53
Fromhealthstatustoprocess 53
Fromself-caretoprofessionalmonitoring 55
5
Newtasks,newgoals 57
Persistentvalues,shiftingnorms 59
Contestablenorms 60
Part II Knowledge and promises
4 Caringfortheself?Enactingproblems,solutionsandformsof
knowledge 63
Shapingproblems 63
MrsJansenandtheheartmonitor 64
MrsJaspersenandthewebcam 65
Enactedtrouble:objectivesymptomsversussubjective
experience 66
Monitoreddisease 66
Webcamworries 68
Articulatingproblems 71
Respondingtoproblems 72
Measurements 72
Mutualsupport 74
Enactingproblems,engaginginself-care 75
Fittinglogics 77
5 Knowingpatients:Onpracticalknowledgeforlivingwith
chronicdisease 79
Theknowledgeofpatients 79
Knowingpatients? 79
Difference 80
Sameness 80
Indifference 81
Toolsforthecasestudy:scientificversuspracticalknowledge 82
Practicalknowledgeforcliniciansandpatients 82
PracticalknowledgeofpeoplewithCOPD 83
Introducing‘know-now’ 84
Transportingknowledge 87
Technologiesandtranslation 88
Coordinatingknowledge 90
Coordinationpractices,blurringdistinctions 90
Unhelpfulknowledge,translationfailures 92
Knowingpatients 94
Practicalknowledgeandwebcams 95
Part III Routines and efficiencies
6 Zoominginonwebcams:Ontheworkingsofamodest
technology 99
6 careatadistance
Doinginvisiblework 99
Webcampractices 99
Webcamsinaction 100
‘Itismuchmorepersonalthanthetelephone’ 100
Webcamsintensifyconcentration 102
Breakingtheintensity 103
Togetherinthesameroom 104
Trust,familiarityandintrusion 107
Buildingonexistingrelations 109
Magnifyingrelationaldistance 111
Whatwebcamsdo 112
Shapingcarepractices 113
Modesttechnology 113
7 Economiesofcare:Newroutines,newtasks 115
What’sinaroutine? 115
Routineefficiency 116
Telecareandefficiency 117
Efficiencyinpractice 118
Theplaceofcaring 120
Reshufflingspace 122
Differenttechnologyandtasks 123
Interpretationroutines 126
Thetelekitasanumbilicalcord 126
Thetelekitasaninhaler 127
Routinesandidentities 128
Oldornewroutines? 129
Treacherousroutines 130
Efficientlyorganisingmessypractices 131
Conclusions: On studying innovation
8 Innovatingcareinnovation 135
Thepoliticsofinnovation 135
Theobjectofresearch:innovativetelecarepractices 136
Researchthatdoesnotfit 137
Fixedvariablesandunpredictableoutcomes 137
Subjectivityandpracticalknowledge 138
Interferencewithconstructionsites 140
Fromsubjectivitytonormativity 141
Fittingresearch 142
Uncontrolledfieldstudies 143
Theinfluenceofusers 143
Frombuying,sellingandvotingtoenactinginnovations 144
Articulatingpositions 145
Thestatusofarticulations:comparisonsandinvolvingothers 146
contents 7
Thestatusofpracticalknowledge 147
Discussionsunleashedbyanuncontrolledfieldstudy 148
Promises,practicesandclosepatients 148
Closeprofessionals 149
Closetechnologies 150
Closeresearch 150
Acknowledgements 153
Appendix:Projectsstudiedforthisbook 157
Notes 161
References 181
Indexofnames 197
Indexofsubjects 199
8 careatadistance
Nightmares, promises
and efficiencies in
care and research
