Bedside Politics and Precarious Care:New Directions of Inquiry in Critical Nursing Studies

Health care systems are facing soaring workforce shortages, challenging their ability to secure timely access to good-quality care. In this context, nurses make difficult decisions about which patients to deliver care to, transfer to other providers, or strategically ignore. Yet, we still know little about how nurses engage in situated practices of bedside rationing. Building on the work of Giorgio Agamben and Judith Butler, we have developed a research agenda that homes in on a politics of bedside rationing. We argue that this agenda is essential to better understand the implications of scarcity for nursing and to explore new ways to cope with challenges faced

Regionalisering in de ouderenzorg:Een beleidssociologisch perspectief op grootschalige verandering

De groeiende ouderenpopulatie met een steeds complexer wordende zorgvraag(een combinatie van zowel somatische als psychogeriatrische aandoeningen) enhet toenemend tekort aan arbeidskrachten maken verregaande beleidsveranderingen noodzakelijk om de ouderenzorg toekomstbestendig te maken (WRR, 2021).Zorginstellingen, en vooral verpleeghuizen, ervaren steeds meer moeilijkheden omhun personeelsbestand op peil te houden (SER, 2021). Dit werd tijdens de coronapandemie pijnlijk zichtbaar toen zorginstellingen met kunst- en vliegwerk debasale zorg probeerden te blijven verlenen en telefonisten en verpleeghuisdirecteuren aan het bed stonden. Maar het arbeidsmarktprobleem is al langer voelbaar,vooral in niet-stedelijke gebieden buiten de Randstad. Voormalig minister vanVolksgezondheid, Welzijn en Sport (VWS), Hugo de Jonge, wees vóór de pandemieal op de onhoudbaarheid van het huidige systeem. In een interview stelde hij dat‘het geloof in de markt als probleemoplosser op de terugtocht is’ (Van der Aa &Kok, 2019). De marktdynamiek in het zorgdomein zou tot versnippering en ongewenste verspilling leiden, bijvoorbeeld in de wijkverpleging. In plaats van een veelvoud aan zorgaanbieders in de wijk zag De Jonge meer heil in een overzichtelijkaanbod om afstemming tussen zorgverleners in de wijk te stimuleren, met nametussen de wijkverpleegkundige en de huisarts. Hetgeen met de overheveling naargemeenten, en de bijbehorende aanbestedingen, grotendeels verloren is gegaan

Regionalization in elderly care: what makes up a healthcare region?

Purpose: The purpose of this paper is to explore the formation and composition of “regions” as places of care, both empirically and conceptually. Design/methodology/approach: This paper draws on action-oriented research involving experiments aimed at designing, implementing and evaluating promising solutions to the entwined problems of a burgeoning elderly population and an increasing shortage of medical staff. It draws on ethnographic research conducted in 14 administrative areas in the Netherlands, a total of 273 in-depth interviews and over 1,000 h of observations. Findings: This research challenges the understanding of a healthcare region as a clearly bounded topological area. It shows that organizations and professionals collaborate in a variety of different networks, some conterminous with the administrative region established by policymakers and others not. These networks are by nature unstable and dynamic. Attempts to form new regional collaborations with neighbouring organizations are complicated by existing healthcare governance and accountability structures that position organizations as competitors. Practical implications: Policymakers should take the pre-established partnerships of healthcare organizations into account before delineating the area in which regionalization is meant to take place. A better alignment of governance and accountability structures is also needed for regionalization to occur in healthcare. Originality/value: This paper combines insights from valuation studies with sociogeographical literature and provides a framework for understanding the assembling and disassembling of “regions”

All the good care: Valuation and task differentiation in older person care

Task reallocation is increasingly foregrounded as a promising solution for capacity problems. Numerous studies show, however, that task reallocation between medical professionals is a highly contested issue and difficult to institutionalise. Conflicts are omnipresent and often arise from ‘intraprofessional competition’: Zero-sum games between professionals from different disciplinary backgrounds where one party’s gains require another party’s losses. In this article, we build on calls to enrich the sociology of professions with new concepts and theories. We analyse a case of task reallocation between medical professionals in a nursing home using concepts from empirical ethics and valuation studies. We argue that modes of good care offer a valuable framework for analysing the reorganisation of professional work because they provide an empirically grounded and fine-grained conceptual toolkit for understanding the dynamics among professionals and between professionals and managers. Enactment of different modes of good care inspires innovation in service provision but at the same time creates new tensions between those involved. We show how, in times of scarcity, a dynamic emerges between professionals attempting to stave off and reallocate work, thereby restricting their professional domains

Bedside Politics and Precarious Care:New Directions of Inquiry in Critical Nursing Studies

Health care systems are facing soaring workforce shortages, challenging their ability to secure timely access to good-quality care. In this context, nurses make difficult decisions about which patients to deliver care to, transfer to other providers, or strategically ignore. Yet, we still know little about how nurses engage in situated practices of bedside rationing. Building on the work of Giorgio Agamben and Judith Butler, we have developed a research agenda that homes in on a politics of bedside rationing. We argue that this agenda is essential to better understand the implications of scarcity for nursing and to explore new ways to cope with challenges faced